Mental status examination

On

Obsessive Compulsive

disorder

SUBMITTED TO: SUBMITTED BY:

Dr. Grace M. Singh Ms. Neha Sharma

Associate Professor M.Sc. Nursing First year

HCN, SRHU HCN, SRHU

SUBMITTED ON:

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 26.6.2023

“It’s like you have two brain- a rational brain and an

irrational brain. And they’re constantly fighting.”

IDENTIFICATION DATA

Name - Taniya

Father Name - Mr.Ashok

Age - 19years

Sex -Female

Religion - Hindu

Address -Dehradun

Domicile - Urban

Educational -12th

Occupation -Student

Marital status -Unmarried

Date of admission - 22-03-2021

Ward -Female Private ward

Brought by -Father

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 Diagnosis -Obsessive Compulsive disorder.

CHIEF COMPLAINTS:

According to Patient

My family members does not support me

I have conflict with my family members 3year

Low mood

Repetitive urges to count page

According to informant

Bhut gussa ata hai ise(for 15 days)

Bar bar ek hi cheej krti rhti hai(for 15 days)

Bar bar page turn krti hai( for 20 days)

History of present illness:

Duration-3 years

Onset- Insidious

Course of illness- Continuous with fluctuations

Intensity: Decreased

Patient was well apparently when 3 years back she started having problem that repetitive urges

to turn pages.

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History:

PAST MEDICAL HISTORY: According to patient she had no illness in the past.

PAST PSYCHIATRIC HISTORY:

 Repetitive urges to abuse family members.

 Repetitive, intrusive, against his will, identified his own thoughts and distressing and

associated with guilt feeling.

She tried to decrease distress by replacing the images by shooting scene going on as movie

shoot or abusing God’s name with name of family members

PAST SURGICAL HISTORY: No significant surgical history was there.

FAMILY HISTORY:

 History of hypothyroidism in mother and is on tab Levothyroxine 75mcg.

 History of hypertension in father.

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 GENOGRAM:

Grandfather Grandmother

Father Mother Aunty

Brother Sister Sister Cousin Sister

Family Key:

Female

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 Patient

Male

 History of depressive episode in sister 2 years back which lasted about 2-3 years due to

disturbed family atmosphere as she was having a love affair with other caste boy and

there were fights between family members, mostly with mother. She had also tried

suicidal attempts twice in past. Not taken any treatment and currently maintaining well

and doing job in Mumbai.

 GENERAL ATMOSPHERE AT HOME: patient told, general atmosphere at home

was not good. She faced too much problems in her life. Disturbed as family members

tried to impose very strong religious and moral standards which was even not followed

by them.

Father was authoritarian and wanted things according to his way.

ANY CHRONIC MEDICAL HISTORY OF THE FAMILY/ PSYCHIATRIC ILLNESS:

According to patient sister was having psychiatric illness but according to family members no

family history of psychiatric illness.

PERSONAL HISTORY:

PARENTAL & BIRTH: Patient was delivered normally through full term normal vaginal

delivery in hospital. She was a planned child. There was no congenital deformity.

EARLY DEVELOPMENT & GROWTH HISTORY: Patient was perfectly developed without

any birth defects. Parents and other family members show love and affection to the child. All

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milestones were achieved at their proper age and time. NEUROTIC TRAITS: patient had no

history of night terrors, sleep walking, temper tantrum, bed wetting etc.

 CHILDHOOD HISTORY: patient’s growth and development was good. She has good

relations with her friends. She was stubborn since childhood and wanted her demands to

be fulfilled at any cost but used to be outgoing and mix up with other children.

 Good in studies and scored good marks.

SCHOOL: She started her schooling at the age of 3 years. She was good in studies and scored

good marks.

INTERPERSONAL RELATION WITH TEACHER/ PEERGROUP: She had good relations

with her friends and teachers.

OCCUPATION: Student.

MARITAL HISTORY: Unmarried

PREMORBID HISTORY:

INTROVERT/ EXTROVERT: She is extrovert.

MORAL STANDARDS: She had positive attitude.

AMBITIONS: She was ambitious.

MOOD: Fluctuating.

SOCIAL INTERPERSONAL RELATIONS: She had good interpersonal relationship with

relatives.

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INTELLECTUAL ACTIVITIES: According to patient she had no specific hobby but she likes

reading books and singing songs.

