ABSTRACT | PDF

CASE CONFERENCE

Paranoid schizophrenia, incomplete remission

Atmesh Kumar
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital

A 28 years old unmarried Muslim male hailing from a middle class family of rural background presented to the psychiatric emergency with complains of excessive praying for five years, fearfulness, suspiciousness, and increased worrying for one and half years, withdrawn behaviour, poor self care, occasional self talk, and hearing voices of invisible people for one year, repeated self injurious behaviour for ten to 12 months, and ideas of committing suicide for 15 days. Insidious onset and slowly progessive course of illness with absence of any precipitating factor or life event. History of present illness showing bizarre praying pattern, continuously disturbing and commanding voices with acting out behaviour with serious deliberate self harming because of guilt feelings with partial response to treatment and never achieving full remission of symptoms to premorbid level with persistance of suicidal ideas under command of voices. Past history revealing abnormal reaction to the suicidal hanging case in neighbourhood by cutting all the low lying branches of the nearby trees. Educational history of poor grades and repeated failures with occupational history of repeated change in profession but not getting success anywhere with psychosexual hisotry of early sexual exposure and promiscuous behaviour with premorbid personality showing poor stress dealing, poor morality, and introvert nature. Physical examination revealing scar marks over dorsum of both hands with brief psychiatric rating scale (BPRS) score of 29, positive symptoms score of 22, negative symptoms score of 31 with mental status examination showing dull facial expression with poor hygiene with mildly retarded psychomotor activity with monotonous speech without maintaing prosody with indifferent mood with appropriate but blunted affect with thought process revealing ideas of guilt with ideas of suicide with ideas of control and second person commanding auditory hallucination and acting out behaviour. Cognitive functions showed conscious and comprehensive patient with attention drawn but concentration ill sustained with intact memory and orientation with slightly impaired abstract thinking and judgement and reasoning with average intelligence with insight level four. Diagnosis was paranoid schizophrenia, incomplete remission (F20.04).  

 

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