INTRODUCTION

The primary goal of an internship is to provide practical knowledge. An internship is a

supervised experience in a professional setting, in which the student gains real world
experience and insight in the field related to their career choice and interest. It is to ensure the
development of proficiency across the basic areas of clinical psychology including
assessment and therapy.

The objective was to apply my theoretical learning into a practical setting. Internships give
students an opportunity to explore their field of choice, to gain greater expertise and to make
early connections with various professionals in the field. Internship fulfilled all of the above
criteria’s and goals which I set my mind to achieve

OBJECTIVES
To assist the counsellor in all ways possible and to contribute as much as possible in devising
treatment plans

To explore all aspects of psychological disorders, their causes, consequences and therapeutic
techniques.

To help and aid the hopeless patients and to bring realistic hope back in their life

To function efficiently as a member of the professional team and as a part of the patient care

To get along with the vision and mission of the organization and to provide my maximum
contribution to the growth of the organization by sticking to their rules and ethical values

PURPOSE
To make the best use of the internship by developing professional identity and skills as
psychologists through participation in training, supervision and modeling of the
psychologist’s values and practices

To enhance competence in research analytics and its integration into practice

To enhance awareness and sensitivity to cultural, ethnic diversity and health disparities

ORGANISATION PROFILE

Mind weavers is an innovative mental health service hub providing quality mental health care
in a supportive and compassionate environment.

They are licensed clinical psychologists aiming to create lasting and meaningful change in
the lives of people who are engaging with them. They seeks not just to improve the clients
but also focus on changing how they live. Drawing from the knowledge of evidence-
based mental health care practices, they seamlessly tailor them to meet the client’s
unique needs.

They uses different types of therapeutic approaches like mindfulness-based psychotherapy,

cognitive behaviour therapy, solution-focused brief therapy and behaviour modification
customized for clients from a different culture and grounded in science.

Clinical Services

Mind Weavers addresses children, individuals, couple and families having various mental
health issues like Depression, Anxiety, Obsessive-Compulsive Disorder (OCD), Phobia,
Adjustment Issues, Learning Difficulty, Marital Issues, Sexual Problems, etc. through:

• Individual Psychotherapy & Counselling

• Couple & Family Therapy

• Psychological Assessments & Diagnostic Psychometrics

• Neuropsychological Assessment & Cognitive Retraining.

• IQ & Learning Disability Assessment

• Remedial Education For Learning Disability

• Online Psychotherapy

Growth and Grooming Lab

• Individual & Group Coaching

• Aptitude Test & Career Counselling

• Corporate Training & Organizational Change

Training and Supervision

They are committed to developing resources in society and one part of this is to ensure that
those who are new to this filed to receive the proper guidance. If you are a new to mental
health, a fresh graduate looking to develop skills and experience, someone looking for a fresh
start in life while being able to give back to society wondering if you are suited to the role, or
even those coming back to this field after a break and want to renew confidence, this is the
right place for you.

• Psychotherapy Supervision

• Clinical Internship
 • MPhil Entrance Training

Research & Development

Conducting research is both an exciting as well as a daunting task and while you’re in the
middle of it can seem quite confusing. Our expert panel with years of experience producing
quality research can help you breeze through with ease.

• Tool Construction

• Research Supervision

• Research Internship

Scientific Event Management

To successfully conduct any event is a mammoth task requiring a lot of time, energy and
manpower. Add to this the pressure of conducting a scientific conference or workshop that
attracts the top minds in academia and anyone would quail at the prospect. But fear not,
professionals are here to help!

An experienced team will take over the nitty-gritty details of bringing to life the vision you
have for your event. Our services will cover scheduling, publicity, handling enquiries,
communicating with delegates and attendees, printing posters, brochures, certificates or other
resource materials, mementoes and other preparation required before the event as well as
ensure smooth proceeding of the event itself.

Conferences: Large scale conferences involving multiple parallel venues can be challenging,
but not when you have a well-oiled machine in a place like we do. We take charge of
procuring speakers and resource persons according to your needs, scheduling sessions
without conflicts, confirm necessary equipment and resources across all venues and ensure
progress in a timely manner.

