Table 1.
Summary of the patient's progress in the inpatient unit.
| Duration | Psychopathology and main lab findings | Therapeutic interventions | Remark | |
|---|---|---|---|---|
| Pharmacological | Psychosocial | |||
| First and the second week | -The patient was hostile, disturbed, and had frequent shouting She did not know where she was and where she was brought from-Lab investigations like CBC, TSH, RFT, and LFT were normal-HCG, negative-Dissociative experiences scale: 66 | -Risperidone 2 mg PO BID -Diazepam 10 mg PO noct In the second week, fluoxetine 20 mg PO in the morning was added |
Rapport building and empathic understanding Psychoeducation on drug adherence and side effects | Dx: dissociative amnesia with dissociative fugue comorbid with schizophrenia |
| Third week | -Abdominal U/S was done and confirmed, as she is not pregnant.-The patient becomes more engaging but very irritable when asked about the trauma-Dissociative experiences scale: 66 | -Risperidone titrated to 6 mg/day-Diazepam was tapered and discontinued-Artane 2 mg PO morning | -Engaging the patient in scheduled routine daily activities | Slight improvement(behaviorally) but a present of neuroleptic-induced Parkinson |
| Fourth week | -Reported suicidal ideation and tried to strangulate herself-SAD PERSONAS = 9/16-Had wrist rigidity and drooling of saliva | -Risperidone titrated to 8 mg/day then to 10 mg/day-Fluoxetine titrated to 40 mg/day | -emphatic understanding and encouragement of social relationships with other patients and attendants | -Worsening-24 hours under close follow-up |
| Fifth and sixth week | -Very irritable-Frequent shouting-Hostile towards her mother-Drug side effects observed-Dissociative experiences scale: 66 | -Risperidone tapered slowly until 4 mg/day diazepam 10 mg PO BID reinitiated-Fluoxetine tapered to 20 mg/day | Engagement in routine daily activities-hypnosis | -An additional diagnosis of neuroleptic-induced pseudo-Parkinson |
| Seventh week | -Simpson Angus scale = 16 | -Antipsychotic discontinued-Diazepam 10 mg PO BID-Fluoxetine 20 mg/day | -Hypnosis-Engagement in routine daily activities like washing clothes, and making coffee | -Dx: dissociative amnesia with dissociative fugue, comorbid with schizophrenia-Neuroleptic-induced Pseudo parkinsonism |
| Eighth and ninth week | -More engaging | -Additionally, phenobarbitone was initiated for drug-assisted hypnosis and titrated to 100 mg PO BID | -Drug-assisted hypnosis-She was let to engage more in daily activities | Improving |
| Tenth week | -Head and neck CT was done and normal finding-Abdominal U/S confirmed no pregnancy-Hostile-Suicidal and homicidal towards her mother-crying-SAD PERSONAS = 7/16 | The same | -Hypnosis continued every day-EMDR | Close follow-up for possible suicidality and homicide |
| Eleventh week | -Sleeplessness-Shouting-Physical and verbal aggression-Severe paranoia towards everybody | -Risperidone 2 mg PO BID reinitiated-Haloperidol 5 mg IM Prn-Phenobarbitone tapered and discontinued-Fluoxetine and diazepam continued | -Engagement in social activities | -Worsening-Close follow-up |
| Twelfth week | -Acute dystonia torticollis) | -Risperidone changed to olanzapine 5 mg PO BID due to unavailability | -hypnosis continued-Encouragement of engagement in routine daily activities | Slight improvement (behaviorally) |
| Thirteenth week | No new finding | -Fluoxetine was changed to amitriptyline due to unavailability | -Hypnosis continued-Encouragement of engagement in routine daily activities | |
| Fourteenth week and fifteenth | -refusal to take medication | -Modicate 12.5 IM testing dose-Amitriptyline was titrated to 100 mg PO noct-Olanzapine titrated to 20 mg PO/day | -Hypnosis continued-encouragement of engagement in routine daily activities | |
| Sixteenth week | -A frequent complaint of constipation | Bisacodyl 5 mg PO BID added | -Hypnosis continued-Encouragement of engagement in routine daily activities | Follow for possible drug side effect |
| Seventeenth week | -Constipation continued despite treatment | -Enema was done-Modicate 25 mg IM given | -Hypnosis continued-Encouragement of engagement in routine daily activities | |
| Eighteenth week | -Good social interaction | -Amitriptyline was changed to sertraline through cross tapering | -Hypnosis continued-Encouragement of engagement in routine daily activities | Improving |
| Nineteenth week | -Good social interaction-Good interaction with her mother but not accepted as her true mother | -Sertraline 100 mg PO morning-Diazepam 10 mg PO BID-Olanzapine 5 mg PO BID-Engage in routine daily activities | -Hypnosis continued-Encouragement of engagement in routine daily activities | Improving |
| Twentieth week | -Improved engagement in social activities like helping other patients-She said her mother is no more her enemy | -Diazepam tapered-Sertraline was discontinued-Discharge considered | -Encouragement of engagement in routine daily activities | -Improving |
Follow-up and outcomes.