Case Presentation: Adolescent Female with Psychological Distress
This case presentation discusses a 16-year-old female patient presenting with symptoms of reduced interest in activities, irritability, and academic stress. The patient's history reveals a decline in mental well-being after experiencing academic pressure, leading to emotional distress and avoidance behaviors. Additional details include past medical history, social background, and menstrual irregularities. Explore the complexities of psychological health in adolescents through this insightful case study.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
CASE PRESENTATION BY Dr ARUNKUMAR B BIRADAR ASSOCIATE PROFESSOR DEPARTMENT OF SHALAKYA TANTRA
IDENTIFICATION DATA Name of the patient: x (identity hidden) Age :16 years Sex : female Marital status: unmarried Education:10thstd Occupation: student Religion: Hindu Socio economic : moderate Address: Chikkodi, Belagavi
OP NO: OP220044932 IP No: IP22005300 Bed no: 244 DOA:5-10-2022 DOD: 25-10-2022 Name of the informant and relationship with the patient: Father
Presenting complaints Informant version: Reduced interest in activities Irritability Not going to school Crying Duration: 1 month Associated symptoms- recurrent sneezing, rhinitis since 1 year Patient version: Unknown fear Lack of concentration Reduced sleep Feverish feeling Duration: since 1 month
History of present illness A female patient aged 16 years not a k/c/o any systemic illness was apparently healthy one and half month back. She got late admission for PU course. She went to school and from there she came to know that half of the portions already covered and exams are also near. She was afraid and she felt blackout and some sort of uneasiness. She came back from school that afternoon itself. She didn t go to school afterwards.She was good in academics. After this the patient seems more gloomy and not interested in any activities which she liked before like watching TV, playing etc. It was observed that she was sitting in the same place for a long time and was crying without reason sometimes. She showed irritability when they asked her to go school. Later 2 times she had gone to school but the same happened and came back.
Past Psychiatric and medical history: nil Treatment history: nil Family history
Personal and social history Diet-Mixed Bowel- clear occassionally hard Appetite- reduced Micturition- 5 to 6 times/ day Sleep- disturbed Perinatal history- no complications Childhood history-NAD Educational history- good in academics, scored highest in 10th std Play history- relationshipwith friends-good
Puberty- Menarche -13 years Menstrual history- irregular
Physical examination General examination Pallor Icterus Cyanosis Clubbing Lymphadenopathy Systemic examination CVS CNS Musculoskeletal Normal NAD
Mental status examination (on 6-9-2022) General appearance and Behaviour General appearance- gloomy Attitude towards behaviour- cooperative Comprehension-intact Gait and posture-normal Motor activity-reduced, social withdrawal-present Rapport- gradually developed Speech Volume-reduced Mood- sad Thought- stream of thought-intact Content of thought-phobia present
Perception-intact Cognition- intact Abstract thinking-present Insight-present Judgement present
Dasavidha pareeksha Prakruti - Kapha pitta Vikruti - Kaphavata Sara-mamsa Satmya-madhyama Satva-avara Aharasakti- Abhyavarana- alpa jarana-madhyama Vyayama shakti-poorvakaleena-madhyama, adhyatanakalena- madhyama Vaya-bala
Samprapti ghataka Dosha Dushya Agni Srotas Srotodushti prakara-sanga Udbhavasthana -Amapakvasaya Sancharasthana -sarvasareera Vyaktasthana Rogamarga Sadhyasadhyata -sadya -Kapha vata -rasa, manas - Jataragni - rasavaha, manovaha -manas -madhyama
Nidana panchaka Nidana :more of Spicy, sweet/bakery food Irregular food timings (vishamasana) Almost everyday night -chicken/fish intake(dushta bhojana) Daytime sleep-occassionally (vishama cheshta, Diwaswapna) Manoabhighata(mental trauma)
(Prefers to live at one place) (prefers not to speak) (Disinclination for food) (Prefers loneliness) Irritability Crying
Poorvarupa Avipaka udwega satatam jwarashchabeekshnam
Samprapti Due to nidana dosha- leena avastha Due to manoabhighata- dosha in prakupita avastha vitiate hrudaya affects manovahasrotas deranges the mind of the patient
DIAGNOSIS Adjustment disorder (with mixed anxiety depressive type) Manodhukhaja kapha vatika unmada
Adjustment disorder falls into the wide categorical spectrum of anxiety and depressive disorders. The DSM-5-TR criteria describes adjustment disorder as a development of emotional or behavioral symptoms in response to an identifiable stressor within three months of onset. The type of stressor may vary in significance for children and adolescents versus adults. These stressors can include but are not limited to death, medical diagnoses, marital discord, unexpected life events, finances, sexuality discoveries, family problems, and the list goes on. The difference between adjustment disorder and other mental disorders lies in the impact it takes on one s daily activities, with a true associated stressor for the cause.
Symptoms Patients experiencing adjustment disorder may exhibit one or a combination of the following symptoms following an identifiable life event three months prior: . Depressed mood behavior such as dysthymia, tearfulness, hopelessness . Anxiety mood behavior such as excessive worrying, nervousness, uneasiness . Disturbance of conduct. For example, if a child is exhibiting this symptom, they may begin to misbehave in school or become aggressive . Unspecified due to maladaptive reactions In addition, these symptoms must affect the patient s daily activities, such as social or occupational functioning. The negative impact on the patient s daily activities must be disproportionate to the event.
Treatment First visit on 6-9-2022 15ml Indukantham kashaya+45 ml water+1 pinch saindhava lavana+1 Arogyavardhini vati Vidangarishtam +Abhayarishtam 10ml BD A/F T. Cephagrain 0-1-0 A/F Second follow up17-9-2022 (Appetite improved, Feverish feeling reduced, irritation reduced, no crying) Repeated same Added Manibhadraleha 5gm with 1 pinch turmeric bedtime Third follow up 24-10-2022 (Appetite good, mood improved, sleep sound, feeling lightness) Kalyanaka ghrita 5ml 6AM empty stomach
IP treatment Admitted on 5-10-22 Indukantham kashaya continued Rooksha pinda sweda with Kolakulathadi choorna for first 2 days Udwartana with udwartana choorna for 4 days Samana sneha Narayana taila 5ml for 3days, afterwards 2ml Narayana taila +3ml Kalyanaka ghrita 6am for 2 days then continued with 5ml kalyanaka ghrita
Abhyanga with Narayana taila for 3 days followed by hot water bath(mrdu sweda) 3rd day of Abhyanga - Manibhadra leha 5gm Bed time One day rest- evening Rasnadi choorna shirothalam Started Shirodhara with Narayana taila for 5days Continued Kalyanaka ghrita 5ml 6am empty stomach
Discharge medicine Kalyanaka ghrita 5ml 6am Brahmarasayana 5gm Bed time After one month follow up (sleep sound, mood good, interested in all day today activities, started PU tution) Continued Brahmarasayana 5gm 6am empty stomach
