CASE REPORT

SOCIO-DEMOGRAPHIC DATA
Name: Mr. S D
Father’s name: Mr. A
Age: 42
Gender: Male
Religion: Islam
Marital status: Married – 10 years back
No. of children: 2
Habitat: Rural
Place of birth: Banaras
Educational status: SSLC
Ordinal status: Elder son among 2 sibs
Occupation: Construction work
Informer: Wife
Reliability: Reliable
Chief Complaints.

-Excessive use of alcohol

-Impaired Sleep and appetite
-Fatty liver
-Work impairment
-Aggressive Behavior
Withdrawal symptoms

First 2 days he feels sleepy and low mood, after that he has some hallucinations like some mills working
near to his room and always disturbing him, he can't sleep at night, he wakes up from sleep and talking a
lot of things which has no connection with reality. His orientation with place and time became extra
ordinary. He feels he staying somewhere else, and he confused with day and night, etc.

Total duration of illness: 22 years

Predisposing Factors. Genetic illness
Perpetuating Factors.
Mode of onset was insidious

History of Present illness.

The client is from a middle socio -economic Islamic family. He is the youngest member in his family.
Two elder brothers had been working abroad. They are living there with their family. Client is now living
with his parents.
He started drinking alcohol at the age of 20years. At that time his father taking alcohol everyday
and he will make issues in home; elder brothers went abroad at their twenties; his father didn’t allowed
him to go abroad. He was under his father’s custody. Father was very strict and he didn’t allow him to do
as he likes. Gradually he started opposing his father. To compete with his father, he started drinking
alcohol; after drinking he feels more confident. Gradually he became addicted. He was very obstinate
and head strong. His mother was a kind hearted women and she always advised him to stop drinking
alcohol. He feels he will get more energy when he takes alcohol and started arguing his father.
Whenever he wants to talk with his father he takes alcohol to become more confident….that leads to a
complete addiction, he is very obstinate and head strong , usually using abusive languages towards his
mother, she is a lovely, kind, orthodox women, many she begged him to stop his addiction.
He had come for de addiction therapy in the same institution 2 years back and relapse now. While
approaching him we understood that he didn't came for de addiction permanently, just for a break
because he is now under pressure from family and friends, to escape from them he agreed therapy now.
He wanted to settle some issues also.

Negative History:
No history suggestive of organicity
No history suggestive of euphoria or depression
No history suggestive of obsessions or compulsions
No history suggestive of psychosis

Past History: N/A

Treatment history

Relapse now.
Treatment taken before 2 years. For de addiction from the same institution.

Medical history
Alcohol liver disease.
Family history:
Substance history: Family in alcohol addiction.
Attitude of family members towards the patient’s illness: Responsible
Patient and family setup:
He started drinking alcohol at the age of 20years. At that time his father taking alcohol everyday and he
will make issues in home; elder brothers went abroad at their twenties; his father didn’t allowed him to
go abroad. He was under his father’s custody. Father was very strict and he didn’t allow him to do as he
likes. Gradually he started opposing his father. To compete with his father he started drinking alcohol;
after drinking he feels more confident. Gradually he became addicted. He was very obstinate and head
strong. His mother was a kind-hearted women and she always advised him to stop drinking alcohol.

42

Personal History:
Birth & Development: The condition of his mother during pregnancy was normal. There is no issues
detected in the childhood and adolescent stages.
Education.
He stopped his studies after his SSLC… after that he started working , in construction field. For getting
more energy during his working time, he regularly taken alcohol and leads to complete addiction….he
starting his day with alcohol….

Occupational.
Service
Sexual History:
Normal
Marital History:
He got married at his 31. His family never informed the addiction, after marriage only wife knows he
completely addicted with alcohol, that made problems in their family life. He never earned or spend
money for his family. Never given importance to his wife, gradually condition became worse, she went
to her home, unfortunately she was pregnant at that time. After delivery she came back, but he
continued the same attitude , she was from a poor family so she stayed with him. Now they have 2 kids.

Legal Issues.
Nil

Premorbid Personality.

Attitude towards work and responsibility: good nature and caring, positive attitude towards his
work. Doesn’t take responsibility at work
Interpersonal relationship: patient exhibits good interpersonal and social relationships.

Standards in moral, religious, social and health matters: adequate moral and religious activity.

