INTERNSHIP REPORT

Name of Learner: Tushar Narang

Enrollment No.: 2006261556
Mobile - +91-9996699367
Email ID: [email protected]

Date of Submission:

Name of the Programme: M.A. in Psychology

Course Title: Internship in Clinical Psychology
Course Code: MPCE-015
Session: July 2021 (2nd
Year)
Study Centre: SC-38043
Regional Centre: RC3
Table of Contents
Appendix I - Declaration

Appendix II – Internship Approval

Appendix III - Consent Letter (Agency Supervisor)

Appendix VIII - Certificate

Internship Program Brochure - Chandraprabha Hospital

Appendix IV - Record of visits/activities carried out by learner

Appendix V - Evaluation Scheme for Internship - (Agency Supervisor)

Appendix VI - Evaluation Scheme for Internship - (Academic Counsellor)

Appendix VII - Evaluation Scheme for Internship - (External Examiner)

Appendix XI – Acknowledgement

Case Study 1

Case Study 2

Case Study 3

Case Study 4

Case Study 5

Case Study 6

Case Study 7

Case Study 8

Case Study 9

Case Study 10
 APPENDIX-I DECLARATION

I Mr. Tushar Narang hereby declare that I am a Learner

of M.A. Psychology (Part II), July 2021 (2nd year), at the Study Centre Code 38043

Regional Centre RC3 and I want to do my Internship (MPCE-015/MPCE-025/MPCE-035) at

Chandraprabha Hospital,Tagore Town Colony, Gate no.3, U.P. college, Mahavir mandir road,

Orderly Bazaar, Bhojubeer, Varanasi, 221002 on my own free will. I will adhere to the

standards of the organization and display professionalism during my internship.

Signature of the Learner Date: 26-06-22

Name of the Learner: Tushar Narang Place: Delhi

Enrollment No.: 2006261556

Internship Approval
 APPENDIX-VIII CERTIFICATE

This is to certify that Mr. TUSHAR NARANG

of MA Psychology Second Year (MAPC Programme) has conducted and successfully completed the
Internship in MPCE 015 (Clinical) in the place Chandraprabha Hospital,Tagore Town Colony, Gate
no.3, U.P. college, Mahavir mandir road, Orderly Bazaar, Bhojubeer, Varanasi, 221002.

Name: Tushar Narang Name: Mr. Sidharth Sagar

Enrollment No.: 2006261556 Designation:

Name of the Study Centre: 38043 Place:

Regional Centre: RC3 Date:

Place: Delhi

Date: 28-06-22

Signature of Agency Supervisor

Ms. Soni Jaiswal
Clinical Psychologist
RCI licensed
CRR No. A56168
Chandraprabha Hospital
Tagore Town Colony, Gate no.3, U.P. college,
Mahavir mandir road, Orderly Bazaar, Bhojubeer, Varanasi, 221002
Date: 28-06-2022
 APPENDIX-IV RECORD OF VISITS/ACTIVITIES
CARRIED BY LEARNER

Name and Signature of

Date Time Duration Nature of Work
Concerned Authority
Day 1 Basic things to keep in mind while taking
16:00 18:00
14/Feb/22 therapy sessions.
Day 2 Steps for diagnosis and History of
16:00 18:00
15/Feb/22 present illness (HOPI).
Day 3 History of intelligence tests and TAT
16:00 18:00
16/Feb/22 tests were conducted.
Day 4
16:00 18:00 Stages of Counselling
17/Feb/22
Day 5 Field of psychiatry and challenges faced
16:00 18:00
18/Feb/22 by professionals in this field.
Day 6
16:00 18:00 CHT and MSE in detail.
19/Feb/22
Day 7 Observation and Intervention
16:00 18:00
21/Feb/22 1ST Assignment: STC log and BASIC ID.
Day 8
16:00 18:00 Mood and Affect in MSE.
22/Feb/22
Discussion on the role of the
Day 9
16:00 18:00 unconscious, short case studies on
23/Feb/22
unconscious processes.
Day 10 Various intelligence theories and two
16:00 18:00
24/Feb/22 cognitive distortion types.
Sources and models of psychopathology,
Day 11
16:00 18:00 psychopathology domains (various
25/Feb/22
disorders).
Day 12 Roleplay (Client with severe depression)
16:00 18:00
26/Feb/22 and discussion on counselling skills.
Cognitive distortions (remaining types),
Day 13
16:00 18:00 Developmental screening tools (by
28/Feb/22
Bharatraj).
Group discussion on ego defence
mechanisms; case studies based on
Day 14 transference, countertransference and
16:00 18:00
2/Mar/22 projective identification.
Activity: To identify “counselling skills”
based on a case study.
Hamilton anxiety rating scale, Children’s
depression rating scale, Hamilton
Day 15
16:00 18:00 depression rating scale.
3/Mar/22
The 2nd Assignment was given on the
Hamilton Depression rating scale.
Yale-Brown obsessive-compulsive scale,
Day 16 Yong mania rating scale.
16:00 18:00
4/Mar/22 Activity: Read about depression and
mania from ICD-10 and DSM-5.
 Judgement; Insight; How to deal with
uncooperative patients using Kirby’s
Day 17
16:00 18:00 Performa; Diagnostic formulation.
5/Mar/22
The task was given to carry out a
diagnosis on a case example.
Psychodynamic theory roleplay, Defence
mechanism, Free association.
Day 18
16:00 18:00 Guidelines to write a research proposal,
7/Mar/22
Quantitative and Qualitative techniques
to carry out research.
Psychopathology, in brief, 4 D’s of
Psychiatric disorders, Description of
Day 19
16:00 18:00 DSM.
8/Mar/22
Told to read about Personality disorders
from ICD-10.
Group discussion: Brief Psychiatric
Day 20
16:00 18:00 Rating Scale (BPRS), Positive
9/Mar/22
psychology introduction.
Day 21 Cognitive Behaviour Therapy
16:00 18:00
10/Mar/22 Transactional Analysis
Day 22 Therapeutic Interventions
16:00 18:00
12/Mar/22 Positive Psychology
Day 23 Case Study and Rolplay of the client
16:00 18:00
14/Mar/22 diagnosed with Gender Dysphoria
Roleplay to understand:
Day 24 Eclectic approach, Solution Focused
16:00 18:00
15/Mar/22 Approach, CBT & Psychodynamic
Approach
Day 25 Case Study discussion of the client
16:00 18:00
21/Mar/22 diagnosed with paranoid schizophrenia.
Day 26 Psychodiagnostic tests: TAT, Rorschach
16:00 18:00
22/Mar/22 Test, House Tree Person
Day 27 Thematic Analysis In Psychology and
16:00 18:00
23/Mar/22 Content Analysis
Day 28
16:00 18:00 Psychopharmacotherapy and ECT
24/Mar/22
Free association
Day 29
16:00 18:00 SWORD Analysis
26/Mar/22
PEPTIS IT
Day 30 Transactional analysis
16:00 18:00
28/Mar/22 Problem-solving
MMPI – 2
Day 31
16:00 18:00 16 PF
29/Mar/22
NEO PI
Day 32 Non-Pharmacological (Psychological)
16:00 18:00
2/Apr/22 Interventions
Behaviour Therapy and Types of
Day 33
16:00 18:00 Behavioural Therapy.
5/Apr/22
Punishment and Reinforcement
Specific Developmental Disorders of
Day 34
16:00 18:00 Scholastic skills
7/Apr/22
Depersonalisation Derealisation Disorder
Day 35 OCD
16:00 18:00
8/Apr/22 Elimination Disorder
Cyclothymia and Dysthymia
Day 36
16:00 18:00 Mental Retardation
11/Apr/22
Tic Disorder
 Humanistic approach
Day 37
16:00 18:00 Existential Theory
12/Apr/22
JPMR
Day 38 Hysteria
16:00 18:00
13/Apr/22 Disorder of Sexual Preference
Histrionic Personality Disorder
Day 39
16:00 18:00 Bipolar Disorder
15/Apr/22
Gender Dysphoria
Maniac Episode
Day 40
16:00 18:00 Trichotillomania
19/Apr/22
Expressive Language Disorder
Day 41
16:00 18:00 Agoraphobia
20/Apr/22
Day 42 Recurrent Depression
16:00 18:00
21/Apr/22 Seasonal Affective Disorder
Multiple Sclerosis
Day 43
16:00 18:00 Clinical Depression
22/Apr/22
Schizophrenia
Day 44 PTSD
16:00 18:00
23/Apr/22 Insomnia Disorder
Positive Punishment, Negative
Day 45
16:00 18:00 Punishment, Positive Reinforcement,
26/Apr/22
Negative Reinforcement
 APPENDIX-V EVALUATION SCHEME FOR
INTERNSHIP – (AGENCY SUPERVISOR)

Name of the Programme: M.A in Psychology (MAPC) Course Code: MPCE-015

Study Centre: SC - 38043 Regional Centre: RC3
Name of the Learner: Tushar Narang
Enrollment No.: 2006261556

