CASE-HISTORY- ALCOHOL

My patient aged 51 years hailing from Belagavi studied till BCOM

working as a painter belonging to middle socio economic class (acc to
B.G Prasad) living in own house with his wife and son.

Informants: Patient and his wife. History is deemed adequate and

reliable
The patient came to the Opd along with his wife with the Chief
Complaints of
Acc to the patient-
h/o alcohol and tobacco consumption- 30 years
Increased Alcohol intake from past 3 months
Last drink was 14 hours back
- h/o fearfulness – 2 months
- Disturbed sleep – 20 days
- Hearing of voices 15 days
Acc to the wife- h/o decreased intake of food – 15 days
- Decreased sleep - 15 days
Total Duration of Ilness- 30 years
Duration of exacerbation- 3 months
Onset- Insidious
Course- Continuous and Progressive
Precipitating Factor- sudden demise of elder son 3 months back.
HOPI- The patient was apparently alright 30 years back when he
started taking 1 bottle of beer with his friends during parties and
local village fairs for recreational reasons. he used to consume 2-3
times a month when he was with his friends., this pattern continued
for about two years. Later he was introduced by his friends country
liquor which was cheaper than beer, patient shifted from beer to the
country liquor as it was more affordable. he increased the quantity
and frequency of alcohol intake to about five to six times a month as
he enjoyed the pleasurable effects of alcohol along with his friends,
this pattern continued for about two years.
he gradually increased the frequency of alcohol intake to about 2-3
quarters a week as being a painter started experiencing body pain
due to long working hours ,patient along with his colleagues would
drink together as he claimed it relaxed his body and mind, he also
claimed that he felt like drinking more quantity than previously as he
was not getting the same effects as before.
Patient when he would be stressed because of financial problems
would drink around 1-2 quarters of alcohol every day for a period of
8-10 days continuously as a result of this he was admitted to BIMS
medicine ward 5 times with the complaints of nausea, vomiting and
abdominal pain. Patient after getting discharged from hospital would
remain abstinent for a period of two to three months and would
restart consuming alcohol along with his friends.
In October 2016 patient complained of severe weakness and he was
admitted for the same in BIMS medicine ward, after discharge
patient remained abstinent from alcohol from 2017 to 2022 February
as he was receiving counselling from the church he was attending.
Patient gives h/0 of facing financial stress during the period of March
2022 and was worried with his elder son’s academic performance,
hence restarted consuming alcohol and increased the quantity and
frequency, he would work in the morning and after work would take
1 quarter in the evening Everyday.
Patient’s son suddenly passed away due to accidental drowning 3
months back after this patient gives h/0 of feeling sad which was
present through out the day and he could not concentrate in his
work, he quit his work and increased his alcohol intake to 1 quarter
in the morning, afternoon and night , he would start crying thinking
about his son in the night and in early morning, patient had no
interest in any household chores which he was previously involved
in.
Patients last drink was 14 hours back, From past two months patient
complaints of fearfulness due to bad dreams wherein he wakes up
because of the dreams, as patient is going to sleep he sees people in
the form of ladies and demons appearing to him in full clear form
patient reports decreased sleep from the past 20 days wherein
previously he was sleeping for six to seven hours but now it has
reduced to one to two hours patient remains awake in his bed
looking at his mobile phone.
Since the past 15 days patient attempted to quit alcohol in the
morning, he complained of hearing of voices in the morning of his
cousin brother abusing him and also hears voices of his cousin and
his friends discussing about him saying that the patient is good for
nothing, the voices seem to come from outside the door but when
patient goes to check he finds no one there, as patient restarts taking
alcohol the voices stop.
From past 15 days the wife c/o decreased intake of food, even after
serving him the food, patient refuses to eat, H/0 decreased sleep
from 15 days wherein patient has difficulty in initiating sleep and is
found on the bed looking at the mobile phone.
h/0 tobacco use from the past 30 years, he started chewing tobacco
around 2-3 packets a week for recreational purposes and gradually
increased it to 1 packet everyday as he was not getting the same
pleasure as before, he remained abstinent from 2017-2022 and
restarted taking from March 2022, currently he takes 1-2 packets
every day.
NEGATIVE HISTORY
No history of head injury, fever, epilepsy or loss of consciousness
No h/o thoughts being inserted or thoughts being taken away, or
being controlled by an external agent
No history of excessive happiness, increased activity or energy
overtalkativeness, increased goal directed activity, inflated self
esteem, increased expenditure.
No h/o suicidal ideations
No history of repeated acts like washing, checking
No h/o other substance use
No history of medico-legal issues
PAST MEDICAL HISTORY- patient has been admitted in BIMS
Medicine Ward around 5 times for complains of nausea vomiting and
generalized weakness, Last admission was six months back for
history of fever and headache admitted for three days, treatment
records are not available
History of surgery due to RTA under the influence of alcohol in 2009
which resulted in fracture of second toe of right foot
No h/o htn, dm, asthma, TB
PAST PSYCHIATRIC HISTORY: Patient has not taken any psychiatric
treatment in the past.
FAMILY HISTORY- Elder son of non-consanguineous marriage.
Father had alleged h/o alcohol consumption and smoking for 48
years, his father died of smoking related lung complications 4 years
back when he was aged 75 years old. Relationship with patient was
cordial.
Mother is aged 70 years and is living in the village along with her
relatives. Relationship is cordial.
Younger Brother: h/o alcohol consumption from past 12 years and he
died by suicide from cutting his hands under the influence of alcohol
after an argument with his wife. He died 2 years ago aged 35 years.
Patient’s relationship with the brother was very friendly.
Patient would drink with his brother also at home 3-4 times a month.
Married wife in 2007
Two sons
Attitude of patient towards illness: Patient believes that his current
condition of drinking alcohol is an illness and a temptation that he
cannot run away from.
Attitude of family towards patient: Patient’s wife is vexed with her
husband’s drinking although she is supportive towards husband in
trying to make him quit alcohol. She claims his drinking is become a
habit for him.
PERSONAL HISTORY
Birth and developmental history: No reliable informant available
Childhood- no frequent childhood illness or history suggestive of
adhd, conduct disorders.
schooling- Patient began his schooling at 5 years old. He got 58% in
his 10std public exams and 61% in 12th std public exams. Patient
graduated B.com
Relationship with peers, teachers and friends was cordial.
Occupation History – Patient started working in his father’s painting
business after graduating college. Currently patient has his own
painting business, he earns around 4000-5000 per week, he claims
that his income is not constant and it depends upon painting
projects.
Patient spends around 1000-1500 per week on alcohol, the rest of
the money he gives to his wife to manage the home.
Sexual History- Patient was not forthcoming with the history
Marital History – Patient married when he was aged 35 years old and
his wife was aged 25 years. The alliance was arranged by elders of
the family, wife is educated up to 10th std and she is housewife. They
have been married for the past 16 years; wife is often irritated with
her husband’s drinking
Elder son was 15 and passed away 3 months back due to accidental
drowning, the son and his cousin bunked school and went to a river
as they were playing in the water the son and his cousin were not
good swimmers, they drowned when they went to the deeper end of
the river.
Younger son aged 13 years studying in 8th std.

