THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[18-09-2025 21.01] PPM 1: Instructions for the patient advocate
Please keep your patient's identity hidden at all times from all participants here.
Please describe your patient's sequence of events that led to the current problems. Please begin the sequence of events from the time your patient had absolutely no problems at all.
Please describe your patient's hourly routine over 24 hours when he was perfectly alright
Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life
Please mention specifically which part of the patient's hourly routine was disrupted
What are the patient's current requirements from us like if we had to give him a single medicine which problem would they prefer it to address?
Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here:
Chief complaint- Difficulty in getting sleep since 1-year ,2months
History of presenting illness- The patient was in his usual state of health 14 months
back when he started having difficulty in sleeping. Patient reports the cycles of insomnia
being triggered by a dog barking continuously by his window which caused disturbances
hence triggering the cycle. Following which the patient switched room and moved to a
silent spot which had no apparent disturbances but the insomnia still persisted. The
patient reports difficulty in sleep onset and maintenance and consolidation and duration
of sleep. Sleep onset often requires more than 40-45 mins and there are multiple night
time awakening with each sleep cycle generally not exceeding 45 mins. Patient wakes
up feeling tired and unfresh in the morning. There is also extreme day time drowsiness
and tiredness and inability to initiate sleep cycle even during daytime.
H/O low moods
H/O reduced attention span
H/O reduced memory
H/O reduced bowel movements
No H/O palpitations
No H/O cough
No H/O feeling breathless, snoring, witnessed apnea, gasping for air or PND
No H/O caffeine intake, alcoholism or stimulant intake
No H/O weight gain, restlessness or appetite change
No H/O seizures, dementia or headaches.
No H/O hyperactivity or reduced scholastic performance
Past medical History-
No H/O thyroid disorders, Diabetes mellitus, Asthma, migraines, hypertension, seizures
or cardiac or renal disorders.
No psychiatric conditions diagnosed yet
No H/O of Obstructive sleep apnea or parasomnias.
Personal history:
Disturbed sleep
Normal appetite and mixed diet
Bowel habits disturbed- constipated whenever sleep deprived.
Bladder habits normal
No Habits or stimulant intake.
Family History-
No H/O of sleep disorders in family.
No H/O of any significant disorder running in family.
General physical Examination:
Patient is conscious Co-operative well oriented to time place and person, well built and
well nourished.
Pallor icterus cyanosis clubbing lymphadenopathy and oedema are all absent.
Vitals:
Pulse –70 bpm regular normal volume normal character no delays in peripheral
pulsations normal tension and condition of vessel wall normal
Blood pressure-118/20 mm of Hg at right arm in sitting position
Respiratory rate- 16 Cycle per minute, abdominothoracic
Temperature- 98°F
Systemic examination:
Respiratory system: - Trachea central, normal chest shape and symmetry, bilateral
equal air, entry normal vesicular breath sounds heard over all lung fields; no added
sounds.
Cardiovascular system: - Normal precordium, apex normal in position and character,
no palpable thrills or parasternal heave, heart borders not shifted, JVP not elevated, S1
and S2 heard, no murmurs.
Per abdomen: - Soft, non tender, not distended, umbilicus central and inverted, no
palpable organomegaly or any visible veins, pulsations or peristalsis, all quadrants
move equally with respiration.
Central nervous system: - Higher mental function intact, no focal neurological deficit.
Mental status examination:
Consciousness: - alert and aware
General Appearance and behavior: -
Rapport – could be established
Appearance – Satisfactory and appropriate of situation.
Eye to eye contact - was maintained.
Facial expression and posture- Neutral
Manner of relating - Slightly anxious.
Motor behavior - Within normal limits
Speech: Normal and satisfactory in terms of volume, tempo, tone, reaction time, elevance and is coherent.
Mood and affect: Stable mood and introvert, non pervasive low mood for majority of
times
Cognitive status:
Attention: - Aroused and maintained
Concertation: - maintained
Memory: - Short term intact, long term and intermediate reported to be intact
General information and intelligence: - Comprehension proper and normal IQ.
