Internship Report

(01-05-23 to 30-05-23)

Learning through offline experience with Dr. Girish Chaudhary Civil hospital, Fatehabad.
A training report submitted towards the partial fulfilment post-graduate degree in
psychology.
M.Sc. Applied psychology (Session 2021-2023)

Submitted by:- Submitted to:-

Kiran Bala Department of Applied Psychology
Department of Applied Psychology

DEPARTMENT OF APPLIED PSYCHOLOGY

GURU JAMBHESHWAR UNIVERSITY OF SCIENCE
& TECHNOLOGY, HISAR (HRY)
 CONTENTS

INTRODUCTION

CLIENTS RECORDS

• Case Study – 1 •
Case Study – 2 •
Case Study – 3 •
Case Study – 4
• Case Study – 5

CONCLUSION
 CASE STUDY-1
Demographic VARIABLE

NAME: XYZ

AGE: 30 yr

SEX- MALE

EDUCATION- 12th Pass

SOCIOECONOMIC STATUS- POOR

MARITAL STATUS - MARRIED

RELIGION- HINDU

ADDRESS: Jhlaniya, Haryana

OCCUPATION - FARMER

DIAGNOSIS – PANIC ATTACK

INFORMANTS - HIMSELF

CHIEF CO MPLAINTS
 GHABRAHAT
 FEAR OF LOSS O F CONTROL OR DEATH
 RAPID, POUNDING HEART RATE
 SHORTNESS OF BREATH
 TIGHTNESS IN HIS THOUGH T
 FEELING OF DETACHMENT

PERSONAL HISTORY

• BIRTH AND DEVELOPMENTAL MILESTONE- GOOD

 • FAMILY ATMOSPHERE-
LIVE ALONE WITH HIS son.
HAVE SOME CONFLICTS WITH BROTHERS
HIS SISTER AND SISTER IN LAW HELP HIM TO TAKE CARE OF HIS SON

• OCCUPATIONAL HISTORY-
 WORKED HARD WITH HIS FATHER SINCE CHILDHOOD
 FACED POVERTY

• PAST HISTORY-

 HE GOT MARRIED AT THE AGE OF 23

 HAVING A DAUGHTER OF 3 YEARS

 LOST HIS WIFE AFTER GIVING BIRTH TO HIS DAUGHTER

 KEEP MEMORISING HIS WIFE

 CONCERNED ABOUT HIS son's HEALTH AND FUTURE

 HAVING A NARROW MENTALITY

HISTORY OF PRESENT ILLNESS

• SUDDENLY LOSE HIS CONTROL

• FEELS AS IF HE WILL DIE
• MAINLY AT NI GHT
•
TRY TO HIDE IT FROM HIS SON
•
GHABRAHAT REMAINS, MOST OF THE TIME
•
HAVE A NEGATIVE THOUGHTS
•
FAMILY HISTORY

• LOST HIS WIFE AFTER GIVING BIRTH TO HIS DAUGHTER

• NOT HAVING GOOD RELATIONS WITH HIS BROTHERS

• NOT HAVING PARENT s

•
• LIVE WITH HIS son
• ALWAYS KEEP THINKING ABOUT HIS DAUGHTER’S HEALTH AND FUTURE
• 10 YRS AGO, LOST HIS MOTHER DUE TO CANCER
AFTER HIS MOTHER, LOST HIS FATHER BECAUSE OF HEART ATTACK

MENTAL STATUS EXAMINATION (MSE)

APPERANCE - NORMAL LOOK WITH KURTA AND PAJMA

TALK – VERY FRANKLY TELLING EVERYTHING

ATTITUDE- NORMAL & SIMPLE

AFFECT AND MOOD- GOOD

THOUGHT- MIXTURE OF POSITIVE AND NEGATIVE & DERAILMENT OF THOUGHT

INSIGHT- PRESENT

DISTORTION OF CONTENT- NO

MEMORY- GOOD

CONCENTRATION- GOOD

PSYCHOPATHOLOGY-
HE WAS DIAGNOSED AS SUFFERING FROM “PANIC ATTACK”. MOST OF THE TIME HE
COMPLAINT-
• CHEST PAIN
• FEAR OF LOSS OF CONTROL OR DEATH
• RAPID, POUNDING HEART RATE