ATTITUDE: Her attitude towards family and life was positive.

FANTASY OF LIFE: According to patient, she had fantasies to become singer.

HABITS: Patient had no habit of smoking and alcohol intake etc.

STRENGTH AND ABILITIES: Before illness, she performs all her activities.

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PHYSICAL EXAMINATION

SUBJECTIVE DATA OBJECTIVE DATA

1.General appearance-  Weight : 42 kg

 Temperature: 98◦

 Respiration : 22 breaths /min.

 Blood pressure: 120/80mmhg.

 Moderately nourished and is

moderately built.

 Hair is black in color and is equally

2. Head to toe examination- distributed.

i. Head  Dandruff and pediculosis not

present.

 No alopecia presents.

ii. Eyes.  Visual acuity: Normal.

 No sty’s or ptosis present.

 Pupils are round, and reacting to

light and accommodation.

 Sclera is red in color.

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  Conjunctiva: pink in color.

iii. Ears.

Patient says, “I’ve no hearing problems.”  External ears symmetrical,

 Hearing acuity: normal.

iv. Nose.  No wax collection or abnormal

Patient says, “I’ve no nose block.” discharges from ears.

 No septal deviation presents

 No nasal discharge or nasal polyp

v. Mouth. present.

Patient says, “I’ve no difficulty in swallowing.”

o Tongue  No lesions are present.

 Color of the is pink, coated

o Lips

o Teeth  No cracks and stomatitis present.

 Reddish discoloration present. No

o Gums
dental caresses present.

 No gingivitis or gum bleeding

o Buccal cavity
present.
o Uvula.
 No infection.
o Tonsils
 Centrally placed.

 No tonsillitis presents.
vi. Neck.
 No lymph node and thyroid
Patient says, “I don’t have any pain on my neck.”
enlargement present.

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3.Systemic Examination-  Complete range of motion possible.

a. Respiratory system.

Patient says, “I’ve no breathing difficulty.”  Respiratory rate: 24 breaths/ min

 Depth of respiration: normal.

 Inspection: Normal chest symmetry.

 Palpation : liver was palpable.

 Auscultation: breath sounds:

normal.

 Percussion: resonance sound heard

b. Cardiovascular system. over the lungs

Patient says, “I’ve no chest pain.”  Pulse :86/min

 BP :120/80mmHg

 No cyanosis or clubbing.

 Inspection: No distension, lesion or

hernia.

c. Abdomen.  Palpation : No liver or spleen

Patient says, “My bowel pattern is normal.” Only enlargement present.

having pain in the abdomen.  Auscultation: Bowel sounds heard

and is normal.

 Percussion: No fluid or gas

accumulation felt.

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d. Muscular skeletal system.  Normal range of motion present.

Patient says, “I’ve no joint pain.”

 No any skin disease is present only

e. Skin. cracking on the feet.

 Patient is oriented to time, place and

f. Nervous system. person

 She is conscious and co- operative.

 Speech normal.

 Gait: normal

 Hand tremors not present

g. Motor control

 No Dysuria or Hematuria present.

 Urine output is normal.

h. Genito- urinary system

Patient says, “my urinary pattern is normal.”

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 MENTAL STATUS EXAMINATION

GENERAL APPEARANCE:

 Facial expression: facial expressions of the client were appropriate. It changes

appropriately with the change of subject.

 She did not show any elation, uncontrollable laughter, fear etc.

 Posture: client’s posture was relaxed.

 Mannerism: patient did not show any mannerism.

 Dress: client was dressed appropriately. Dress was clean and tidy and is appropriate

according to season and occasion.

 Hygiene: Hygiene of the patient is not maintained her hygiene, patient appeared clean &

tidy, nails were cut short.

 Physical features: client looked appropriate according to her age. Appeared thin built. His

gait was normal and there was not any physical deformity.

 Weight: 42 Kg

MOTOR DISTURBANCE:

 Overactivity or hyperactivity: client show mild restlessness.

Outcome: overactivity is present.

 Underactivity or motor retardation: client do not show slowing down of activity level

and bodily functions.

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Outcome: underactivity is absent.

 Stupor: patient showed progressiveness and is not motionless.

Outcome: stupor is absent.

 Stereotype: patient had not repetition of speech.

Outcome: stereotype is Present

 Compulsive movements or compulsion: patient compelled to carry out a certain pattern of

behavior.