Workshops: The primary requirement to conduct an effective workshop is to create the right
learning atmosphere. We facilitate a learning environment by creating the right tone right
from advertising the event to the physical settings of the venue and equipping participants
with resource materials necessary.

Installation

Setting up something new is always challenging. Through our services, we make this process
easier for you by taking charge of the groundwork required to establish your facility
Library Installation

Visualize your requirements for your library, and then make it a reality. Taking into
consideration your specific requirements, we facilitate procurement of materials through our
network of suppliers for books, journals as well as other fixtures. We also aid in setting up
online library resources for your institution.

Psychology Lab Installation

Need to set up an efficient and scientific environment to supplement your course

requirements, research work or clinical? No worries, we’ve got you covered! Beginning with
designing and planning, then proceeding to contact vendors and suppliers, putting in orders,
managing logistics and finally overseeing the setting up of equipment we will be there every
step of the way.
CHAPTIOR 2

CASE REPORT
CASE REPORT 1

Socio Demographic data

Name: AK

Age: 7 (05/04/2013)

Gender: male

Education: 2nd Std (Malayalam)

Religion: hindu

Marital status: unmarried

Occupation: nil

Socio Economic status: middle

Address: Omessery, Calicut,Kerala

Informants

Father and mother were the informants. The information provided by the informants are
reliable and adiquate.

Chief complaints

• Hyperactivity
• Poor academic performance
• Fighting with friends
• Disturbing others
• Decreased attenton and concentration

History of Presenting illness

The child is a 6 year 10 months old boy, second born out of two in a non-consanguineous
marriage, brought by the parents with complaints of hyperactivity, decreased attention and
concentration.

Negetive history

No history of head injury

No history of seizure

Treatment history
No treatment history is present

Past history

No history of physical of psychiatric illness is present.

Family history

Genoram

Theres is family history of LD in the elder sister.

Personal history

Delivery and birth cry was normal. There wereno prenatal complications. Gestation period
was fullterm. The development milestones was delayed.

There is no history of childhood disorders.

Poor performance in school and decreased attention and concentration.

MENTAKL STATUS EXAMINATION

General appearence

Dressing: neat and well dressed

Eye to eye contact: The child could maintain eye contact with the examiner.

Rapport: Rapport could be established easily.

Psychomotor activities
He was running around the room and indulging in different activities.

Attitude towards the examiner

The child was alert and cooperative.

Orientation: orientation towards time, place and person is intact

Memory

Immediate, remote and recent memory was intact

Attention and concentration

His attention could be aroused but not sustained for the required period of time.

Speech

speech was audible and voice was loud

Intelligence

The child’s intellectual functioning was found to be average.

Mood and affect

He appeared to be pleasant.

Thought Process: Normal

Perception: No abnormalities present

Judgement: Social and personal judgement was intact

Insight: Grade IV - awareness that illness is caused by something unknown

Diagnosis

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD rating scale was administered and the score of 26 indicate the child has moderate
level of Attention deficit hyper activity disorder.

It is a medical condition. A person with ADHD has differences in brain development and
brain activity that affect attention, the ability to sit still, and self-control. ADHD can affect a
child at school, at home, and in friendships.
Trearment plan

• Psychoeducation to the parents

• Attention Enhancement Training
• Behavior modification
• Reassessment after 6 months.
CASE REPORT 2

Socio Demographic data

Name: KK

Age: 10 (23/09/2009)

Gender: Female

Education: 5nd Std (Malayalam)

Religion: hindu

Marital status: unmarried

Occupation: nil

Socio Economic status: middle

Address: Omessery, Calicut,Kerala

Informants

Father and mother were the informants. The information provided by the informants are
reliable and adiquate.

Chief complaints

• Lying behaviour
• Do not do home work, because of parent’s fight.
• Poor scholestic performance
• Slow learning
• Spelling mistakes
• Slow in activities

History of Presenting illness

The child is a 10 year 5 months old girl, first born out of two in a non-

consanguineous marriage, brought by the parents with complaints of poor scholastic

performance,increased lying behaviour and anger outbursts.

