My senior is presenting a case for case conference. From it, I have to ask a simple question focusing on phenomenology and psychopathology. I will send it here:

Roshan Poudel, 27 years, male, unmarried, MBS, student, hindu, Brahmin, Hemja, pokhara(P), Source of Referral : for better treatment Informant- 1. Patient himself​ 2 Mrs Shanti Poudel,48 years female, mother of patient, homemaker, primary caretaker, knows about the patient, actively involved in patient treatment 3.Mr Krishna Prasad Poudel, 51 years ,male,SLC, hardware shopowner , father of patient, knows about the patient, actively involve in patient treatment Adequacy: Adequate Reliability: Reliable Presenting Complaints: According to patient: abdominal pain According to patient party: Abdominal pain since 3 years Decreased food intake and weight loss since 3 years Suspiciousness since 1 yr Decreased interaction since 2 weeks History of presenting illness: Total duration of illness: 1 years Onset: insidious Course: Continuous Progression: increasing since 2 weeks prior to presentation Ppt. factor: not obvious The patient was in his usual state of health when he developed pain abdomen for past 3 years in the epigastric region, intermittent , described as sensation of fullness and twisting of abdomen as well as sensation of something being stuck in his abdomen after eating food immediately . The pain is mild to moderate in intensity and aggravated by increased food intake , he reports that consuming large amount of food produces abdominal fullness and burning like sensation where as if he takes lesser amounts there is no pain . As a result patient has adopted fixed decreased pattern of food as a means of avoiding the discomfort . There was no fever, vomiting, loose stools, or yellowish discoloration of the body or difficulty in swallowing . Patient does not attribute decreased food intake to food being mixed with poison or restricting food intake for weight / body figure issues. Patient does not attribute his pain abdomen to foreign body or some external agaency or organs being damaged . Patient does not have suspiciousness that abdominal pain is due to someone trying to harm him. there is also no history sensation of insect or other organism crawling in his abdomen. Patient also has associated weight loss in relation to abdominal pain and decrease food intake. Patient weight was about 50 kg before illness but after illness it has decreased significantly now 37 kg . Intially weight loss was gradual but Patient weight significantly reduced 2 weeks prior to presentation according to informant. Patient is not concerned of weight loss as patient says that weight loss is due to his reduced food intake not deliberate calorie restriction or disinterest in food items. Patient has no fear of weight gain , has no preoccupation with his body size and shape. There has been no history of eating large amount of foods, no fasting for weight control and no self vomiting. Patient also has no fear of choking or vomiting and does not have problem with food color, smell. After admission patient abdominal pain has decreased and food intake has increased. Suspiciousness since 1 yr Patient developed suspiciousness towards neighbour , who is involved in metal-welding work. Noises from this work made the patient fearful, and he repeatedly told his mother that the neighbour was trying to kill them.. According to patient it started after the neighbour started to park his bike in the area of vicinity of the patients shop. Patient then developed thought that the neighbour was intentionally doing this on purpose to disturb them. Patient also felt that neighbour was disturbing them by producing the sound by hitting the rod and fence. Patient felt fearful and did not feel safe . He would tell to his family why he is giving us torture by disturbing us . Then the suspiciousness increased when his parents was away for 1 month , patient felt threat that the neighbour could do harm to his younger brother and sister , patient at one occasion hit the fence with his fist in respond to anger and frustration he had due to his belief that the neighbour was against and disturbing on purpose , he also hit to test if the neighbour would respond , the neighbour did not respond and his father told him what are you doing, there is no need to do that, patoent did not say anything. Patient had also preoccupied with the belief that his neigbours posed threat to him and his family. According to patient he had sleep disturbance and he also could not focus on study . Patient also avoided the neighbour and he would laso tell bis family member to not go near the neighbours shop as he might harm them. This belief was held with strong conviction and he told he was 100 percent sure that his neighbour was his enemy . Patient had also suspiciousness that his neighbour was talking bad about him and his family. after talking with his brother about this, his brother told he did not fear the neighbour and told it was wrong belief of patient to think that way , patient thought that I was worrying about my family safety but they all say I had false belief so he felt that he may have interpreted in wrong away and now he belief that his neighbour could have produced sound while doing the work and say he is 50 -50 on this belief. Hearing voices since 4 months : According to patient would hear voices unheard by others since about 4 months , duration he is not sure . The voices were of multiple people, some familiar voice and some unfamiliar of adult, predominantly male, and were experienced as originating from outside, at a perceived distance of approximately 50 meters and, at times, closer. He described at least two distinguishable voices with content about him "Yesle jandaina" ("He doesn't know anything") and "Kei pani garna sakdaina" ("He can't do anything") and other voices supporting that comments. He would actively attempt to interpret the meaning of these voices but he would not give example. Patient would be fearful of voice , he would not clarify if it would be most time of the day or daily . The voices would not command him and he thought it was true voice. When asked if this present at hospital he told he would not make any judgement and did not give yes or