Outcome: compulsion is absent.

 Echopraxia: patient have pathological repetition by imitation of the movements of another

person.

Outcome: echopraxia is absent.

 Negativism: patient was cooperative. She refuses simple requests without apparent reasons.

Outcome: negativism is absent

 Automatic obedience: patient did show a pathological degree of compliance.

Outcome: automatic obedience is present

DISORDER OF FORM OF THOUGHT

 Circumstantiality: patient includes unnecessary details and explanations before the goal is

reached.

Nurse: Aapke ghar me kaun kaun hai?

Patient: Mom, and I

Outcome: circumstantiality is absent.

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 Tangential thinking: patient did not give unnecessary detail and explanation and reached at

the goal finally.

Outcome: tangential thinking is absent.

 Incoherence: patient’s speech was clear and sense can be extracted from her speech.

Outcome: incoherence is absent.

 Irrelevant: patient answer appropriately according to the questions.

Outcome: irrelevant is absent.

 Neologism: patient did not coin or invented own language and words which has special

meaning to the patient.

Outcome: neologism is absent.

 Word salad: patient did not mix isolated, disconnected words in hopeless jumble.

Outcome: word salad is absent.

 Perseveration: patient does not have involuntary and morbid repetition of specific word or

idea that persists in spite of patient’s effort to move to another side.

Outcome: perseveration is absent.

 Ambivalence or ambivalent ideas: patient does not have two contradictory ideas,

emotions, attitude and wishes in mind about something.

Outcome: ambivalent ideas are absent.

EVALUATION OF SPEECH

 Intensity: the patient’s voice is normal.

 Pitch: voice is not monotonous, pitch is high.

 Speed: patient speaks normally.

 Spontaneity: patient respond spontaneously.

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 Manner: the manner of speaking was informal.

 Reaction of time: the reaction of time was normal.

DISORDER IN CONTENT OF THOUGHT

a) Delusions:

 Persecutory delusions:

Patient have fixed false belief that she is being deliberately interfered with, discriminated

against, threatened or otherwise mistreated.

Nurse: Kya aapko aisa lagta hai k koi aapko marna ya nuksaan pahuchana chahta hai?

Patient: Han,mere Ghar wale.

Outcome: persecutory delusions are present.

 Delusions of reference:

Patient have fixed false beliefs that other are talking about her and referring to her.

Nurse: kabhi aapko aisa lagta hai k aapke bare me log baat kar rhe ho?

Patient:Nai

Outcome: delusions of reference are absent

 Delusions of influence or passivity: patient does not have fixed false beliefs that enemies

are influencing her in many ways or someone else is controlling.

Nurse: Kya aapko lagta hai k kisi ne aapke shareer or vichaar ko vas me kiya hai?

Patient: No, I do not think so.

Outcome: delusion of influence is absent.

 Delusion of sin or guilt: patient does not have fixed false beliefs that she has committed

unforgivable sin.

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Nurse: Kya aapko lagta hai k aapne pichlle janam me aisa kaam kiya hai jiske karan aapke

saath yeh sab ho raha hai?

Patient: Rarely.

Outcome: delusion of sin or guilt are absent.

 Hypochondrial delusions: patient does not have a fixed false beliefs or conviction

concerning the presence of disease.

Nurse: Kya aapko aisa lagta hai k aapko koi shareerak bimari hai jo theek nhi ho sakti?

Patient: No

Outcome: Hypochondrial delusions are absent.

 Delusion of grandeur: patient have no fixed false beliefs of great power or wealth.

Nurse: Kya appko aisa lagta hai k aap bahut taakatvaar hai ya paise wale hai?

Patient: lgne ki kya bat hai mai hun.

Outcome: Delusion of grandeur is Present.

 Nihilistic delusions:

Derealization: patient does not have fixed false beliefs that all the things in the environment are

changed or destroyed.

Nurse: Kya aapko aisa lagta hai k sari duniya khatam ho gyi?

Patient: I think that world would come to an end.

Outcome: Derealization is present.

Depersonalization: patient does not have fixed false beliefs that she herself is changed or

destroyed.

Nurse: Kya aapko aisa lagta hai k aapme koi cheej bddl or khatam ho gyi ho?

Patient: Yes

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Outcome: Depersonalization is present.

b) Obsessions: patient does not have persistent occurrence of thoughts, ideas, images in her

mind.

