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CASE STUDY OF Mr. JOHNSON BABU WITH ALCOHOL DEPENDENCE
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Name :- J.P Johnson Babu Address :-Manjunatha Chicken Center 2 nd^ main Bapuji Nagar Bangalore Age :- 24 yrs Sex :- Male Ward :- De addiction centre Address :- P Religion :- Christian Education :- 10th^ Std. Martial Status :- Single Occupation :- Non agriculture labor Income :- 1000 Rs Date of Admission :- 16/1/ Diagnosis :- Alcohol dependancy Reliability :- Reliable Language :- Hindi/ English/kannada Informant
No h/o. sleep disturbances, no thumb sucking, no tics and mannerism, no h/o bed wetting, no sibling rivalry
3. Physical illness during childhood No history of ant major physical illness during childhood. No h/o epilepsy, head injury, encephalitis during childhood. 4. School Patient studied till 10th^ std. Relationship with peers and teachers normal. He was an average student. 5. Occupation He is non-agriculture labor. Running a poultry farm near Bangalore 6. Sexual history Normal sexual history. No abnormalities reported. 7. Martial History Not Married 8. Use and abuse of alcohol, tobacco He is using alcohol and tobacco since six years. Daily take half litre of alcohol and 15- cigarette. **PREMORBID PERSONALITY
6. Fantasy life Not reported 7. Habits No habit of using tobacco and alcohol MENTAL STATUS EXAMINATION: A. General appearance and behaviour:
A. 14th^ may 1985 Inference: Remote memory is intact. G. Attention and concentration: Q. How many days in a week and tell them? A. 7 days, he says from Monday to sunday Q. Subtract 100-5? A. 95 Reference: Attention is aroused and concentration is also sustained. H. Orientation: Q. what must be the time now? A. it must be 10’o clock Q. who brought you here? A. I came along with my father. Q. who is that lady wearing white saree? A. she is a ward sister. Q. Where are you now? A. I am in NIMHANS hospital. Inference: he is oriented to time, place, and person. I. Abstraction: Q. what is the different between the potato and stone? A. Potato is eatable and stone is hard. Q. What is the similarity of banana and orange? A. both are fruits Inference: Abstraction is good. J. Comprehension:
Q. What will you do, if u miss the bus? A. I’ll catch another bus. Q. what you will do if you feel cold? A. I’ll wear sweater. Inference: comprehension is good. k. Intelligence: Q. What is the capital of India? A. Delhi Inference: Intelligent is good. L. Judgment: -Personal judgment: Q. What are you planning to do after discharging from here? A. I want to settle my life. -Social judgment: Q. What will you do when you saw a person drowning? A. I will call other people because I don’t know swimming -Test judgment: Q. What you will you do if your ward is fire? A. I’ll pour water to stop the fire. Inference: Judgment of the patient is good. M. Insight: Q. Why you are coming and staying here? A. I have to stop alcohol drinking. Inference: Insight is present. Physical examination
a.Expression: pleasant b.Eye brows: equal, evenly distributed and no dandruff noted. c.Eye lids: no lesion and scars, eye lashes are equally distributed d.Lacrimation: clear fluid expressed, no discharges present. e.Conjunctiva:appears pale and clear G.EARS a.Appearance: No masses or lesions present in the external ear. b.No discharge c.Hearing: is able to hear in both ears; Weber test-negative; Rinne test-positive d.No lesions or mass. H.NOSE: a.Appearance: septum not deviated; no growth or lumps externally noted b.Discharge: no discharge present c.Patency: Both nostrils are patent d.Sense of smell: good I.MOUTH AND THROAT: a.Lips, tongue: normal, no lesions or ulcers b.Teeth: intact in the upper and in lower jaw J.NECK: a.Trachea is normal position, no palpable mass. b.Lymph nodes: no palpable K.CHEST AND RESPIRATORY SYSTEM : a.Inspection: Size and shape is normal. Chest expansion equal in both the sides and respirations are normal. b.Palsation: No local sweeling; no lymph node palpated
c.Percussion: No fluid collection d. Auscultation: Breath sounds are loud, high pitch in both sides; no consolidations, respiratory rate-20/mt L.CARDIOVUSCULAR SYSTEM: a.Inspection: size and shape of the chest is with the normal limits; no surgical scar b.Palpation: carotid pulse and peripheral pulses are regular; normal sinus rhythm; rate-80/mt c.Percussion: cardiac borders well within normal limits, no cardiac or supracardiac dullness d.Auscultation: S1 S2 auscultated. No abnormalities noted, pulse-80/mt M.ABDOMEN: a.Inpection: size and shape of the abdomen normal, no distention and tenderness. b.Palpation: no abnormalities found. Firm musculature noted c.Perscussion: no ascitis and fluid collection. d.auscultation: peristalsis heard in the right lower quadrant N.BACK: a.Spine and curvature: no abnormalities noted; no lymphs or lesions present b.Movement: all movements are possible c.Tenderness: no tenderness noted O.GENITALIA: Normal male genitalia; has no discharges P.UPPER EXTREMITIES: a.Deformity: no deformities noted b.Sweeling/edema: no swelling or edema c.Muscles: no emaciate