• SHORTNESS OF BREATH
• TIGHTNESS IN YOUR THOUGHT
• FEELING OF DETACHMENT

TREATMENT PLAN
• PSYCHOTHERAPY
• MEDICATION

SUMMARY

Mr. XYZ, a 27-year-old farmer having a single daughter lost his wife after giving birth to his
daughter. He lost his mother due to cancer and his father having a heart attack. He doesn’t
have some good relations with his brother and brother’s wife as he felt that after getting a
government job they don’t give importance to him. He had faced so many difficulties like
ignorance and poverty since childhood only. He remains anxious because of his daughter. He
had also met with other doctors and had taken medicines the name of which he doesn’t even
aware about.

He complaints about chest pain, fear of loss of control or death, breathing problem, and many
more symptoms. So finally it is concluded that he is diagnosed with panic attack.
 CASE STUDY-2
Socio-Demographic Details
NAME: XYZ

AGE: 25YEARS

GENDER: MALE

EDUCATIONAL QUALIFICATION : GRADUATE (B.TECH)

OCCUPATIONAL : PRRESENTLY NOT EMPLOYED

MARITAL STATUS : SINGLE

RELIGIOUS: HINDU

ADDRESS:- MANAWALI, HARYANA

SOCIO-ECONOMIC STATUS: MIDDLE

DIAGNOSIS : SOCIAL PHOBIA, MILD DEPRESSIVE EPISODE

INFORMANT
Client himself

Reliability : Information is Reliable and Adequate

CHIEF COMPLAINTS
Ghabrahat
Excessive worry about career and exams since the past 7 year
Decreased self-confidence
 Ghabrahat in social situations
Palpitations and bechaini during interviews

Sad mood since the past 7 months

Decreased interest in daily activities
ONSET : INSIDIOUS
COURSE: CONTINOUS

Precipitating Factor : The client had a fight with a group of boys in

his school, as well as with his best friend , 7years back, after which he started
experiencing excessive ghabrahat.

HISTORY OF PRESENT ILLNESS

The client was apparently fine around 7year back , when he was about to appear for his
class 12th Board exams. He reportedly had excessive pressure from his parents to perform
well in these examination, as he had not done well in his class 10th exams.
He was reportedly excessively worried about the outcome of these examination.
A week prior to his exam, the client and best friend had a fight with a group of boys in his
school. Following, this client told his friend that he will not able to help him further in the
matter, as he thought it would interfere with his studies. His friend reportedly reacted
with surprise and called him a ‘coward’.
Then the client started experiencing decreased sleep, ghabrahat lasting most of the day,
restlessness .
He was unable to concentrate on his studies.
He began to fear with group with whom he had fight or his friend and not going outside
from his house.
He also having thoughts that he cannot do anything in his life and that he was not
‘normal’.
After finishing, he joined a coaching course in Haldwani, where he stayed in hostel with a
group of boys. He continued to experience ghabrahat and faced difficulty also concentrate
in the class.
 He reported that one of his friends had jokingly remarked that he was going to buy a gun
and kill him. Although the client knew that this was a joke, he began excessive ghabrahat
and fear that he had again come in the company of ‘bad boys’.
He felt scared of disappointing his father. .
He joint a gang and start smo king cigarettes and consuming alcohol excessively in order
to fit.

In 2010 he discontinued medication and decided to stop consuming alcohol and smoking.
Then he reported that his friends made fun of him for the same, saying that he had
become a ‘saint’ and was not ‘cool’ anymore.
He completed his B.TECH and come back to home and took up a job on contract basis.
But he could not concentrate on the job and not performed well,
He always thinking about his friends that he was fun for him.
He left the job
His father always comparing him with other boys of neighbourhood In 2012 he came to
Delhi with a group of friends to search for a job.
Since then, his ghabrahat and increased when he was in the company of friends and he
started experiencing sleep disturbance.
He gave a few job interviews, during which he experienced excessive ghabarahat
fearfulness, palpitation and sweating and reportedly could not reply to the questions
posed to him during the interviews.
Gradually , since the past 6-7 months , he started experiencing excessive ghabrahat in the
presence of his friends as well.
He reported that he did not experience much ghabrahat when he was alone in his room .
in alone he preferring to watch TV , read books .
He came to present psychiatric facility and has been on medication since 2 weeks , with
slight improvement in symptoms reported.