Nurse: Aapko lagta hai k aapke mnn me koi vichaar baar baar aata hai?

Patient: Yes

Outcome: obsessions is present.

c) Phobia: patient does not have persistent excessive irrational fear about a real object.

Nurse: Kya aapko kisi insaan ya is jagah se dar lagta hai?

Patient: No, I am not afraid of anybody.

Outcome: Phobia is absent.

d) Preoccupation: patient does not remain preoccupied with the thoughts around a particular

idea.

Outcome: preoccupation is absent.

e) Phantasy or fantasy: patient does not have imaginary or imagination that is unrecognized

or unreal.

Outcome: fantasy was absent.

DISORDER OF RATE OF SPEECH:

 Pressure of speech: the rate of speech was normal but some time it is fast that one cannot

understand it.

Outcome: pressure of speech was absent.

 Flight of ideas: patient talk regarding a particular subject matter and does not switch to

another unless it was not asked.

Outcome: Flights of ideas are absent.

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 Retardation:

there is no slowing of speech.

Outcome: retardation is absent.

 Mutism:

patient answer appropriately and is not mute.

Outcome: mutism is absent.

 Aphonia:

patient does not speak in whispering.

Outcome: aphonia is absent.

 Thought block:

patient does not have sudden stoppage of thinking process altogether.

Outcome: thought block is absent.

 Clang association:

patient does not say rhythmic words which have sounds same but do not have meaningful

conceptual relationship i.e. hang, bang, tang, sang.

Outcome: clang association is absent.

DISORDER OF PERCEPTION

a) Illusion: patient does not misinterpret the stimuli or wrong meaning to the object.

Nurse: Aapke pass yeh table par kya rakha hai?

Patient:Pen

Outcome: illusion is absent.

 Macropsia: patient does not interpret the objects in increased size.

Outcome: macropsia is absent.

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 Micropsia: patient does not interpret the objects in decreased size.

Outcome: micropsia is absent.

b) Hallucinations:

 Auditory hallucinations: patient does not hear the voices in the absence of auditory

stimuli.

Nurse: Jab aap akele hote ho to aapko koi aawajein sunai deti hai?

Patient: nhi

Outcome: auditory hallucinations are absent.

 Visual hallucinations: patient see a person in the absence of visual stimuli.

Nurse: Jab aap akele hote ho to aapko koi dikhaayi deta hai?

Patient: No, I did not see anybody

Outcome: Visual hallucinations are absent.

 Olfactory hallucinations: patient did not smell anything particularly in the absence of

olfactory stimuli.

Nurse: Jab aap akele hote ho to aako koi smell to nhi aati?

Patient: No

Outcome: olfactory hallucinations are absent.

 Gustatory hallucinations: patient did not have any peculiar taste when there is nothing in

mouth.

Nurse: Kya aapke mooh me koi ajeeb sa swaad aata hai?

Patient: No

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Outcome: gustatory hallucinations are absent.

 Tactile hallucinations: patient have tactile sensations in the absence of stimuli.

Nurse: aapko aisa lagta hai k aapke sharer pe koi cheej raing rahi hai?

Patient: No

Outcome: tactile hallucinations are present.

 Hypnopepnic hallucinations: patient does not have false sensory perception occurring

midway between sleep and awakening.

Outcome: hypnopepnic hallucinations are absent.

 Hypnogagic hallucinations: patient does not have false sensory perception between falling

asleep & being awake.

Outcome: hypnogagic hallucinations are absent.

 Lilliputian hallucination: patient does not have perception of objects reduced in size in

absence of stimuli.

Outcome: Lilliputian hallucination is absent.

 Kinesthetic hallucinations: patient does not have any amputated limb.

Outcome: kinesthetic hallucinations are absent.

 Autoscopic hallucinations: patient does not have sensory experience of herself.

Outcome: autoscopic is absent.

 Extracampine hallucinations: patient does not have sensory experience of stimulus

beyond the sensory field.

Outcome: extracampine is absent.

DISTURBANCE IN AFFECT

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a) Inappropriate or incongruent affect: patient does not have disharmony of affect and

ideation.

Outcome: incongruent affect is absent.

b) Pleasurable affect:

 Euphoria: patient does not have feeling of emotional and physical well-being.

Outcome: euphoria is absent.

 Elation: patient show effect of gladness, sometime have self-confidence, air of enjoyment.

