CASE 1

Socio-demographic details:-

Name : Ms. A
Age : 35 years
Gender : Female
Educational Qualification : 8th standard
Marital status : Married
Occupation : Housewife
Socio-Economic Status : Low
Religion : Hindu
Residence : Urban
Language : Chhattisgarhi, Hindi
Informant : Patient herself and Husband
Information : Adequate and reliable

Chief Complaints:-

▪ Feelings of hopelessness

▪ Reduced interest in daily activities

▪ Negative thoughts regarding the future.

▪ Low mood

▪ Strained relations with husband and in-laws

▪ Dissatisfied with her sexual relations with her husband.

▪ Decreased sleep and appetite

Nature of Illness:-

Precipitating Factor: Extra marital affair and alcohol abuse of her husband.

Mode of Onset: chronic

Course of Illness: continuous

Progress of the Illness: deteriorating.

Client was asymptomatic 3 years ago. Three years back, she came to know about several
affairs her husband was having with other women in her village. She came to know this,
when she caught her husband having sexual intercourse with another women in their
bedroom. Since then she feels hopeless about her situation and says that there is nothing
much she can do about her situation as her husband is not loyal to her. She also experiences
reduced interest in doing daily activities and says that the only reason why she is doing them
is because her children don’t get affected. She also has negative thoughts regarding her future
and says that her situation has not improved for 3 years.

For the last three years because of this she has had a strained relationship with her husband
and in-laws. The patient confessed during the interview that the only reason she is with her
husband at present is her children. She is also not satisfied with the sexual relations she has
with her husband.

The predominant mood of the client was reported to be depressed. She had decreased sleep
and appetite. She had problems in maintaining sleep. Her socio-occupational functioning has
decreased as she left, like staying at home and not meeting other people. Ho history
suggestive of any head injury, epilepsy, delusions, hallucinations, sustained elated or
depressed mood.

Treatment history:- Nil.

Past illness:- Nil

Family history:-

Client was born to non-consanguineous parents. Her father died of an unknown medical
condition 30 years ago. Her mother is 62 years old, educated till 5th standard and is a farmer,
she raised the client and her siblings after the death of her husband. She has a loving and a
caring attitude towards the client. Her husband is educated till 12th standard, and is a
government contractor. They have two children, the elder son who is 17 years old and is
currently in 12th standard and a younger daughter who is 15 years old and is in 10th standard.
History of alcohol use in her father was found to be present.

Personal History:-

Personal history could not be elicited as the informant was her husband and she did not have
any information regarding her birth and development.
Educational history:-

She started going to school at the age of 7 years. She is educated up to 8th standard. She left
her studies at the age of 16 years as her marriage got fixed. She was average in studies. Peer
relations were found to be present. She participated in extracurricular activities like koko,
dancing and cooking.

Occupation history:-

Ms. A is a housewife.

Sexual history:-

She came to know about sex from her friends at school, when she was about to get married.
Upon knowing it she was very shy to face her husband. Her the first time, she had sexual
intercourse on the eve of her marriage, which she described to be very painful and
uncomfortable. Later she adapted herself and used to have intercourse 3-4 times in a week
with her husband. At present they have intercourse 1-2 times a week. This client finds it very
distressing and complains of severe body ache every time they have intercourse.

Marital history:-

Age of the client at marriage was 17 years and that of her husband was 22 years. It was an
arranged marriage with parental consent. Their marital adjustment is strained because of her
husband’s extra marital affair and alcohol abuse. Many times they pick up fights and he and
his in-laws used to beat her up. He never allows her to go out of the house and does not
contribute much to his duties towards his family other than paying bills. She wishes to
divorcee him but does not do so to secure the future of his children.

Present living conditions:-

At present she lives with her husband and two children separately in a house in the same
locality where her in-laws live. Her husband supports them financially and he is the only
earning member of the family. Present living conditions are strained.

Premorbid personality:-

Premorbid personality could not be elicited as her husband was lying throughout the
interview and blaming his wife for not being loyal to him.
 Mental status examination

1. General appearance: - well kept and tidy

2. Touch with surroundings: - Present

3. Eye contact with the examiner: - Present

4. Dress: - appropriate

5. Hair: - well groomed

6. Finger nails: - appropriate

7. Rapport: - easily established

8. Attitude towards the examiner: - cooperative, frank

9. Motor behaviour: - appropriate

10. Voice and Speech: - normal

11. Volition: - present (disorder of volition absent).

12. Affect: -

● Subjectively: Client reported her mind to be depressed because of her condition.

● Objectively: depressed.

Affect was appropriate with normal reactivity and relatedness.

13. Thought stream:- normal

14. Thought Possession:- absent

15. Formal thought disorder:- absent

16. Thought content: - depressive cognitions

17. Perceptual disturbances: - absent.

18. Attention and concentration: - easily aroused and sustained.

19. Memory: - remote recent and immediate memory was judged to be intact.
 20. Orientation: - well oriented to time, place, date , day, month, year, person
Intelligence:- Based on comprehension, vocabulary, calculation and general
information, patient intelligence was assessed to be average.

21. Abstract thinking: - On the basis of similarities and dissimilarities, her level of
abstraction was found to be functional.

22. Judgement: - social, personal and test judgement was found to be good.

23. Insight: - level IV (Awareness that illness is due to something unknown in the
patient).

Provisional diagnosis:- F32.10 ( Moderate depression without somatic syndrome)

Points in favour:-

▪ Low mood.

▪ Reduced interest in daily activity.

▪ Hopelessness.

▪ Negative thoughts regarding the future.