GOVT.

MEDICAL COLLEGE AND HOSPITAL

SECTOR-32, CHANDIGARH
DEPARTMENT OF PSYCHIATRY

Discharge Summary

Patient’s Name NAVKIRAN SINGH CR No. 230918296

PSY No. 69519 Admission No. 202336743
DC No. 8880
Date of Admission 30.09.2023 Date of Discharge 13.10.2023
Type of Admission Independent admission under Section 86 of MHCA-2017
Type of Discharge Regular discharge, in satisfactory conditions, under Section 88 of MHCA-2017

Treating Team:
Consultant in-charge: Dr. Ajeet Sidana
Senior Resident: Dr. Ramandeep Chhabra
PGJR: Dr. Geeteshwar Dewan
CP Trainee: Ms Sushmita, Ms.Rimjhim, Ms. Simran
Medical Social Officer: Dr. Rajnish, Mr. Akshit

Chief complaint
● Nasha karta hai since 3 yrs
● Nasha chorna chahta hai since 3 days
● Gussa zyada ho rha hai since 2 days

Brief history:
Mr. NS, 25yr/Male, unmarried, Graduate (B.C.A.), currently unemployed, b/t SEF of UMSES, R/o Chandigarh
presented with an illness of total duration of 3 years of insidious in onset, continuous progressive course
characterized by desire, and compulsion to consume opioids in the form of heroin via chasing method,
progressively increasing the quantity from ½ gram per day to 1 gram per day over course of illness for pleasurable
experience with last intake of 300mg of opioids in the form of heroin via chasing method on 28/9/23 with
withdrawals characterized by joint pains, restlessness, disturbed sleep, iritability and agitation with well adjusted
premorbid personality with
On GPE:HR=78 bpm, BP=126/76 mmHg, BMI= 23.05 kg/m2
On MSE: An average built young male with euthymic affect and normal RTV of speech with content of thought s/o
being in action stage of motivation with preserved cognitions with intact PST judgement and insight of 5/6.

Ward Course: Patient was started with tab Tapentadol 100 mg/d in divided doses and Tab. Flupertine 300mg/day
in divided doses for body aches and management of withdrawl symptoms. Thereafter, they were stopped and
patient was counseled for Naltrexone therapy. After obtaining adequate informed consent, a test dose of Tab
Naltrexone was given to the patient and the patient was observed for any possible Adverse Drug Reactions. After
close monitoring and checking stability of the patient, the patient was started on Tab Naltrexone 50 mg given in
afternoon.

Scales Baseline At discharge

COWS 7 0
SOWS 3 0
SOCRATES 8D 35/16/28
SODQ 32

Final Diagnosis:
As per ICD-10, Mental and behavioural disorders due to use of opioids Dependence syndrome. (F11.2)

Lab investigations:
Hemoglobin 14 g% TSH 0.96 uIU/mL
TLC 6.5 ×109/L fT3 3.17pg/mL
 DLC(N/L/M/E/B) 59.9/32.8/5.5/2.4/0.1 fT4 1.11 ng/mL
Platelets 142×109/L Cholesterol 165 mg/dL
Vitamin B12 230 pg/mL HDL 48 mg/dL
Sodium 140 mEq/L LDL 87 mg/dL
Potassium 4.8 mEq/L VLDL 13 mg/dL
Urea 14 mg/dL TGs 67mg/dL
Creatinine 0.9 mg/dL Blirubin 0.4 mg/dL
SGPT 30 IU/L ALP 108 IU/L
Total protein 6.9 g/dL SGOT 21 IU/L
Albumin 4.3 g/dL Vitamin D 13.88pg/mL

Treatment given in hospital:

Pharmacological management-
Drug Max dose Total duration Response
Tb. Tapentadol 100 mg/d 2days Good
Tb Flupertine 300 mg/d 6 days Good
Tab. Diazepam 40 mg/day 8 days Good
Tab. Quitiapine 50 mg/day 2 days Good
Tb. Vitamin D3 60K IU/week 1week Good
Inj Tetanus Toxoid I/M 0.5 mL One stat dose Good

Non-pharmacological management-
Psycho-education of patient and family members by addressing knowledge, behaviour, practices regarding the
patient’s illness. Daily activity scheduling, Motivation Enhancement Therapy

Advice at discharge:

Ensure regular follow ups and adherence

Drug Dose Regimen
Tb. Melatonin 3 mg (x-x-1)
Tb. Quitiapine 25 mg HS (x-x-1) for 2 days, then stop
Tb. Naltrexone 50mg (x-1-x)
Vitamin D 60K IU Once a week Next dose of 16/10/2023

Follow up in Psychiatry OPD under Dr. Ajeet Sidana, at Level 4, B block, GMCH-32, Chandigarh, on
Tuesday/Friday and with Clinical psychologist.
In case of emergency, call at
ASHA helpline 0172-2660078, 2660178
Telemanas helpline 18008914416
Telepsychiatry 9517771750

Dr. Ramandeep Chhabra Dr. Geeteshwar Dewan

Senior Resident PGJR