Internal Marks by Agency Supervisor

Details Maximum Marks Marks Obtained

Sincerity and professional competence 10
Assessment (Case history, Mental 15
Status Examination, Interview,
Psychological Testing etc.)
Overall interaction with patients, clients & 5
employees and handling of cases
Total Marks 30

Comments, if any: _________________

Signature

Name of Agency Supervisor

Ms. Soni Jaiswal
Clinical Psychologist
RCI licensed
CRR No. A56168
Chandraprabha Hospital
Tagore Town Colony, Gate no.3, U.P. college,
Mahavir mandir road, Orderly Bazaar, Bhojubeer, Varanasi, 221002
Date: 28-06-2022
 APPENDIX-VI EVALUATION SCHEME FOR
INTERNSHIP – (ACADEMIC COUNSELLOR)

Name of the Programme: M.A in Psychology (MAPC) Course Code: MPCE-015

Study Centre: SC - 38043 Regional Centre: RC3
Name of the Learner: Tushar Narang
Enrollment No.: 2006261556

Internal Marks by Academic Counsellor

Details Maximum Marks Marks Obtained

Report 20
Provisional diagnosis and Planning of 5
Intervention

Overall Understanding of Cases 5

Total Marks 30

Comments, if any: _________________

Signature

Name of Academic Counsellor

Mr. Sidharth Sagar

Date: 28-06-2022
 APPENDIX-VII EVALUATION SCHEME FOR
INTERNSHIP – (EXTERNAL EXAMINER)
Name of the Programme: M.A in Psychology (MAPC) Course Code: MPCE-015
Study Centre: SC - 38043 Regional Centre: RC3
Name of the Learner: Tushar Narang
Enrollment No.: 2006261556
External Marks (Viva Voce)

Details Maximum Marks Marks Obtained

Viva 40
Total Marks 30

Comments, if any: _________________

Signature
Name & Address of External Examiner

Date:

Note: The marks given by the External Examiner are to be entered in the Award Sheet along with
the internal marks received from the Study Centre at the time of TEE of Internship.
 APPENDIX-XI

ACKNOWLEDGEMENT

This is to acknowledge that Ms./Mr. ........................................................................................

Enrollment No. ........................................................ of MAPC (2nd Year) has submitted
the Internship Report at the Study Centre ...................................................................
Regional Centre .................................................

Date: Signature (with

stamp)
Received by
 CASE HISTORY 1
Socio-demographic data: -
Name - Santosh Kumar
Age - 40
Sex- Male
D.O.B - 23/02/1982
Marital status - Married
Educational Qualification - B.Com (Hons)
Residential Address - Tilak Nagar, New Delhi
Native Place/Place of Birth – New Delhi
Income - 30,000/month
Current circumstances of living - Lives with family
Religion - Hindu
Socio-Economic Status - (Kuppuswamy Scale) Lower middle class

Informants: -
Information is adequate and reliable
Source of referral: Wife
Reason for referral: History of substance abuse such as alcohol and cannabis.
Reliability of informant: Informant is patient’s wife. The information is reliable as she has
been living with the patient for 20 years.

Onset: - Insidious

Course: - Continuous and Static

Duration: - 10 years

Biological Functions:
Sleep: Patient has inconsistent sleep patterns
Appetite: High
Bowel/Bladder Functioning: Abnormal, sometimes unable to control.
Libido Functioning: N/A

PPM factors:

Predisposing factors: Patient lost his father due to alcoholism leading to liver cirrhosis.

Precipitating factors: Patient grew up with an alcoholic father. Patient’s social circle would
consume cannabis in secret every single day.

Perpetuating factors: Patient’s friends continuously stock up on his alcohol and cannabis
every week.
Effects of symptoms
Affects work negatively.
Other mental function: Unable to concentrate anywhere
Biological functions: Patient suffers from inconsistent sleep, cannot control bladder.
Engages in. physical and verbal violence, does not maintain eye contact.
Legal: Taken to police station for physical and verbal violence towards wife.

Chief Complains: -
Patient comes with a history of substance abuse - alcohol since 10 years and cannabis since2
years with some severe withdrawal symptoms.

HOPI (history of present illness): -

The patient is a 40-year-old male who comes with a history of substance abuse. He has
consumed alcohol since the last 10 years and cannabis since the last 2 years, and has
developed some severe withdrawal symptoms. Moreover, patient has psychosis symptoms
such as auditory hallucinations like hearing voices that tell him not to make eye contact, and
episodes of delusion of grandeur.

Negative history: Consumes alcohol and cannabis since the last 10 years and 2 years
respectively. His wife is a victim of physical and verbal violence.

Past history: - N/A

Family history: -

GENOGRAM

40 35

10 15

Educational /Occupation History: -

He has completed his graduation. Used to work as a manager

Sexual and Marital history: - Patient is married, and was sexually involved with his wife.
Religious History: - Patient is Hindu and follows religious festivities.

Pre-morbid Personality: -
Patient was calm, composed and kept to himself.

MENTAL STATUS EXAMINATION

General appearance and examination

General appearance and grooming: Unkempt and untidy, stinks of alcohol, looked
perplexed
Estimate of age: Older
Body Built: Ectomorph with a protruding belly
Touch with surroundings: Not entirely in-touch with surroundings
Eye contact: No eye contact
Posture: Slouched, drooping shoulders, head was down, and hands and legs were crossed.

Psycho-motor activity
Odd posturing - patient had a slouched back with drooping shoulders. His hands and legs
were crossed at all times to prevent shivering. and he did not look up.

Speech
Soft-spoken, decreased reaction time. Pitch was high. Answers were not goal oriented. Patient
took long pauses followed by an answer which were not understandable or comprehensible.
Patient was found stuttering and stammering all the time.

Mood/Affect
Subjectively, the patient felt uncomfortable in the session. Objectively, the patient was
disconnected through-out, displayed flat affect in the interaction, and was in stupor state at
times.

Thought/Perception
Stream: Abnormal, not goal-directed at all.
Form: Unstructured, not understandable.
Possession: Patient does not recognize that his thoughts are not his own.
Content: Delusion of grandeur is present.
Perceptual: Sensory deception is present (auditory hallucinations).
Language: Speech is incomprehensible and vague.
Perceptual disturbance:
Auditory Hallucinations
Delusion of grandeur (Episodes)
Dreams: N/A
Higher cognitive functioning
Attention - Attention was not aroused.
Orientation - Oriented to time and place but not the person.
Concentration - Could not concentrate during most times.
Memory - Impaired
Intelligence - Low.
Abstract ability/thinking - Poor planning and abstract thinking
Judgment - Impaired
Insight - Grade II - Admission to illness but denying at the same time.

Psychological Testing:
Brief Substance Craving Scale (BSCS)
Brief Psychiatric Rating Scale (BPRS)
Bush-Francis Catatonia Rating Scale (BCRS)

Diagnostic Formulation: - The patient is a 40-year-old man from Varanasi, who has a
history of substance abuse namely alcohol and cannabis. His wife is a victim of physical and
verbal violence. In this case the predisposing factor is losing his father due to alcoholism
leading to liver cirrhosis. The precipitating factor is patient growing up with an alcoholic
father and his social circle consuming cannabis in secret every single day. The perpetuating
factor is the patient’s friends stocking up substances every week.

Diagnosis: - On the basis of comprehensive Case History, Mental Status Examination and
psychological test the diagnosis is as under:

F10 - Mental and behavioral disorders due to use of alcohol

F12 - Mental and behavioral disorders due to use of cannabinoids

Intervention/Therapy: -
In cases of psychotherapy for disorders due to use of alcohol and cannabinoids, a
psychologist might help a patient better understand and manage their moods through the
following methods:
Cognitive Behavioral Therapy (CBT)
Psychiatric medication (psychiatrist to be referred by psychologist)
Psychoeducation
.
 CASE HISTORY 2
Socio-demographic data: -
Name - Sandeep Kumar
Age - 35
Sex- Male
D.O.B - 15/02/1988
Marital status - Married
Educational Qualification - B.A. Programme
Residential Address - Greater Noida
Native Place/Place of Birth - Greater Noida
Income - 10,000/month
Current circumstances of living - Lives with family
Religion - Hindu
Socio-Economic Status - (Kuppuswamy Scale) Lower middle class

Informants: -
Information is adequate and reliable
Source of referral: Manager
Reason for referral: Symptoms being manifested as panic like.
Reliability of informant: The informant is the patient’s younger brother who has been living
with the him for 1 year. The information is reliable.

Onset: - Insidious

Course: - Fluctuating and Static

Duration: - 2.5 months

Biological Functions:
Sleep: Patient has regular sleep patterns
Appetite: Normal
Bowel/Bladder Functioning: Normal.
Libido Functioning: N/A

PPM factors:

Predisposing factors: Patient began to sweat profusely while dealing with fussy customer 2
months ago. Two weeks later, patient had a similar experience.