NEGATIVE HISTORY
No H/O free-floating anxiety (anxiety experienced throughout the day)
No H/O anxiety evoked by specific objects
No H/O repetitive and intrusive thoughts, images, impulses or acts
No H/O hearing voices/ seeing images not heard / seen by others
 No H/O head injury, seizure, high grade fever

HISTORY OF PAST ILLNESS

NO H/O past psychiatric illness

No H/O significant medical illness in the past

FAMILY HISTORY
Family tree

46 yrs 54yrs

25 yrs 20 yrs
The client belongs to a middle SES, nuclear, Hindu family. His father works as an assistant
manager in a blank and is seen by the client as conservative, dominating and authoritarian. He
reported being afraid of disappointing his father. He further reported that his father used to
used to constantly compare him to neighbourhood children and used to tell him that he was
incapable of achieving as much as they had , as he was ‘week and not serious about achieving
success’. The client’s mother is a housewife and is seen by him as loving and caring . As
reported by the client, she is prone to getting anxious and scared over small issues and feel
anxiety during the exams when he was in the school. His younger brother is domineering like
his father.
  In addition to history of anxiety in the client’s mother, there is history of alcohol abuse in
the client’s father, who reportedly used to shout at and beat his family members when he
was in an inebriated state.
 He had not told his family about his family about his continuing problems as he reported
there is a prevailing ‘male attitude’ in his community, due to which his problems would be
perceived as a weakness.

PERSONAL HISTORY
BIRTH AND DEVELOPMENTAL HISTORY
The client was born at home and it was a full-term vaginal dilvery.

Detailed developmental history- not available

There is no history of any significant illness in childhood. No history of neurotic traits.

EDUCATIONAL HISTORY
 He was studied from English medium, school.
 He was above average student in the school.  He reportedly a naughty child
 He was generally liked by his teachers.
 He preferred to be in a small group of close friends.
 From the 7th to class 10th , he used to be bullied by a group of classmates, who used to call
him rude names.
 this used to hurt and anger him immensely
 he never used to express his anger and used to come back from school, lock himself in the
room and cry.
 He did not share this problem with his parents, as he did not want to be perceived as
‘weak’.
 After completing the school , he completing the B.Tech from a private institute and pass
in all sem with the difficulties.

OCCUPATIONAL HISTORY
 He worked in a private firm for three months as a research assistant on contract basis . 
He left the job as he could not concentrate on it and used to experiencing ghabrahat.
  So start avoiding interviews as he feels anxious and thinks he is going to embarrass
himself.

SEXUAL HISTORY
 He reported that gained knowledge about sex and masturbation through his friends when
he was in 9th class and some from the books in class 10th.
 He has not been in any romantic relationship thus far.
 He reported that he used to like a girl in school but he felt shy around her and did not tell
her about his feelings.

RELIGIOUS HISTORY
He reported that although his father is quite religious person. He had never been very
interested in religious and did not participate in religious functions. However, he reported that
he had developed more of a religious orientation since his problems have started.

HISTORY OF SUBSTANCE USE

 He started smoking cigarettes and drinking alcohol when he was in class 11 th.
 He has been abstaining from alcohol and cigarettes, since 2010 as he felt that they were
bad for his health and would exacerbate his experienced problems.
 He does not want to resume his smoking and drinking habit.

PREMORBID PERSONALITY
• Social relations: The client was attached to his family , wanted to make
his parents proud of him and had a group of few friends with whom he was close.

• Intellectual activities, hobbies and interests: He was interested in

music, movies, especially ‘rocky’ movies , which he found very inspiring and
idolized the main character and he was ‘strong against all odds’.

• Mood : He was of a cheerful disposition. However he used to get disturbed and

anxious when he encountered conflicts among his friends.
• Character : He used to worried by responsibilities was sensitive to criticism ,
desired to be the center of attention among his friends-used to be the ‘joker’ of
his group.
 • Fantasy : He dreamt of setting up a personal gym n his future home and do
body-building , boxing etc to become ‘strong’.
• Habits : He had a habit of consuming alcohol and smoking each day since class
10th which he reportedly used to enjoy.

