Jan-Mar 2010


Vol. 1 No. 1


Case Report I

Pranjal Sharma
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital

P., a 23 years old Hindu unmarried male, educated up to VIII standard who earned his living by working as a mason, coming from Gagrapar II, Cachar district, was admitted in psychiatry ward with symptoms of decreased social interaction, talking out of context, decreased self care, self muttering, self laughing and staying aloof for last one year as well as tremulousness of hands, difficulty in walking, drooling of saliva from angle of mouth and stiffness of his body after receiving parenteral long-acting typical antipsychotic, one month back.

On mental status examination, patient was conscious, oriented to time, place and person, comprehensive, not adequately maintained dress and hygiene, had self muttering, stereotypic lip movement, a rigid posture and retarded psychomotor activity with coherent, relevant but at times irrelevant speech and repetition of a particular phrase, “paathaat naam laagse” with euthymic mood and mood congruent but constricted affect. Thought process revealed occasional loosening of association and a preoccupation of repeating the phrase. Perceptual disturbance in the form of auditory hallucination, described by patient as voices of Lord Shiva coming to his ears who asked him to repeat the phrase “paathaat naam laagse” because that would help him to remove the “jam in his brain”. According to patient, the phrase “paathaat naam laagse” meant paathaa (goat), which was a belonging of Goddess Kaali, was given to him by Lord Shiva for his betterment and he had kept it in the corner of his home. He said that the voices of Lord Shiva came towards the evening when cool breeze blew and thereafter Lord Shiva stayed inside his stomach and often reminded him of saying the phrase. The patient felt that he could clearly hear the voices from within but didn’t have the ability to control these voices. He felt that if he didn’t say this phrase it would cause him some harm but couldn’t explain what it would be.

He was diagnosed as a case of paranoid schizophrenia, continuous (F20.00) with drug-induced secondary parkinsonism (G24.1). On treatment with olanzapine 10mg at bedtime, benzhexol 2mg twice daily and lorazepam 2mg at bedtime, he showed improvement.


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