Undifferentiated Schizophrenia Case Study
A person with undifferentiated schizophrenia meets the usual criteria for schizophrenia including delusions, hallucinations and disordered thoughts and bizarre behaviours but does not clearly fit into one of the other types of schizophrenia because of a mixed-symptom picture.
People in the acute, early schizophrenic episodes breakdowns frequently exhibits undifferentiated schizophrenia symptoms as do those whose clinical picture may change enough over time to warrant a change in diagnosis from a specific sub type to the undifferentiated sub type. The criteria’s for undifferentiated schizophrenia was named, described and classified in the American psychiatric association’s diagnostic manual –IV-TR. Symptoms of schizophrenia that do not meet criteria for the paranoid, disorganised and catatonic types.
SOCIO DEMOGHRAPHIC DATA
Name : D.K
Age : 36 years
Sex : Female
Occupation : Housewife
Socio-economic-status : Middle class
Marital status : Married
Education : Degree passed
INFORMANTS
The informant was the patient himself as well as the social workers and nurses. The information is reliable and adequate.
COMPLAINTS AND THEIR DURATION
Reduced self-esteem and self-confidence : 8 years
Suicidal thought : 5 years
Disturbed sleep : 4 years
Hearing noises : 2 years
HISTORY OF PRESENT ILLNESS
Mode of onset : Sub acute (few days to few weeks)
Course of illness: Fluctuating
Precipitating factor: Psychological in nature such as love failure and related quarrels in the family
Associated disturbances: Lack of sleep, loss of appetite and weight.
PAST HISTORY
There was no significant past physical illness.
Family History
(Family genogram will come here)
– DEAD MALE, FEMALE
– AFFECTED MALE, FEMALE
– UNAFFECTED MALE, FEMALE
– INDEX PATIENT
PERSONAL HISTORY
Birth and early development
Mother’s health during pregnancy time was normal with full term normal delivery. Birth cry was present, birth weight and skin colour was normal. She was born from non-consanguineous union.
Behaviour during childhood
Frequent fights with siblings
Physical illness during childhood
There is no clear evidence of physical illness during childhood.
Educational history
The relationship between teachers and peers was good. She was interested in extracurricular activities and has average scholastic performance.
Occupation
1997- Receptionist in dental clinic
2005- Sales woman in a saree shop
Menstrual history
No significant information.
Marital history
The client is married and the husband used to beat her after drinking alcohol.
Sexual History
High levels of anxiety related to sexual fantasies/ practises.
Use and abuse of alcohol, drugs
None
PREMORBID PERSONALITY
Attitude to others in social, family and sexual relationships.
Inability to trust others, anxious, dominant and suspiciousness. But she is very attached to her children.
Attitude toward self
Critical, self-conscious, pessimistic attitude toward present and future slightly shows narcissism.
Moral and religious attitude
Moral and religious attitude is good. But after the illness started she used to visit temples every week
Mood
Anxious, irritable, over expression of feelings anxiety.
Fantasy life
Day dreaming
Reaction pattern to stress
Decreased ability to tolerate frustration, losses, and anxiety.
Habit
Watching movies.
MENTAL STATUS EXAMINATION
General appearance and behaviour
The patient appeared hygienic and cooperative. She has orientations with surroundings. She avoided eye contact.
Psycho-motor activity
Psycho-motor activity is increased.
Talk
Spontaneous. Her talk was irrelevant.
Thought
Stream: There was flight of ideas.
Form: Intact
Possession: Nil
Content: Auditory hallucination.
Mood
Subjective explanation of emotion, anxious and tensed.
Perception
The patient feels restless.
Cognitive functions
Attention and concentration: Intact
Memory: Good Immediate memory, recent memory and long term memory
General information: Average general awareness.
Intelligence:She has average level of intelligence.
Judgement: Intact
Personal: The patient has the awareness of his illness and also need for treatment.
Social : Poor
Test : Her test judgement is intact.
Insight: Presence of insight
Summary
Ms. D.K is 42 years old married female, graduate, from middle class socio economic rural background with no significant past or family history of alcoholism of husband with nil personal history of illness. Pre morbidly well adjusted. Presented with sub-acute onset, fluctuating course illness of 8 years duration precipitated by love failure and related psychological causes characterised by decreased sleep, suicidal thoughts, and diminished appetite. Mental status examination revealed auditory hallucinations, irritable mood with intact judgement with presence of insight.
Provisional diagnosis
Undifferentiated schizophrenia
Management
• Psycho social therapy
• Cognitive therapy
• Interpersonal therapy
• Behavioural therapy
• Family therapy
• Pharmacotherapy
Sources:
Detailed model of Case work in Social Work
Model Of Case History On Intellectual Disability In NIMHANS, Banglore Model
Example format of a Case study of patients with Paranoid Schizophrenia
