ABSTRACT | PDF
Case Study
Childhood acute schizophrenia-like psychotic disorder
Debjit Roy
Postgraduate Trainee of Psychiatry, Silchar Medical College and Hospital
Twelve years old Islam male J. is brought by his brother with no chief complaint. Information obtained from brother is reliable and adequate; according to him, patient is suspicious, fearful, exhibiting disorganised behaviour, self muttering, collection of unimportant things, and decreased sleep for ten days. Mode of onset was acute with neither significant life event nor precipitating factor.
J. was having increased suspiciousness and fearfulness for last seven days. 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 for the same duration. He would urinate or evacuate on his dress occasionally, throw off his dress, and moved about naked in the house. He was also seen to go out of the house, wander about in the street, and collect plastic bottles, pieces of wood, and other unimportant things. His sleep decreased for the same duration. 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., move about in the house, and peep through the window.
No significant past medical, surgical, or psychiatric history.
He was delivered at home. No complication in the intrapartum or postpartum period. He achieved milestones at appropriate ages. He studied up to class VIII. Occupation was student. He attained puberty at 12 years of age, no history of childhood sexual abuse. Not Married. No substance abuse.
He lived in a joint family. Great grandfather had history of mental illness.
Premorbidly had limited number of friends, was religious from before, stress coping was adequate.
General and systemic physical examinations were within normal limits.
On mental state examination, average built, dress and hygiene improper, eye contact not adequate. Psychomotor activity slightly retarded. Uncooperative, rapport not established. In speech, no articulation defect, tone is decreased, flow interrupted, quality reduced. Mood was euthymic; affect inappropriate, stable, constricted. In thought, no formal thought disorder but delusion of persecution. There was perceptual disturbance in the form of third person auditory hallucination. Cognitive functions revealed conscious, comprehensive, attention drawn, concentration not sustained. Memory was intact. He was oriented to person but not to time and place. Insight level 3.
He was provisionally diagnosed to be suffering from acute schizophrenia-like psychotic disorder, without associated acute stress (F23.20).
Treatment started with aripiprazole 10mg and lorazepam 1mg at bedtime and advised review in three weeks.
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