MENTAL STATUS EXAMINATION

The following are the findings of the mental state examination of the client done during the
intake session.

• General Appearance and Behaviour

• A young adult male of average built, dressed appropriately .
• Eye to eye contact was established but was not maintained for long and looking
downward while speaking.
• The client was cooperative and help-seeking
• He was restless and constantly shifted in his seat while speaking. He mostly sat on
the edge of the chair.
PSYCHOMOTOR ACTIVITY
 The client appeared restless and kept moving and shifting in his seat
Speech
 Rate
 Volume NORMAL
 Reaction
 Tone
Speech was coherent and relevant

AFFECT:
Quality: subjective – “ghabarhat hua rahta hai mann” “mann nahi lagta kisi cheez mein”

Objective- anxious, low mood

Range : normal

Lability : not present

Reactive

Congruent and Appropriate

THOUGHT :
Flow and form : no abnormality detectd

“mere sab dosto ki Naukri lag jayegi sirf main hi reh jaunga , ghar main sab kya bolenge sab dukhi
honge kitni expectations thi unki main kuch bhi pura nahi kar paunga”

WORRIES ABOUT BEING SOCIALLY INADEQUATE”

“mere sab dost calm rhte hain sirf main hi ghabra jata hoon samajh nahi aata kya bolna hain bilkul
freeze ho jata hoon aur koi mere sath time nahi bitana chahta hain isliye”.

“sochta rehta hoon ki kya bolna hain logo ke samne , aisa bhi lgta hain ki vo hasenge mujhpe.
Main cool nahi hoon apne friend ki tarah “.

PERCEPTION: No abnormality detected

ORIENTATION : Time
Place intact
Person

MEMORY:
Immediate – Intact (digit span test- forward: 5 digits, backward:4 digits)

Recent – Intact( recall of recent news articles)

Remote – Intact ( recall of significant dates in life)

GENERAL INFORMATION AND INTELLIGENCE : Adequate (serial

substraction of 7 from 100, naming the months of the year in reverse order)
ABSTRACT THINKING: Present (similarities test, meaning of proverbs)

TREATMENT PLANS

MEDICATION
PSYCHOTHERAPY – CBT , SUPPORT GROUP , BEHAVIOR THERAPY

SUMMARY
Client XYZ,25 year old graduate, unmarried male, belonging to a middle socio-economic status,
Hindu , nuclear family, currently unemployed, presented with chief complaints of ghabrahat ,
headache, palpitations, excessive worry about career and exams, sad mood, since 7years and
decreased self-confidence, anxiety in social situations, ghabrahat during interviews, since the
past one year. The total duration of illness was reported to be approximately 7years, with
exacerbation in the symptoms since the past 7 months. The illness had an insidious onset with a
continuous and static course. There is family history of similar symptoms in client’s mother.
There is history of alcohol abuse in his father, who was perceived by him to be overly critical
and dominating. Exploration of premorbid personality revealed low frustration tolerance,
sensitivity to criticism and high desire for achievement. Mental status examination of
the client reveals anxiety about career, about disappointing his family and about his social

