CASE
Socialized conduct disorder
Susmita Hazarika
Author is Postgraduate Trainee of Psychiatry at Silchar Medical College Hospital, Silchar
Patient SD, a 15 years old male, unmarried Hindu from lower middle class family of urban background, a class X student, brought by family members, was admitted in male psychiatry ward through outpatient department with chief complains of disobedience, excessive lying for last five years; occasional consumption of alcohol for three years and consumption of heroin for one year. History of present illness showing presence of complete disobedience, repeated lying, truancy from home on two occasions, frequent complaints from school regarding his behaviour with school mates, frequent fights with peers and younger brother, stealing money from home with no history of withdrawal symptoms on abstinence from the substances of abuse. Many of the facts mentioned by him were found to be totally untrue on confirmation from his parents.
There was no significant past medical, surgical or psychiatric illness in the past but personal history showed presence of nail biting in childhood with multiple affairs in the past three years with history of two episodes of exposure with girlfriend as well as female sex partner. There were history of disturbed family environment with repeated physical assaults by parents as well as alcohol abuse by father and paternal uncle with premorbid temperamental type of 'a difficult child'.
There was no significant finding in general and systemic examination and blood parameters. 'Draw A Person' (DAP) test showed egocentric, antisocial personality traits and Rorschach test showed an intelligent, emotionally unstable, impulsive person.
Mental state examination revealed an average built person maintaining proper dress and hygiene with proper eye contact with normal psychomotor activity, cooperative, established rapport. Speech was relevant and coherent with euthymic mood and appropriate affect with no abnormality of thought and perception. Concentration was sustained with intact memory, proper orientation to time, place and person, good intelligence with intact abstract thinking, judgement and reasoning with level four insight.
Provisional diagnosis is socialized conduct disorder (F91.2).
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