Notes

Write a noteThere was significant family history of alcohol dependence in father. There was no history of fever, head injury, seizure or attention deficit hyperactive disorder. There was no history of stress, tension or depressive thoughts. The toluene based substance abuse began gradually from 5ml/day and picked up to 20 ml each per day gradually over a span of 1 year which remained relatively stable during the presentation to the outpatient.

During the phase of withdrawal, there was coprolalia with assaultive and abusive behaviour, increasing fights, maladaptive behaviour and headache. He further added that the alcohol abuse began when the patient’s friends circle changed to include more people of higher age group. The patient used to steal money from his house in order to fetch the abused substance. The child was a school drop out as he faced inability to concentrate and low scores at school.

Moreover, he often was involved in assaultive behaviour at school. The child abused glue more than the alcohol due to its easy availability. A progressively increasing tendency of violence, disorientation, restlessness was noticed by the mother and his family in the form of anger outbursts, abusive and assaultive behaviour in the last two months during which alcohol intake was accelerated. The child presented to the clinic in a state of withdrawal since the mother had not let the child consume any substances since the last 2 days.

The central nervous examination exhibited symptoms of withdrawal including combativeness, irritability, aggressiveness, an impaired long term recall on minimental status examination with a score of 20. IQ assessment was done using Seguin Form board, Malin’s intelligence scale for Indian child. The test score indicated to a below average intelligence in the child. The areas of behaviour control, problem solving, communication, affective response scored low.

Cranial nerve examination showed normal pupillary reflexes and mild pallor of both optic discs on fundus examination, hearing loss of sensorineural type on both sides of moderate type. The child had a normal motor examination and sensory examination and flexor plantar response. The vitamin B12 levels were low 12pg/dl and liver function tests had transaminases 3 times the upper limit. A grade I fatty liver was noticed on abdominal sonogram.

Renal Function tests, serum electrolyte, glucose, serologic tests for syphilis, urinalysis and chest radiograph were normal. Urine EEG, electromyogram, nerve conduction studies and electro retinogram was found to be normal. A family based approach and person centered general counselling was adopted to help in recognizing and reducing craving and avoiding high risk situations. The general debilitation of the adolescent was improved during the process of detoxification and high energy feeds were instituted after correcting the vitamin and metabolic disturbances.

Engagement in healthy was promoted and periodic rewards for abstaining were offered to the child. Alcohol dependence in father was also addressed and was included in the treatment. The child was discharged from the hospital uneventfully. The alcohol intake decreased during the subsequent follow-up visits.

The child had a regular follow up with the clinic for a span of 1 year during which general condition of the child showed improvement however then subsequently dropped out.
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