BIOPSYCHOSOCIAL HISTORY OF A 35/F PRESENTED WITH PAINFUL SKIN LESIONS

BIOPSYCHOSOCIAL HISTORY OF 35 F PRESENTED WITH PAINFUL SKIN LESIONS OVER BOTH HANDS AND LEGS LATER DIAGNOSED AS PYODERMA GANGRENOSUM

Case blog link:https://asjad24.blogspot.com/2023/09/note-following-e-log-aims-at-discussing.html

MEDICAL HISTORY - H/O Rheumatoid Arthritis since 16years, non compliant to medication with deformities of both hands and legs. 

PSYCHOLOGICAL HISTORY 

Before Disease :

Patient was brought up in a rural background without having proper facilities. Father was farmer and they always had financial constraints due to which she always felt herself inferior to peers.  Frequent quarrels at home always made family environment not too healthy. 

As she wasn't educated due to financial constraints and social background; she always had fear of her upcoming future. 

She got married at an early age of 18 years with a child at same age which overburdened her shoulder. Her family was supportive with husband and 3 children. She started working as daily wage worker (carrying soil over head). She was cheerfully enjoying her marital life. 

After disease 

After 2 years she got pain in her joints and was diagnosed with Rheumatoid Arthritis but due to financial crisis and social ignorance she stopped taking medication which slowly progressed into deformities but still it neither affected her mental health nor her functional abilities. She was earning her living and doing all the household chores without any disability.

2 months back she got painful ulceration and now provisionally diagnosed as Pyoderma Gangrenosum. 

After which she feels too much low with depression. She has Ill appearance with Marked cachexia and She has low self esteem due to ugly ulceration. She talks in low voice with anxious look. 

She stopped interacting much with neighbours but she interacts normally with her husband and children. 

She prefers social seclusion.

Coping strategies : She prefers company of her husband and children only.

Mental state : Cooperative

Speech : decrease rate and volume

Addiction : H/o toddy drink once in a month 

No h/o alcohol intake, smoking and substance abuse

No signs of perceptual disturbances. 

No suicidal thoughts

No h/o medication for psychological disorders. 

BIOLOGICAL HISTORY 

Family history : No h/o similar complaints in other family members 

Diet : Before disease- appetite was normal 

After disease - appetite significantly reduced

She takes small quantity of rice with some amount of curry in all her 3 meals. Her calorie requirement per day - 1500kcal

She eats 3 and 1/2 cup rice and 2 bowls of curry in a day 

Her daily calorie intake = 669 kcal

Calorie deficit = 831 kcal 

Required protein per day = 56 gm

Amount consumed 20gms 

Protein deficit = 36gms

BMI - 11.6kg/m2

Status : Severely undernourished

Sleep : Before disease : 6 hours continuous sound sleep during night. 

After disease - Decreased intermittent sleep as she gets up multiple times during sleep . Taking 5-6 hours sleep but not continuous and not sound sleep. 

Physical traumas - No h/o significant accidents or trauma. But minor abrasions over skin is common due to her soil carrying occupation. 

Lifestyle : Before disease : she used wake up around 6 in the morning, prepare breakfast for for her family. Completes her household chores and go for work. Around 6pm she used to return from work and prepare dinner and do household chores take dinner and goes to bed by 10pm

After disease : she is mostly staying on bed and going to washroom with support of husband. 

She can't even dress up herself due to intense weakness for that also she's taking support. 

She is not able to do even minor household chores like (washing utensil) 

SOCIAL HISTORY 

Living situation : She lives with her husband and 3 children 

Nuclear family 

Occupation : Daily wager but not going for work since 2 months because of crippling disease. 

Occupational hazards : continuous dust and pollution 

Prone to minor abrasions

No educational history 

Socio economic status : Upper lower Class (IV) according to kuppuswamy scale 2018

Pucca house with two bedrooms with separate kitchen. 

Groundwater for drinking. 

Attached toilet and bathroom 

Support system : stable family support from husband and children

Stressor and life events : painful ulceration since 2 months which deprived her from carrying out normal daily activities.