Precipitating factors: After receiving the complaint, when the manager checked on the
patient, he was found slumped in a chair in the back room trembling.

Perpetuating factors: Patient is constantly worried of experiencing the same unexpected

situation.
Effects of symptoms
Affects work negatively, starts worrying constantly.
Other mental function: Unable to concentrate anywhere
Biological functions: None.
Legal: None.

Chief Complains: -
During the two panic like episodes, the patient was sweating profusely, had a pounding head,
was feeling dizzy, became fearful that he was “going to die”, and started trembling. Now he
has started worrying continuously about having another attack.

HOPI (history of present illness): -

The patient is a 35-year-old male working as a salesman in a clothing brand. Two months
ago, while dealing with a fussy customer, he started sweating profusely, feeling dizzy, and his
heart started to pound. He became fearful that he was about to die, so he excused himself and
went to lie down at the back of the store. The customer had not noticed these signs and was
questioning every single detail during this time, but when he left, they felt insulted and
complained to the manager. When the manager went to check, the patient was found slumped
in a chair trembling, which subsided after ten minutes. The patient saw a physician who did
not find any signs of medical illness. However, the patient encountered mother episode of a
similar nature.

Negative history: N/A.

Past history: - N/A

Family history: -

GENOGRAM

60

35 30 25
Educational /Occupation History: -
He has completed his graduation and currently works as a clothing salesman.
Sexual and Marital history: - Patient is unmarried. Sexual history is unavailable.
Religious History: - Patient does not follow any religious practices.
Pre-morbid Personality: -
Patient was spontaneous and outgoing.

MENTAL STATUS EXAMINATION

General appearance and examination

General appearance and grooming: Kempt, tidy, good hygiene, looked nervous
Estimate of age: Younger
Body Built: Ectomorph
Touch with surroundings: In-touch with surroundings
Eye contact: Maintained eye contact
Posture: Upright but tense.

Psycho-motor activity
Patient sat upright but kept shaking his right leg constantly.

Speech
Increased reaction time. Pitch and quality were normal. Intensity of speech varied while
answering speaking about different incidents. Answers were goal oriented, understandable
and comprehensible. Speed of speech was also normal; ease of speech was present.

Mood/Affect
Subjectively and objectively, the patient was slightly tired and nervous in the session.

Thought/Perception
Stream: Normal, goal-directed.
Form: Structured and understandable.
Possession: Patient recognizes that his thoughts are his own.
Content: Tangentially is present.
Perceptual: No distortion or deception.
Language: Speech is comprehensible.
Perceptual disturbance: None.
Dreams: Fear of losing his job.

Higher cognitive functioning

Attention - Attention was aroused.
Orientation - Oriented to time, place, and person.
Concentration - High.
Memory - Intact (remote / long term memory)
Intelligence - High.
Abstract ability/thinking - High planning and abstract thinking
Judgment - Normal
Insight - Grade IV (Intellectual Insight) - Admission to illness, recognizes that symptoms are
due to irrational feelings and disturbances, but has not applied to future experiences.
Psychological Testing:
Hamilton Anxiety Rating Scale (HARS)

Diagnostic Formulation: - The patient is a 35-year-old salesman from Greater Noida. In this
case the predisposing factor is sweating profusely while dealing with fussy customers 2
months ago and 2 weeks ago. The precipitating factor is patient being slumped in a chair in
the back room trembling after manager received complaint. The perpetuating factor is
constant worrying of experiencing similar or same episodes.

Diagnosis: - On the basis of comprehensive Case History, Mental Status Examination and
psychological test the diagnosis is as under:
F41.0: Panic disorder (episodic paroxysmal anxiety)

Intervention/Therapy: -
In cases of psychotherapy for panic anxiety disorders, a psychologist might help a patient
better understand and manage their moods through the following methods:
Counselling
Cognitive Behavioral Therapy (CBT)
Psychoeducation
Journaling
Sleep Hygiene
Psychotherapy sessions can last for some weeks to a month unless symptoms reoccur. During
psychotherapy, the psychologist and patient develop a relationship on the basis of trust,
openness, and confidentiality.
 CASE HISTORY 3
Socio-demographic data: -
Name - Ashura
Age - 22 years
Sex- Female
D.O.B - 06.05.1998
Marital status - Unmarried
Educational Qualification - Mass Comm.
Residential Address - Pune, Maharashtra
Native Place/Place of Birth – New Delhi
Income - N/A
Current circumstances of living - Lives with family
Religion - Hindu
Socio-Economic Status - (Kuppuswamy Scale) Upper middle class

Informants: -
Information is adequate and reliable
Source of referral: Brother
Reason for referral: Suspected eating disorder
Reliability of informant: In this case, the brother is the informant who has been living with
the patient for 22 years. Hence, information is reliable.

Onset: - Insidious

Course: - Continuous and Deteriorating

Duration: - 7 years

Biological Functions:
Sleep: Irregular
Appetite: Abnormal
Bowel/Bladder Functioning: Abnormal
Libido Functioning: N/A

PPM factors:

Predisposing factors: Mother’s constant desire to make the patient look worry-free, perfect,
have her achieve only A’s, peer pressure during school years, not feeling good enough, state
of depression and anxiety at age 15

Precipitating factors: Denial of a specific event

Perpetuating factors: Binge-eating and inducing vomitus helps her “relax”, afraid of gaining
weight.
Effects of symptoms
Feels lighter after inducing vomit
Other mental function: Always stressed, anxious, worried, unable to concentrate
Biological functions: Loss of appetite after inducing vomitus, has difficulty in bladder and
bowel functioning.
Legal: None

Chief Complains: - Patient is a 22-year-old female who currently has complaints of

depressed mood, anxiety, and binge eating and purging episodes.

HOPI (history of present illness): -

Patient has reported that her binge eating and vomiting developed at age 16 and seemed to
help her “relax,” especially in the evenings when her binge/purge episodes typically occurred.
She reported binge eating and vomiting up to four times each evening. She hoped to avoid
these episodes but was afraid of gaining weight. Her current weight was 120 lb. and her
height was 5’4” (BMI=20.6).

Negative history: The patient reported drinking one or two alcoholic drinks once monthly.
She smoked marijuana on three occasions in tenth grade and related this to “peer pressure.”
She denied the use of any other substances. Exercise, Diet, and Stress Management Ashura
exercised five times weekly for 1.5 hours during each episode. Her exercise routine included
running for 60 minutes and a weight-lifting routine lasting 30 minutes. She reported
exercising even though on most days she felt fatigued. She had had some dizziness when
running. Her meal plan was also quite stringent, including a diet of 1,500 calories per day and
limited fat intake. However, on most days she reported being unable to follow her diet and
feeling “ravenous” when arriving home from work at 6 P.M. She did not experience the urge
to binge eat during the day; however, when leaving work, she became anxious about her
performance during the day. She reported intrusive thoughts of binge eating on her drive
home from work and feel compelled to stop at the grocery store for a few items to prepare for
dinner. Her binge eating episodes always involved high-fat food items such as pizza, cookies,
chocolate milk, and chips. She reported eating quickly and feeling as if she “blacked out”
when she had a binge eating episode. She stated, “I know what I’m doing, bingeing on all
that food, I just can’t stop.” She became overwhelmed with a sense of guilt after her eating
episodes and then vomited several times. The vomiting decreased her anxiety and “clears my
head… I don’t have to worry when I’m binge eating and I can then just get rid of the food.”
Ashura related her depressed mood to her inability to control her food intake and “feeling
fat.” She desired to weigh 110 lb. (BMI=18.9).

Past history: - The patient reported a history of depressed mood and anxiety since age 15.
She denied a specific event that precipitated her mood symptoms. She had suicidal ideations
at age 15, although she reported no current plan or intent. At age 15, she often felt as if she
was “not good enough or pretty enough,”, especially when compared with other girls at
school. She experienced bouts of unprovoked crying, anhedonia, concentration difficulties,
and worry about the future, which caused her to have difficulty falling asleep. She reported
that these symptoms have continued since age 15 but “aren’t as intense” as they were when
they first occurred. She denied past psychological treatment for any mental health concerns.
At age 15, patient began to gain weight. Her highest weight was 140 lb. She then began to
diet, reducing her intake to 1,200 calories per day. She reported that this dieting lasted about
a month and that she lost approximately 8 lb. On a Saturday when her parents were away, she
experienced a binge eating episode. She then developed a pattern of binge eating every
weekend and then restarting her dieting pattern every Monday. After approximately 2 months
in this pattern, the patient experienced a binge eating episode that was larger than her prior
episodes. She felt the urge to vomit in order to “feel just a little less stuffed.” Vomiting came
easily to Ashura and she thought she could be successful at losing more weight if she vomited
after each dinner. Ashura’s binge/purge cycle then became more frequent and was occurring
at least once per day by the time she was 17 years old.

