1. M.Zubair is a 26-year-old gentleman, who dropped out of studies in 8th
grade, is working as a shopkeeper and comes from a village near Murree
Two elder brothers supporting him from either side brought him to the
OPD while he was having an intense generalized jerky movements, for
less than a minute. He remained conscious throughout and recovered
spontaneously.
He has been in this state for the last three months.
Features of an epileptic fit were excluded.
Further inquiry revealed that the onset had a temporal relation with
the date fixed for this marriage.
Personal history reflected a childhood deprived of a father figure (who
died when he was 3 of intestinal cancer) and psychosexual difficulties.
He carries masturbatory guilt and anxiety centered around his
performance on the day of marriage.
Premorbidly he is described as a sensitive, shy and solitary individual
who never had many friends and doesn't take responsibility around the
house. Frequent change of jobs shows his low threshold to stress.

2. Mental State Examination shows 'la
belle indifference' with a normal speech
and a euthymic mood.
He is diagnosed to have a conversion
disorder.

3. Parveen Begum is a 35-year-old lady, who is married to a construction
worker based in Saudia Arabia at present for the last 3 years
She is the mother of 2 sons and 2 daughters. She comes from
Kohat where she stays with her brother-in-law and his family.
One fine day she woke up to complete loss of vision and was
taken to a nearby hospital. The physician saw no abnormality and
referred her to a psychiatrist.
Her vision returned in a couple of days. 2 months later she
developed episodes of stiffening of the body followed by a
phase of unresponsiveness and then irrelevant talk and agitation.
Each episode lasted few minutes to few hours. There were no
epileptic features.
Accompanying these symptoms were those of decreased sleep,
appetite and easy fatigability with a low mood persistent
throughout the day.

4. 6 years ago a similar situation arose when her husband left for
Saudia Arabia and she recovered in a week's time.
She has 4 children and her husband is a carefree and
irresponsible individual who mostly spends money on himself and
seldom sends it home. Her 15-year-old son, Imran, is nowadays
exhibiting school truancy and smoking with friends. He stays out
of home for days without informing and doesn't take
responsibility.
Premorbidly she is quiet, submissive and adaptable person who
doesn't share her feelings with anyone. She has a moderately
religious inclination and wants her children educated and well
placed in the society.

5. On mental state examination, she was
uncooperative and had low mood as well as
psychomotor retardation. Her thinking was
abstract and she lacked insight into her
illness.
She was diagnosed to have conversion fits
with underlying depressive illness.

6. Shakeela Bibi is a 19-year-old girl, single and comes
from Fateh Jang, Attock.
She was brought by her parents with complaints of
difficulty in breathing, dizziness and decreased sleep
for the last month.
They had been to various physicians and she had
taken several medicines without improvement. In the
last week she had hardly slept and recited na'ats all
night.

7. A possible precipitant is a proposal from within family that came
for her a month ago and is being considered. She belongs to a
fairly religious household where decisions of marriage are taken
by the head of the family.
Her personal history has highlighted a confidential affair with a
middle-aged man belonging to the same neighborhood with whom
she is having sexual relations. 6 months ago the guy's family
asked her hand in marriage but her father gave a final word of
refusal. Following this refusal she had similar symptoms.
Premorbidly she is an outgoing, friendly girl having a short
temper and an element of stubborn attitude. She engages in a
variety of hobbies such as music, poetry and painting.

8. Her mental state had important findings. Initial part of the
interview had relevant answers from her but when she was
specifically involved in the topic of marriage and her affair, she
would repeatedly go into a trance-like state and start lipsmacking and adopting postures of sexual nature.
Further pressure made her have episodes of breathlessness.
She also kept wiping her face with her hand. Her thinking was
abstract and insight was lacking.
Her diagnosis is that of a dissociative state.

9. Farzana Afzal is a 20-year-old lady, who is single and a resident of Murree.
Her parents, brought her in in an uncontainable state in which she was
running about singing songs, commenting on everything she noticed in
the environment in a disinhibited manner. and laughing as well as crying
in the same sentence,.
She had 15 days history of this behavior and had not slept for the last
3 days. A stress factor prior to this development was the worsening of
her mother's condition who happens to be a patient of chronic liver
disease. She is admitted in the same hospital for the last month and
Farzana was taking care of her.
Farzana is engaged to her maternal aunt's eldest son. The ceremony
took place a year and a half ago and he has gone to Dubai a year back
for employment. Before leaving he took advantage of her being alone in
the house once and convinced her to have intercourse. She hates him
now for all of this. She did not tell her mom later on but the guilt slowly
built up in her. Now her mother had not many days to live.

10. Premorbidly she is a confident, caring and responsible individual
who prays regularly. She is sensitive to criticism and her mood
remains stable. She has the habit of confiding everything to her
mother.
On mental state examination, eye contact and rapport could not
be established. Throughout the interview, she was rocking to
and fro, gesturing as if seeing spirits around her, singing songs
the content of which was fear of God and of this world and selfcurse. Her mood was variable and she had multiple crying
episodes. She was unable to recognize family members. Physical
Examination was unremarkable.
She was diagnosed to be in a dissociative state.

11. Faiza Aziz is a 20-year-old girl from Rawalpindi. She is illiterate,
single and the youngest of 5 siblings.
Her father owns a PCO call point and mother is a house-wife.
Faiza and her elder sister have moderate learning disability and
are dependent on their mother.
She was brought to the OPD by her mother with a 5 month
gradual decline of interest in the environment and incline in selfconsciousness as well as easy fatigability. For the last month she
has developed jerky movements of the upper half of the body of
varying intensity lasting few minutes to few hours. There are no
epileptic features and no precipitating factor is identifiable.

12. When she was 4 years of age, she contracted polio followed by
viral meningitis. Both these conditions have left her both
physically and mentally disabled on top of the predisposing
genetic factor. She had a pampered and overprotected
environment as a result of which she has poor social skills.
On mental state examination, she has low mood, speaks in single
sentences only, low self-esteem together with preoccupation
about her cousins being better than herself in appearance.
There are no perceptual abnormalities and she retains insight.
She was diagnosed as a case of conversion with underlying
depression.