GEMS AND THE ISI

Mr. Laxmipati, a 42 year old male bachelor, Geologist by profession was brought to the emergency bt the police. He was taken into custody after he had beaten up a beggar. According to Mr. Laxmipati the Beggar was an ISI agent in disguise. But the police claimed that the beggar had been inhabiting the area for years and that there was no chance of him being an ISI agent. The interview session that followed was marked by verbal outbursts, Speech content was seemingly unrelated except for an oft repeated statement about a conspiracy by ISI to ostracize him. He was not ready to share why they were after him. On confronting Mr. Laxmipati with the truth about the beggar he grew disruptive. at this point the interview had to be adjourned. He was admitted and put on injectable antipsychotics and sedatives. (Sleep inducing medication)

Next day Mr. Laxmipati was much more approachable and a cord was struck easily. He went on to say that he had discovered a rich deposit of gem stones in his native village. He had all ready informed the Shri Rajiv Gandhi, Prime Minister of India, who he claimed was an old friend. (This incident is 9 years after Shri Rajiv Gandhi passed away). He went on to say that Shri Gandhi had asked him to maintain secrecy about the discovery, but unfortunately it was leaked by Shri Gandhi's Personal Secreatary. After this the ISI agents had been following him and keeping watch of his whereabouts. All this they were doing to locate the deposit of precious stones. Fortunately for him he had attained the special powers to identify the real identity and motives of people he met. This power he acquired by sitting in the rays emanated by the precious stones. Thus he could make out who the beggar really was. Begging on the pavement opposite his living quarters provided the ISI the best possible setup to keep track of his activities.

He went on with his pompous proclamations about his connections, bank balances, geological discoveries etc. None of these were found to be true. He also had big plans about setting up a global gems export company and solve India's foreign exchange problem. He begged us to discharge him cause he had only one life to live in which he had to do a lot of work. and staying in a hospital was an awful waste of time. The sister on duty reported that the patient had made unbecoming sexual approaches towards the sister who was on duty the previous night.

Discussion:

The patient satisfied the diagnostic criteria  of  a manic episode. Manic episodes are marked by inflated self esteem, racing thoughts and pressure of speech, increase in goal directed and pleasurable activities and decreased need for sleep. Laxmipati was put on necessarry medication (Valproate Constant release in the acute phase, tittrated to Lithium after stabilization). Slowly his grandiosity decreased along with his excessive drive for goal oriented and pleasure seeking activities. Mr. Laxmipati recovered totally over a period of 2 months and has been on a maintenance dose of Lithium ever since and has not had any relapse of symptoms.