29 yr old male with mobile addiction

 Rambai ( intern) 

Roll no :89 

This is a case of 29 yr old male student by occupation resident of mathabhanga complains of loneliness since 2005 , outbursts of emotions , excessive anger,loss of intrest in social gatherings ,loss of intrest in life, studies and enjoyment since 5 yrs 

Reduced concentration and attention

Reduced self confidence and self esteem ,acts of self harm during exams 

Detailed history: 

 Pt  was born on 08-04-1994 in Siliguri by forceps delivery, premature delivery at 7 months, low birth weight 1.15kgs. 

Mother was anxious about her mothers condition at the time of pregnancy. Her mother lost consciousness which worried her at that time and broke water for which she had to go immediately to Siliguri for delivery.

Milestones achieved normal till 13 years of age.

In 2005 he lost his father due to renal failure. He did not cry and did not feel sad at that particular moment but 15 days later he realised what he lost and started feeling isolated, sorrow, missed his father.

Relationship with his father is like a best friend and shared many happy, silly and painful moments. He felt he was the happiest person when he was with his father.He started missing him and felt lonely thereafter.

Five months after fathers death they moved to mom’s parents house where he, his mom, moms mother and father, uncle and his family all lived together. The relationship with his moms family wasn’t healthy. They had ideological differences, views, outlooks and judgemental differences.

Relationship with his mom wasn’t healthy since childhood. After death of his father he came into mothers supervision and company of his mother which he didn’t enjoy. 

In 2006 he visited psychiatrist at Ramachandran institute of medical sciences for anxiety and counselling was done.

At age of 13 he had breathing difficulty and visited pediatrician and diagnosed with asthma was advised inhalers, steam, gargling. At the same time he was told his bone development wasn’t satisfactory, and low BMI.

He had intermittent asthma attacks in between 2007-2009

In 2008 he visited psychiatrist for anxiety, frustration and he was prescribed medications but the problem was not resolved and medicines weren’t affective for him at that time.

At age 16 on one fine day while he was drinking banana shake he had severe asthma attack and had angioedema went to pharmacy and managed conservatively. After two hours symptoms subsided. 

In 2011 he passed his higher secondary examination and just after that he returned to his fathers house which he very much enjoyed and stayed there for five years. Mother used to accompany him during examination time and leaves after exams.

In 2012 he visited Chennai to consult allergy specialist in view of his swollen eyes, lips, and nasal polyps. Necessary investigations were done like skin Prick test and diagnosed with allergic rhinitis. Advised to stay away from cold, dust and pollen. 

He was prescribed levocetrizine 5mg. Used for 5-8 years and then changed to cetrizine 10mg in 2022

He dropped out from school (B A English honours) due to lack of preparation. He was addicted to mobile phone..he was obsessed with adult contents and he did not know how to protect himself from watching explicit contents. The level of watching grew day by day so he watched YouTube for guidance to come out of it and tried to engage himself in other activities but he failed. 

He visited psychiatrist for anxiety, frustration, loneliness and was prescribed medications which weren’t effective.

In 2013 he picked up new hobby of rooftop gardening and he was obsessed with it. He used to spend hours to hours gardening and try to engage himself most of the time in a day with that hobby.

He passed B A English honours first part in 2013 and was promoted to part two.

In 2014 during his part two of BA English honours he topped his college. Mentally and physically he did well.

In 2015 he was promoted to part three but unfortunately he dropped again due to lack of preparation. His addiction of watching explicit contents came back. During nights at bed time he used to have fantasies and desires and that triggers him to watch more and more of such contents along with masturbation.

He sat back for exam which was his last chance to complete his course and he passed the examination. 

In 2016 he got his degree. 

In 2017 he applied for MA to university but due to lack of cooperation he discontinued.

Due to discontinuation he felt sense of failure and underestimated himself, inferiority complex. But after passing sometime he started feeling less uncomfortable with that particular isssue and started himself engaging in other activities such as listening to music (popular music, foreign music) most of the time in a day.he started enjoying music very much and the habit of watch explicit content along with masturbation has suddenly come down . But there was no academic activity except that he felt mentally and physically good. He feels Through music he discovered himself in a new way

When he was in pensive mood music acted like a medicine through which he solved most of the common problems of a day.

He had anger outburst, loss of interest in life, poor hygiene , did not change clothes nor bath daily. Visited psychiatrist and diagnosed with schizophrenia but did not follow his advise.

In 2018 there is no academic activity. But he did lot of things that include listening to music, playing pubg and it turned into obsession and played for five years.

He used to lock doors and windows and started sleeping most of the time in a day by skipping meals. He had decreased intake of food at daytime and usually had two rotis at late night. 