Energy, initiative: good Fantasy life: realistic Habits: alcohol

Suicide & Homicide: Nil

Habits & Addiction:

Frequency of intake: Repeated
Morning drinking: Every day before breakfast, he keeps one bottle in the flush tank in his toilet
Type of intake: Alone or with company
Place of intake: At any place
Brand: Any brand(available)
Volume per day: 1 bottle minimum
Stock in home: Yes
Friction with others: Shouting and using abusive languages with wife showing disrespect with
psychiatrist and other staffs.
H/O Accident: present
H/O Fall: present
H/O Financial problems: He spends all his savings for alcoholism, so some financial problems with his
brothers
Abstinent for: 8 days
Last intake: Same day before coming to hospital
Habits: Using Hanse , Smoking

Diagnosis

Alcoholic addiction syndrome- ADS

Treatment

Pharmacotherapy
Behavioral therapy- Aversion therapy
Psycho education
Awareness training
Family counselling

Mental status examination

General appearance and behaviour:

The patient is kempt and tidy, looking appropriate for his age, properly oriented with
surroundings, while maintaining eye contact with the examiner. His dress is fitting, hair neatly
combed, and finger nails trimmed. Rapport with the patient was easily established .He was
cooperative and attentive.

Psycho-motor behaviour:

Psychomotor activity was appropriate. Mood and affect:

Subjectively: I asked “mann kaisa rehta hai” He replied “man pareshaan rehta hai” Objectively:

He was irritable.
Range was normal. Affect was appropriate.

Voice and speech:

His voice was audible with normal fluctuations, normal rate, tone and volume of speech.
Speech was spontaneous, relevant, coherent. Productivity was normal and manner was normal

Thought:
Stream of thought
Thought stream was normal

Possession of thought:

Possession of thought was absent

Form of thought:

Formal thought disorder was not present

Content of thought: There was no disorder of content.

Perception disturbances: There was no disorder of perception like illusion and

hallucinations.

Attention and concentration:

He could not be easily aroused and not sustained for the required period of time. Serial
subtraction test:
100-7 not able to do
40-3 with more than 5 mistakes

30-3 with more than 5 mistakes

20-1 correct but not require period of time

Orientation:
He was oriented to time, place and person.

Memory:

Immediate: Not Intact Recent: intact Remote: intact

Digit forward 2,8 8,5,1

Digit backward 8,5 4,3,7

Words recall with mistakes.

I asked “ what did you have for dinner last night?”

He replied “ roti, dal and paneer.”
I asked: “what is the date of your birth”?
He replied: “13thoct.” (Confirmed basis documents’ cross-checking) Intelligence:
His intellectual ability was found to be average as per assessment of all four aspects.
Comprehension :

I asked: “Why is an engine attached to a train?”

He replied: “In order to make it move”
Vocabulary: I asked “What is another term for flower?” He replied: “Rose”

Calculation: I asked “If one mango cost me INR 5, how much money will 5 mangoes cost me?”

His response: “INR 25”

General information:
I asked:”Who is the prime minister of our nation?” His reply: Mr. Narendra Modi

Abstract thinking:

His abstract thinking was functional on the basis of assessment:

Response to proverb:

I asked : “nach na jane aagan teda” and

“Bandar kya janey adrak ka swaad”

He did not reply : “blaming others for your own mistakes/faults” and “jab aap kisi cheez ki
qadar nai karte ha I mean you do not value a thing”

Similarity and differences:

I asked” banana or orange mai kya similarity and difference hai?”

He replied “dono fruits hai or khate hain” and “banana sweet hota hai aur orange sour.”

Judgement:

His social, personal and test judgement was good.

For checking the test judgement: I asked: “What will you do, if inside a theatre, you are the first
person to spot a fire break out?”

He replied : I will inform all and run away”

Insight: grade 3rd insight: awareness of being sick but blaming it on external factors.
Diagnostic formulation:

The patient, who is 42 years old, is a Muslim, married male. He is a graduate, currently in a
service, belongs to the middle income socio-economic strata, & currently residing in a rural
area, was brought here by his wife; following being the chief complaints: excessive use/
consumption of alcohol, showing aggressive behaviour, sleep and appetite being disturbed for
the last 20 years. Upon mental status examination, he was found to be kempt and tidy, in touch
with surroundings. Eye-contact with the examiner is maintained. His dress was appropriate,
hair neatly combed; finger nails clipped, rapport was easily established as he was cooperative
and attentive. His attention and concentration could not be easily aroused and sustained for the
required period of time. He was oriented to the time, the place and to the persons around him,
with average intelligence, intact memory, functional abstract thinking, good judgement and
grade 3rd insight.

Diagnostic impression:

According to ICD 10
F10.F1x.2 mental and behaviour disorder due to use of alcohol with dependence syndrome.

Point in favour: F10.F1x.2

Excessive use of alcohol
Inability to stop consuming despite problems (craving) Increase in quantity of intake from time
to time (tolerance) Aggressive Behavior
Sleep and appetite decrease