Negetive history

No history of head injury

No history of seizure

Treatment history
No treatment history is present

Past history

No history of physical of psychiatric illness is present.

Family history

Genoram

Theres is family history of ADHD in the younger brother.

Personal history

Birth history indicates cessarian delivery with normal developmental milestones. birth cry
was normal. There wereno prenatal complications. Gestation period was fullterm.

There is no history of childhood disorders.

Slow learning and slow activities

Educational histort

She has shifted her schools frequently and shifted to malayalam medium while she was in
first standard.

MENTAKL STATUS EXAMINATION

General appearence

Dressing: neat and well dressed

Eye to eye contact: The child could maintain eye contact with the examiner.

Rapport: Rapport could be established easily.

Psychomotor activities: normal

Attitude towards the examiner

The child was alert and cooperative.

Orientation: orientation towards time, place and person is intact

Memory

Immediate, remote and recent memory was intact

Attention and concentration

Her attention could be aroused sustained for the required period of time.

Speech

speech was audible and voice was low

Intelligence

The child’s intellectual functioning was found to be at dull normal level.

Mood and affect

She appeared to be pleasant.

Thought Process: Normal

Perception: No abnormalities present

Judgement: Social and personal judgement was intact

Insight: Grade IV - awareness that illness is caused by something unknown

Diagnosis

Mixed disorder of scholastic skills

NIMHANS Specific Learning Disability Index was administered to assess child’s scholastic
performance. The child was assessed in Malayalam.

The overall test results indicate that the child has severe learning disability in reading,
writing, spelling and difficulty in arithmetic skills.

Trearment plan
• Psychoeducation to the parents
• LD Remediation will be beneficial for the child
• Behavioural therapy
• Home based remediation
• To follow up regularly
CHAPTER 3

CASE STUDY
CASE STUDY 1

Socio-Demographic Data

Name: ML

Age: 54

Gender: Male

Marital status: Married

Education: 6th standard

Occupation:Currently not working

Informant:Patient alone, (Reliable and adequate)

Chief Complaints:

• Anger outbursts: 11 years onwards.

• Seeing a person coming to his room to harm him, during night- 6Years onwards.
• Hearing voice of pulling chain: 5years onwards.
• Suicidal ideation- 2 years onwards.
• Decreased sleep- 2 years onwards.
Onset: Insidious.

Precipitating factor: nil

Course of illness: Continuous.

History of Presenting illness:

The client was apparently doing well before 11 years. Gradually he has started
showing increased anger outbursts towards his family members. He used to get angry for silly
reasons and react to it with out thinking about the consequences. He used to through things
whenever he is angry. He has harmed his wife and daughter when he got angry. One day he
was doing some electrical works and asked to his daughter for a help, while she was moving
the torch, it has flashed to his face, suddenly he has got angry and pulled her forward and has
beaten her. Due to this incident he was in prison for 8 days as his wife has petitioned a case
against himunder JJ Act.

From past 6 years onwards the client is seeing a person coming to his room to harm
him. The person is not much clear, but he sees a male person and his only intention is to harm
the client. Some times the client images that the person will throw him to the wall in order to
harm him deeply.
 The client used to suspect that a snake has been there with him always. During night
times he often see the snake at his bedroom.

From past 5 years onwards he used to hear a voice of pulling chain and it disturbed
him a lot. The sound is disturbing him only during night. The client is having active suicidal
ideation from past 2 years onwards. He as planned how to commit suicide also. He has tried
to suicide once before 6 yearsbut not attended.

He is not able to sleep soundly from past two years onwards. He goes to bed by 10:00
PM but fails to fall into sleep. He will get disturbed thoughts during the time. For getting
sleep the client has started consuming large amount of alcohol by past 2 years onwards. He
consumes 500ml of alcohol during night thrice in a week.

The client suspect that his wives are cheating on him as they used to say that he is
mad. One of his wives was having an extra-marital relationship and he comes to know about
it later. He was harmed her without any consideration.

The client is sad always by last 2 years onwards. He is not able to go for job. He lost
his interest in pleasurable activities. He used to cry alone during day time and night time also.