no answer also. According to informant the have not notice him and patient has not told about the voices. Decreased interaction since 2 weeks : Approximately 10 days prior to presentation, the patient's interaction with family members progressively declined. He initially began speaking less than his usual baseline, describing a sensation of his voice being "stuck in his throat" with associated difficulty speaking; his responses during this period were reduced in amount, delayed in onset, and monotonous in quality, with minimal spontaneous interaction. Over the subsequent 4–5 days, patient did not speak at all , at which point he stopped verbally responding altogether, though he continued to make eye contact when spoken to. During this period, he was also noted to adopt and maintain specific posture . He would remain in this position for hours without spontaneous change. Since 3 days prior to presentation Patient would also not eat at all , patient mother had to forcefully put the food in mouth but he would not swallow and would keep food in mouth . He had an episode of urinary retention, unable to void urine for 3 days; a Foley's catheter was inserted at another centre. However there was no h/o rigidity of body,repeating actions seen or words heard. Negative history: No history of traumatic brain injury in the past, prolonged fever, no h/o not recognizing family members, not being aware of one’s surroundings, no h/o prolonged diarrhea , LOC, problems with vision, sensation or balance, rashes, joint or muscle pain, no h/o persistent sad mood, deacrease interest , guilt or feeling of hopelessness and worthlessness no h/o excessive talkativeness, over familiarity, persistent elevated or irritable mood, great ideas regarding self No history of seeing others unseen by others no h/o hearing own thoughts out loud, thoughts being withdrawn, broadcasted or inserted no h/o feelings of being under control of foreign agency, Biological functions: Sleep: patient used to sleep at around 9 pm and used to wake up at 5 am. There was no history of difficulty initiating, maintaining sleep or snoring during the sleep prior to the illness. The patient would have disturbed sleep occasional 12 times per month . Appetite: Patient used to take 2 major and 1 minor non vegetarian meals. . Patient has been on vegetarian diet since 1.5 years after he developed jaundice. After start of illness his appetite has decreased. Weight loss/gain: significant weight loss from 45 kg to 37 kg B/B: decreased urine output and urinary retention ; constipation Libido: No changes in libido noted. Personal care: Patient used to bath 2 times per week and would change his clothes, would brush his teeth regularly. He would comb his hair regularly and would trim his nails, cut his beard and moustasche as necessary. Work performances: patient used to help in household chores and would also assist in shop . Personality changes: Couldn’t be commented on Treatment history: prior The patient was consulted at another centre for decreased responsiveness and urinary retention. A Foley's catheter was inserted there, and he was subsequently referred to this centre for psychiatric evaluation. Patient had not received any psychiatric medication prior to presentation in our hospital. Patient was evaluated at ER of TUTH, psychiatric consultation was done and Lorazepam 2 mg was started and patient was admitted in psychiatry ward. After admission patient was .gastro consulatation was done for abdominal pain and they advise for UGI endoscopy and USG. Dietary consulation was done for nutritional deficiency. Neuro consulatation was done . Now patient is under Lorazepam 2 mg po tds, olanzapine 7.5 mg /day, Inj vitamin B12, Vit D , Thiamine, lactulose, Triple therapy regimen for erosive gastritis pantoprazole 40 mg bd, amoxicillin 1 gm bd and clarithromycin 500 mg bd. Patient has improved with improvement noticed in terms of increased interaction , increased appetite and food inatke, movement of body parts. Past history: According to patient informant , patient would not go to other toilet and would hold urine and do at home. Patient also would not eat at other place and would tell I have eaten at my house already. This was noticed by parents when he was about 6 years of age . According to patient he would have difficulty in outside of his home, he would have difficulty in eating at other place as he would feel shy and he would be fearful if others will judge him . Patient would have also difficulty in speaking in public or in crowd. In school patient would also have difficulty talking with friends, he would have difficulty in initiating conversation . He would also not eat food with friends. He attributes to being shy and having fearful that his friends might judge him differently in negative way like feeling humiliated. According to patient this happened during most of his childhood days upto now and the symptoms would be increased in social situations and would decrease at home or when he is alone. When patient would be exposed to the certain situation like speaking in class, playing football initially he would have intense fearfulness with increased sense of heat beat and after repeated exposure his symptoms would decrease. According to patient this has affected the patient's ability to establish and maintain friendships and has interfered with important functional activities, such as attending job interviews despite a desire to do so When patient was 8 years of age patient was found to have difference in kidney size , Right kidney was increased in size and diagnosed to have mild hydronephrosis, after 1 year both the kidney size was normal Diagnosed to have Gastritis since 3 years with PPI prescribed for 1 month initially then on intermittent basis Jaundice

Can commanding auditory hallucination be called second person hallucination

Another question

No no give another psychopathology question I can ask

Can I ask about what psychopathology could explain not swallowing food and hearing voices

Just one question

Another question

About the hallucination

Can I ask it like what does it say us about the patients insight

And I want to ask another question about him not urinating or eating food at other places since childhood