1. Case Presentation
Dr. Rehab Shafik
Dr. Reham Abd-Elmohsen

2. Personal Data:
• 48 years old, female patient, she has
divorced since 17 years, has one son,
she’s house-wife.
• Admitted on 30/10/2012, involuntary
admission.(several admission)

3. ‫‪Complaint‬‬
‫:‪• from patient‬‬
‫أخويا عمل لى عمل – بيحضر الشياطين عليا – بيخلى عينى تتشعلق‬
‫فوق.‬
‫دول مش أهلى أنا اتخطفت من وانا صغيرة – ممكن تكون الناس‬
‫بتتكلم عليا.‬
‫الناس اللى معايا عارفين أنا بافكر فى إيه إنما الناس اللى معاكم انتوا‬
‫مش عارفين – الناس اللى معايا دول ناس أنا الوحيدة اللى باشوفهم‬
‫واسمعهم وأحيانا بيتكلموا مع بعض عليا وأحيانا بيعلقوا على‬
‫تصرفاتى.جوزي طلقني ورجعني تاني هم بيقولوا انه مات بس انا‬
‫متأكدة انه عايش شوفته قريب.انا اهلي بيسيطروا على تصرفاتي‬
‫بعمل حاجات من غير ارادتي‬

4. ‫‪Complaint‬‬
‫)‪• from relative: (her sister‬‬
‫بتشك فينا وبتكرهنا – بتقول علينا مش أهلها – بتكلم نفسها‬
‫كأن حد بيكلمها – بتقول باشوف خيال ت – بتكلم نفسها كل م‬
‫مش مفهو م – رافضة العل ج – مش بتعمل أى حاجه فى‬
‫البيت – مش بتقو م من على السرير.‬

5. History of present illness:
The condition started by insidious onset, progressive
course of lack of sleep since one week, believes that
her father will harm her, and that her relatives are
foreign and she didn’t know them since 1 month, ideas
that others may talk about her since 1 month, saying
that she sees persons who aren’t real and hears voices
talking with her & comment on her behaviors
sometimes, and sometimes argue about her since 1
month, refuse medication, lack of activity & self neglect
since 2 months. She says that her husband is still alive
but he’s died.

6. Past History:
•Psychiatric:
- Condition started since 16 years, by delusions of
persecution, reference, ideas of grandeur, bouts of agitation,
visual & auditory hallucinations since 10 years, bouts of
hyperactivity and talkativeness since 10 years in which
symptoms continue in-between attack, the ptient received
Prianil 600 mg/day – clozapex 600 mg/day, since 14 years
- Since 2 years she said that her parents kidnaped her but
they treated her will, delusion of influnce and diagnosed as
schizophrenia, received treatment and improved.

7. Past History:
•Drug Abuse:
heavy cigarette smoker
•Medical: No HTN, No D.M, No other specific
medical condition.
•Surgical: No previous surgical operations.

8. Family History:
No similar cases in her family
Family setting & Appearance:
•Father:
seller, has renal failure, good relationship with her.
•Mother:
intact personality, good personality, has good relationship
with her.
(‫)مامتى كانت مغنية مشهورة اسمها شوشو عبده‬
•Consanguinity: positive.
•Relation in between: good
•Siblings: 2 sisters, 3 brothers.
•Housing & living atmosphere: medium.

9. Personal Hx:
•Pregnancy: normal,
•Delivery: normal.
•Early Development: Normal.
•Neurotic trait: didn’t present.
•Child abuse: no child abuse.

10. Personal Hx:
•Scholastic history: good, ‫دبلو م تجارة‬
•Occupational history: never has work.
•Sexual history: good.
•Marital History & offspring: good, widow, one son,
denies that her husband is died.

11. Premorbid personality
•Social relationship : has limited social relationship.
• Mood: stable.
•Energy: in reality.
•Habits & hobbies: cooking.
•Religiosity: was religious, praying regularly.
•Personality trait: introvert.

12. Mental State Examination
•General appearance & Behavior: suspicious with
wandering eyes, average PMA,
•Consciousness: fully conscious
•Attention & Concentration: attentive, average
concentration.
•Orientation: oriented TPP.
•Memory: intact recent, short, and long term memory.

13. Mental State Examination
•Speech: induced coherent speech, relevant answers.
•Thinking:
- Form & stream: no Formal Thought Disorder
-Content: Delusions of persecution, ideas of
reference ?? Delusions that her husband is alive,
delusions that her parents kidnapped her?, and her son
isn’t her son. Thought broadcasting,
-Possession: possessed by her brother.
•Abstraction: abstract

14. Mental State Examination
•Perception: auditory & visual hallucinations.
•Mood & Affect: suspicious mood, constricted affect.
•General information: average.
•Assessment Of intelligence: average.
•Judgment: impaired
•Insight: partial.

15. Mental State Examination
•Risk:
-self: no suicidal ideas, no previous attempts
-Others: no homicidal acts.
-Neglection: mild
•Mental capacity:

16. Physical Examination:
-B.P: 110/70 - pulse: 80 temp 37
-Appearance: NO abnormalities
-Clinical examination free.
Investigations: routine are normal

17. ‫جزاكم ال خيرا‬
‫‪Thank You‬‬