Negative History:

There is no history of fever, headache, vomiting, hypertension and diabetes. There is

no history of manic symptoms and illusion.

Family history:

The client is born out of a non- consanguineous union. his father died at the age of 92
(paralysed) and mother died before 15 years. His elder brother died at the age of 35 due to
accident.

There is history of mental disorders in family, his elder brother had hebephrenic
schizophrenia and elder sister had PICA disorder. He is currently staying with younger sister.
There is no history of physical disability and epilepsy.
 The client has married 2 females with in a period of 15 years and has four children.
Elder child is working in abroad. There is family issues between client and wives.

Personal History

Physical illness during childhood:Polio

School: Studied up to 6th standard.

Occupation:

• Vegetable loading: 14 years

• Construction work: 16 years
• Auto driver: 18 years
• Packing bakery items (Abroad): 18 years
• Well construction: 22 years
• Construction works: 28 years.
Use and abuse of alcohol, tobacco and drugs:

Started using alcohol at the age of 34 years due to stressor, issues in family of origin.
Started using tobacco at the same year onwards. Still consumes more than 500ml per day.

Abstinent from tobacco: past 20 years onwards.

Again started by last 5 months onwards.

Premorbid personality:

Premorbidly well adjusted.

Mental Status Examination

General behaviour and appearance:

Well kempt, Co-operative during interview, Rapport established, eye contact maintained.

Psycho motor activity:Normal

Talk: Tone, tempo, volume and reaction time are normal.

Relevant and coherent speech

Thought:

• Stream, form and possession are normal.

• Content: Suicidal ideation present, feeling of hopelessness.
Mood:

• Subjective: relaxed when sharing feelings

• Objective: Euthymic.
Perception:

• He used to see images of a person, coming to harm him during nights. The person
some times try to throw the client to the wall.
• See images of snake at room during night.
Inference: Visual hallucination

• Hear voice of chain pulling during night time

Inference: Auditory Hallucination.

Cognitive Functions:

Orientation: oriented with time, place and problem.

Attention and concentration:

• Digit spam test: forward: 3 ; backward: impaired

• Serial substraction: 25 seconds : 20-1
Memory:

• Immediate: impaired
• Recent: not able to remember the name of food he has consumed yesterday.
-Bed time forget

• Remote: intact
Intelligence:

Good at general information.

• Comprehension: Intact
• Arithmetic: intact
• Abstraction: stone-potato: not edible-edible
• Differences: TV- Radio: Visual, audio- Audio
• Similarities: dog-lion: animals
• Proverb: intact.
Judgement:

• Personal: good
• Social: Client’s behaviour in the hospital was well judged.
Test: Letter problem: will give to police

Fire problem: will call fire force.

Insight: Present

Axis I: Psychosis NOS

Axis II: Occupational Dysfunction

Axis III:Z63.0 : Problem in relationship with spouse

Z81.1: Family history of Alcohol abuse

Z81.8: Family history of other mental and behavioral disorders

Z91.5: Personal History of self-harm

Diagnosis:

Differential diagnosis :

Psychosis NOS
CASE STUDY 2

Socio demographic data

Name : AN
Age : 10 years/ F
DOB : 20.11.2008
Educational status : 4th Standard
Place if residence : Malappuram
Socio economic status: Low
Informant : Parents
Information: Reliable and adequate

Chief Complaints

According to the informant (mother)

● Fainting ( 1 week before )
● Difficulty in mathematics( from 4th std)
● Constant worrying about scored low marks in mathematics ( 2 weeks before)
● Intense tension during exam days ( 2 weeks)

According to the client

● Feeling like headache and fainting (1 week before)
● Feeling sleepy while studying ( 2 weeks)
● Worrying that friends are making ashamed of her due to scored low marks ( after
exam, 2 weeks )

Family history

Genogram:

Family history of illness: No history of Psychiatrist illness and other significant medical
illness in the family were reported.