Patient’s major activities are increased.

Outcome: elation is Present.

 Exaltation: patient does not have intense feeling of grandiosity.

Outcome: exaltation is absent.

 Ectasy: patient does not have feeling of extreme joy.

Outcome: ectasy is absent.

c) Unpleasurable affect:

 Depression: patient has feelings of sadness.

Outcome: depression is Present.

 Grief or mourning: patient has sadness related to loss of her family.

Outcome: Grief or mourning is present.

d) Another affect:

 Anxiety: patient show feeling of apprehension.

Outcome: anxiety is absent.

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 Fear: patient does not be afraid/anxiety due to consciously recognized realistic danger.

Outcome: fear is absent.

 Agitation: patient have anxiety associated with severe motor restlessness.

Outcome: agitation is present.

 Panic: patient does not have acute level of anxiety associated with personality

disorganizations.

Outcome: panic is absent.

 Free floating anxiety: patient have anxiety of unknown cause.

Outcome: free floating anxiety is present.

 Apathy: patient does not have dull emotional associated with attachment of indifference.

Outcome: apathy is absent.

 Aggression: patient does not have forceful goal directed action verbal or physical.

Outcome: aggression is absent.

 Mood swings: patient does not show oscillation between periods of euphoria and

depression.

Outcome: mood swings are absent.

 Emotional liability: patient does not show rapid change in emotional tone to tears or

laughter with slight or even no provocation.

Outcome: emotional liability is absent.

MEMORY:

 Immediate:

Nurse: Mein 5 naam bolungi…. Pen, pencil, copy, rubber, scale aap mere piche bolna

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Patient: pen, pencil. Scale, rubber, copy

Outcome: immediate memory was intact.

 Recent:

Nurse: Raat khaane me kya khaya?

Patient: Chapati dal

Outcome: recent memory is intact.

 Remote:

Nurse: aapke school ka naam kya haal hai?

Patient: Xavier School

Outcome: remote memory is intact.

DISORDER OF MEMORY:

 Amnesia: patient cannot recall many events fully.

Outcome: amnesia is absent.

 Paramnesia: there is falsification of memory by distortion of recall.

Outcome: paramnesia is absent.

 Anterograde amnesia: patient is not able to recall recent events.

Outcome: anterograde amnesia is present.

 Retrograde amnesia: patient is not able to recall past events fully.

Outcome: retrograde amnesia is present.

 Confabulation: patient does not fill the gaps in memory by imaginary or untrue experiences

unconsciously.

Outcome: confabulation is absent.

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 Dija vu: patient does not experience of seeing with the feeling that one has seen it before

but does not know when or where.

Outcome: dija vu is absent.

 .Hyperamnesia: patient does not have exaggerated degree of retention and recall.

Outcome: hyperamnesia is absent.

Orientation:

 Time:

Nurse: Abhi kitna time hua hai?

Patient:12 o’clock.

Outcome: patient is oriented to time.

 Place:

Nurse: iss samay aap kaha par ho?

Patient: In hospital

Outcome: patient is oriented to place.

 Person:

Nurse: Mein kaun hoon?

Patient: Student

Outcome: patient is oriented to person.

 Insight

Nurse: Aapko kya bimaari hai?

Patient: OCD.

Outcome: insight is present

 Concentration:

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Nurse: Aap 100 me se 5 baar 7 minus kar k bttayein?

Patient: Its 93, 86, 79, 77, 70

Outcome: concentration is Good.

 Abstract thinking:

Nurse: Table or Chair mein kya frrk hai?

Patient: We sit on Chair and we keep things on table.

Outcome: abstract thinking is good.

 Judgment:

Nurse: Agar raaste mein koi letter mile jispe pta likha ho to aap kya krogge?

Patient: post kr dugi.

Outcome: judgement is good.

 Intelligence:

Nurse: Bharat ki rajdhani kaun si hai?

Patient: Delhi

Nurse: Bharat ka pardhan mantri kaun hai?

Patient: Narendara Modi

Outcome: patient has good intelligence level.

 Sleep:

Patient’s sleep has decreased and feels difficult to fall asleep at night.

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Insomnia is present.

 Episodic disturbance: patient does not have any attacks of epilepsy, hysterical fits,

impulsiveness, aggression or destructive.

 General observation:

Repetitive urge

Delusion of persecution

Patient has decreased sleep.

Vital signs are normal.

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