ByDr.Ahmad Khattab

Psychiatric Resident

Under supervision of:

Dr.Sonia AlzayatPsychiatric Consultant

“What truly is logic? Who decides reason? My quest has taken me to the physical, the metaphysical, the delusional, and

back. I have made the most important discovery of my career - the most important discovery of my life. It is only in the

mysterious equations of love that any logic or reasons can be found. I am only here tonight because of you, You are the

only reason I am. You are all my reasons. Thank you. “John Nash

a single male patient, aged 27 years old. He is an

Egyptian citizen, lives in Alexandria, He Studied at Workers University. Graduated in 2007. But

he has no work now. He has been admitted in our hospital by outpatient clinic

psychiatrist under compulsive authority in 10th November 2012.

From patient

بشوف حاجات مش موجودة..أنا عندي قدرات ” Beautiful Mind“أنا زي ”جون ناش“ في فيلم واحد شغالين مع الشيوعيين.95خاصة..لما بسلط طاقة المخ على حد يموت..أنا قدرت أموت

أنا قدرت أنقذ أحمد ماهر و أحمد أبو الغيط و عاطف عبيد من الشيوعية.كلمت ربنا مرة واحدة و قاللي ”أنا أنت و أنت أنا“.

لغات بس جلسات الكهرباء ضيعت كل اإلبداع اللي عندي..و مرة قريت صيني صح 6أنا اكتسبت من الشمال لليمين..و لغات الهيبيز و الشيتوس.

مجلدات عن الرجل األيسر..ده التشخيص بتاعي.9فيه كتاب من الناس بتشاور عليا عشان قدراتي..بس أنا مش بخرج وسط الناس كتير عشان الناس اللي موتهم.

جنيه عشان يذلوني..هم اللي حبسوني في أوضتي عشان قتلت عاطف 5000الشيوعيين دفعوا عبيد.

� بيحيوني..كلهم و أنا في أوضتي بسمع اللواء و واحد صاحبي في كلية الطب..دايماأصدقائي..بيقولولي لو فيه خطر فألف زي المروحة..لو لفيت عكس اإلتجاهأحيي الموتى..و

الناس اللي أحييتهم بيقولولي ”أنت الرب اللي شفناه فوق“ ألن ربنا قاللي ”أنا أنت و أنت أنا“.انا الرجل األيسر..اللي هو المهدي المنتظر..اللي هو الرب..

مليون واحد عشان يموتوني..كنت برفع العربيات و بموتهم 5أنا موت واحد سلفي كان جايب باألشعة.

مع دكتور مصطفى عبد الظاهر مساعد وزير ” Dynamic Electronic Head“أنا كان ليا مشروع الداخلية..خدنا بيه جائزة الدولة التقديرية.

الريس مرسي عرض عليا منصب مستشار رئيس الجمهورية..و عرضوا عليا أشتغل في المخابرات خاليا إرهابية..بس أنا 3و األمم المتحدة ألني بقدر أشوف أي حد في أي مكان و ألني كشفت

رفضت ألني رافض أسيب مصر.

From relative

األم

خارج من المستش�فى من ش�هرين قع�د أس�بوع ك�ويس و ه�و حبس نفس�ه في حجرت�ه و كل و الشرب م�عانا و �بيقول إ�ننا بنح�ط له ب�راز ف�ي ا�ألك�ل و القهوة. رافض األ�

و بيقول إنه لو خرج من أوضته الشيوعيين هيموتوه.رمى وال�ده من على س�طوح ال�دور األول عش�ان ك�ان رافض يجي معان�ا المستش�فى و

� بيهددنا �بالقتل� و بيشرب س�جاير كت�ير و� رافض ع�الجه. دايما في آخ�ر س�نة في الكلي�ة..ك�ان عن�ده م�ادة..و نس�ي مع�اد 2007مش�كلته ب�دأت في

.� ال�دور �التان�ي فاضطر� يعيد ا�لسنة ك�لها ع�لى ماد�ة..فانه�ار و تعب �نفسيا ش�غالنات في وقت واح�د.و بي�نزل يقع�د م�ع أص�حابه على 3كان بيش�تغل وقت الكلي�ة

� بنفس��ه..�في أول ا�لس��نة الدراس��ية� يجيب ب��أل�ف جني��ه ه��دوم ال�قه��وة.و مهتم ج��داجديدة.

بع�د التعب مابق�اش يخ�رج م�ع أص�حابه..و يق�وللي ق�وليلهم مش موج�ود..أن�ا ل�و ن�زلت الشارع الشيوعيين هيموتوني.

� بمظه�ره و ي�رتب أوض�ته..و غ�اوي كم�بيوتر يقع�د عليه..و يص�لحه..دل�وقت كان مهتم ج�داأهمل نفسه.

