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Disclaimer Note: Any resemblance of the person with the same psychological sufferings is purely COINCIDENTAL and we, the staff of the Dept of Psychiatry and the RLJ Hospital do not intend to cause any hurt/pains to the sentiments of the people. Any resemblance to someone, if any, is purely coincidental and the following examples are intended purely for patients to seek help for their psychological sufferings AND PROMOTE MENTAL HEALTH!

Case 2

A 36-year-old married male who lost his job secondary to the unfortunate pandemic situation who made to stat consume alcohol daily so much that it negatively affected his daily living including an inability to sleep without taking alcohol. He attributed that his dependence on alcohol as secondary due to the stress of the inability to pay his existing home loans and to meet the basic needs of his family members. He came to us in a state when he was having seizures after suddenly stopping alcohol due to severe abdominal pains.

He was admitted to our de-addiction ward for 10 days during which he was treated with appropriate medicines and was discharged with complete recovery of his withdrawal symptoms.

The client has reportedly joined a small MNC and is doing good with no use of any substances at all. His recovery was a boon and an example to prove that Alcoholics do make a recovery, a complete recovery!

Case 3

A 22-year-old girl complained that she can hear voices of people talking to her from a different state with a clear voice even in the night which no one could hear of any such voices but the girl did not believe them. She claimed that her dead aunty is doing some black magic so that she and her entire family members suffer. She would not sleep at all and spend the entire night talking to herself as if she is in conversation with these voices.

She was given appropriate medicines and she made a very good recovery and is currently happily married with a sweet child as well!

Case 4

This is a clinical story of a 40-year-old married lady who was sad throughout the day, did not sleep, and did not participate in any of the tasks which she used to enjoy before. She did not go to work claiming that she gets tired very soon even if she walks for few steps. All these depressive symptoms started after the death of a closed person in her life a few months ago.

She was given appropriate medicines and regular counseling following which she recovered completely and is currently back to work with a better position and a much higher income than before her illness!

Case 5 - A Curious case of a Young Female with Thanatophobia- Running Away from Death and Towards Nicotine.

A 28-year-old female married presented with complaints of excessive fear of death since last 10 years. Patient described a childhood traumatic experience where she witnessed a gory road traffic accident of her friend in school. For a month after such incident, she had sleep disturbances and panic attacks. She would recall the traumatic memory repeatedly. Patient had gestational hypertension during pregnancy and delivered twins. She had excessive fear about death during pregnancy. After delivery she felt very sad most of the time, unable to enjoy previously pleasurable activities, feeling disinterested in taking care of her children, sleep disturbances for about six months. Her Postnatal depression went undiagnosed, and patient eventually got better. She had experienced excessive fear during death of a sick relative where she feels she might get the same illness and die, travelling, death of a neighbour etc. she becomes very restless, gets sleep disturbances for few days. Patient uses chewable nicotine in dependence pattern since last five years. Mental status examination revealed Preoccupation about fear of death. Motivation to quit chewable nicotine was poor. She was admitted in psychiatry ward for a shorter duration voluntarily. Patient was given medications, Psychotherapy, Cognitive behavioural therapy for about three sessions. Patient reported reduction in anxiety. Patient was lost to follow-up after.

Case 6 - Troubling trio- Tuberculosis, alcohol use disorder and nicotine use disorder

A 32-Year-old male with history of Alcohol, Nicotine use in dependence pattern for 15 years have become home bound started to hear voices in isolation, he kept on muttering to self, told his mother that he could hear his dead friends’ voices in his ear, and they tell him to kill himself. He had a suspicion that those friends would kill him. He had sustained pervasive low mood, crying spells, decreased personal hygiene, Fatigue, feelings of worthlessness, hopelessness, sleep and appetite disturbances, suicidal attempts. These symptoms persisted for a period of three months. Mental status examination revealed he had second person auditory hallucinations, delusion of persecution, depressive mood. Patient had developed fever and cough on and off for about one month. Radiological and laboratory investigations revealed he had Pulmonary Tuberculosis. He received Antitubercular drug therapy and Psychiatric management which included antipsychotics for a brief period following which he had improvement in psychotic symptoms. He was treated with detoxifying agent and stopped. Anticraving agent was started as well. familial use of alcohol and nicotine dependence in father.

Case 7 A Case Report of Cut throat injury as a result of Poly substance induced psychosis.

A 26-year-old male, single, daily wage labourer, was brought to emergency department with cut throat injury in the anterior aspect of the neck. Trachea and underlying structures were safe none of neurovascular structure was involved. The patient was hemodynamically stable, conscious, oriented and was able to speak with difficulty secondary to pain. Patient was referred from ENT to psychiatry for his self-harm attempt. On evaluation, patient reported he smokes cannabis since last 4 years. Frequency 4-5 times a week.

Patient also reports of Alcohol and nicotine use in dependence pattern for 4 years. He reported of hearing voices in isolation and the content was commanding and threatening in nature. Patient had wandering tendency as well. On the day of presentation to hospital he suddenly slit his throat without any hesitation or warning at his residence in front of his mother. Laboratory investigations revealed LFT derangement. USG showed hepatomegaly and fatty liver Urine toxicology revealed cannabis to be positive. Mental status examination revealed second person auditory hallucinations. Motivation to quit polysubstance present. In hospital stay, significant improvement shown by resolution of psychotic symptoms, improvement in appetite, sleep. In the follow up he was abstinent from substances and maintained well.

Case 8 - A case report of a child with West syndrome, Phenylketonuria and Autism.

A 5 years old male child, 1 st born out of non-consanguineous marriage, term delivery presented with regression of attained milestones, infantile spasms at his 7 months of age, EEG showed hypsarrhythmia. Patient was treated with ACTH Therapy, Tab.Vigabatrin and sodium valproate for about 9-10 months and improved. Then child has been noticed to have minimal eye contact, delay in speech in the form of uttering only one or two words, restrictive repetitive behaviours like jumping, hand flapping etc at 3-4 years of age. Enzymatic testing revealed Phenylketonuria, an inborn metabolic disorder. The child has been diagnosed as West syndrome with autism with above mentioned features, screening tools and MRI brain and treated with medications and Therapy like Parent Management techniques, developing peer interaction, structured routine.

Case 9 HEAD UP, HANDS DOWN - DISORDER OR DECISION - TRICHOTILLOMANIA

CASE SERIES
Case 1:
62 years old female, case of Hodgkin’s Lymphoma diagnosed 1 month back, presenting with sudden hairpulling of scalp and became a daily routine during the last 4months. This started during times of stress, but was aware only on occasions. The rest of the time, she reported that she pulled “automatically” or without consciously noticing it. She also had injury over her forehead due to repeated banging of head, which she denied.
Case 2:
21 years old, female presented to dermatologist with patchy loss of scalp hair and was referred to us. On evaluation: Depressed mood, anhedonia, occasional death wishes, sleep disturbances, anxiety, preoccupation about her breakup 3months back. She hides her pulled hairs in her personal belongings. She also had an increased repetitive urge to pull out hair and obtained relief.
Case 3:
19 years old girl, brought to OPD with c/o repeated hand washing, bathing for >4 hours/day since 3 months, she reports she had scalp dandruff for past 1 month due to which she was extremely anxious and worried and was relieved on hair picking which was predominantly from scalp, but also from eyebrows, eyelashes. This lead to distorted hair in multiple areas in scalp.