inadequacy . finally he was diagnosed with social phobia , Mode Depressive Episode.
 3. CASE HISTORY
Name- Mrs. MP
Age/Sex- 38 years / female
Marital status- married
Education- illiterate
Occupation- housemaker
Religion- Hindu
ADDRESS:- Dhingsara, Haryana
Family Type- Joint family
Referral- None
Informants- Self and Daughter
Chief Complaints- Neend nahi aati
Sar ki nasso me dard aur ghabrahat rehna
Onset – Subacute
Duration – 2-3 months
Course – Continuous
Precipitating Factors – Beating of the son by family member and getting hurt in
process of saving him.
Perpetuating factor – Behavior of the son
Predisposing Factor- death of father 20 years back
HOPI – The patient was apparently asymptotic before her son was beaten up
by the family members, 2-3 months back. Then she started feeling restlessness,
insomanic, apprehensive pain in veins of head in the back.
She is not interested in taking to family members and whenever family
members talked to her, she replied in low voice and sometimes become
irritable. Patient’s sleep was also disturbed with difficulty both in initiation and
maintenance of sleep. In night when not sleeping, she remains lying or sitting
on bed, worrying about future. Her appetite was reduced. According to her
daughter. patient was eating less than previous.
Negative History-
No H/O of fever, head injury, vomiting, abnormality of gait
No H/O of substance intoxication
No H/O of muttering to self / suspiciousness and any other hallucinating behavior
No H/O of other cheerfulness of mood, excessive talking or over spending
No H/O of suicidal thoughts/ attempts
Past History – Not significant for any psychiatric or any chronic medical illness.
Treatment History- The patient have High blood pressure condition as stated by
informant and patient both.
Family History – It was reported by patient and the informant that no other
family member suffers from same illness in family. Head of family is the
husband of the patient.
Personal History-
Birth History – full term vaginal delivery at home with no
complication Childhood History – No complaints of any childhood
fear.
Menstrual History – Menarche at the age of 14-15 of age
Got knowledge from Bhabhi
Regular menstrual cycle – 4-5 days
2 years back had an operation of sterilization for birth control
Non consanguineous arranged marriage with consent of both partners.
*No history of substance abuse
*Legal History – No legal history
Premorbid Personality –
Interpersonal relationship – of patients with family members, friends and
relatives are good.
Predominant mood – Pessimistic thinking, negative reaction to stressful life event,
prone to anxiety.
Leisure time – Gossiping with neighbors, dancing
Character – Hardworking female, would take responsibility for her work.
Cordial relations with family and friends.
Participants in religions activities.
Participants in family functions.
Regular sleeping and excretory and functions.
GPE- the patients was conscious, alert and cooperative.
She is moderately built.
Afebrile to touch.
No pallor, icterus, cyanosis, hyphae no pathey, pedal edama
MSE-
GAB- an adult female, looking stated age, average built, dressed adequately and
appropriate according to weather and socio-cultural norms, hygiene maintained.
Walked into interview room with her daughter, appeared to in contact with
surroundings, did not greet counselor, sat on bed offered, laid down in bed saying
she is tired.
No abnormal movements and no hallucinatory behavior noticed.
Psychomotor activity- decreased
Eye to Eye Contact- established and not sustained
Rapport- established
Speech- decreased tone, rate and volume
Co
mpr
ehe
nsib
le
Coh
ere
nt
rele
van
t
Affect-
Subjective- Neend nahi aati
Sar ki nasso me dard ahta
Ghabrahat rahti
Objective- Thoughts Resmination
Tired/fatigued
Sad
Thought- No disorder of stream, form and possession
Content – No suicidal
ideas Ideas of
helplessness and
hopelessness
Perception- No
abnormality found.
Higher Mental Functions-
Orientation - oriented to time, place and person
Attention- Arouse about -: Digit span test – Patient was able to complete till 3
digit backward and 4 digit forward.
Concentration - Not sustained – Patient was not able to subtract 3 from 100.
Memory-
Immediate- Intact (she was able to complete digit span test forward)
Recent – she was able to recall what she had in dinner last night and today morning.
Remote- she wasn’t able to recall her marriage anniversary or date of birth of
her kids. General funds of knowledge – adequate – she was able to tell CM of
Haryana, seasonal crops and fruits.
Abstract thinking – Similarities : Between Birds and Plane (that they
both fly) Proverbs – she stated that she has no knowledge.
Insight- 4/5 Patient accept that she is suffering from illness for which she
requires regular treatment Judgement- test intact (fire test – set off with
water) (social and personal impaired) Diagnostic formulation- Mrs. M, 30
years, homemaker from rural background presents with her daughter with chief
complaints of sleeplessness, restlessness, pain in the back of head, lack of
interest in leisure activities and sad behavior.
With past history reflecting no significant for any psychiatric or any chronic
medical illness. The patient have high blood pressure condition for which she
takes medications and Clonazepam and paracetamol for headaches.
On MSE, her eye contact was established but not sustained decreased
psychomotor activity, normal reaction time, speech decreased in tone, flow and
volume, depressed affect with decreased self- esteems, self-confidence,