Living arrangements: The child is living with her parents and siblings from her birth
onwards.
Description of parents: Client's father is 45 years old, studied till 10th standard and he is
working as a driver. Client's mother is 35 years old, studied till 10th standard and she is a
house wife. The client has 2 elder siblings, brother is 18 years old and he is doing his under
graduation. And sister is 14 years old and she is studying in 10 standards.

Home and neighborhood: Neighbors are very interactive to the client, she has so many
friends from the neighborhood and most of them are her classmates.

Family life and relationship: Family members are very interactive and communicative. The
client used to share her all difficulties to her parents. Since her 2 siblings are studying well,
she used to study with them and asks doubts. Also there is a good cohesiveness in the family.
Parents are very supportive in her studies and extracurricular activities. Parents are highly
motivating her to score good marks. There is no comparison of studies among the client and
her siblings were reported.

Child rearing practices: Client's mother is very concerned about her physical health from
early ages. And the client is very attached to her mother. The client is like to do all her daily
activities alone in the family. Parents are very openness to communicate with the client.

Pattern of child rearing: According to the father, mother was over protective during the
client's early ages, because she us the younger child (Last born). Both parents are very
supportive.
The client belonged to a low class family. They lived in a nuclear family system. The
relationship of client's parents was satisfactory as they have mutual understanding.

Personal history

There were no prenatal, perinatal factors, health issues during pregnancy and post natal
development problems reported.

Developmental milestones: Motor, social, adaptive, and language development of the client
were attained on appropriate age.

Current developmental status: Speech/ language ability and self help skills are at normal
range. Clinical impression of the client's general intelligence was above average.

Schooling history: The client started her studies at the age of 4 years (L.K.G). As her mother
reported that she was a very bright student in her class, she always got good grades in all
subjects till her 3rd standard. During that time, she was having a problem with stomach. So
that she mostly missed her classes and decreased academic performance. And when she
entered into 4th standard, she has a difficulty in mathematics. She scored low marks for that
subject. And she reported that friends are making ashamed of her due to scored less marks in
mathematics. She got B+ for that examination. But the teachers are very supportive teachers
reported that she is one of the best student in their class. Not only studies but she is also
performing well on extracurricular activities like singing and dancing. Now her parents and
teachers paid full of attention on her studies and some of her friends helped her to complete
notes. At home she studied under the supervision of her siblings.

Habits, interest and talents: Singing and Dancing

Premorbid personality

Emotionality: The client was very friendly and happy before these episodes of fainting. She
was very lively and hard a calm personality. She was also very sensitive to anxiety provoking
situations, criticisms and threatening events.

Attention and concentration: From her very early ages onwards she was able to do sustained
work which requires attention and concentration.

Sociability: The client liked to interact with her neighbors and she had many friends. But
somewhere she was like a shy person and did not talk too much with strangers. She was very
helpful in nature and helped her grandparents.

Adaptability: She was early adjust to new situation, but not much able to deal with stress.

Any particular strength: The client was a very hardworking and brilliant student. She liked to
participate in extracurricular activities like singing and dancing. She got so many prizes for
such activities.

Temperament type: The child was an easy child. That means she was adjust easily to new
situations, quickly establish routines, generally cheerful and easy to calm.

Level of activity and aggression of the client were normal to her age appropriate.

History of presenting illness

The client was apparently normal till 1 week before. Mother reported that 1 week back, the
client has a headache and followed by dizziness and fainting. It happened like episodes when
she was in school, during the lunch break. Mother reported, the teachers observed that during
the episodes the child couldn't open her eyes and feels that full of tiredness, she aware about
what happened around but she couldn't respond to others and her eye falls were moved even
her eyes are closed. When teachers asked questions at that time she responds orally without
any clarity. This episode last around 30 - 45 minutes. After that time, she was okay, and she
couldn't remember what happened in that 45 minutes.
 After 1 week, she had the next episode, while she was in school. The same was happened
and 2 times in the presence of parents. The parents took her to a private hospital and glucose
trip was given by the doctor. During last episode, Doctor said her to consult IMHANS for the
detailed check up and evaluation.

Treatment history
The client was under observation and done medical checkup for the difficulties such as
headache and fainting from Medical College. After all medical checkups were done the
Doctor referred to IMHANS.

