CASE RECORD 10

Socio-demographic profile

 Name: Mrs. V

 Age: 28

 Sex: Female

 Education: M.A.

 Occupation: Employed

 Socio economic status: Upper-middle class

 Marital status: Married

 Religion: Hindu

 Residence: Sanganer, Rajasthan

 Language spoken: Hindi

Type of admission: IPD

Identification marks: N/A

Informant: Husband, mother, sister

Reliability of informant: Reliable and adequate

Ideas of infidelity

Increased aggression

Decreased sleep

Increased talkativeness

Increased socialization 3 months

Overfamiliarity

Increased self-esteem and confidence

Ideas of grandiosity

Total duration of illness: 3 months

Current duration of illness: 3 months

 Factors in illness

 Predisposing factors: impaired premorbid personality (psychological)

 Precipitating factors: conflict with sister-in-law (social)

 Perpetuating factors: lack of insight and expressed emotions (psychological)

 Mode of onset: insidious

 Course of illness: continuous

 Progress of illness: deteriorating

The patient had reportedly been functioning well and remained asymptomatic until February

2025. In early February 2025, the patient experienced a significant interpersonal conflict with

her sister-in-law. The dispute arose over the patient's inability to manage full-time

employment alongside the household responsibilities, which were reportedly not being

equally shared or supported by the family. This event appeared to be a major psychosocial

stressor and was followed by a noticeable change in the patient’s behavior and emotional

state.

In the immediate aftermath of the conflict, the patient began exhibiting increased irritability

and aggression. She became verbally confrontational and was reported to have frequent

outbursts of anger, which were described as disproportionate to the situation. Within a few

days, her behavior further escalated, and she started displaying strong suspicions about her

husband's fidelity.

She became convinced that he was having an extramarital affair, based primarily on

circumstantial evidence such as his phone being "busy" for extended periods over the

previous two days and his delayed return from work, which was in reality attributed to

increased workload. Despite reassurances from her husband, she remained suspicious and

confrontational, often accusing him without any concrete proof.

Around the same time, the patient had another conflict with her father-in-law. She had

expressed a desire to resume or pursue a professional role outside the home, but her father-in-

law allegedly questioned her motives and whereabouts, which further exacerbated her

feelings of being controlled and disrespected.

often sleeping only 1–2 hours a night, yet remained physically energetic and active

throughout the day. Her speech became markedly pressured, and she would often talk

excessively, even in inappropriate contexts or to unfamiliar individuals. Her social behavior

changed drastically — she began to actively seek out social events, attend multiple

gatherings, and demonstrated overfamiliarity with strangers. Family members observed a

sharp increase in her confidence, with grandiose claims about her abilities and

accomplishments. She would often declare that she could achieve anything she set her mind

to, and nothing was beyond her capability. During conversations, she would boast about her

perceived intelligence, status, and abilities, despite there being no basis in reality for many of

these claims.

The patient also started considering herself to be a police officer, asserting her ‘authority’ in

public spaces and among acquaintances. This was accompanied by risky and impulsive

behavior — she began traveling alone to far-off places such as Mumbai and Mirzapur without

informing any family members. These unplanned and unaccompanied journeys caused

considerable distress to her family, especially as she made no arrangements for safety or

communication during these trips.

One particularly alarming incident involved the patient sneaking into her own house through

the neighbor’s balcony after finding the main door locked. During this episode, she engaged

in destructive behavior — breaking personal belongings of her sister-in-law and father-in-

law, setting fire to some of her father-in-law’s clothing, and causing significant damage to her

sister-in-law’s residence. The severity and unpredictability of these actions led to increased

concern for the safety of the patient and others around her. two days before, she also joined a

consulting company.
Due to the worsening of her symptoms her husband decided to remove her from the

household environment for her and the family's safety. She was subsequently brought to

Hospital for psychiatric evaluation and management.

Negative history

There is no history suggestive of:

 No history suggestive of any organic brain disease, brain fever or traumatic brain

injury

 No history suggestive of apprehension about future, excessive worry, repetitive

thoughts &/or acts, loss of memory/travel away from home, repetitive physical

complaints without evidence

Treatment history

There is no significant past treatment history.

Past history

Past medical history:

There is no significant past medical history.

Past psychiatric history:

There is no significant past psychiatric history.

Family history

The patient was first born to her parents in a non-consanguineous union. She is the 3rd born,

has one elder brother, one elder sister and a younger sister. She has been over-pampered by

her parents since childhood and has maintained cordial relations with everyone in the family.
Her parents and siblings have also had loving relationship with each other. There is no

positive history of psychiatric illness in the family.