concentration, intact immediate and recent memory but her remote memory was
impaired. Her insight in the illness is of grade 4.
Differential diagnosis- as from the history, physical and systematic
examination, there is no sign of suggestive of organicity, so it is ruled out. -
General Anxiety Disorder (F 41.1)
Point in Favor – Apprehension, Motor Tension, Autonomic Overactivity
Definitive diagnosis - Anxietic- depression continuous course
Treatment –
Acute Phase Management- First step in acute stage was to admit the patient, as he
was not showing improvement and has significant disturbances in personal, social and
occupational functioning.
Pharmacotherapy:
Antidepressant-SSRI
Benzodiazepine- to relieve anxiety and insomnia.
Nonpharmacological treatment:
Due to significant loss of appetite, we will plan for MECT thrice a week on alternate days.
We will do serial MSE’s of the patient and look for improvement in the symptoms.
Monitor the side effects of the drugs and MECT’s.
Psychotherapy can be started along with the medication after partial benefit.
It will target persistent cognitive, self-esteem and interpersonal difficulties.
It will not only augment the treatment but also:
Increase the adherence to the treatment.
Help in symptom remission.
Will treat the sequelae of the disorder like occupational difficulties,
familial problems. Cognitive therapy- to address the distorted thought
about self, world and future. Continuation phase:- To preserve
remission.
To continue the pharmacotherapy in the same effective dose as of acute phase and
advice for close follow ups to monitor the symptoms and side effects.
In the subsequent visits the doses are adjusted according the response..
 4. CASE HISTORY
Name - R
Age/Sex- 22 years old/ female
Marital status -Single
Education-Saloon course (10th pass)
Occupation- Unemployed
Religion- Hindu
ADDRESS:- Ayalki, Haryana
Family Type- Nuclear
Referral- none
Informants- Mother and self
(Reliable informant giving adequate
information) Chief Complaints-
Hath pair me khujli.
Nind nahi aati aur bukh
nahi lagti. Gussa aata
hai aur chakkr aate hai
Pith mein dard.
Onset- insidious
Course- progressive
Percipitating factor - not known
HOPI -
History date back to 2 years when patient started taking smack (2017), in the
company of his brother. For the first time, about 1/2 gram. She continued taking
smack in company of her brother after 1.5 year she took chitta with foil paper,
which she contiuing till date for 8-9 months. She injects 1 ml -3ml of drug with a
14 unit syring. Last time she took the drug was this morning before coming to
hospital.
She reported that after taking drug she is euporic and she have no appetite but
afterwards when the effect of drug wears off she lacks sleep., their is itchiness
in her hands, arms and legs. She has an irritable mood most of time and gets
aggressive on small things.
15 -20 days back she started having a backpain. She have suicidal thoughts. she
sells jewelry for money to buy drugs.
Her sleeping patterns is abnormal as she sleeps around 3-4 in the morning and
wakes up around 5-6 pm in the evening. She had scars on both of her hands due
to self-administered injections.
Negative History-
No h/o seizures and head injury.
No h/o voices or thoughts being interfered with.
No h/o mutering to self, suspicious , and any other
hallucinatory behavior No h/o other cheerfulness of mood,
excessive talking No h/o suicidal attempts.
No h/o chronic medical illness.
Past History-
There is no past H/O any psychiatric illness.
She takes dicopin drug for itchiness and restlessness in her hands and legs.
Treatment History-
No prior treatment was taken by the patient.
Family History-
Belongs to a Hindu nuclear family from urban background. Father is the head of the family.
Personal History-
Birth History:- full term vaginal delivery in hospital with no complications.
Childhood History :- no complains of any childhood fear.
Academic History:- started going to school at the age of 3 years and studied
upto 10th standard. She has completed a salon course.
Upto 10th class she was average in studies and had cordial relations with peers and
teachers. Menstrual history:- age at menarche 12 yrs
Information regarding menstruation and hygiene was given by her mother. Her periods
are continuous with duration of 3-4 days.
Date of last menstrual period - 12/07/2021
Had cordial relations with family and friends and neighbours.
Patient is friendly and outgoing and stubborn.
Confidence and responsible attitude
towards work. Premorbid
personality:- Religious by nature.
Liked to sew clothes in her leisure time.
GPE:-
The patient was conscious, alert and cooperative
She was well built Afebrite to touch
Pallor, icterus, cyanosis, clubbing, pedal enema all absent
Mental Status Examination
A well-built young female with poor hygiene dressed appropriately according to
weather and socio cultural norms to be in contact with surrounding greeted
examiner and and sat on chair offered.
No abnormal moments and no hallucinatory behaviour was noticed, was
cooperative throughout the interview.
Eye To Eye Contact- established but not sustained
Psychomotor activity- increased
Reaction time - increased
Rapport- established
Speech- In response to questions normal in tone and volume ; rate was fast
comprehensive, coherent and relevant.
Affect-
Subjective- bechaini, chidchidapan
Objective- restlessness, irritable behaviour
Thought- no disorder of steam, form qnd possession
Content –ideas of worthlessness and suicidal ideas low self esteem

