Mhp final report - case history of a schizophrenic in patient client. PDF

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case history of a schizophrenic in patient client. ...

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PSYCHODIAGNOSTIC REPORT

Background Information Name:

Khushbakht

Father’s Name:

Not mentioned

Education:

Intermediate

Gender:

Female

Age:

Between 45-55

Date of Assessment: 4th May 2019 Date of Report:

21st May 2019

Assessment by:

Ayesha Hashmi and Fatima Batool Qazi

Reason for Assessment Self-referred: she was brought to the Karachi Psychiatric Hospital by her sister. Reason for Referral: After Graduating from grade 12, she started becoming extremely aggressive and violent due to which her relationship with family members started getting affected and her anger and irritability reached to the extent that she started hurting people around her.

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Summary of Previous Evaluation The onset was soon after the cleint graduated from 12th grade. Her family members and people around her noticed her elavated aggression and irritibality but nobody thought to bring her for the diagnosis. After a very long time, when her situation worsened and she started hurting people, her sister brought her to the Karachi Psychiatric Hospital for the treatment. In her earlier medical condition, she also suffers from Limb Length Discrepancy (LLD). The medicines she is using currently due to her mental illness are Hexidyl, Flucate and Ativan.

Sources of Information If the sources of information were reliable or not, depends on from whom the information was received. The information received from the nurse was not very reliable as she was in charge of many patients around and did not show much concern. Source of information received from the client was not reliable at all. The client was a psychotic patient and she did not even give out her correct name so the information provided by her cannot by relied upon. Then the source of information received from the client’s file was reliable. The file consisted all the reliable details and diagnosis about the client which gave us a clear insight about the client’s disorder. The source of information for the client was client herself but she could not be considered reliable. Another unreliable source of information was the nurse. Client’s sister who dropped her to the Karachi Psychiatric Hospital and client’s file which consisted of her history were the actual reliable source of information. Along with these, the assessment conducted on her by us was another major reliable source of information.

Tests Administered: •

Clinical Interview

•

Behavioral Observation

•

Standardized Mini Mental Status Examination (SMMSE)

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Clinical Interview The client’s name is Khushbakht and her age is between 45-55. The client had a very happy and healthy life during her childhood and teenage. She was quite a studious student in her school and scored position in her grade 10. After graduating from grade 12, she started developing anger and frustration issues where she used to start hitting her siblings and peers. This led to the deteriotation of relation between her and her siblings. Her family tried to take her to different clinics and hospitals for treatment but no such change could be noted. The client did not opt for marriage so did not have her own family as well. Later, her sister brought her to Karachi Psychiatric Hospital for the diagnosis and treatment.

Behavioral Observation The client had satisfactory hearing, vision and motor skills. She wore simple neutral colored clothes, had short hair and appeared to be in her early fifties. The client looked disheveled and unkempt. Her appearance and state of her hair, nails and teeth showed signs of self neglect and extremely poor hygeine. Though the client’s attitude was cooperative, she was extremely talkative and showed slightly anxious behavior.Throughout the interview, the client maintained intense eye contact and had lack of facial expressions, showing negative symptoms. The cleint was fluent in her speech and spoke in a normal tone of voice. The individual’s speech was pressured and she showed positive symptoms of loose associations and tangentiality. The cleint’s mood and affect was congruent as she showed emotions once and experienced observable sadness when talking about a loved one’s death. The individual stated her name to be Khadija when her name mentioned is Khushbakht. The client stated that she has had fits since her childhood and her mother would tell her to not eat around people as she gets fits due to the evil eye. She still believes in that and that is why avoids eating and being in crowded places. There was no history of seizures found in the client’s childhood history. She had 2 brothers and two elder sisters. One of her brothers died due to an illness when he was young. She also told that she believes she has got thyroid issues and she has 3

difficulty in urination while there was no history of any physiological illness.This shows that the cleint has somatic delusions. The Nurse responsilble for Kushbakht’s care complained that the cleint often gets extremely angry and violent. She doesnot have friendly relations with any of the women staying in the ward. On the other hand, the cleint used positive management and told that she ahs good relations with everyone. She further used the defense mechanism of projection and told that the women in the bed next to her often gets extremely violent and aggressive, throws things and food and is never friendly with any of the people in the ward. The client excessively talked about her family and friends. The client’s family had complained that after the onset of her illnes, the cleint’s relationship with her siblings became very weak and abusive as her behavior became awfully aggressive and violent. While the cleint was in denial and emphasized on the love and healthy relationship she has always has had with her siblings. She repeated multiple times that she and her sisters have always have had a bond and still have great love for each other. The cleint also experiences other forms of delusions. She said during the interview that her parents and her brother are dead but they do send for her gifts and toys from the “Paradise”. The client also holds this belief that she shouldn’t use these toys and gifts often as she does not want her family’s money to go to waste. The cleint was also having hallucinations. She said, “ It is raining outside and I have got a fever and am feeling really cold. It will soon be maghrib, I will have some tea, pray the night prayer and then goto sleep. The cleint was aware that she was in a psychiatric hospital. Apart from that, that cleint’s orientation to time, person or self was not intact as she was showing multiple psychotic symptoms.

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Cognitive Test Scores for the Standardized Mini Mental Status Examination (SMMSE) DOMAIN

SCORE

1. Orientation to Time

0

2. Orientation to Place

3

3. Hearing/ Immediate Recall

3

4. Language

2

5. Memory

1

6. Level of Consciousness

0

7. Thought and Perception

1

8. Attention/ Speech

0

9. Language/ Perception

0

10. Language/Motor Responses

0

11. Constructional ability

0

12. Motor activity

3

Total Test Score

13/30

The cleint’s scores show that she has moderate cognitive impairment. The client has poor Self orientation and Orientation to time. The cleint has a very poor insight. She disorganized speech as she shows symptoms of pressured speech, tangentiality and loose associations. The client scored zero on the level of consciousness as she is a psychotic client and has kittle contact with the reality.

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The individual has a sound memory and can immediately recall a list of given words. She also has adequate motor skills. The cleint, being psychotic, did not respond to some of the questions and thus was marked 0 on those questions. Diagnostic and Statistical Manual of Mental Disorder- V Diagnostic and Statistical Manual of Mental Disorder- V (DSM-V) is the standard classification of mental disorder used by mental health professionals and contains a listing of diagnostic criteria for every psychiatric disorder. Tentative Diagnosis 295.90 (F20.9) Schizophrenia, Multiple episodes, currently in acute episode. Summary Kushbakht is a middle aged female cleint. She is experiencing somatic, other unspecified delusions and auditory hallucinations. It was also observed that she has disorganized thought patterns which can be detected through her pressured speech, loose association and tangentiality of speech. The individual was tested on the SMMSE, which showed that she has moderate cognitive impairment. The client is tentatively diagnosed as a patient suffering from chronic schizophrenia. Recommendation ➢ Medications are the cornerstone of schizophrenia treatment. Though the client is already on medication, I would recommend that the medicines and their effects should be assessed and then she should be prescribed better medications as inspite of taking medications, she is still in the acute stage and is consistently experiencing major signs and symptoms of schizophrenia.

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➢ The client should be provided with Individual therapy. Psychotherapy may help to normalize her thought patterns and will help in creating insight. Also, learning to cope with aggression, stress and identify early warning signs of relapse can help her in managing her illness. ➢ The client views her family as an important part of her life but her illness has resulted in damaging her family relationships and the relationship with her siblings. Family therapy will help the client in fighting with her illness and will give her family a better understanding of her illness and sufferings.

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