Family history: - Patient was raised by her biological mother and father. She had one older
brother who was studying medicine. She reported that her upbringing was “good…just
typical, I guess.” Her father was employed as an executive at a good company, and her
mother was an administrative assistant. She reported a “good” relationship with her brother
and parents but suggested her mother was sometimes critical of her, accepting only “A”
grades as “good.” Her mother was often concerned about what other members of the colony
thought about the family and was focused on appearing “worry-free…or perfect.”

GENOGRAM

50
55

22
25
Educational /Occupation History: - The patient completed the twelfth grade and attained
her Mass communication degree at a private college.

Sexual and Marital history: - N/A

Religious History: - N/A

Social History: - Ashura reported three or four close friends throughout her schooling and
several acquaintances. She had been involved in basketball and tennis during eighth grade;
however, she quit both teams to pursue her interest in playing piano, drawing, and painting.
At the time of her evaluation, she had very few friends. She denied involvement in a romantic
relationship.

Pre-morbid Personality: - Patient was active, social, out-going.

Other significant findings:

Unremarkable except for occasional headaches, primarily frontal and usually relieved by
aspirin
Occasional palpitations and tachycardia post vomiting
Problems with intermittent constipation and diarrhea; occasional upper abdominal pain
associated with binge eating
Had two episodes in which she found trace amounts of blood in her vomitus

Physical Examination: Patient was a well-developed, well-nourished female in no acute

distress. Her blood pressure was 110 over 62, her right arm sitting; her pulse was 64 and
regular, and her respiratory rate was 12. Physical examination was essentially negative except
for some evidence of scar formation on the dorsum of her right hand where she had
traumatized the skin while self-induced vomiting.

MENTAL STATUS EXAMINATION

General appearance and examination

General appearance and grooming: Tidy and kempt, well-groomed, but looked flushed,
perplexed, and sickly.
Estimate of age: Older
Body Built: Ectomorph (on the weaker side)
Touch with surroundings: In touch with surroundings
Eye contact: Did not maintain eye contact throughout the session
Posture: Slouched, not relaxed.

Psycho-motor activity
Patient was constantly rocking back and forth, hands were placed on her stomach, and did not
maintain eye contact during the session.
Speech
Pitch was soft, almost inaudible. Pressured speech, goal-directed and relevant and adequate
answers. Spoke in detail about her past experiences. Speech was coherent and
comprehensible.

Mood/Affect
Subjectively, the patient was feeling better than usual. Full range of affect was present.
Objectively, the patient seemed distressed, nervous, rigid, and perplexed.

Thought/Perception
Stream: Normal, goal-directed.
Form: Structured and understandable.
Possession: Patient recognizes that her thoughts are his own.
Content: Tangentially and circumstantiality were present.
Perceptual: Cognitive distortions were present.
Language: Speech is comprehensible.
Perceptual disturbance: None.
Dreams: Patient often dreamt of adhering to her mother’s standards of being “worry free”
and “perfect”

Higher cognitive functioning

Attention - Attention was aroused
Orientation - Oriented to time, place, and person
Concentration - Patient was able to concentrate
Memory - Intact (Recent)
Intelligence - High
Abstract ability/thinking - Fair abstract ability and thinking
Judgment - Impaired
Insight - Grade V (Intellectual insight) - Awareness of being ill and that the symptoms/
failures in social adjustment are due to own particular irrational feelings/ thoughts; yet
doesn’t apply this knowledge to the current/ future experiences.

Psychological Testing -
Hamilton Anxiety Rating Scale (HARS)
Hamilton Depression Rating Scale (HDRS)
Eating Disorder Examination Questionnaire - Short (EDQS)
Eating Disorder Examination Questionnaire (EDE-Q)

Diagnostic Formulation: - The patient is a 22-year-old female who has completed her 12th
grade and attained a degree in Mass Comm. In this case the predisposing factors are the
patient’s mother’s constant desire to make the patient look worry-free, perfect, have her
achieve only A’s, peer pressure during school years, not feeling good enough, state of
depression and anxiety at age 15. The precipitating factor is denial of a specific event. The
perpetuating factor is feeling relaxed after inducing vomitus and constant worry of gaining
weight and becoming fat.
Diagnosis: - On the basis of comprehensive Case History, Mental Status Examination and
psychological test the diagnosis is as under:

F50.2 - Bulimia nervosa

Intervention/Therapy: -
In cases of psychotherapy for panic anxiety disorders, a psychologist might help a patient
better understand and manage their moods through the following methods:
Counselling
Cognitive Behavioral Therapy (CBT)
Rational Emotional Behavioral Therapy (REBT)
Psychoeducation
Psychiatric intervention
Sleep Hygiene
Psychotherapy sessions can last for some weeks to a month unless symptoms reoccur. During
psychotherapy, the psychologist and patient develop a relationship on the basis of trust,
openness, and confidentiality.
 CASE HISTORY 4
Socio-demographic data: -
Name - Vikas
Age - 29
Sex- Male
D.O.B - 05/10/1992
Marital status - Unmarried
Educational Qualification - B.A. Programme
Residential Address - Laxmi Nagar, New Delhi
Native Place/Place of Birth - New Delhi
Income - Rs. 20,000
Current circumstances of living - Lives alone
Religion - Hindu
Socio-Economic Status - (Kuppuswamy Scale) Lower middle class

Informants: -
Information is adequate and reliable Source of referral: Current girlfriend
Reason for referral: Suspected a mood disorder
Reliability of informants: Informant is the girlfriend who has been living with the patient for
8 months, hence information is reliable.

Onset: - Insidious

Course: - Continuous and Static

Duration: - 15 years

Biological Functions:
Sleep: Erratic and inconsistent
Appetite: Normal
Bowel/Bladder Functioning: Normal
Libido Functioning: Low

PPM factors: -

Predisposing factors: During school, patient experienced repeated alternating cycles of

“good and bad times”.

Precipitating factors: Uneven performances as a salesman. Loses out on patients on his “bad
times” or “bad days”. Usage of alcohol to heighten his good mood on “good days” or to help
him sleep on “bad days”.
Perpetuating factors: Alcohol consumption to enhance experience of good days and put
himself to sleep on bad days.

Effects of symptoms
Affects work negatively.
Other mental function: N/A
Biological functions: On bad days, he sleeps for 10 to 14 hours.
Social functioning is badly affected. He alienates his friends when he is hostile and irritable.
Interpersonal relations are also affected
Legal: No legal problem is encountered,

Chief Complains: -
Patient feels like he lacks energy, confidence, and motivation. Patient also feels like he is
“just vegetating”.

HOPI (history of present illness): -

The patient is a 29 years old car salesman working in New Delhi. According to him, since the
age of 14 years, the patient has been experiencing repeated alternating cycles of “good times
and bad times”. In school, his high grades alternated with low grades. While the teachers
called him a bright student, they also stated that he has “unstable motivation”. During a bad
period, he would sleep for 10 to 14 hours every single day. He started staying alone most of
the time and started avoiding interaction with people. As a result, he felt as if he lacks
confidence, energy, and motivation. In his words, he says he is “just vegetating”. These
feelings would last a week. However, after an abrupt shift, he would experience a 3 to 4 days’
stretch of overconfidence, followed by heightened social awareness, promiscuity, and
sharpened thinking. He says “things would flash in my mind”. In such times, he would
enhance this experience by taking alcohol. The good periods would last for 7 to 10 days.
However, it could culminate in hostile and irritable outbursts which thereafter transitioned to
bad days. As a car salesman, his performance has been uneven. Even on his good days, he
would argue with his patients that appeared sure and end up losing out on them.

Negative history: - Alcohol consumption to enhance experience of “good days” and help in
sleeping on “bad days”.

Past history: - N/A

Family history: - GENOGRAM

60 55

29 27
Educational /Occupation History: -
He has completed his B.A. Programme. He was a bright student with unstable motivation.

Sexual and Marital history: - Patient is unmarried. Sexual history unavailable.

Religious History: - Patient is Hindu but does not follow rituals.

Pre-morbid Personality: -
Patient was highly social, liked interacting with people. He could easily strike a conversation
with guests at a social function, and loved to be everyone’s center of attention.

MENTAL STATUS EXAMINATION

General appearance and examination

General appearance and grooming: Kempt, tidy, according to season
Estimate of age: Older
Body Built: Ectomorph with a protruding belly
Touch with surroundings: In-touch
Eye contact: Inconsistent
Posture: Upright and rigid

Psycho-motor activity
Odd posturing - patient constantly had his palms on his thighs, and was swaying back and
forth at times.

Speech
Spontaneous with normal reaction time and pitch. It is not always goal directed. Patient
usually starts answers with “so..uh..” followed by an answer which is somewhat
understandable.

Mood/Affect
Subjectively and objectively, the patient was anxious through-out the session.