Perception-no abnormality found

Higher Mental Functions-

Orientation- oriented to time, place and person
Attention - aroused and sustained
Patient was able to complete till 5 digit forward and 4 digit backwards
Concentration- serial subtraction of 100-6 was completed

Memory
Immediate- intact (was able to do complete digit span test)
Recent - intact (able to tell what she had in breakfast and dinner)
Remote - intact (able to te her address and date of birth)
(Information was varified from mother)
General fund of knowledge- she was able to tell CM of haryana, PM of India,
seasons in year and use of thermometer.
Abstract thinking -
Similarities -apple and banana ]-edible
Bird and aeroplane]- fly

Insight – Grade 4/5

 Judgement - Intact social and personal judgement

Diagnostic formulation- A 22yrs old unemployed female presented with

misuse of Chita and smack for last 2 years with increase intake for 8-9 months
and history suggestive of tolerance, dependence , blackouts and withdrawal
symptoms and considerable impairment socially , occupational and in
interpersonal relationships along with physical complications like itchiness and
restlessness in hands and legs

Definitive diagnosis –
Mental and behavioral disorder due to the use of opioids, dependence
syndrome, currently using the substance (F 11.24)
Compulsion to take substance
Difficulties controlling substance use behavior
Withdrawal state when substance use ceased or been reduced
Evidence of tolerance
Progressive neglect of alternative pleasures or interests because of substance use
Persistence of substance use despite harm
Treatment –
DETOXIFICATION
Tab. Lorazepam 8mg/day in divided dosages (1-1-2) gradually to be tapered by
approx. 20% each day and omit it within 7-10 days.
The main principle guiding
dosage: Tremors, anxiety and
sleep disturbances Assess
improvement:
Serial MSE and physical examinations
Inj.B Complex im/iv for 5 days (Thiamine 150 mg daily)
Injection Diazepam 10 mg iv slow SOS (if seizures)
Adequate nutrition and hydration
Pt, continue with rest, good nutrition and oral M.V.
INTERVENTION:
Break through feelings of denial and help pt recognize the adverse consequences
occurred or likely to occur if disorder not treated
Aimed at maximizing the motivation for treatment and continued abstinence.
 CASE STUDY-5
SOCIO-DEMOGRAPHIC DETAILS
NAME: XYZ

AGE: 35 YEARS

GENDER: MALE

EDUCATIONAL QUALIFICATION : CLASS 12TH

OCCUPATION: PRESENTLY NOT EMPLOYED

MARITAL STATUS: SINGLE

RELIGIOUS: HINDU

ADDRESS:- Bijalamba, Haryana

SOCIO-ECONOMIC STATUS: LOWER-MIDDLE

INFORMANT
Patient’s mother, patient himself

Reliability : Information is reliable and adequate

CHIEF COMPLAINTS
 • Sad mood
• Crying spells
• Death wishes-1 attempt to poison himself
• Decreased interest and pleasure in daily activities
since past1& half mnths
• Decreased sleep
• Not going appetite
• Not going to work

• Consumption of alcohol since 12 years

• Excessive anger outburst toward family members.

ONSET: INSIDIOUS

COURSE: CONTINUOUS

PRECIPITATING FACTOR: The patient had been sent by his family members to
a drug de-addiction centre. The current symptoms began upon his return from there.

