Case - Nimhans

NIMHANS DIGITAL ACADEMY

Case record Performa

Date: 9/10/2019
Name: RAJASHREE PRAVEEN

Identifying Data:
Name – Ms.A.R
Age – 15
Sex – Female
Education – 10th grade student
Occupation – None
Marital Status – Unmarried
Socioeconomic Status – Lower -middle Class
Residence – Urban
Informant: Patient’s mother and class teacher.
Reliability – Yes
Adequacy – Yes
Chief Complaints: Over the past one year patient is reported to be having
headaches, loss of interest in studies, dizziness and vomiting, loss of
appetite, spells of forgetfulness, mobile addiction, excessive social
networking to the extent of lapse in academics and manipulative
behaviour[ such as crying uncontrollably, and creating temper tantrums ],
towards authority when asked to limit networking usage, severe sibling
rivalry , defiance towards requests towards keeping personal hygiene and
to keeping belongings neat, tidy and in order. Has been increasingly
dependent on mother for the same since the past 7 to 8 months.
Onset: Insidious
Course: Continuous [progressive]
Precipitating Factors/Stressors: Father abandoned the family when

patient was 5 years old. Since then mother has had to take financial
responsibility of the household, she is the sole bread winner. Her job
requires her to work till late in the evening. Hence, patient spends many
hours after school time, all alone in the house. To appease her daughter the
mother took a loan and bought her a cell phone with internet connectivity
as soon as she entered her 10th grade. Sibling, who is 3 years younger to
her, being a male child, enjoys more attention from relatives and
grandparent. Patient got into an infatuated relationship with a boy whom
she befriended through social media. He passed away in an accident while
speaking to her on the phone. A schoolmate who was her only close friend,
and who studied with her for the past 8 years shifted to another school
.Patient who was otherwise a quiet and shy person did not make many
friends in school and so doesn’t clear doubts or asks for notes to complete
unfinished work. Poor interpersonal relations among mother and patient’s
paternal side of family.
History of Present Illness: Physical symptoms started a year ago when she is
said to had a seizure with convulsions, ending in a brief hospital stay. Her
addiction to the mobile and the relationship increased as days progressed,
initially occasionally, later on, on daily basis, worsened by stressors mentioned
above. Loss of memory increased and there have been two incidents of vomiting
and dizziness within the past year. She was taken for psychiatric consultation
from where she was referred for counseling to psychologist due to non
cooperation. [She kept silent]
Associated Disturbances: Headaches, Irritability, claims to seeing aura of blue

light, sometimes multiple colors, when headaches occur.
Negative History: Patient admits to feeling lost and sad and has suicidal
thoughts. She is also obsessed with getting back the mobile phone that her
mother has kept away.
Past History: None
Past Psychiatric history – None.
Medical and Surgical history – Patient has been hospitalized only once this past
year owing to the seizure .She developed fever for which she was treated and
discharged.
Family History:
____________________________ I
________________________ II
III
Personal History:
Birth History – Normal
Behaviour during childhood – Had an easy going and adaptable nature. Was shy
and did not speak much other than to mother and sibling.
School History – Till 9th grade patient was an average student.
Occupational History – None.
Menstrual History – Started menstruating at age 10 followed by regular cycles

till date.
Sexual History – None.
Marital and Relationship History – None.
Premorbid Personality –
 Social relations: Does not mingle much but is not uncomfortable in social
situations. Patient prefers to be silent most of the time.
 Intellectual activities: None
 Mood: Fluctuating sometimes pleasant, sometimes melancholic.
 Character: Good.
 Interpersonal relationships: Not well established.
 Energy and Initiative: No.
 Habits: Watching television.
Mental Status Examination
General Appearance and behaviour:

