CLINICAL CASE HISTORY - MENTAL HEALTH NURSING

Psychosis NOS

I. IDENTIFICATION DATA

II. CHIEF COMPLAINTS (duration ~2 months, some for past 4 days)

• Disturbed sleep
• Pacing around / psychomotor restlessness
• Irritability
• Talking to self
• Suspiciousness
• Black magic ideas
• "Possession" attacks
• Reduced food intake (loss of appetite)

III. HISTORY OF PRESENTING ILLNESS (HOPI)

• She began claiming that she was possessed by "Naga" (a snake deity) and started to dance like a Naga. These possession-like episodes lasted 5-10 minutes, after which she had no memory of the incident (amnesia for the episode).
• Following this, her husband came to her home and noticed she was not sleeping at night at all. She would stay up all night claiming she needed to watch the cattle and protect her vegetables and fruits.
• She developed suspiciousness that her neighbours had performed black magic against her, and would get into fights with them, accusing them of stealing her plum fruits.
• She repeatedly told others that her neighbours had "taken away her Naga powers" and "added devil powers" to her through black magic.
• She reported hearing voices of unknown people (auditory hallucinations) and claimed unknown people had stolen utensils from her home.
• Family also observed her talking to herself.
• She was taken to a hospital and admitted for 1 week; symptoms improved following discharge (treatment history below, July 2026).
• For the past 4 days, however, she has relapsed - not sleeping at night, and now believes that black magic/devil powers have been transferred onto her husband, brother, and brother-in-law, who are now trying to kill her (delusion of persecution extending to family). She has been pacing around and remains restless throughout the day.
• She also has reduced food intake, and family has noticed her crying spells, which she denies when asked directly.

IV. PAST PSYCHIATRIC/TREATMENT HISTORY

• Treated previously (July 2026) with:
  • Tab. Risperidone 2 mg - OD (HS)
  • Tab. THP (Trihexyphenidyl) 2 mg - 1-0-0
  • Tab. Amitriptyline 25 mg - OD (HS)
  • Tab. BC1 - 1-0-1
  • Tab. VP1-C - 1-0-0

V. PAST MEDICAL HISTORY

• History of anemia - received 10 units of whole blood transfusion at Government Hospital, Theni.
• No history of Type 2 Diabetes Mellitus or Systemic Hypertension.

VI. FAMILY HISTORY

• Family history significant for hospitalized psychiatric illness in an elder sibling, on treatment for the past 15 years.
• Possible hypochondriasis suspected in a brother.
• No history of completed suicide in the family.
• (Genogram was drawn showing the family tree with an affected sibling.)

VII. PERSONAL HISTORY

• Birth: Full-term normal delivery (FTND)
• Development: No history of developmental delay
• Education: Illiterate
• Occupation: Coolie labourer
• Marital history: Married 20 years ago; separated from husband 10 years back

VIII. PREMORBID PERSONALITY

• Social relations: attached to family
• Predominant mood: got irritated easily
• Intellectual ability: good intellectual functioning
• Attitude to work/responsibility: responsible
• Good standards in moral, religious, and social matters

IX. MENTAL STATUS EXAMINATION (MSE)

X. PROVISIONAL DIAGNOSIS

XI. MANAGEMENT / TREATMENT PLAN

• Inj. Lorazepam 4 mg IM/IV - STAT/HS
• Tab. Risperidone 2 mg - as per chart
• Tab. THP (Trihexyphenidyl) 2 mg - 1-0-0
• Tab. Diazepam 5 mg - OD
• Tab. BC1 - 1-0-0
• Cap. B12 (20) - 1-0-0

Nursing Considerations for this Case

• Safety: Monitor closely for risk to self (denies suicidal ideation but has crying spells and severe distress) and risk related to persecutory delusions about family members trying to kill her - assess for risk of aggression toward family/neighbours out of self-defense.
• Sleep and nutrition: Monitor sleep pattern and food/fluid intake given reported insomnia and reduced appetite; ensure adequate hydration/nutrition.
• Therapeutic communication: Avoid directly challenging delusional beliefs (black magic, possession, persecution); use empathetic, non-confrontational listening; build trust/rapport (already noted as established).
• Psychoeducation: For family/brother (informant) regarding nature of illness (psychosis vs. cultural beliefs of possession/black magic), medication adherence, and relapse signs (this appears to be a relapse after a prior admission and improvement).
• Medication monitoring: Watch for extrapyramidal side effects of Risperidone (hence co-prescribed Trihexyphenidyl), sedation from Lorazepam/Diazepam, and reassess mental state serially.
• Cultural sensitivity: Beliefs about Naga possession and black magic are locally significant cultural idioms of distress; nursing care should integrate culturally sensitive communication while still working toward insight and treatment engagement.
• Family involvement: Given family history of psychiatric illness in a sibling, consider family psychoeducation and support, and screening/monitoring of at-risk family members.