CASE
Paranoid schizophrenia
Arnab Bhattacharya
Author is Postgraduate Trainee of Psychiatry at Silchar Medical College Hospital, Silchar
Mr F I, a 25 years old male from a poor socioeconomic strata of rural Assam presented with an acute onset of illness precipitated after a financial loss with complaints of not working properly and poor sleep for one month followed by irrelevant talks, aggressive behaviour and fearfulness for past seven days associated with disturbed interpersonal relations, self care, work output, poor sleep and appetite. Past history revealed jaundice six years ago and an episode of psychotic illness four years back needing inhospital treatment with return to premorbid levels of functioning after medications. Family history revealed a history of bipolar illness in father and schizophrenia in paternal cousin sister. Personal history revealed three episodes of forceful same sex encounters at the age of five years. Premorbidly there were schizoid personality traits. Physical findings were unremarkable and psychodiagnostic testing showed an ongoing psychotic process in Rorschach and thematic apperception test (TAT). Mental state showed reduced eye contact, guarded attitude at times, anxious mood, restricted range and reactivity of affect, circumstantial speech, paranoid ideations, ideas of guilt, somatic preoccupation, second and third person auditory hallucinations with acting out behaviour, impaired abstraction and judgement and level one insight. On floor discussion a consensus diagnosis of paranoid schizophrenia, episodic with stable deficit (F20.02) was reached. Management plan was made on a biopsychosocial framework including olanzapine tablet 20 mg/day, psychotherapy of supportive type and family involvement was stressed targeting medication compliance and decreasing expressed emotions.
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