ABSTRACT | PDF
CASE CONFERENCE
Acute schizophrenia-like psychotic disorder
Debjit Roy
Twelve years old Islam male J. was brought by his brother. Patient had no complaints. According to brother, symptoms were suspiciousness, fearfulness, disorganised behaviour, self muttering, collection of unimportant things, decreased sleep, for duration of ten days. Mode of onset was acute, neither life events nor precipitating factors were significant.
The patient was having suspiciousness and fearfulness. He would complain that somebody was coming to harm him, he would then run from one room to another and lock the door. He would not interact with people and preferred remaining aloof. He had also been exhibiting disorganised behaviour. He would urinate or evacuate on his dress occasionally and throw off his dress and move about naked in the house. He was seen to go out of the house as well, wander about in the street and collect plastic bottles, pieces of wood and other unimportant things. His sleep was decreased. There was delayed onset of sleep and the total duration was only one and half hours. He would wake up at about 2 A.M. in the morning, move about in the house and peeped through the window. No significant past medical, surgical or psychiatric history.
He was delivered at home with no complication in the intrapartum or postpartum period. He achieved milestones at appropriate ages. He was a student of class VIII. He attained puberty and there was no history of childhood sexual abuse. He hailed from a joint family and his great grandfather had history of mental illness. Premorbidly he had limited friends, was religious, stress coping was adequate.
No abnormality was detected on physical examination. Mental state examination revealed average built, improper dress and hygiene, inadequate eye contact. Psychomotor activity was slightly retarded. He was uncooperative, rapport not established. Speech showed no articulation defect, tone was decreased, flow interrupted, quantity reduced. Mood was euthymic, affect inappropriate, stable and constricted. Thought exhibited delusion of persecution but no formal thought disorder. There was perceptual disturbance in the form of third person auditory hallucination. He was conscious, comprehensive, attention drawn, concentration not sustained. Memory was intact. He was oriented to person but not to time and place. Insight was level three.
He was diagnosed as a patient of acute schizophrenia-like psychotic disorder without associated acute stress (F23.20) and treatment started with aripiprazole 10mg and lorazepam 1mg at bedtime.
Author is Postgraduate Trainee of Psychiatry at Silchar Medical College Hospital, Silchar.
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