س�نين لم�ا لقيت�ه منط�وي..ك�ان حال�ة متقلب..أوق�ات 5خطبت ل�ه م�ره في أول تعب�ه من يف��رح ق��وي إ�نه��ا ب�تكلم��ه أو ل�م��ا بيزو�رون��ا..و� بع��دين بق�ى رافض �يتص��ل بيه��ا أو

يزورها..الخطوبة قعدت شهرين و انتهت.

The condition deteriorated gradually during last 2 months after patient stopped his psychiatric medication by his own will one week after discharge from our hospital, showing some irritability, tendency to stay in his room alone, afraid of people to kill him, He was aggressive against his family members, Refuse eating with them as he was suspicious of food poisoning. So he threatened to kill his family.Now, He claims that he can see non existing things like “John Nash” in “Beautiful Mind” movie. Also he says that he has a special gifts and power of killing and revival of dead people, and because of these power UN asked him to work together, but he refused.He claims that he was speaking at least 9 languages but he forgot them during the last admission in our hospital “Last September” because of ECT.

.

Psychiatric history:The condition started about 5 years back, Seeked advice in private clinics.Admitted to our hospital 2 times before this one.1st Admission: 13th September 2011 – 1st October 2011 Diagnosed as “Schizophrenia” and controlled by Atypical antipsychotic

“Resperidone tab. 6mg/day” , “Benzotropine mesylate tab. 2mg /day” and long Acting antipsychotic “Haloperidol decanause 2amp./15 days”.

2nd Admission: 19th July 2012 – 1st September 2012 Diagnosed as “Schizophrenia” and controlled by Atypical antipsychotic

“Resperidone tab. 6mg/day” , “Benzotropine mesylate tab. 2mg /day” and long Acting antipsychotic “Haloperidol decanause 2amp./15 days”.

6 sets of ECT was added to treatment after 3 weeks of admission and improved.

Substance: No evident history about substance abuse. Medical: No evident history of any chronic medical disease or admission in

general hospital. Surgical: No evident history of any major surgical operation or Head

Trauma.

His father is an old man with history of a psychiatric disorder, but he stopped his treatment several years before, and he is mentally stable now without treatment, But he is not working now.

His mother is an old woman, house wife with no history of any psychiatric disorder.

Negative consanguinity. Our patient is the 4th in order of siblings, 2 brothers & 2

sisters. His elder brother is also a psychotic patient, mentally

stable and functioning on treatment.

 

Pregnancy: No history of any diseases or medications or trauma to his mother during pregnancy.

Delivery: Normal

Early Development: No evident history of any proplems.

Neurotic trait: No evident history.

Child abuse: No evident history.

Scholastic history: He dropped in the last year in university, and graduated in 2007.

Military History: Exemption from conscription.

Occupational history: 3 jobs at the same time divided into 3 shifts during university study as a security & a worker . Sexual history: No evident history.

Marital History & offspring: Not married.

No history of any illegal problems.

He was friendly, Loitering out with friends and go out to coffee shop.He was spending his time using computer, and he could fix any problems.He was smoker, and became a heavy smoker after his disorder, he smokes about 5 packs of cigarettes (100 cig.) per day..??He wasn’t religious, No pray or Fasting.

Patient is conscious, alert, calm and cooperative, within average general appearance, oriented to time, place & personality. He has an intact memory (Immediate, Recent & Remote).His speech is induced, coherent with relevant answers.He has poor judgment, poor insight.He thinks magically with bizarre delusions of grandeur, persecution and reference.Auditory & Visual hallucinations.Mood congruent delusions & hallucinations and flat affect.

Blood pressure: 110/70 Pulse: 80 b/m

Abdominal examination:Lax abdomen, no organomegaly felt by palpation.

Chest examination:No abnormalities detected.

Investigations results:In 5/12/2012 : Hb 14.5 gm% - RBCs 4970000/cmm - Platelets 240000/cmm - WBCs 5.300/cmmIn 12/11/2012 : Fasting blood sugar 85 mg% - SGPT 9 U/I

Chronic Relapsing Schizophrenia

Psychopharmacology:We started by:Clopexol acquafase Amp. IM/ 15 daysResperidone tab. 6mg/dayBenzotropine mesylate tab. 4mg/dayClozapine tab. 25mg /day increased gradually to 100mg /day divided into 2 doses.In 6/12/2012 we started ECT sessions, as his condition showed poor improvement, and he has history of better improvement on ECT.He received 2 sessions of 6 sessions recommended till now.

Psychosocial intervention:Because of his social withdrawal, I think it’s better to start group therapy plus occupational therapy gradually for rehabilitation.After discharge, day care should be continued, and it’s challenging to have that in our hospital.

� جزاكم الله خيراThank You