Thought/Perception
Stream: Normal though not goal-directed at all times
Form: Structured, understandable.
Possession: Patient recognizes that her thoughts are his own.
Content: Antisocial urges, Depressive cognition
Perceptual: Patient answers to the point, thought block is present, tangentially is present.
Language: speech is coherent and comprehensible
Perceptual disturbance: N/A
Dreams: N/A

Higher cognitive functioning

Attention - Attention was not aroused, lethargic
Orientation - Disoriented to time, place and person
Concentration - Could somewhat concentrate, but not for too long.
Memory - Impaired short term memory
Intelligence - High.
Abstract ability/thinking - Poor planning and abstract thinking
Judgment - Impaired
Insight - Grade II - Slight awareness of being sick or needing help but at the same time
ignoring it

Psychological Testing:
Hamilton Depression Rating Scale (HDRS)
Brief Psychiatric Rating Scale (BPRS)
Young Mania Rating Scale (YDRS)

Diagnostic Formulation: - The patient is a 29-year-old car salesman working in New Delhi,
who feels as if he is “just vegetating”. In this case the predisposing factor is experiencing
“cycles of good and bad times”. The precipitating factors are uneven performances as a
salesman, losing out on patients on his “bad times” or “bad days”, followed by usage of
alcohol to heighten his good mood on “good days” or to help him sleep on “bad days”. The
perpetuating factor is consuming alcohol to enhance experience of good days and put
himself to sleep on bad days

Diagnosis: - On the basis of comprehensive Case History, Mental Status Examination and
psychological test the diagnosis is as under:
F34.0 - Cyclothymia

Intervention/Therapy: -
In cases of psychotherapy for cyclothymia, a psychologist might help a patient better
understand and manage their moods through the following methods:
Cognitive Behavioral Therapy (CBT)
Psychiatric medication (psychiatrist to be referred by psychologist)
Journaling
Mapping
Sleep hygiene
Psychotherapy sessions can last for a lifetime. During psychotherapy, the psychologist and
patient develop a relationship on the basis of trust, openness, and confidentiality.
 CASE HISTORY 5
Socio-demographic data: -
Name - Shikha (name changed for confidentiality)
Age - 26
Sex- Female
D.O.B - 10/05/1994
Marital status - Unmarried
Educational Qualification - Post Graduation
Residential Address - Ghaziabad, Uttar Pradesh
Native Place/Place of Birth - Meerut, Uttar Pradesh
Income - N/A
Current circumstances of living - Lives with parents
Religion - Hindu
Socio-Economic Status - (Kuppuswamy Scale) Upper middle class

Informants: -
Information is adequate and reliable
Source of referral: Father
Reason for referral: Suspected depression. Father was diagnosed with depression 7 years
ago.
Reliability of informant: The informant is father who has been living with the patient for 26
years, thus informant is reliable.

Onset: - Insidious

Course: - Continuous and Deteriorating

Duration: - 3 years

Biological Functions:
Sleep: Patient has complained of insomnia
Appetite: Loss of appetite
Bowel/Bladder Functioning: Normal
Libido Functioning: Low
Menstrual History: Patient is diagnosed with PCOD (polycystic ovarian disorder)
Last Menstruation Cycle Date: 26th January

PPM factors:

Predisposing factors: Patient has recently suffered from break-up as her boyfriend was
cheating on her.

Precipitating factors: Patient had adjustment issues at research center, thus had to resign
which affected her health.
Perpetuating factors: Loss of present job has made her demotivated in life.

Effects of symptoms
Affects work negatively.
Other mental function: N/A
Biological functions: Patient suffers from loss of appetite.
Engages in social comparison and low self-esteem due to friends being employed in different
companies.
Legal: No legal problem is encountered,

Chief Complains: -
Patient experiences low mood, insomnia, loss of interest in any activity, loss of appetite, and
suicidal ideations.

HOPI (history of present illness): -

The patient is a 26 years old female. According to her, her mood is low, she suffers from
insomnia, loss of interest in any activity, loss of appetite, and has suicidal ideations. She has
completed her post-graduation from a renowned college and has been a high achiever all her
life. She got placed in a good research center in Ghaziabad, and when she went to that place
she didn't like the environment and had a lot of adjustment issues. As a reason, she had to
leave her job which affected her health as well. She has a very supportive family, parents, and
her brother who lives away but has supported her in most of her decisions in life. However,
she recently suffered a breakup as her boyfriend cheated on her and the loss of the present job
has made her all demotivated in life.

Negative history: N/A

Past history: - N/A

Family history: - Supportive family, parents, and brother.

GENOGRAM

60
65

26
30
Educational /Occupation History: -
She has completed her Post Graduation. She has been a high achiever all her life.

Sexual and Marital history: - Patient is unmarried, and was sexually involved with her
boyfriend.

Religious History: - Patient does not follow any religious practices.

Pre-morbid Personality: -
Patient was a jolly, sociable person before the present illness.

MENTAL STATUS EXAMINATION

General appearance and examination

General appearance and grooming: Kempt, tidy, according to season
Estimate of age: Age appropriate
Body Built: Endomorph
Touch with surroundings: In-touch
Eye contact: Inconsistent
Posture: Slouched, drooping shoulders, hands near stomach.

Psycho-motor activity
Odd posturing - patient had a slouched back with drooping shoulders. Her hands were near
stomach and was holding it at times.

Speech
Soft-spoken, decreased reaction time. Pitch was somewhat monotonous. Answers were goal
oriented. Patient took long pauses followed by an answer which was well structured and
understandable. Patient stuttered at times.

Mood/Affect
Subjectively and objectively, the patient was nervous and disconnected through-out the
session.

Thought/Perception
Stream: Normal though not goal-directed at all times
Form: Structured, understandable.
Possession: Patient recognizes that her thoughts are his own.
Content: Depressive cognition, Suicidal ideas
Perceptual: Patient answers to the point, thought block is present, perseveration is present.
Language: Speech is comprehensible.
Perceptual disturbance: N/A
Dreams: N/A
Higher cognitive functioning
Attention - Attention was aroused.
Orientation - Oriented to time, place and person
Concentration - Could concentrate most of the times.
Memory - Intact (remote / long term memory)
Intelligence - High.
Abstract ability/thinking - Fair planning and abstract thinking
Judgment - Not impaired
Insight - Grade IV (Intellectual Insight) - Admission to illness, recognizes that symptoms are
due to irrational feelings and disturbances, but has not applied to future experiences.

Psychological Testing:
Hamilton Depression Rating Scale (HDRS)
Young Mania Rating Scale (YDRS)

Diagnostic Formulation: - The patient is a 26-year-old woman from Uttar Pradesh, who
feels low, has complained of insomnia, low appetite, and suicidal ideations. In this case the
predisposing factor is breaking up with her boyfriend after finding out he chatted on her.
The precipitating factor is adjustment issues at research center, leading to resign which
affected her health. The perpetuating factor is feeling demotivated due to loss of job and
knowing her friends have jobs, thus leading to social comparison and low self-esteem.

Diagnosis: - On the basis of comprehensive Case History, Mental Status Examination and
psychological test the diagnosis is as under:

F32 - Depressive episode

F32.2 - Severe depressive episode without psychotic symptoms

Intervention/Therapy: -
In cases of psychotherapy for depression, a psychologist might help a patient better
understand and manage their moods through the following methods:
Cognitive Behavioral Therapy (CBT)
Rational Emotional Behavioral Therapy (REBT)
Counseling
Sleep hygiene
Psychotherapy sessions can last for some weeks to a month unless symptoms reoccur. During
psychotherapy, the psychologist and patient develop a relationship on the basis of trust,
openness, and confidentiality.
 CASE HISTORY 6
Socio-demographic data: -
Name- Anuj Roy
Age-54
Sex- Male
D.O.B- 12/04/1967
Marital status- Separated
Educational Qualification- Graduate
Native Place/Place of Birth- Delhi
Income- 40,000/m
Current circumstances of living- single
Religion- Hindu
Socio-Economic Status- lower middle class
Informants: -
Information is adequate and reliable
Source of referral: State hospital
Reason for referral: further assessment and psychological test
Reliability of informants: self
Onset: -
Insidious- slow and gradual
Course: -
Continuous and deteriorating
Duration: -
6 months
PPM factors: -
I) predisposing factors-: Peer pressure
II) Precipitating factors-: Separation from wife
III) Perpetuating factors: He is alone and depressed that children have also rejected him.
Chief Complains: -
Abdominal pain for several days. The pain is a constant dull ache which is central and
radiates to the right. He has had some associated vomiting but the vomit is usually bile as he
has not been eating well. He has on a few occasions vomited some blood (hematemesis) but
says that this was after particularly heavy consumption of alcohol.
HOPI (history of present illness): -
The client is a 54-year-old man who is separated from his wife 6 months ago, not in touch
with his children, as they turned against him. The marriage had been difficult for some years
because he was unable to hold down a regular job. He held a middle manager’s post until he
turned 50. Since then he has had a series of short-term junior posts. He says he was sacked
for taking time off work for physical complaints
The client is suffering from abdominal pain for several days. The pain is a constant dull ache
which is central and radiates to the right. He has had some associated vomiting but the vomit
is usually bile as he has not been eating well. He has on a few occasions vomited some blood
(hematemesis) but says that this was after particularly heavy consumption of alcohol. He is
not aware how many units he drinks in a week but reluctantly admits he drinks every day. His
breakfast often consists of a drink as he feels very shaky otherwise. Once he has had a drink
he feels better able to manage the day ahead. He lives alone in a bedsit and eats poorly.
Before his marriage, 30 years ago he used to live in hostel as he was away from home for job
so he developed the habit of drinking slowly and gradually as they were all bachelor group
and used to have parties most of the time. But earlier it was restricted to weekend only.
Slowly after marriage and having kids whenever he used to get upset or stressed to cut his
stress he started taking alcohol and started enjoying it. It’s now part of his life, he does not
feel good if he does not take alcohol a single day. It is his life now as he is now lonely and
withered and ignored by all.
Family history: -
Before marriage he was living in a joint family but after marriage due to job and kids’
education they started living in nuclear family, in another city in the same state. No one in his
family has any such complaint of drinking and addiction. They share a good relation with
their in-laws and extended family.
GENOGRAM

