A 28-year-old unmarried male from low socioeconomic status came to the hospital for consultation of psychiatric problems along with his caregivers. There was no past psychiatric or medical history or family history of mental illness. The presenting complaints were unprovoked aggressive outbursts, poor self-care, disorganized behavior and self-mutilating behaviors for last 4 years. Physical examination revealed old burnt scar over the forehead, fused ear lobules bilaterally and polydactyly in right upper limb and crush injury of left thumb and index finger. On mental status examination, patient was unkempt, disheveled with poor eye contact. He was irritable and guarded. No thought and the perceptual abnormality were elicited at the time of admission. He was diagnosed as "undifferentiated schizophrenia" according to International Classification of Disease-10th version.
Patient was advised to take in-patient psychiatric care on the same day of consultation. He remained aggressive, disorganized and on two occasions, he tried to crush his left index finger and thumb by hammering it with a stone. He was started on electro convulsive therapy (ECT) sessions considering aggressive outburst and self-mutilating behavior. During pre-ECT evaluation "computed tomography" scan of the head revealed "Grade II CSP" [Refer Figure 1]. Along with ECT, patient also received oral chlorpromazine 600 mg/day, which was hiked gradually over 2 weeks.
Patient started showing improvement in aggressive and self-mutilating behavior. On mental status examination, he reported that he became angry for no apparent reason, following which he would start hammering his fingers with stones. He also reported delusion of persecution against parents. He received nine sessions of ECT with minimal cognitive impairment and was continued on oral chlorpromazine 600 mg/day without any side effects. There was improvement in self-mutilating behavior, disorganized behavior and poor self-care, but occasional aggressive outbursts persisted. He was discharged on chlorpromazine 600 mg/day.