Drug Induced Psychosis
4 years ago
Name- A. J.
Education- Arabic school
“My problem is a small problem that I smoke marijuana”
History of presenting complain
Patient was brought in by father on account of fighting violently with his elder brother who had asked him to carry some goods to Costa Road which the patient decline to do because the place was far. He is a self-confessed marijuana smoker since young age and smokes 9 joints and 12 cigarette per day. He believes his family does not like him and they cannot understand him. He states that his family disturb him as well. Furthermore, he has a habit of talking to himself (but he does not remember what he says) and fighting with people after smoking marijuana.
Currently, the patient feels fine and is not complaining of any symptoms. He does not complain of loss of appetite and difficulty sleeping. He denies hearing any voices, seeing things or feeling strange sensations. However, since last 8 years he stopped praying but still claims to believe in God and since last Ramadan he stopped fasting as well. This is because he has loss interest in religion.
Past Psychiatric History
He states this is his 3rd admission.
Past Medical History
He does not have any known medication conditions and has not had any surgeries, blood transfusion or prior hospital admission except at Tanka Tanka.
He used to take some medications given to him at polyclinic and currently is taking medications given at Tanka Tanka but cannot remember the name of the medications.
He has no known drug or food allergies.
He is the 3rd child of 6 siblings.
His father and mother are alive and has no history of mental illness.
All this 3 brothers and 2 sisters are alive and have no history of mental illness.
There is no history of mental illness among his uncles, aunts and cousins.
He is single and woks as a mechanic. He likes to socialize with friends who are also marijuana smokers. He lives with his family. He 1st started smoking at the garage where he was learning mechanic work at age 14. He had been smoking regularly except when he does not have money. Of recent, due to his smoking is out of work and is now unemployed.
Review of Mental Status Examination
Appearance- patient presented calm but on admission was aggressive. He has normal hygiene and normal gait. Behavior- alert and responsive. Attitude- co-operative, relaxed with normal eye contact.
Mood- patient say he feels happy.
Speech- Rate: Average, Volume: soft, Articulation: well articulated, Tone: friendly.
Perception- No hallucinations or illusions.
Thought- process- No tangentiality, no Loosening of associations, no Flight of ideas, no Neologisms, Content- No Poverty of thought/overabundance, no Suicidal and no homicidal thoughts, no Phobias, no Obsessions or Compulsions. He has paranoid delusions towards the family members.
Sensorium/Cognition- Alert and oriented, memory immediate, medium and long term-intact, calculation- intact, Fund of knowledge- average can call the names of current and 2 past presidents, cannot assess reading or writing as the patient cannot read or write neither in English nor in Arabic.
Insight/Judgment- Patient lacks insight but have judgment.
Diagnosis- secondary to cannabis abuse. DSM 5- 292.11
1. Delusional disorder excluded because presence of psychotic symptoms and significant social and occupational impairment.
2. Schizophrenia and schizophreniform disorder excluded because of presence of substance abuse.
3. Mood disorder excluded because of normal mood present during MSE.
Tab Haldol 5mg BD
Tab Artane 2.5mg daily
Tab chlorpromazine 100mg Nocte
Psychotherapy- Group therapy and occupational therapy
Enroll in rehabilitation program
Factors- multiple relapses, poor compliance, male sex, early age of abuse with prolonged period, circle of friends are addicts.
what are the signs and symptoms of EPSE? Tardive dyskinesia, parkinsonism, akathisia.
What you do when there are extrapyramidal side effects and how you identify them? Stop the medication only in severe cases. Neuroleptic malignant syndrome include- HTN, with palpitation, tachycardia, dystonia, seizures, fever, perspiration/diaphoresis, delirium.
1.The contents of MSE should have been described well and thoroughly in the hx of presenting complain. The hx and MSE are in congruence with each other.
2. Drug dosage, minimum, medium and maximum for each drug mentioned.
4. Mentions the references used to assess MMSE in adequate details.
5. Note- if the pt. reports talking to self this might indicate they are having auditory hallucination despite denying it on direct questioning.
5. A non-cooperative pt. who denies using cannabis despite showing all the signs, their dx. Can be DIP 2’ to cannabis abuse despite pt. denying to cannabis abuse.
6. A recurrent episode is between 1-2, which chronic is 3-4 and above.
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