Educational /Occupation History: -

He started his school at the age of 6, completed his graduation and started doing job. He was
very happy in his job. He was always getting appraisals and promotion, once he reaches the
managerial post too but now he is hardly getting junior posts.
Sexual and Marital history: -
He was having good marital and sexual life as his behaviour was not unbearable earlier. His
wife was a loving and caring wife and mother but slowly due to his habit of drinking she
started getting irritated and so the distance in relationship. Also he was not having a stable
job so she suffered a lot financially also. Later the condition was so bad that she also started
doing odd works for living.
Religious History: -
He follows Hindu religion but does not visit temple at all.
Pre-morbid Temperament/Personality: -
He was very jolly and friendly person. Like to enjoy life and had many friends. He is an
extrovert.
MENTAL STATUS EXAMINATION
He smells of alcohol. He is reasonably well dressed. He looks unwell and is clearly
uncomfortable. He has good eye contact. His speech is normal. He admits he has felt low as
his life has deteriorated over the last few months but says he is not ‘depressed’. He can still
enjoy himself and is reactive at interview. He does not have any self-harm ideation. He has
little hope for the future. There is no evidence of psychosis. He is orientated in time, place
and person. His short-term memory is poor but there are no long term memory problems
Insight
Grade I-Complete denial of illness
Psychological Tests: - Psychological assessment of the case for alcohol dependence was
carried out utilizing the MAST and CAGE Questionnaire
Diagnostic Formulation: - The client was a 54-year-old man with complaints of abdominal
pain for several days. The pain is a constant dull ache which is central and radiates to the
right. He has had some associated vomiting but the vomit is usually bile as he has not been
eating well. He has on a few occasions vomited some blood (hematemesis) but says that this
was after particularly heavy consumption of alcohol. He is not aware how many units he
drinks in a week but reluctantly admits he drinks every day. His breakfast often consists of a
drink as he feels very shaky otherwise. Once he has had a drink he feels better able to manage
the day ahead. He lives alone in a bedsit and eats poorly. He says he was sacked for taking
time off work for physical complaints. He has been separated from his wife for 6 months and
no longer has regular contact with his children who he says have turned against him. In this
case act as precipitating factor. The marriage had been difficult for some years because he
was unable to hold down a regular job. He held a middle manager’s post until he turned 50.
Since then he has had a series of short-term junior posts. He believes that this is a result of
changes in local government and not related to his drinking.
Diagnosis: - On the basis of MSE, Case History and psychological test the diagnosis is given
as under: F10.-Mental and behavioural disorders due to use of alcohol
F10. 21 Currently abstinent, but in a protected environment
Process of intervention
Rapport establishment: Rapport establishment aims to maintain a good relationship with the
client, and to assess the level of cooperation and participation of the client. During the
discussion, the client was informed about the importance of therapy and bennet he would
gain. Repeated reassurance and positive attitude toward the client made the session
successful. Client was able to open up in the initial session itself; he expressed and shared
about his drinking problem.
MET: MET evokes change in individuals. It is a systematic approach and is based on
motivational psychology. MET is considered to produce change through mobilising the
person’s internal resources.us, the intervention is brief and used during the client’s •rest
contact although repeating it during subsequent sessions may prove helpful. It is particularly
useful when contact with the client is limited to one or few sessions.
The index client was exposed to motivation enhancement and relapse prevention therapy.
A baseline assessment on understanding the drinking pattern, abstinence period, locus of
control, coping pattern, internal relationship problems, and client’s attitude toward drinking
was done throughout the MET sessions, the therapist recognised the client’s individual
efforts, appreciated his strengths, and feedbacks were provided. Further, in MET the client
was provided warmth, advice, empowerment, and support.
Relapse prevention technique Craving management skill Craving management skills were
taught to the client. “5 Ds”, i.e. Delay, Deep breathing, Distraction, drinking water, and
Discussion was taught to the client to deal with the craving. Coping skills Coping skills’
training was provided to the client with objectives to teach how to avoid high-risk situations,
to recognise urge “triggers”, and handling stressor.
Social group work interactive sessions A group is a collection of individuals with similar
problems. Group work intervention helps them to discuss and share their experiences with
one another, and through this process, learns skills of coping, decision making, and problem
solving. The number of members in the group was eight with two psychiatric social work
trainees. Each session for 45 minutes once in a week. The client’s level of awareness was
increased, and he got insight regarding his problem of drinking.
Follow-up session After the discharge, the client came for follow-up. Feedback was taken
from the client and his wife. It was found that client was maintaining well and was following
the instruction and advice provided to him in dealing with his alcoholic behaviour.
 CASE HISTORY 7
Socio-demographic data: -
Name- Kartika
Age- 19
Sex- Female
D.O.B- 2/03/2002
Marital status- unmarried
Educational Qualification- 10th
Residential Address (Phone Number)- New Delhi
Native Place/Place of Birth- West Bengal
Income- 25,000
Current circumstances of living- nuclear family
Religion- Christian
Socio-Economic Status- lower middle class
Informants: -
Information is adequate and reliable
Source of referral: Psychiatric Hospital
Reason for referral: For psychological assessment and proper diagnosis
Reliability of informants: patient and her mother
{Relation with Pt, duration of stay with Pt, familiarity and concern for the Pt}
Onset: -
Insidious- slow and gradual
Course: -
Continuous
Duration: -
6yearsPresent
Chief Complains: - She is afraid of losing her boyfriend, under the influence of drug she
became pregnant twice with another man, but aborted it. After each termination she had a
period when she described herself as ‘constantly suicidal’
HOPI (history of present illness): - The client is a 19-year-old woman with 6 years’ history
of self-harming. Her self-harm is usually in the form of cutting, but every few weeks when
she feels things are getting on top of her, she takes an overdose. The overdoses are usually
impulsive and precipitated by a row with her boyfriend or mother. She took treatment from
psychiatrist previously & had been hospitalized for herself injurious behaviour.
The relationship with the boyfriend is volatile and the police have been called out on more
than one occasion when things have become heated and violent. The woman has alleged
domestic violence but then retracts her allegations and the police have not taken any action
against her boyfriend. From the family history we found that she belonged to a middle-class
family. The family environment was described by the patient as very
chaotic, hostile & distressful. Family rules were harsh, rigid & inconsistent. There was poor
bonding with her father. History of parental confrontation & wrangling in early childhood.
There is also a long history of substance misuse, usually alcohol but she has also dabbled in
all sorts of illegal substances She also had history of drug noncompliance. She was a smoker
& occasional drinker of alcohol. She took this for relieving her distress. She also had low
mood that remain most of the day. She felt no interest to do her activity. She had sleep
disturbance. She could not sleep at night because she continuously thought about her past
events. She can only sleep for 2-3 hours at night & woke up early in the morning but did not
feel refreshing. When under the influence of drug, she has had unprotected sex with men
other than her boyfriend and has become pregnant on two occasions. Both times she chose to
end the pregnancy feeling that if she did not her boyfriend would leave her. After each
termination she had a period when she described herself as ‘constantly suicidal’
Negative history: -
Substance related disorders suicidal ideation present.
Past history: -
She took treatment from psychiatrist previously & had been hospitalized for herself injurious
behaviour
Family history and Genogram: - Regarding her family history she belonged to a middle-
class family. The family environment was described by the patient as very chaotic, hostile &
distressful. Family rules were harsh, rigid & inconsistent. There was poor bonding with her
father. History of parental confrontation & wrangling in early childhood.

