Schizophrenia
30 year old unmarried lady with history of severe illness started at the age of 17
A 30-year-old unmarried anxious lady came to my clinic accompanied by her father with complaints ofmental distress from 17yrs of age. Her complaints started at 17yrs of age, when she started hearing voices when she was alone in her room. She could hear 2-3 people talking & discussing among themselves about her in a derogatory manner. She would feel really perplexed, anxious & fearful and would in turn go out of the room and search around trying to find from where these voices are coming from; but she wouldn’t find anyone around. So, she thought these were coming from neighbouring house and began suspecting them. She asked her parents & elder sister if they could hear these voices but they would in fact ridicule her and rub it aside. Later these voices were like a running commentary about whatever she does. She began to fight back against these voices, sometimes talking back, quarrelling and sometimes yelling at them. Family members noticed that she was sometimes muttering and smiling to self with hand gestures as if talking with invisible persons. When others around her would discuss something, she became suspicious that they are talking ill about her. She began to feel that the news in the television and newspapers are about her. As a result, she became sad, angry and irritable towards others.In her college class, because of this continuous hearing voices and resultant fear and suspiciousness, she couldn’t concentrate on her studies and began to score low marks.She began to be fearful and anxious and suspicious that there is a gang who may be watching & spying on her all the time through some cameras placed inside the house and is tracking her all movements through mobile phones & satellites.She also began to feel that others around her are able to read and control her thoughts and body using some kind of electronic device.While sleeping alone in her own room with closed door, she sometimes began to feel that somebody is touching her private parts, and began suspecting and accusing her father of sexual harassment. Subsequently she stopped going out of her home and interacting with others. Shebecame more and more withdrawn, spending most of the time in her own room – locked from inside; self-absorbed in her own magical world of voices, suspiciousness and fear, to the extent that she even began to neglect her own self-care activities like brushing teeth and bathing. She also couldn’t sleep well and her appetite became very low that she began losing weight.
She was taken to many Psychiatrists and psychologistsaround Mumbai but she reported only max 20% improvement, with side-effects like sedation and weight gain. So in between she would discontinue therapy. Later she was shown at NIMHANS Bangalore and CMC Vellore, but not much improvement was noted. So, at 30 years of age, 13 years after the illness began, she was brought to me for consultation.
On examination- Patient was moderately built and nourished, fully conscious & cooperative, but rapport was difficult to establish. Psychomotor activity was slightly decreased, Talk was decreased in amount, tone & tempo, reaction time was increased, prosody was maintained, relevant & coherent. Examination of her Thought showed that she hadretardation of thinking, thought blocking, loosening of association, Delusion of persecution, Delusion of reference, Thought withdrawal, Thought broadcast, Thought insertion, Delusion of control & passivity. Mood was anxious, depressed& irritable. Affect was appropriate. 3rd person auditory hallucinations were present with running commentary. Cognitive functions showed decreased attention and concentration with normal intelligence, memory and abstractability with impaired judgement and poor insight.
Diagnosis of Schizophrenia was made.
Patient and relative were extensively psychoeducated regarding the illness, a definitive management plan was made taking the patient into confidence. She was started on Pharmacotherapy (Medicines) and Psychotherapy (CBT). After 6 weeks – up titration of medicines to therapeutic level & 6 CBT sessions, 100% improvement was attained and maintained. No side effects to medicines were reported. She still remains symptom free and happy, back to her normal self- now doing a job in an IT company.
Self-Assessment