PREMORBID-PERSONALITY
Patient was outgoing. He loved to spend time with friends and family. He was
attached to his family members and adjusted well to work surrounding.
Intellectual activities: Patient would read the newspaper
Mood: Bright and cheerful
Character (i) Interpersonal relations- Good interpersonal relationships
Energetic and output sustained
No day dreaming
INFERENCE: WELL ADJUSTED PRE-MORBID PERSONALITY.
 GENERAL PHYSICAL EXAMINATION

Patient is Conscious, co-operative and oriented to time/place and person

Asthenic male looking older than his said age
Height: 170cm weight : 65 kg
BMI : 22.49
HEAD TO TOE EXAMINATION :
Scalp : no injuries
Hair: receding hairline
Eyes: no congestion
Oral cavity: poor hygiene, tobacco stains +
Upper and lower limbs : no evidence of self inflected injury , tremors of hands
Pallor- present

No icterus, clubbing, lymphadenopathy, edema

SYSTEMIC EXAMINATION
CVS- S1 S2 heard
No murmurs
RS- NVBS heard
No crepitations
Per Abdomen-
Inspection: no dilated veins, umbilicus inverted, no abdominal
distension
Palpation: Soft Non-tender
No organomegaly
Percussion: liver span- 12cm
Auscultation: bowel sounds heard

CNS- Cranial Nerve Examination- normal

Motor system- normal power and tone
Reflexes- normal
Cerebellar signs : NAD
MENTAL SATUS EXAMINATION
Eye to eye contact made
Rapport established
Normal psychomotor activity

COGNITIVE FUNCTIONS:
1. Oriented to time, place and person
2. Attention and concentration-
Forward Digit span test- up to 4 digits
Backward- up to 3 digits
Serial Subtraction: Patient was taking more than 15sec to
answer when asked to subtract 7 serially from 100, he correctly
attempted till 79
ASK EVERYTHING
Inference- Attention aroused concentration ill sustained
3. Memory- immediate- intact
Recent- intact
Remote -intact
4. Intelligence- average, as he could name capital of different
states and current events
Comprehension- Patient could comprehend and answer to the
question of what would you do when you feel cold as- covering
myself with blanket.
 Arithmetic- could do divisions and multiplications
5. Abstraction-
similarities:
i. Dog-lion : Both are animals but they have different body
proportions
ii. Eye-Ear: we see with our eyes and listen with our ears.
Differences
i. Stone & potato- Stone is a stone, we can eat a potato
Proverbs : Approximate answers
Impression: concrete
6. Judgement:
i. Personal- intact
ii. Social - Intact
iii. Test- intact
7. Speech- normal rate/tone/volume/prosody
Normal reactivity time, spontaneous and coherent
RECORD SPEECH SAMPL
8. Mood – I am fearful
9. Affect- Quality- DEPRESSION
Range- Towards depression
Reactivity-
Intensity- low
Lability- no
Volatility no
Communicability-no
Appropriateness- present
Congruent to thought
10. Thought – form-no formal thought disorders
stream-normal
possession – no obessions or compulsions
 content – RUMINATIONS
motivation- patient is motivated to quit
alcohol . in contemplation stage
locus of control – external like peer pressure
internal due to loss of son and
financial reasons.
11. Perception-no sensory distortions
Hypnogogic hallucinations
2nd and 3rd person Auditory hallucinations

12. Insight: Grade 3

DIAGNOSIS