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Case Report No 2
(A Case of Drug Abuse)
Bio Data:
Name:
L.A
S/O:
M.H
Age:
25 years
Sex:
Male
Address:
Chack No 85 Junbi, Sargodha.
Education:
Illiterate
Religion:
Islam
Occupation:
Rickshaw Driver
Monthly Income:
Rs. 8000/-
Siblings:
6
Birth Order:
6th
Material Status:
Married
Wife’s Age:
21 years
Wife’s Education:
Illiterate
Wife’s Occupation:
Housewife
Children:
One
Father living / dead:
Dead
Father’s education:
illiterate
Father’s Occupation:
Labourer
Mother living / dead:
Alive
Mother’s Education:
Illiterate
Mother’s occupation:
Housewife
Socio - economic – status:
Lower class
(Brothers
3
Sisters 3)
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Assessment Procedure:
The patient’s assessment was done through clinical interview, behavioral
observation and psychological tests (SDCT, SPM, RISB, HFD, BDI).
Reason & Source of Referral:
The patient was referred by one of my friend and was taken for learning
purposes.
Presenting complaints (verbatim):
Symptoms of illness:
Symptoms
Duration
Loss of appetite
9 days
Insomnia
9 days
Restlessness
9 days
Body Pain
9 days
Vomiting
9 days
Headache
9 days
Addiction
4 years
Behavioral Observations:
The behavior of the patient was cooperative and he responds well. He talked
friendly. He showed his determination to get rid of drugs. Eye contact and motor
control also was appropriate.
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Pertinent Background Data
Family history:
The patient belongs to a lower class. He lived in Sargodha with his family
(mother, wife and children). His father died in 1986 at the age of 58 years. The patient
mother is illiterate and a house wife. He has three brothers and three sisters. The
patient’s birth order is 6th. The patient’s elder brother was died in 2008 due to heart
attack. His second elder brother is in Prison in case of a murder. There are good
relationships among all the siblings. All the siblings are married. The patient is
married and he has one child (Boy) and who is three years old.
Family history of illness:
The patient’s uncle was drug addict. His mother is suffering from Hepatitis C.
PERSONAL HISTORY:
His birth was normal, no neonatal problems were reported and he grew up
normally as other normal children in his family.
Early Childhood:
He achieved all developmental milestones at appropriate age. He was one year
old., when his father was died.
Adolescence:
He spent most of his time with his friends. He was very found of listening
music. He was very good in football. His relations with his siblings were normal.
Adulthoods:
He was 19 years old, when he became Rickshaws Driver. He was interested in
a girl, but she was already engaged with some one else. He was 21 years old, when
he got married with her cousin. Then he joined a company of addicts. Due to his
sitting with such friends he started to take drugs. The sudden death of his elder brother
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disturbed him. He had good marital relations but after he becomes a drug addict, his
relations with his wife and family affected. He did not commit any other crime in his
life except addiction.
Premorbid Personality:
Before his illness, he was socially useful personality. He was a Rickshaw
Driver. He had good relations with his friends, family and relatives. His attitude
towards moral and religious values was not much concerned.
History of present illness (reported by Patient):
The patient is a drug addict. He uses chars and Heroin. The patient started
these drugs in 2006.
Physical / Biological Problems:
The patient has no physical / biological problem except he reports vomiting
sometimes.
Psychosomatic Disturbances:
He reports headache, muscular pain, lack of energy and restlessness.
Psychological Assessment:

Clinical interview

Behavioral observation

Mental status examination

Slosson drawing coordination test (SDCT)

Standard progressive matrices (SPM)

Beck Depression Inventory (BDI)

Human figure Drawing (HFD)