Educational /Occupation History: -

She passed her high school and started doing job in a supermarket
Sexual and Marital history: -
She is not married but have abortions twice, conceived with other man
Religious History: -
She is Christian but not so believer in God.
Pre-morbid Personality: -
She was very short tempered, demanding, reckless, irritable, occasional aggressive. She had
difficulty to control her anger & intense emotional fluctuation. Relationship with her friends
& family were not good. She was a good student but her academic performance gradually
became deteriorated. She had started with multiple relationship with different boys but those
were very superficial. She had feeling of insecurity & fear of rejection. So, she never made
those relationships very close. Those events made her lonelier. She was feeling empty inside
her own. According to her mother she has ran away from home several times & lived with his
boyfriend’s house.
MENTAL STATUS EXAMINATION
Her eye contact is fleeting. She is distraught and shouting that she just wants to be left alone
so that she can kill herself. She is verbally abusive and threatening violence if she is not given
what she wants. She is irritable and agitated. She is unkempt and looks like she has recently
been in a fight. Her speech is rapid but coherent. Objectively her mood is labile and
subjectively she says that she is depressed and life is not worth living. She says she is suicidal
and wants to kill herself. She is angry as she feels she is being thwarted in this. She says there
is no point in living especially as her boyfriend has broken up with her. There is no evidence
of any psychotic features and she is orientated in time, place and person.
Insight
Grade II-Slight awareness of being sick or needing help but at the same time ignoring it
Psychological Tests: - A brief but valid self-report measure to screen for personality
disorders (PDs) would be a valuable tool in making decisions about further assessment and in
planning optimal treatments, visa
1. Interview Method
2. Self-Report Method
3. IIP Personality Disorder Scales(IIP-PD)
4. Self-directedness Scale: Temperament and character Inventory(TCI-SD)
Diagnostic Formulation: -
The client is a 19-year-old woman with a 6-year history of self-harm attends the emergency
department. Her self-harm is usually in the form of cutting, but every few weeks when she
feels things are getting on top of her, she takes an overdose. The overdoses are usually
impulsive and precipitated by a row with her boyfriend or mother. She took treatment from
psychiatrist previously & had been hospitalized for herself injurious behaviour. The
relationship with the boyfriend is volatile and the police have been called out on more than
one occasion when things have become heated and violent. The woman has alleged domestic
violence but then retracts her allegations and the police have not taken any action against her
boyfriend. From the family history we found that she belonged to a middle-class family. The
family environment was described by the patient as very chaotic, hostile & distressful.
Family rules were harsh, rigid & inconsistent. There was poor bonding with her father.
History of parental confrontation & wrangling in early childhood. So the poor interpersonal
relation with parents is the perpetuating factor in this case. There is also a long history of
substance misuse, usually alcohol but she has also dabbled in all sorts of illegal substances
She also had history of drug noncompliance. She was a smoker & occasional drinker of
alcohol. She took this for relieving her distress. She also had low mood that remain most of
the day. She felt no interest to do her activity. She had sleep disturbance. She could not sleep
at night because she continuously thought about her past events. She can only sleep for 2-3
hours at night & woke up early in the morning but did not feel refreshing. When under the
influence of drug, she has had unprotected sex with men other than her boyfriend
and has become pregnant on two occasions. Both times she chose to end the pregnancy
feeling that if she did not her boyfriend would leave her. After each termination she had a
period when she described herself as ‘constantly suicidal’.
The abortion is the precipitating factor for the client.
Diagnosis: -
So on the basis of comprehensive case history personal information and observation the
diagnosis is:
F60.3 Emotionally unstable personality disorder
F60.30 Impulsive type
Intervention/Therapy: -
Therapy and counselling:
Many types of psychotherapy can help you manage BPD. You might have dialectical
behaviour therapy (DBT) or cognitive behavioural therapy (CBT). A counsellor works with
you during several sessions to learn to manage emotions, recognize and change unwanted
behaviours and gain a new perspective. You may have group therapy or talk one-on-one with
a specially trained counsellor.
Medications:
Although no medication treats the disorder itself, your provider may recommend one or
more drugs to treat EUPD symptoms. Medications can treat anxiety and depression, regulate
mood swings or help you control impulsive behaviour. Anti-psychotic drugs help some
people with EUP.
 CASE HISTORY 08

Socio-demographic data: -
Name- Simran
Age- 25
Sex- Female
D.O.B- 11/11/1996
Marital status- Unmarried
Educational Qualification- Graduation
Place of Birth- Delhi
Occupation- Student
Income- Nil
Current circumstances of living- Joint family
Religion-Hindu
Socio-Economic Status- Middle Class
Informants: -
Information is adequate and reliable.
Source of referral: None
Reason for referral: For Counselling Case History and MSE.
Reliability of informants: Self
Onset: -
Insidious Mode of Onset.
Course: -
Continuous course of illness.
Duration: -
1 year.
PPM factors: -
predisposing factors: -.
Sleeping alone in her room.
II) Precipitating factors-
Fear from spiders.
III) Perpetuating factors: -
She knows that most spiders are harmless but nevertheless experiences very intense anxiety.

Chief Complains: -
Fear, Sweating, Shaking and Heart Rate increase.

HOPI (history of present illness): -

A 24-year-old girl comes to see her general practitioner saying that a fear of spiders is
causing her significant problems. When she sees a spider she becomes fearful. She sweats,
shakes and her heart rate increases. She needs to get out of the room very quickly and
requires family members to come and remove the spider. She cannot re-enter the room until
she is certain the spider is gone. She cannot sleep in a room if she has seen a spider there and
could not go on to school trips because of worries about encountering a spider. She has been
offered a job in a hotel as an apprentice domestic supervisor. She is keen to take it, but does
not think she can do the job with her fears. She is also thinking of committing to a new
relationship and up until now her family have helped her solve her problems. She has not
revealed the extent of her difficulties to her boyfriend. She requests diazepam tablets, because
her aunt uses these for her fear of aeroplanes, and believes them to be effective for phobias.
Medical History: - None.
Family History: - She lives in a joint family with her parents, siblings and uncle & aunt.

GENOGRAM

Social History- She is a family-centred person and very emotionally attached with her
family members and also loves and cares about all.
Educational /Occupation History: -
She has just completed her graduation and she has been offered a job in a hotel as an
apprentice domestic supervisor.

Sexual and Marital History: -

NA

Religious History: -
She follows Hindu religion and occasionally visits shiv temples.

Pre-morbid Personality: -
The client was always a social person, fond of maintaining social relationship. She is very
emotional kind of person. She uses her leisure time by cooking and watching movies. She is a
very optimistic and anxious kind of person. She is also very self-conscious and thinks a lot
about a little thing.

MENTAL STATUS EXAMINATION

When she comes in it is noticeable that she is on edge. She scans the room quickly and
explains later that this was to check for spiders and that she does this routinely. Once she has
done this she is relaxed and discusses her fears. She explains that they are ‘irrational’ and she
knows that most spiders are harmless, but nevertheless experiences very intense anxiety. She
has no evidence of other mental illness and no symptoms or signs of psychosis or depression.

General appearance
She is well-dressed and looked younger.
Psycho-motor activity
Motor behaviour - She is looking anxious and restless.
Speech: Low
Mood/Affect: Her mood is low subjectively and objectively.
Thought/Perception
There is no delusions or hallucinations and nothing else of note.

Cognition: -
Attention
Inadequate
Orientation:
Oriented to time, place and person.

Concentration
Inadequate

Memory
Intact memory.

Intelligence Able to answer general knowledge questions.

Judgment: - Impaired judgement.

Insight
Grade 5
Behavioural Observation: -
Diagnostic Formulation: - The client was a 24year old unmarried, pursing his post-graduation
and currently unemployed. He started taking alcohol, when he was 14 in the influence of his
friends and now addicted to it. He smokes marijuana every day. In this case the predisposing
factor is his extreme social nature. He is very social and meets his friends very regularly, this
is he precipitating factor in this case. Whenever he goes out with his friends, he drinks 4 or 5
glasses of whiskey and, he would subsequently drink a couple of glasses of wine in the night
order to feel relaxed.

Diagnosis: - On the basis of comprehensive Case- History, Mental Status Examination the
diagnosis is as under:
F40.2 - Specific (isolated) Phobias
 CASE HISTORY 09

Socio-demographic Data: -
Name- Dr. Shubham
Age- 54 years
Sex- Male
D.O.B- 21/03/1968
Marital status- Married
Educational Qualification- MBBS, MD
Place of Birth- Delhi
Occupation- Physician (Oncologist)
Income- 1 Lakh.
Current circumstances of living- Nuclear family
Religion- Hindu
Socio-Economic Status- Higher Middle Class

Informants: -
Information is adequate and reliable.
Source of referral: None.
Reason for referral: For Clinical Case History and MSE.
Reliability of informants: Self

Onset: -
Insidious Mode of Onset.

Course: -
Continuous course of illness.

