Concluded Case

Geriatric depression

75 year old male patient present with irritability and refusal to walk and even get up from the bed following a hairline fracture he sustained in the left tibia which was 3 months back ( fracture was treated with pop and orthopaedics advised weight bearing but patient says he cannot walk All the blood parameters are normal Mri brain is normal 1st he refused any oral medication then he was treated with inj haloperidol 2.5mg and inj phenergan 12.5 mg hs for 3 days along with inj renerve Now he is being treated with duloxetine 20mg od and encorate chrono 300mg 1-0-1, tab olanzapine 5 mg 0-0-1 Along with supportive psychotherapy Now patient is better 60% also cooperative with physiotherapist walks few steps with the help of Walker . Kindly give ur opinion

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Concluded answer

This case is required more details...as per possible. He have a Irritable and refuse to walk in front of them a such type of mood congruent patterns of behaviour by due to some unspecified stressors if have to define insight of patient behave. This is unconscious demand to unexplained justification by patient behaviour,so everytime to do uncooperative and denial provoking activities. These are related to secondary psychosis to form by unspecified stressors with rule out organic cause. History of these patients are related to personality, tabacco, alcohol, stubborn attitude.

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This case is required more details...as per possible. He have a Irritable and refuse to walk in front of them a such type of mood congruent patterns of behaviour by due to some unspecified stressors if have to define insight of patient behave. This is unconscious demand to unexplained justification by patient behaviour,so everytime to do uncooperative and denial provoking activities. These are related to secondary psychosis to form by unspecified stressors with rule out organic cause. History of these patients are related to personality, tabacco, alcohol, stubborn attitude.

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

You need to know his history when he was young and even if he's 60% better after these medications we need to remember that he's 75 yrs old. It's good that psychotherapist is also helping in this. The first point you mentioned that he doesn't want to walk or get up is the point that happens with most of the patient's who aren't in routine job means a job which doesn't have fixed time. I may be wrong but maybe the patient has suffered from mild facial paralysis and sciatica too and cuz of not a fixed time job the patient must've suffered from stress when he was young. And these kinds of patients who have suffered from the points I've mentioned always feels tired or fever even if he's not suffering from fever and they become attentionseeker and that's why they stop doing their daily routine like walking and getting up. The patient shouldn't stop consuming duloxetine and this case is completely a attentionseeker kinda case ( psychosis) the patient must've suffered from some of the points I've mentioned above. And the patient should be suggested to do their own works liek changing their bedsheets and folding their clothes etc etc. Forget not to tell me Dr.vini if he's suffered from the points I've mentioned

This patient is a criminal lawyer high SES who was practicing till he sustained fracture and became totally dependent Premorbidly described as a opinionated independent person with strong views No addictions
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How long will you continue antipsychitic and anticonvulsants?

Upto 6 months along with monitoring of serum valproate level and LFT then taper very slowly
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