Abstract ability: - Satisfactory
Thought and perception: Reports to have multiple pessimistic and negative thoughts
with regards to self, future and world. OCPD++, overvalued ideas, unsettling standards,
death wishes, ideas of worthlessness, hopelessness, helplessness, non pervasive low
mood, and pre morbidly sensitive to criticisms, excessive preoccupation with regards to
self-image and rumination. No hallucinations and Illusions.
Summary of Psychological assessment: -
1. NEO-FFI: Neuroticism very high, Extraversion very low, agreeableness low.
2. YSQ-R: Multiple maladaptive schemas noted as presented below.
3. GHQ: Clinically significant psychological distress.
4. ISI: Clinical insomnia of moderate severity.
5. DASS: Severe stress, extremely severe depression and severe anxiety
[06-10-2025 19.40] PPM 3: @PPM1 our advocate managed to take a detailed case report sir. The PRO goals for this group would be to set his sleep schedule on track and help elevate mood.. as per my understanding
[06-10-2025 19.43] PPM 1: Very well written 👏👏
[06-10-2025 19.45] PPM 4: What is severe stress, extremely severe depression and severe stress? What is the root cause please?
[06-10-2025 19.47] PPM 3: @PA, Please ask the patient and let us know
[06-10-2025 19.52] PA: Apparently the patient is hiding a lot of things give me a day more to dig more into it but what I could understand so far was that he's very worried about self image and future self and gets disturbed psychologically very easily has multiple thoughts running in his head. He is an overthinker and generally tends to overanalyze situations and circumstances. DASS is an psychological assessment tool conducted by a licensed clinical psychologist in his area and reports showed high anxiety stress and depression.
[06-10-2025 20.08] PPM 1: Should we change the title of the group to insomnia depression Karnataka PaJR?
[06-10-2025 20.10] PA: As you feel right sir🙏 I do find some level of subclinical depressive tendencies in him but he says psychiatrists didn't diagnose him with depression.
[06-10-2025 20.15] PPM 4: That means he diagnosed himself with depression and the psychiatrists did not confirm his self diagnosis. Strange!!! Not a single psychiatrist but multiple psychiatrists. This is not something that is clear.
[06-10-2025 20.17] PPM 1: Alright I was going by his DASS score but it's specificity is not High
[06-10-2025 20.18] PPM 1: In my reading of his case report it appears that the psychiatry department may have run a Dass score on him that apparently turned out high at that moment.
[06-10-2025 20.23] PA: Yes sir Exactly! it's not that he considers himself to have depression but a clinical psychologist conducted few psychological assessment on him to initiate appropriate therapy for his sleep issues one of which was DASS and has more of importance in how someone is as a person rather than clinical diagnosis.
Also I'm currently writing his therapy history and medications he took and how much each helped will send that too shortly.
[06-10-2025 20.26] PPM 1: All our scoring questionnaires are true only for that point of time when taken but with time the significance of those scores fall as all human cognition is dynamic and keeps changing.
[06-10-2025 20.27] PA: Exactly my point sir 🙏
[06-10-2025 20.27] PPM 1: I'll not add depression but just add Karnataka
[06-10-2025 20.28] PA: Sure sir👍
[06-10-2025 20.30] PPM 1: To quote:
The patient was in his usual state of health 14 months
back when he started having difficulty in sleeping.
👆 Please tell us more about his usual state of health before that.
Describe your patient's hourly routine over 24 hours when he was perfectly alright
Next please describe what happened to his hourly 24 hour routine once the disease took hold on his life
Please mention specifically which part of the patient's hourly routine was disrupted
Please post the patient's clinical photo of abdomen and arm muscle as demonstrated below in the image here:
[06-10-2025 20.32] PA: Sure sir I'll make a document of the same and send by tomorrow
No comments:
Post a Comment