 Alertness- Decreased.
 Appearance-Pleasant
 Nutritional status- Normal
 Dress and grooming- Neat.
 Eye contact- partially maintained, otherwise, vacant stare towards sides.
 Posture-Most of the time slouched.
 Motor activity- loss in spontaneity
 Gait- Measured
 Rapport-Established
 Attitude towards examiner- Cooperative
Speech:
 Tone-decreased and at a loss when faced with difficulty in finding words.
 Tempo- decreased rate/tempo while describing state of stress otherwise
normal.
 Volume- Soft.
 Coherence- Coherent
 Relevance- Relevant
Emotions:
 Mood- Dysphoric when describing herself reliving the situation and
finding it unrealistic and sad that she was attending to the phone call of
someone while he had an accident. Also not being able to remember
school work, having the mobile phone when she wanted and also being
less favored than her sibling. Slightly euphoric when describing matters
such as her friend, programs she likes and her relationship with her
mother were described in gloom.
 Affect - Constricted.
Thought:
 Form -Sequential.
 Stream (Flight of ideas/ retardation of thinking/ perseveration/ thought
blocking) - None.
 Possession (Obsessions and compulsions/ thought
alienation/insertion/deprivation/ broadcasting)-None.
 Content-Relevant.
Perception: Intact.
Consciousness: Conscious.
Orientation: Oriented to person, place and time.
Attention and concentration: Diminished.
Calculations: Took more time to perform but avoided mistakes.
Memory (Immediate, recent, remote): Immediate memory –Intact,

Recent memory- Faltered in between, took more time.
Remote memory-Intact, took more time.
Intelligence: Average.
Insight: No insight.
Judgment: Impaired.
 Test – Patient was asked opinion on personal hygiene and taking care of
sibling.
 Social –Was depending on mother to help make decision and avoided
response.
 Personal –Was depending on mother to help make decision and avoided
response.
Proposed Diagnosis: Patient seems to be developing a dependant

personality disorder along with internet and mobile addiction. She also
suffers from post trauma.
Biopsychosocial model (Risk, precipitating, maintaining and protective
factors): Risk Trigger Maintaining Protective
Biological Has been admitted Long hours of Nuclear family Is attentive and not
once after seizure mobile phone and mother, who aggressive by nature.
with convulsions. usage. Irregular is the sole bread
Claims to see auras hours of food winner reaches
of light when intake and sleep. home late.
headaches occur, Sibling rivalry.
which are
frequent.
Psychological Abandonment, Death of someone Feeling Cooperative towards
hence no father with whom she abandoned by her the
figures in the shared an friend and the psychologist/counselor.
family. Depended infatuation. Close person [deceased]
for everything on friend shifted she befriended
mother. school. This was through social
followed by falling networking. Only
grades. Resorted grandparent and a
to tantrums to get few relatives
phone after that. favors sibling for
being male.
Social Highly dependent Social networking Mothers lack of Immediate family,
and has not was limited to the awareness about which is, mother and
developed life mobile phone was situation and sibling are motivated to
skills. taken away. As parenting. Lack of support therapy for
friend left, school familial support patient and also ready
notes and from paternal and for family counseling.
academic doubts maternal side of
were left patient. Sibling
unattended to. rivalry.
Management Plan:
 Referrals- Patient has been referred to for detailed medical, neurological
and psychiatric checkups.
 Psychosocial treatment- Supportive counseling for the family is being
provided, encompassing strategies that may alter faulty parenting
techniques and also methods that would improve familial interpersonal
dynamics. Care is being taken so as to create awareness about need for
patient’s physical illness to be diagnosed and treated and also managing
patient’s emotional state of mind, post medical treatment. Aptitude
testing as well as goal setting and strategies that could aid the same
would be formulated. This to follow as soon as patient’s medical state is
investigated in detail. Regular follow ups will be encouraged.

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NIMHANS DIGITAL ACADEMY

Case record Performa

Informant: Patient’s mother and class teacher.

Course: Continuous [progressive]

Precipitating Factors/Stressors: Father abandoned the family when

Associated Disturbances: Headaches, Irritability, claims to seeing aura of blue

Past History: None

Past Psychiatric history – None.

Birth History – Normal

School History – Till 9th grade patient was an average student.

Occupational History – None.

Menstrual History – Started menstruating at age 10 followed by regular cycles

Sexual History – None.

Marital and Relationship History – None.

Mental Status Examination

General Appearance and behaviour:

Orientation: Oriented to person, place and time.

Attention and concentration: Diminished.

Calculations: Took more time to perform but avoided mistakes.

Memory (Immediate, recent, remote): Immediate memory –Intact,

Proposed Diagnosis: Patient seems to be developing a dependant

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