Case Studies

He had only a daughter, who was married, she had accompanied the patient. She was living with the patient along with her husband & children. He had lost his wife three years ago. About two & half years ago he started having severe pain in the abdomen, nausea, anorexia, loss of weight, diarrhea with mucus in the stools. Upper abdominal sonography revealed mild hepatomegaly & doughtful abscess in the liver. He was treated with metronidazole & antibiotics. Aspiration of liver abscess was attempted but there was hardly any aspirate. The patient only had partial relief lasting for few days. As he became progressively worse, he could not go to work infact he had not been to work for practically one & half years. The patient was told that he had neglected certain religious rituals after the death of his wife. He went to his native village in south India to perform those rituals.

While returning, his daughter stayed back with her children & he came with his son-in-law. In the overcrowded train, in the hot & humid weather in the last week of the month of May, he was very uncomfortable. He could not move about, did not feel eating anything & started vomiting. By the time he reached Mumbai, he was totally exhausted & tired & had no strength left. He was directly taken to a small nursing home because there was nobody to look after him at home. In the nursing home it was observed that he had pain & tenderness in the right inguinal region & that he was mildly dehydrated. It was decided to perform emergency appendicectomy.

On psychiatric evaluation, he was agitated, uncooperative & was not willing for any treatment. He wanted to be left alone to his destiny & asked for some poison to bring an early end to his suffering. His daughter informed that he had taken overdose of medicines few times & said that he was a burden to everybody & was fade with life. He hardly ever ventured out of the house & spoke only in monosyllables. He did not like any visitors & was irritated by any noise. He did not get any sleep at all. He constantly shouted at his grandchild to switch of the T.V. He had lost lot of weight.

A diagnosis of Major Depressive Disorder was made & he was prescribed Prothiaden 25 mg. b.i.d. He was informed that he might have dryness of mouth, postural giddiness & constipation for few days. The patient retorted why the doctor was knowingly giving him medicines which will make him worse, as it is he had all the three complaints. He was explained that this side effect will only be temporary & soon he will start feeling better. He would have take to frequent sips of water to counter dryness, should get up gradually to avoid postural giddiness & should take Cremaffin liquid for constipation. At follow up after one week, he was looking little better, had started eating. His daughter had noticed improvement too. But the patient insisted that he was still the same & that he had only started sleeping well & could eat a little without nausea & vomiting. The dose was increased to Prothiaden 25 mg. t.d.s. By the end of three weeks he was much better & had put on 4 kg weight. The dose was increased to Prothiaden 100 mg per day, 25 mg in morning & 75 mg at night after dinner. He started going to work six weeks after starting the treatment. One of his close colleagues was very happy to see him back at work & confided in him that he had thought he would not recover & would succumb to his illness. He also told that he had also prayed to Lord Ayappa for his recovery.

When seen at follow after 4 months, he was much better, had no complaints & was planning a pilgrimage to Lord Ayappa at Sabarimala. He was told that he would have to continue medicines for another four to six months to consolidate the improvement & to prevent relapse.