ABSTRACT | PDF
CASE CONFERENCE
Bipolar affective disorder, current episode manic with psychotic symptoms
Pranjal Sharma
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital
A 25 years old unmarried muslim male of low socioeconomic status, educated up to primary level belonging to urban locality and working as a carpenter was admitted in the Department of Psychiatry, Silchar Medical College and Hospital through outdoor patients' department (OPD) with chief complaints of nausea and informant complaining of decrease interest for work, weakness, disturbed sleep for one month followed by talking excessively, speaking of things beyond his capacity, suspiciousness, aggressive behaviour and decreased appetite for nine days. Past history of two episodes of similar kind in the last ten years and one attempt of suicidal hanging with complete recovery of symptoms following treatment. Comorbid medical illnesses of otomycosis and deviated nasal septum (DNS). Negative family history of any psychotic or mood disorders. Premorbid personality of extrovert type with adequate coping skills. No abnormality on general and systemic examinations. Mental status examination showing an asthenic built person with short hair, poor oral hygiene, dressed shabby with adequate eye contact, easily distractable and restless at times. Rapport established with difficulty. Speech having mild pressure, mostly relevant and coherent with occasional slurring and mostly religious content. Irritable mood with labile affect and thought process revealing flight of ideas (Delhi-r mashid jaimu, Babri masjid, Hindu-Muslim bhai bhai, rokto amar 'A', ek phuta dia jalai dimu, la ilaha illalah), rhyming (pakhi hoilo paat, meetha meetha maat, pakhi pakhi), sense of inflated self esteem (ami brihaspatibarer veer, ek patar modhe dus pata likhte pari - urdu, arabic - ami veer hoye gechi), religiosity (boin [sister] dia Durga mai puri [daughter] paisi) and ideas of persecution. Inconsistent auditory hallucinations. Impaired attention and concentration and immediate memory with intact orientation to time, place and person. Impaired abstract thinking, judgement and reasoning with below average intelligence and level one insight. He was diagnosed as a patient of bipolar affective disorder, current episode manic with psychotic symptoms (F31.2).
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