Sociodemographic details: Mr.

M, 30 years old, male, graduate in BCA, currently unemployed

and unmarried. Hailing from a middle socioeconomic status, nuclear family. Speaks Hindi and
English.

Informant: Self and mother

Information: Adequate and reliable

Chief Complaints:
According to patient:
1. “Koi right wing wala goli maar sakta hai mujhe. Uska darr hai.” (Someone from
the right wing can shoot me. I am scared about it.) x 2 weeks

2. “Life mein jo ek event hua, ussi ko le kar thoughts aate rehta hain.” (I
keep thinking about that one event of my life.) x 5 years

According to informant:
1. “Gussa bahut jaldi ho jaata hai.” (He
becomes angry very quickly) x 5 years
2. “Pata nahi kya problem hai, job baar baar change karta rehta hai”
(I don’t know what his problem is. He keeps changing his jobs) x 5 years

History of Present Illness:

Onset: Insidious Duration: 13 years (since 2004)
Course: Continuous Progress: Deteriorating

Mr. M was apparently maintaining well till 2004. He reportedly gained admission in a course of
his father’s wish and continually felt disinterested and lonely. He missed his lectures and sat
alone in a nearby park and read newspapers. He reportedly had persistent thoughts about
disturbing information seen or read by him. Though he could cope up with his ADLs, he had
problem sleeping at night.

2009: Post completion of course, Mr. M’s father started a small business for him. As reported,
one evening after work, Mr. M was approached by a sex worker. As he responded to her, he was
pushed away and was told about a specific procedure that had to be followed. He reported being
uncomfortable, he apologised and left the scene. He reportedly saw the sex worker engaged with
another man immediately after he left; he felt uncomfortable and that his actions would have
troubled the girl; and these thoughts bothered him persistently.
2010-2015: The business reportedly took a hit so Mr. M took up various jobs. He reported that
different thoughts persistently disturbed him and he could not get rid of them. He once attempted
to meet the sex worker with the intention to apologise, he was unsuccessful. He reported feeling
uneasy, and was unable to concentrate on his work and had diffculty falling asleep.

2015: He reportedly felt concerned about international events (Syrian .. ), and national events
(Demo, aadhar), and he spent time reading about these issues even when he felt sleepy.

2016-2017: Mr. M reportedly felt highly responsible for humanity’s protection and filed a PIL
against the Government of India. Post which he felt that somebody from the ‘right’ wing is
trying to kill him. He wrote an email to the PM of Russia regarding a catastrophic radioactive
weapon and another email to the President of USA. He wanted to travel West but fears that KGB
would destroy the plane.

Currently, the patient is fearful and unable to sleep. He presented to the setting with the above
mentioned complaints.

Form the following:

1. Provisional Diagnosis
2. Differential Diagnosis
3. Diagnostic Formulation (take reference from task 3 and the article shared)
4. MSE

1. F25.1 – Schizoaffective disorder, depressive type.

Points in Favour – The client has at least two or more symptoms of depression – insomnia,
loss of interest, poor attention and concentration, and guilt – along with one prominent
symptom of schizophrenia, that is delusions of the persecutory type. Moreover, the
diagnosis for Schizoaffective disorder was made as the client experienced delusions for
about two weeks without symptoms of mood disorder.
2. Differential Diagnosis –
i. Schizophrenia – The client does not meet the full criteria for schizophrenia as
there were so reports or presence of hallucinations, and catatonic or
disorganised/ bizzare behavior. The diagnosis of schizophrenia can only be
made if the symptoms of only schizophrenia predominate the total duration of
the illness.
ii. Major Depressive Disorder with Psychotic features- The client, though meets
certain criteria for depression, it was observed that he did not meet the criteria
for full-blown depression. Clients having major depressive disorder with
psychotic features do not meet criterion A specified for schizoaffective disorder.
As mentioned, the diagnosis of schizoaffective disorder has been made as the
client experienced delusions without mood symptoms for a period of two weeks.
iii. Bipolar Disorder with Psychotic features – Similar to major depressive disorder
with psychotic features, patients with bipolar disorder with psychotic features
experience the psychotic features only during a manic episode, thereby, not
fulfilling the criterion A of schizoaffective disorder.
 iv. Schizoaffective Disorder, Manic Type – No evidence of elevated mood meeting
the criteria for schizoaffective disorder, manic type was found. The clinical
picture and history of the client displayed predominant depressive symptoms.

3. Diagnostic Formulation –