HISTORY OF PRESENT ILLNESS

 The patient was apparently fine around 12 years back, when he moved into a new
neighbourhood and joined a new circle of friends.
 He was asked by his group of friends to try out alcohol
 He reported that he started consuming alcohol in order to fit in with the group and did
not tell his family members about it.
 He reported that he would make one bottle of beer last for the entire duration of time
that he would spend with his friends (2-3 times)
 The quantity of consumption also increased to around two to three pegs per day.
 Alcohol helps the client to reduce stress at the end of the day and he feel relaxed
 Then he reported that he began to experience occasional craving for alcohol when he
could not obtain it.
 The patient had started a clothes business during this time , with one of his friends. After
about 8-9months, the business incurred massive losses and they were forced to shut
down.
 The patient reported that his consumption of alcohol increased.
 He started drinking alcohol almost constantly from morning till night
 He would spend most of the time with his friends , chatting with them and consuming
alcohol
 He reported experiencing intense craving whenever he was at home and could not get
access to alcohol. Early in the morning , he would experience dizziness, headache, due to
which he would have to consume some country liquor in order to feel better  Following
this, he was brought by his brother to IHBAS
 He reported that the follow-up visits for treatment irregular. His compliance to
medication has also been poor.
 He continued his alcohol consumption of alcohol through reduced it in amount of around
a bottle(90ml) of country liquor in 2 days
 He would do small jobs in the local market and did not have any stable employment
 5years back his marriage was fixed. However due to financial condition of the patient’s
family, the girl’s family backed out of the engagement.
 This came has a huge shock to the patient and his consumption of alcohol increased
again.
 He did not have any stable job so he start asking for money from his family members to
buy alcohol but they denied , so he start stealing the money from the house and also
from the family temple
 He would remain under the influence of alcohol throughout the day  He reported that
he begin visiting sex-workers in a nearby colony each day.
 He was brought to IBHAS and admitted to the DATRC ward for a month
 After the discharge around six months he was not in the touch of his friends and also not
visit outside the home
 After the six month he began spending time with the group of friends and began to
consume alcohol again(2-3pegs ,3-4 days per week)
 He reported experiencing guilt due to his past actions
 He tried to set up the new cloth business , so he borrowed money from his friends but
around six months and more he was not able to setup the business . he also reported
that he tried his hand at a few business but incurred huge losses again.
 He began drinking alcohol excessively again and reported intense craving.
 He would also experience ghabrahat, restlessness and headache, whenever he would not
consume alcohol for a few hours
 He would shout and fight with family and neighbours and stopped working as well
  In august 2013 he was drinking in the company of his friends. When his brother asked
him to come home he slapped his brother for humiliating him in front of his group. He
reported that his friends suggest to his brother that the patient was a serious addict and
needed intensive treatment.
 They suggested to his family members that they should take him to a de-addiction facility
nearby. Taking this advice. The patient insisted that he did not have a problem and his
habits were controlled. He stayed there for 40 days with no contact from his family
members and friends.
 He reported that he started remain sad throughout the day.
 He reported wondering how his family members could have left him there alone and
what he had done to deserve such punishment. He reported feeling that he had no one
in life who loved him and feeling betrayed by this group for complaining to his family.
 After the completion of the treatment , he was brought home by his family members. 
He reported that he remain sad throughout the day and not talking to anyone.
 He shows his anger towards family members and friends and felt that they had caused
him humiliating in society. He worried about people think about him and felt ahto step
out of the house.
 He experienced decreased sleep and appetite.  He blaming his family to ruin his life
 He start feeling that his life was finished
 He was bought to IBHAS out-patient department and prescribed medication
 The next day, he overdosed on sleeping pills prescribed to him. He rushed to GURU
TEGHBAHADUR hospital, where his stomach was pumped.
 Following this , he referred back to IBHAS and referred to the clinical psychology
department for management.

NEGATIVE HISTORY
• No history of use of any psychoactive substance apart from alcohol and ganja
• No H/O pervasive anxiety, or anxiety evoked by specific objects or situation
• No H/O repetitive and intrusive thoughts, images, impulses or acts
• No H/O hearing voices/seeing images not heard/seen by others
• No H/O head injury, seizure, high grade fever

HISTORY OF PAST ILLNESS

No H/O past psychiatric illness
No H/O significant medical illness in the past

FAMILY HISTORY
FAMILY TREE
 CONCLUSION

This one-month training was a unique exposure towards profession. It taught me a lot of things. I
gained a lot of confidence, and had better understanding of my capacities and capabilities. But
personally I feel that one-month training was a very short period to understand all things
properly. It was the high privilege to be able to share the experience of so many different people,
counselor are in an enviable role because they are able to interact with a very wide range of
unique individuals.