Her mother consultant psychiatry without his consent and gave him syrup riseperidone mixed with tea for two and half years. His anger and frustration subsided. She increased dose after one year of starting medication and he felt uneasiness and his pulse and blood pressure fell down and he had to go to local hospital emergency. After that she didn’t increase the dose and gave one ml of riseperidone. 

In 2020 he caught her red handed while mixing the medication and later allowed her to give him voluntarily.

In 2019 during a health check up he was incidentally diagnosed with hypothyroidism.not on regular medication.

In 2019 he came to kamineni and visited psychiatrist.diagnosed with eccentric personality disorder.did not start on medicine which was advised by psychiatrist because his mother was worried about side effects of the medicine penfluridol 20mg-chest pain and breathing trouble

In 2021 he felt nausea, lack of appetite, indigestion and visited endocrinologist. Necessary investigations were done and was found out sgot 96 and sgpt 99 levels raised, prescribed t udiliv for three months.

Took doses of covishield. 

He came to kamineni and visited psychiatrist. Counselling was done and was prescribed t fluvaxin cr 100mg. If he stops the medication he feels strange sensation at his occipital region and it becomes like acute problem for him.

He doesn’t like his neighbors. So he avoided people he doesn’t like and started enjoying his own company. Doesn’t like public and social gatherings. Only talks with his mom. Doesn’t enjoy company of other family members. He says he used to enjoy the presence of the people like his dad, fathers elder brother, fathers elder sister, fathers younger brother who all left this world and reminisce those memories. And he started losing faith in god and his mom.

He feels his mother is not spending enough time with him and not prioritising him over his cousins.

From 7 yrs back,he started having anger outbursts occasionally at his mother and other family members even without any provocation and informant says that pt starts hitting walls with his bare fits in anger ,sudden in onset and persists for a while.

Pt reports that since past 4 yrs ,he has been having unwanted thoughts which are repetitive in nature in terms of checking his phone over and over for any physical damage which he tries to resist without any sucess , locking and unlocking repeatedly just to make sure he had done it properly for around 4-5 times continuously.

He also reports that he has been experiencing low mood since 5 yrs not interested in doing anything like playing , watching tv ,talking to people,he also mentions that even doing little work is tiring him with no energy .pt is not able to focus on his studies or games .

Referal done to psychiatry i/v/o eccentric personality disorder and advise followed

Past history : 

K/c/o asthma since 15 yrs 

K/c/o allergic rhinitis since 15 yrs 

K/c/o hypothyroidism since 5 yrs 

Treatment history : 

On salbutamol and ipratropium bromide inhaler since 15 yrs 

On tab.cetrizine 10 mg /sos since 15 yrs 

On tab.thyronorm 37.5 mg since 5 yrs 

Personal history : 

Diet: mixed 

Appetite : normal

Bowel: pass stools once in 2 days 

Bladder: regular 

Sleep : adequate 

Allergies : allergic to dust 

No addictions 

Family history: 

Father has DM type 2 , hypertension 

Father's elder brother had heart stroke 

Father had ear cancer 

Father's elder brother had psychiatric history 

General examination:

Pt is conscious, coherent, cooperative 

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema 

Vitals:

PR: 78  bpm

Bp: 110/70 mmhg

Rr: 14 cpm

Spo2 :99%

Systemic examination 

Cvs: s1,s2 normal,no murmurs 

Rs: BAE present ,NVBS

P/A: soft, non tender 

CNS:

Pt is conscious, 

Speech is normal

No meningeal signs

Normal cranial nerve examination, motor system, sensory system

Gcs: E4,V5,M6

Reflexes:

       R  L

B +++  +++

T +++  ++

S ++  ++

K +++  +++

A +++  +++

P Flexor  Flexor 

Provisional diagnosis : 

Eccentric personality disorder 

Obsessive compulsive disorder,depressive episode 

Treatment given : 

Course in the hospital: 

29 yr old male pateint came to OPD with c/o loneliness , outbursts of emotions ,loss of intrest since 2005, diagnosed as eccentric personality disorder , obsessive compulsive disorder , psychiatry review was done for the above mentioned complaints and advise followed.

Patient is haemodynamically stable at the time of discharge.

Vitals at the time of discharge

Temp:98.6F 

Bp:120/70 mmHg 

PR : 78 bpm 

RR: 16 cpm

Tab.Thyronorm 37.5 mcg po/od

Tab.cetrizine 10 mg po/sos 

Psychiatry advise: 

Tab. Fluvoxamine 100 mg night

                                 50 mg morning 

Tab.clonazepam 0.5 mg po/sos 

Relaxation and diversion techniques