CASE HISTORY – 05

(26 SEPTEMBER 2022)

Name : Mr. K J

Age : 25 years

Gender : Male

Education : Graduation

Family Type : Nuclear Family

Occupation : Unemployed

Religion : Hinduism

Socioeconomic status : MSES

Locality : Urban

Informant : Mother

Psychiatrist : Dr. Arjun Arya

Psychologist : Dr. Amit Dwivedi

Reliability & Validity : The information given was reliable and adequate
for the assessment

History of Present Illness:

Chief Complaints

Mr. K J, a 25-year-old male belonging to the MSES urban area of Zirakpur, Punjab, and living in a
nuclear family, was presented for a comprehensive psychological evaluation with the chief
complaints of aggressive behavior, interpersonal conflicts, physical abuse, and gambling and mobile
addiction.
In a detailed interview, the client mentioned that since his childhood, he had witnessed an abusive
familial environment; his parents often had verbal and physical arguments, and they were often
beaten by his father. For the past few years, the client shares a turbulent relationship with his father,
he mentions that his father forces him to everything little things and if not complied with his words
he would just beat him up. The client mentioned an incident where his father asked him to fill out a
government examination form, but he did not, and as a result, the client and his father got into a
violent altercation. He also says that the impending divorce of his parents is contributing to his
stress. The client expressed concern about his employment as well; he also indicated that he had
received a job offer, but that his experience letter and offer letter had gone missing. This made him
agitated, and he had fought with his mother. The client began placing bets on numerous websites
about two to three years ago. At first, he wagered 5,000 - 10,000 every month, but later he increased
it to 2,000 - 3,000 daily.

During the lockdown, his addiction to mobile phones and betting increased. The client often asked
his parents for money, but they denied it, which led to clashes with the family and the destruction of
household items. The client revealed that his mother is receiving therapy for obsessive-compulsive
disorder and that he frequently feels distressed by her conduct. He had been receiving treatment and
therapy from GMCH-32, Chandigarh for his aggressive behaviour.

Onset : Insidious
Course : Progressive
Duration : 2-3 Years

Informant History:

Relation: Mother

The true cause of the client's hostile temperament, according to the informant, was an increase in the
client's gambling and mobile phone addiction during the lockdown. When a client was denied money
for betting, the informant said, the client would become argumentative and, on occasion, even this
might result in acts of aggression.

Negative History:

 Phone addiction & Gambling.

 No significant history of any brain/head injury
 No significant history of self-harm.
  No significant history of euphoric/ elated mood.
 No significant history of seizure/ epilepsy.

History of Past Illness:

Past Psychiatric History : The client had taken treatment for his hostile behaviour and betting
habits in 2020, from Chandigarh. He took medications for about 6-7 months and left them without
consultation from his psychiatrist. In 2022, he has taken treatment for 2 months along with
medications and therapy sessions. The client says he has seen improvement post taking sessions.

Past Medical History : Not Significant

Family History:

The client is eldest among the two siblings and he shares a close bond with his mother. He lives in a
nuclear family. As his parents were getting separated, he moved in his father’s house and his younger
brother stays with his mother. The client mentioned that his mother suffers from obsessive-
compulsive-disorder, and his brother has a history of asthma. His father’s relationship with his
maternal side of family is discordant.

Personal History:

Birth and Developmental History : Could not be elicited as biological parent was not present at
the time of the interview.

Educational History:

The client studied in Abohar from nursery to 6 th grade. Later he shifted to Mohali where he studied
from class 7th to class 10th. In 2016, he moved to Chandigarh for his senior secondary classes. He
completed his Bachelors in Arts from Chandigarh in 2020. The client has represented his college in
various sports competitions for table-tennis and badminton. He played cricket at district and state
level.

Occupational History:

The customer was employed by a company in 2020. He later began working for a BPO, where he
spent six months, but quit after a short time since the daily commute was challenging. He then joined
the building process, but he soon left that position as well because of the minimal wages. The client's
substandard performance led him to leave digital marketing after four months of employment there..
Pre-morbid Personality:

The client was confident person. He enjoyed socializing with people, and had a great sense of self.
The client enjoyed playing cricket and possessed good level of intellect.

Mental Status Examination

● Language of the interview : English & Hindi

● Time taken : 30 minutes
● Level of consciousness : Alert
● General appearance and behaviour : Appropriate
● Handedness : Right-Handed
● Rapport : Established
● Eye contact : Not Maintained
● Facial expressions : Minimally Expressive
● Attitude towards the examiner : Managed Co-operation
● Manner of relating : Tensed, Anxious
● Motor activities & behaviour : Voluntary, Goal-Directed movements
● Speech : Relevant & Coherent
Volume : Low
Pitch : Normal
Tone : Loud
Tempo : Increased
● Attention & Concentration : Aroused & Sustained
● Orientation : Orientation towards time, place, person
● Memory
Immediate : Intact
Recent : Intact
Remote : Intact
● Abstract ability : Concrete
● General information : Average
● Thought
Stream : Spontaneous
 Form : No FTD Present
Content : Worried, Anxious
Possessions : Not present
● Mood
Range : Normal
Reactivity : Present
Communicability : Present
Mobility : Average
● Affect : Normal
● Hallucinations : Absent
● Trance & Possession : Absent
● Judgment
o Personal : Intact
o Social : Intact
o Test : Intact
● Insight : Grade III

PSYCHOLOGICAL TESTS

Sr. No. Tests conducted Score & Interpretation

1. Beck Depression Inventory 24: Moderate Depression

2. PGI- Health Questionnaire A: 56.25% : (Moderate Physiological Distress)

B: 59.09% : (Moderate Psychological Distress)

Overall: 57.89% : (Moderate Physiological &

Psychological Distress)

3 GRID HAM-D 17: Moderate Depression

4. Adult Anxiety Checklist 27: Mild Anxiety

 SUMMARY

Mr. Karan Jagga, 25-year- old male, living in a nuclear family belonging to MSES of urban area of
Zirakpur, Punjab was presented for comprehensive psychological evaluation with the chief
complaints of hostility, irritability, physical and verbal aggression, mobile and gambling addiction.
According to his MSE, the client was appropriately dressed and rapport was established,
consciousness alert, was tensed and anxious and there was minimum to no eye contact. Mood range
was normal, memory was intact with average level of intellect, with judgement intact.

On psychological evaluation, PGI-HQ indicated moderate level of physiological and psychological

distress, Beck’s-Depression Inventory indicated moderate depression, GRID HAM-D indicating
moderate depression and Adult Anxiety Checklist stating mild anxiety. The insight level of Grade III
was present. The protocol goes consistent with the clinical impression of Gambling Addiction.

Recommendation: The client has been advised to take behavioural therapy along with
pharmacotherapy and intensive counselling sessions.

Follow-up: The client was re-admitted to the hospital due to aggressive episode post his discharge.
The client has been given behavioural therapy. Also, he has been given counselling regarding anger
management.

Dr. Amit Kr. Dwivedi

Psychologist