Nurse: What is your date of birth? Patient: 14th^ may 1985 Remote memory intact. Nurse: Do you like your parents and brother? Patient: Yes, I like my parents and brother Nurse: why you are quarrelling with brother? Patient: When I drink alcohol I will lose my control. Nurse: What is your plan after discharge? Patient: I want to go for a good job or start a business. Nurse: Once you get discharged you must come for regular follow-up and continues taking the medicines till doctor says. Patient: OK brother. Nurse: Do you want to ask any question? Patient: No, tomorrow I will talk to you brother. Nurse: OK, we will stop here and thank you for answering my questions. Patient: Bye! Brother. Patient is attached with his family. Willing to work after discharge. Concentration is good. LAB INVESTIGATIONS Sl No Investigations Patient’s value Normal value Interence
driving skills, irritability. muscle. T. Rantac Ranitidine Oral 150- 300 mg Oral IV Histamine H2recepto r antagonist Headache,Dizzi ness,rarelyhepati tis,thrombocyto penia,breast symptoms, hypersensitivity, confusion, Administer correct dose T. BC BC 32.5mg oral Vitamin B and C complex supplemet . Hypervitaminosi s,G.I.Symptoms, yellow coloured urine. Look for side effects,exp lain about urine colour change T. Liv 52 sihymanin 140mg oral Liver protectant Occasional laxative effects See for hypersensit ivity. T. Fluoxtine fluoxtine 20mg oral Antidepre ssant Nervousness, insomnia, anxiety, tremor, headache, drowsiness, nausea and drymouth. CASE STUDY INTRODUCTION From time immemorial human beings have looked for substances to make life more pleasurable and to avoid or decrease pain, discomfort and frustration. Despite definite improvements in health care in most countries, problems related to drug and alcohol abuse are increasing almost everywhere. DEFINITION Alcohol dependence was earlier called as “alcoholism”. Alcoholism is defined as a chronic disease by repeated drinking that produces injury to the drunken health or to his social or economic functioning. EFFECT Low to moderate consumption produces a feeling of well-being and reduced inhibitions. At higher concentrations motor and intellectual functions are impaired, mood becomes very labile and behavior characteristic of depression, euphoria and aggression are exhibited.
Synonym Milieu limited Milieu – limited Sex Both sexes Mostly in males greater than 25 years. Age of onset >25 years. <25 years. Etiological Genetic factors Heritable Factors Important, strong Environmental influences are Contributory Environmental influences are limited. Family history May be positive. Parental alcoholism and antisocial behavior usually present Loss of control Present No loss of control Other features Psychological dependence and guilt present Drinking followed by aggressive behavior, spontaneous alcohol seeking. Pre-morbid personality traits Harm avoidance, high reward dependence Novelty seeking. Under classification client comes under Type- BOOK STUDY PATIENT STUDY ETIOLOGICAL FACTORS BIOLOGICAL FACTORS PSYCHOLOGICAL FACTORS SOCIAL FACTORS
Child hood trauma or loss. Relief from fatigue and for boredom. Escape from reality. Lack of interest in conventional goals. Psychological distress.
Loss of control over amount, time and occasion of drinking. Keeping away from alcohol for sometime but going back to obsessive drinking after each such abstinent period. CHRONIC STAGE Getting drunk ever on small amounts of alcohol. Willing to i.e., beg, borrow, or steal to maintain supply to alcohol. Living to drink – alcohol takes priority over family or job. DIAGNOSTIC EVALUATION Certain laboratory makers of alcohol dependence have been suggested. There include: Physical examination. History collection. Neurological examination. Mental status examination. GGT (gamma glutyl transfarase) MCV (mean corpuscular volume) GGT is raised to about 40 IU/L in 80% of alcohol dependant individuals. An increase in GGT of more than 50% in an abstinent individual signifies a resumption of heavy drinking. MCV is more than 92 fi (normal= 80-90 H) is 60% of alcohol dependent Individuals. In case of client’s physical examination, history, collection, neurological examination, MSE and blood investigation done. BOOK STUDY PATIENT STUDY OTHER LAB MARKETS It includes, Alkaline phosphatase. AST ALT Uric acid Blood triglycerides CPK COMPLICATIONS I PHYSICAL OR MEDICAL COMPLICATIONS A GASTRO-INTESTINAL SYSTEM Gastritis. Dyspepsia Vomiting Peptic ulcer Cancer Esophageal varices Mallory-weiss syndrome Achlorohydria Carcinoma stomach and esophagus. Client developed the
Fathy degeneration of the liver. Alcoholic hepatitis Cirrhosis Liver cell carcinoma Liver failure complication of vomiting, muscle wastage and vitamin deficiency. PANCREASE Acute and chronic pancreatitis. B CENTRAL NERVOUS SYSTEM Peripheral neuropathy. Delirium tremors. Rum fits. Alcoholic hallucinosis. Alcoholic Jealousy Wernicke- Korakoff psychosis Alcoholic dementia. Suicide Cerebellar degeneration Central posture myelinosis Head injury and fractures. C CARDIO VASCULAR Alcoholic cardiomyopathy High risk for myocardial infarction. Cardiac beri-beri. Alcoholic myopathy. Risk for coronary artery disease. D BLOOD Folic acid deficiency aneamia. Decreased WBC production. Anemia, thrombocytopenia, vilk factor deficiency, hemolytic anemia. BOOK STUDY PATIENT STUDY E MUSCLE Peripheral muscle weakness and wasting of muscles. F SKIN Spider angiomas. Acnerosacea Palmar erythema Rhinophyma Spider revi Parotid enlargement Ascitis. G NUTRITION Protein malnutrition. Vitamin deficiency disorders like pellagra and beri-beri. Client does not develop the reproductive complications