Natural death Natural death

48 50

Accident

28

Fig: Genogram

Personal history

Birth and early development: The patient had a normal delivery and his mother had no

perinatal complications. He achieved all the significant milestones on time.

Presence of childhood disorders: No childhood disorders were reported.

Home atmosphere in childhood and adolescence: A congenial home atmosphere was

provided to the patient during childhood and adolescence.

Scholastic and extracurricular activities: The patient completed her 12th in 2012 from a

private institute followed by B.A. in 2015 and M.A. in 2017. She has always been an average

student and maintained cordial relations with peers and teachers.

as a primary teacher and taught there till 2020 but had to leave the job as after the demise of

the principal the school was shut down. In 2020, she joined another private school as a

primary teacher but had to leave the job in 2022 as the job was not paying her fairly. She

maintained good relations with her colleagues.

Menstrual history: The patient achieved menarche at the age of 18 years and got knowledge

about periods from her mother. her reaction towards periods was neutral and experiences

regular menstrual cycle.

Sexual and marital history: The patient got married in the year 2022 in an arrange setup with

consent. She did not have any romantic relations before marriage. She had got sexual

knowledge from her friends and sisters at the age of around 17 years.

Forensic history: There is no forensic history.

General pattern of living: The patient was living with her in-laws but at the time of admission

she had shifted to a 1BHK rented apartment with her husband.

Premorbid personality:

 Social relations: The patient had good and cordial relations with her family, was not

dependent on them for her needs fully, had few close friends, did not participate much

in societal activities, had cordial and friendly relations with a few colleagues with

whom she worked closely, was considered to be a leader, was aggressive, ambitious,

independent but had difficulty adjust to new situations.

 Intellectual interest, hobbies, use of leisure time: The patient liked listening to music,

to shop and to travel different places.

about small matters, was optimistic, satisfied with self, her mood would change in

response to situations as she would become aggressive, irritable and stubborn if her

needs were not fulfilled, would also engage in verbal abuse when aggressive and

generally had a fluctuating mood.

 Character:

 Attitude towards self: As per the informant, the patient would describe herself

as confident, believed in her strengths and abilities, would ignore her

shortcomings, had poor ability to plan ahead, was ambitious with regards to

being independent, self-approving, did not compare herself to others, had low

tolerance of frustration and interests would change.

 Attitude towards work and responsibility: The patient always handled

responsibilities well, was rigid with rules, and had the ability to make

decisions easily however would sometimes make impulsive decisions without

thinking of the consequences.

 Interpersonal relationships: The patient was described as confident, sensitive

to criticism, irritable and quick-tempered, avoided display of her emotions and

thoughts, intolerant of others, had difficulty adjust to new situations, had few a

lasting or close relations, was critical of other people’s mistakes.

 Standards in moral, religious and health matters: The patient believed in god,

had adequate concern towards her own heath and had adequate moral values.

 Energy, initiative: The patient was energetic and would not get easily fatigued.

 Fantasy life: No significant fantasy life was reported.

Mental status examination

Could not be elicited as the patient was sedated and sleeping.

Diagnostic formulation

Index patient, Mrs. V, a 28 year old female, employed, married, M.A. graduate, from an

upper middle class Hindu family, hailing from Sanganer district of Rajasthan with informant

presented complaints of ideas of infidelity, increased aggression, decreased sleep, increased

talkativeness, socialization, overfamiliarity increased self-esteem and confidence, ideas of

grandiosity for a period of 3 months, predisposed by an impaired premorbid personality,

precipitated by conflict with sister-in-law and perpetuated by lack of insight and expressed

emotions. Premorbidly, she was aggressive, had difficulty adjust to new situations, irritable,

stubborn, would engage in verbal abuse when aggressive, confident, ignored shortcomings,

did not plan ahead, decide impulsively, sensitive to criticism, avoided display of emotions,

intolerant of others and was critical of others mistakes suggesting the diagnosis of Manic

episode with psychotic symptoms.

Provisional diagnosis: (F30.1) Manic episode with psychotic symptoms

Points in favor:

 Presence of symptoms that characterize a manic episode

 Significant impairment of social and interpersonal functioning

 No previous episode of mood disturbance

 Presence of psychotic symptoms

 Psychoeducation

 Interpersonal Social Rhythms Therapy

Examined By- Supervised By-

Anushka Goyal Ms. Sanse Bhatt

M.Phil Clinical Psychology Trainee (1st year) Assistant Professor

Department of Clinical Psychology Department of Clinical Psychology

Suresh Gyan Vihar University Suresh Gyan Vihar University