Duration: -
From last 2 months.
PPM factors: -
predisposing factors: -.
His busy and stressful job where he saw his many ill patients died.
.
II) Precipitating factors-
His continuous feeling of being not fully appreciated by the other doctors with whom he
worked.
III) Perpetuating factors: -
His volatile disposition nature, Distance from his children and wife, regularly facing of his
colleagues (other doctors), His non-accepting attitude regarding his medical illness.
Chief Complaints: -
Disturbed appetite.
Pessimistic views of the future.
He had a very volatile disposition.
Frequent anger.
Shouting on everyone whenever he had had a bad day.
His non-acceptance that he, a physician, had a severe medical problem.
His sabotaged efforts to lose weight
Fear of having another heart attack.
His pessimistic attitude about his living.

HOPI (history of present illness): -

He was a 54-year-old physician. The middle son of parents who had, he was ambitious and
determined to make a successful life for himself and his family. He worked long hours
helping patients with cancer, and he was caring and compassionate. His patients loved him.
But his job was also very stressful. Added to the many demands of maintaining a busy
medical practice was a great sadness that he felt when (inevitably) many of his terminally ill
patients died. At home, he was a loyal husband and devoted father to his three children. But
he was not an easy person to live with. He found it hard to relax, and he had a very volatile
disposition. He was frequently angry and would shout at everyone whenever he had had a bad
day. Often his moods were caused by his feeling that he was not fully appreciated by the
other doctors with whom he worked. Although his wife realized that he “just needed to vent,”
his moods took a toll on the family. His children distanced themselves from him much of the
time, and his wife became less and less happy in the marriage.
One day at work, he started to feel unwell. He began to sweat and experienced a heavy
pressure in his chest. It was difficult for him to breathe. He recognized the severity of his
symptoms and called out for medical help. He had a sudden and severe heart attack and
survived only because he was working in a hospital at the time of the attack. If he had not
received prompt medical attention, he almost certainly would have died.
Social History- He is being an honest and an obedient child of his family from childhood.
He was determined to make a successful life for himself and his family. After marriage also,
he was a very loyal husband and devoted father to his three children. He has less number of
friends but he loves his family very much.

Educational /Occupation History: -

He is a cancer physician (oncologist) and presently working in ESI Hospital, Jhilmil.

Sexual and Marital history: -

Good physical relation with his wife.

Religious History: -
He follows Hindu religion and often visit temples.

Pre-morbid Personality: -
The client was the middle son of his parents, who was very ambitious and determined to
make a successful life for himself and his family. He worked really hard for that and now
living a compassionate life as a cancer physician, who worked long hours for helping his
patients with cancer. His patients also loved him. He was loyal and devoted to his work and
family.

MENTAL STATUS EXAMINATION

After his heart attack, He became very depressed. It was almost as though he could not accept
that he, a physician, had a severe medical problem. Although he lived in fear of having
another heart attack, his efforts to lose weight (which his doctor had told him to do) were
sabotaged by his unwillingness to follow any diet. He would try and then give up, coming
back from the bakery with bags of pastries. Making the problem
worse was the fact that because he was a doctor, his own doctors were somewhat reticent
about telling him what he had to do to
manage his illness. He went back to work, and his family walked
on eggshells, afraid to do or say anything that might stress him.
His wife tried to encourage him to follow the doctors’ recommendations. However, his
attitude was that if he was going to die anyway, he might as well enjoy himself until he did.

General appearance
Dress- Appropriate
Eye-contact- Established and sustained
Posture: Still
Facial expressions: Not expressing
General appearance- Sickly

Psycho-motor activity
Motor behaviour - Preoccupied
Impression- Well- adjusted status.
Speech- Speed is Slow but with minimal pauses.
Quality: Clear
Tone: Tone was high
Intensity: Audible
Reaction Time: Decreased
Mood/Affect - Mood is not good and very low.
Affect is reactive, communicable and non-labile.

Thought/Perception
Possession- Doubts and fear
Stream - Increased rate and flow of ideas.
Form - No disorder found

Cognition: -
Attention
Adequate.
Orientation
Oriented to time, place and person.
Concentration
Inadequate.

Memory: -
Intact memory.
Intelligence
Adequate

Judgment: -
Social: Impaired.
On-test: Impaired.

Insight
Grade 2

Behavioural observation: -
Diagnostic Formulation: - The client was a 54 years old married, ambitious person, who
always worked really hard to make his and his family’s life good and successful. He is an
oncologist, who worked long hours helping patients with cancer, and was really caring and
compassionate about the same. But at the same time his job was also very stressful, which
demanded a busy medical practice, which brings a great sadness to him as inevitably many of
his terminally ill patients died. In this case this is the predisposing factor.
After doing all his hard work, he regularly felt that he was not fully appreciated by the other
doctors with whom he worked, which became the precipitating factor for him. Due to these
factors he had developed some severe medical problems also related to heart.

Diagnosis: - On the basis of comprehensive Case- History, Mental Status Examination the
diagnosis is as under:
F32- Depressive Episode
F32.01 Mild depressive episode with somatic syndrome.
 CASE HISTORY 10

Socio-demographic data: -
Name- Naman
Age- 23
Sex- Male
D.O.B- 09/11/1999
Marital status- Unmarried
Educational Qualification- Graduate
Place of Birth- Delhi
Occupation- Student
Income- Nil
Current circumstances of living- Nuclear family
Religion-Hindu
Socio-Economic Status- Lower middle class

Informants: -
Information is adequate and reliable.
Source of referral: NA
Reason for referral: For Clinical Case History and MSE.
Reliability of informants: Self

Onset: -
Insidious- slow and gradual

Course: -
Continuous and Deteriorating

Duration: -
10 Years
PPM factors: -
predisposing factors: -
He is very social and meets his friends very regularly and doing parties.
II) Precipitating factors-
Ten years back, when he entered in his teenage, he started taking substance with his other
teenage friends, just for fun.
III) Perpetuating factors
Staying alone in an apartment, where there is no family member who can stop him for
abusing substance every day. Also all these substances are very easily available to him.

Chief Complains: -
Alcohol Abuse, Use of Marijuana every day, Smoking and Other drug abuse.

HOPI (history of present illness): -

He is a 22-year-old graduate student.
He is attractive, neatly dressed, and clearly very bright. If you were to meet him, you would
think that he had few problems in his life; but he has been drinking alcohol since he was 14,
and he
smokes marijuana every day. Although he describes himself as
“just a social drinker,” he drinks four or five glasses of whiskey when he goes out with
friends and also drinks a couple of glasses of wine a night when he is alone in his apartment
in the evening.
He frequently misses early-morning classes because he feels too
hungover to get out of bed. On several occasions, his drinking
has caused him to black out. Although he denies having any problems with alcohol, he
admits that his friends and family have become very concerned about him and have suggested
that he seek help. He, however, says, “I don’t think I am an alcoholic because I never drink in
the mornings.” The previous week he decided to stop smoking marijuana entirely because he
was
concerned that he might have a drug problem. However, he
found it impossible to stop and is now smoking regularly again.

Medical History: - No Any.

Family History: - He Lives Alone in an apartment
GENOGRAM

Social History- He was a bright student of his school and was very hard working. He was
always bothered about the outside world and also about his own family and friends. He was
an extrovert kind of person, who use to do party regularly with his friends. He was very
amiable.

Educational /Occupation History: -

He is pursuing his graduation from Delhi university and currently he is not working
anywhere.
Sexual and Marital history: - NA
Religious History: -
He follows Hindu religion but neither he goes to meander nor believe much in God.
Pre-morbid Personality: -
The client was always a social person, fond of maintaining social relationship. He was active
and a very high on moral and very emotional kind of person. He used to do his leisure time
by doing parties and hang out with his friends.

MENTAL STATUS EXAMINATION

General appearance
He is attractive, neatly dressed and clearly very bright.

Psycho-motor activity
Motor behaviour - Normal
Mood/Affect - He is euphonic and subjectively not depressed.

Thought/Perception
Thought Form: No disorder present.
Content of thought is rational.
There is no Hallucinations, Delusions, Dissociation and Obsessives

Attention
Attention was aroused.

Orientation
Oriented for time, place and person.

Concentration
Adequate

Memory
Intact memory.

Intelligence: Able to answer general knowledge questions.

Judgment: -
Intact judgement.
Insight
Grade I-Complete Denial of the illness.
Behavioural observation: -
Diagnostic Formulation: - The client was a 24-year-old unmarried, pursing his post-
graduation and currently unemployed. He started taking alcohol, when he was 14 in the
influence of his friends and now addicted to it. He smokes marijuana every day. In this case
the predisposing factor is his extreme social nature. He is very social and meets his friends
very regularly, this is he precipitating factor in this case. Whenever he goes out with his
friends, he drinks 4 or 5 glasses of whiskey and, he would subsequently drink a couple of
glasses of wine in the night order to feel relaxed.

Diagnosis: - On the basis of comprehensive Case- History, Mental Status Examination the
diagnosis is as under:
F12- Mental and behavioural disorders due to use of cannabinoids.
F12.20- moderate