MENTAL STATUS EXAMINATION

General Appearance and Behavior

The client was well and season appropriate dressed. She seemed to be tired and weak
apparently. She combed her hair well. Her eye contact was frequent. She was not comfortable
at first but when confidentiality was assured she easily explained all issues. She kept her
hands and legs in a comfortable posture throughout the sitting.

Speech and Thought

Content
Her content of speech was adequate and understandable with appropriate answering of all
questions. Progression of speech was quite slow. She was logical and meaningful. Her
speaking was in an organized way.
Form
She spoke in average and serious tone, her volume was quite low and her speech was
comprehensive.

Thought
Client’s thought process was quit inadequate. As some questions were asked to the client,
She reported that she do not know why she get tensed about getting low marks in
examinations. Because in certain cases, she only helps her friends who scored low marks by
saying that failing in exam is not a big problem. Client’s answers showed that she has
inadequate thought content.

Mood and Affect

Objective: The client seemed to be with fine mood. His mood got low at explanation of her
problems.
Subjective: She reported that she is in fine mood was comfortable in sitting.
Affect Client’s affect was appropriate to the situation.
Range: Her affect was restricted did not show high emotions.
Intensity: Client’s intensity was flat.
Quality: She was sad and after sometime she became anxious.
Perception

Visual Perception
The client’s visual perception seemed to be adequate. She can easily read and understand the
things. She can easily read all the formal tests provided him.

Auditory Perception
She was having an excellent auditory perception. She was able to understand the instructions
given to her and could hear the questions easily. She could understand the conversation
indicating well auditory perception.

Motor Assessment

Gross Motor Assessment

Client’s gross motor activities seemed to be fine. She could walk and run easily and did not
find any difficulty to handle these skills.

Fine Motor Assessment

Client’s fine motor activities also seemed to be fine. She is right handed. She was able to hold
pencil the correct way. She can cut things, use scissors properly with other hand.

Cognitive Functioning

General Fund of Knowledge

The client seemed to be having good general fund of knowledge. He responded to questions
correctly.

Abstract Reasoning
The client’s abstract reasoning seemed to be average. She could easily explain the similarities
and differences between things e.g book and laptop, Tiger and Leopard.

Attention and Concentration

The Clients attention and concentration seemed to be above average. She remained attentive
during the sessions and answered to questions attentively and also showed high interest in
attempting psychological tests.

Memory

Short Term Memory

The client’s short term memory was good. She was able to recall things properly. She could
memorize the name of her institute and his teacher’s name. Which dress she had worn
yesterday.
Long Term Memory
The client’s long term memory was also above average. She can recall her address, her date
of birth. He was able to memorize her early school days.

Orientation
The orientation of time place person was accurate. She could report the time exactly. As
some questions were asked what is day today? What is date today? How would you describe
this situation? She knew the persons around well, also was well aware of the place she was
living in. She easily answered all the questions.

Insight and Judgment

The client had a developed insight of her problem. (She knew her difficulties, she knew that
studies are essential part of life and failing exams are not big problem. But she is constantly
worried about her studies. As some questions were asked by her)

PROVISIONAL DIAGNOSIS

F44.5 Dissociative convulsions

Dissociative convulsions (pseudo seizures) may mimic epileptic seizures very closely in
terms of movements, but tongue-biting, serious bruising due to falling, and incontinence of
urine are rare in dissociative convulsion, and loss of consciousness is absent or replaced by a
state of stupor or trance.
CASE STUDY 3

Socio-Demographic Data

Name: X

Age:42

Gender: Female

Marital Status: Married

Education: PG

Occupation: ICICI Insurance

Informant:Patient with Husband (Information Reliable and adequate)

Chief Complaint

• Disturbed Sleep
• Memory Disturbances
• Whenever sad tears coming out from eyes without her knowledge.
• Persistent sadness of mood.
• Decrease interest in pleasurable activities.
Onset: Insidious

Duration: 7 Years

Precipitating factor: Family Issues

Course of illness: Continues

History of presenting illness

The client was apparently doing well before 7 years, gradually she has started
showing some discomfort in her life. There are family issues in her family oforigin and
family of procreation as reported by the client her husband is an alcoholic person who used to
drink every day. His increased use of alcohol made some issues in their family gradually and
there were breakdowns in their relationships. As reported by her husband the problem started
by last 4 years onwards. There was problem in the client’s house and her mother is
dominating character. Due to some issues the client not talking to each other (the matter not
discussed).