Rotter Incomplete Sentence Blank (RISB)
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Clinical Interview:
The patient comes to hospital with the complaints of restlessness, body pain,
headache and insomnia. Clinical interview was conducted with patient and his
mother. The patient has not physical / biological problem except vomiting. Almost
four years ago, he joined the company of addicts, due to his sitting with such friends
he started the smoking. But with the passage of time he started to take chars and
heroin. He spent most of his time with his friends. According to his mother, he was
loving and caring person but after he becomes a drug addict, he became very
aggressive and often beat her wife. The patient belongs to lower class.
Mental status examination:
A young man, wearing dirty dress and was lying on bed. His personal hygiene
was not satisfactory and hairs were not well combed. He was talkative person. He
acknowledged that he had teased his mother. He had no interested in religious
activities and he had very little knowledge regarding religion. He participated in talk
with interest and in active mood. He had no specific hobby. Eye contact and motor
control was found normal. Orientation of time place and person was there.
INTERPRETATION OF RESULTS
Slosson Drawing Coordination Test (SDCT)
Quantitative analysis:
Age
25 years
Errors
25
Accuracy Score
33 %
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Qualitative Analysis:
According to the SDCT scores, the patient’s eye-hand coordination does not
seems to be intact.
Standard Progressive Matrices (SPM)
Quantitative Analysis:
Patient’s age
25 years
Total Score
23
Percentile
5%
Discrepancies
4, 1, 0, -2, -1
Time taken
45 minutes
Intellectual level
Intellectual defective
Qualitative Analysis:
The score indicates that the patient seems to be intellectually defective.
Beck Depression Inventory (BDI):
Quantitative Analysis
Score
28
Range
20 – 28
Category
Moderate
Qualitative Analysis:
The patient’s scores on the BDI, shows that he has moderate level of due
depression.
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Rotter Incomplete Sentence Blanks (RISB)
Quantitative Analysis
Types of
No of
Categories of No of Responses in
responses
Responses
Reponses
C
28
Values
Total
categories
C3
7
6
42
C2
13
5
65
N
5
C1
8
4
32
P
6
N
5
3
15
P1
4
2
8
P2
2
1
2
P3
0
0
0
Total
164
Total
Calculated Score:
164
Cut off Score :
135
Qualitative Analysis:
According to the RISB scores, the patient seems to have maladjustment.
Familiar attitude:
The patient showed conflicting attitude at home. For example, Item No. 4:
Beck home…… “I get sleep”. Item No. 26: Marriage….. “Should be done”. Item No.
35: My father…….. “Not remembered”. These responses indicate conflicts regarding
family. Any how, he has positive feelings about his mother as he respond on item No.
11: A mother…….. “Is a pious woman”.
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Social and sexual attitude:
He showed conflicting attitude as he responded on item No. 3,5,19,21,and 40
Item No. 3: I want to know……. “Nothing”.
He showed conflicts regarding addiction as at
Item No. 5: I regret…… “Why I take drugs”
Item No. 19: other people….. “Are Selfish”.
Item No. 21: I Failed ……. “In life”.
Item No. 40: Most women…….. “Are Good”.
All these items are indicating that patient has conflicts in social life.
General attitudes:
He showed conflicted attitudes again at item No. 6: At bed……… “May Allah give
me Rizkay Halal”. Item No. 12: I feel………. “I hurt my mother. Item No. 13: My
greatest fear……. “Death”. He showed inferiority complex at the response of item
No. 18: My nerves…….. “Are very weak”. A ambiguous and conflicting response
was at item No. 30: I hate……. “A Person”. He also showed inferiority complex
again at the response of item No. 33: The only trouble….. “ Earn money”.
Character trait related to the patient:
Above mentioned items 13,18,33 indicates that the patient has feelings of
inferiority and worthlessness. He showed a bit determination to optimistic as shown
on item No. 1: I like….. “I wish to up bring my children in a good way”. And item
No. 24: The future….. “The future will be good”. He also had a little bit positive
attitudes regarding social life as he wants to live as a cooperative society members, as
show on item no: 9 and 16, I dislikes…….. “Make a quarrel”. And sports …… In
sports every body should be happy.
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Human Figure Drawing (HFD):
Qualitative Analysis:
The picture on HFD revels that the patient seems to have immaturity,
instability, anxiety, poor coordination, impulsivity, Lack of balance and aggressive
behavior towards environment.
Discussion:
From clinical interview and behavioral observation and psychological tests, It
was identified that the patient came to hospital with the symptoms of restlessness,
body Pain, Insomnia, loss of appetite from 9 days. These complaints are short due to
withdrawal of drugs. Different psychological tests were administered like SPM,
SDCT, HFD, RISB, BDI. Then therapeutic plan is designed for the treatment of
problem.
Conclusion:
The patient history, behavioral observation, clinical interview and test
administered showed that he is a patient of Opioid abuse.
DIAGNOSIS:
Axis I:
Axis II:
305.50
Opioid Abuse
292.0
Opioid Withdrawal
71.09
No diagnosis
Axis III:
None
Axis IV:
Job dissatisfaction
Axis V :
GAF = 42
(current)
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Case Formulation:
The diagnosis was done by clinical interview, behavioral observation and
psychological tests. The results of SDCT indicates that the patient’s eye-hand
coordination does not seems to be intact. According to the result of SPM the patient
seems to be intellectually defective. According to the score of BDI that the patient
seems to have moderate level of depression. The results of RISB indicates that the
patient seems to have maladjustment. According to the result of HFD the patient
seems to have immaturity instability, anxiety, poor coordination, impulsivity and
aggressive behavior. So it is
concluded that the patient is suffering from these
problems due to drug abuse. These symptoms and duration meet the criteria of DSM
IVTR of Opioid abuse and Opioid withdrawal.
PROGNOSIS:
The prognosis for a psychological intervention is good. At the time of
admission, the patient was so much aggressive, restless. He had insomnia and loss of
appetite. So, with the help of medicines all the problems of the patient are some what
settled now, except addiction. So with the help of biological and psychological
treatment and with the co – operation of family the patient may become healthy.
RECOMMENDATION
Psychological Treatment:

In behavioral modification techniques, aversive technique, assertive therapy
and Token economy can be successfully used.

Deep breathing and other relaxation should be done for the management of
restlessness.

Environmental conditions, which force him to take drugs, should be
eliminated.
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
Family members should pay attention to him because co – operation of the
family is very important for patient.

Cognitive – behavioral treatment should be used to maintain and enhance the
better cognition.