One day he went and sat in the company Boss’s chair claiming that God had taken over this company and has entrusted him with leading it to glory. He even shouted and gave orders to fire its actual boss. Thus, he lost his job. His family back home was informed and was brought back to Cochin his home. Back home he continued to be highly irritable, pacing up and down the room, picking up quarrels and fights with others. He would go outside and buy new clothes every day, buy grocery items in excess of what was needed. He would visit neighbouring and relatives houses very frequently, would talk to strangers about various matters without stopping. He also began to use alcohol in excess. He used to be only an occasional drinker before.

My Client was psychoeducated regarding his illness, a definitive management plan was worked out with. He was started on Pharmacotherapy – anti-anxiety medicines and Psychotherapy (CBT for Anxiety). After 4 weeks – up titration of medicines to therapeutic level & 4 CBT sessions, 75% improvement were noted. HAM-A: 18. But still he had panic attacks in between although the frequency & intensity of the episodes were very much reduced. With further refinement of treatment, after 4 more weeks, he was 95% better & after about 3 months, 100% improvement & full recovery was noted. No side effects to medicines were reported.

He would have repeated thoughts that his body if full of germs and is contaminated. Hence, he would go and bath. Before beginning to bath he would find that the floor of bathroom is unclean and hence have to clean it first very thoroughly. Then he would clean his bucket and mug. He would even clean his soap to make sure that its clean! Then he would bath very meticulously for about 1 hour, being very careful to wash each and every part of his body. He would waste a lot of water and his parents would scold him for that. After bathing, when he closes the tap, he would feel that his hands have again become contaminated and he would have to again wash the tap and his hands. Sometimes after coming out of the bathroom after a marathon bathing, he would feel that his feet are still contaminated and not washed properly and so he would have to again go back and wash it properly all over again. He used to bath only once a day. But now he was compelled to bath 3 times a day.

Along with his alcohol use he also used to smoke cigarettes- nicotine and cannabis. Initially he would smoke about 2-3 cigarettes occasionally, but slowly after a year he was addicted to it and began to smoke about 15-20 cigarettes per day. He had intense craving for nicotine, more than that he had for alcohol. He also began to use cannabis initially along with friends for fun, but later on a regular basis alone. Whenever he smoked cannabis, he had this dreamy state where he could hear voices which nobody else could and see images which  nobody else could. He was frightened and became paranoid. A couple of times he had fight with his friends accusing them of spying on him when he was high on weed. After smoking cannabis his eyes would become red and muddy and he would have high appetite and would become irritable and frequently quarrelled with his friends. He began to be suspicious of his girlfriend, whom he accused of having relationship with others. Once he beat his girl friend very badly that she had to be hospitalized. Once in a Bar, under the influence of alcohol he had a fight with locals and caused damage to the property. A legal case was filed against him. He was suspended from college and later became a college drop out.