From past 7 year onwards the client is not getting sound sleep. She is having disturbed
sleep and which make her frustrated and tired during the next day. Recently the client’s son
has used substances from his college and this made the client more worried and tensed. Her
husband is an alcoholic and communication between them is poor, due to this she is not
satisfied in her life. These two reasons are making her more disturbed day by day.

The client is having memory disturbances, she forgets things easily. Due to which she
is having issues with work place also. She is having difficulty in remembering things which
she had done recently. She forget the place where she kept important files also.

Whenever the client is sad, some chemical changes will happen to her. Tears will
come from eyes which she reports that it is not crying, head ache increases feels like fatigue.

The client is always sad and she is not able to enjoy things which she felt pleasurable
found before.

As reported by the client she is lazy now to do her works. She feels that she is lack in
energy and not able to do anything, and tired always. She is anxious about almost everything
if she has some pain, she suspects that she has some dangerous disease. She has taken many
check-up and consulted many doctors for her physical symptoms. As due to these all issues
her social life has negatively affected. Now she is not interested to interact with others as
before.

Negative History:

• No history of trauma, fever, confusion, disorientation,vomiting and hyper tension.

• No history of hallucination, illusion, delusion, obsession and compulsion, manic
symptoms, seizure disorder andhistory of Deliberate self harm (suicide attempt).

Past History

Has consulted doctors for disturbed sleep and has taken treatment from both allopathy
and homeo and Ayurveda.

Treatment History:sinusitis on medication.

Family History

Client’s mother and father were separated and client has no communication with
father. There is a history of suicide in family - Maternal Aunty on 2003 due to family issue.
There is no history of MR, mental illness, epilepsy and physical disabilities.
 Client married at the age of 21 years, and husband was 30 years during the time of
marriage. Husband studied up to pre degree and working as painting contractor. The marriage
was arranged with mutual consent. Client has two children. Her son is doing degree and
daughter studying in 9th standard.Her husband is having ADS symptoms, NDS and was under
treatment for Depression.

Personal History:

Birth and Early development:FTND Normal developmental milestone.

Behaviour during childhood:Full term normal delivery, and normal developmental milestones

Physical illness during childhood:

• Jaundice- 10 years
• Typhoid- 17 years
School:

Begin at the age of 6 years and studied up to PG. above average student during
schooling.

Occupation:

• 25 years: Five-year plan officer; worked up to 4 years.

• 32 years: ICICI Insurance manager
Menstrual History:Menarche at the age of 17 years.

Sexual History: Hetero Sexual.

Premorbid Personality

Attitude to others in Social, Family and sexual relationship:

• Ability to trust others, secure, leader, participation, capacity to make decision

• Attitude to Self: Self Concerned
• Moral and Religious attitude: Believes in God.
Mood: Good Control over her emotion.

Leisure Activities and interest: Reading, Watching news

Reaction Pattern to Stress: ability to tolerate frustration, losses, and disappoiments.

Habits: Eating, Sleeping, Excretory functions are normal

Inference : Premorbidly well adjusted.

Mental Status Examination

General behaviour and appearance:

Well Kempt, Cooperative, Rapport Established.

Psychomotor activity : normal

Talk: Tone, Tempo, Volume, Reaction time are normal.

Prosody of speech is maintained

Relevant and coherent speech.

Thought: Stream, Form and Possession are Normal.

Content: Worried about Physical health. Somatic pre occupation has taken check ups and
consultation for somatic symptoms.

Hypochondriacal ideation:Doctor shopping, Multiple Concentration.

Mood:

• Subjective: Not Happy, Not sad

• Objective: Euthymic(not happy not sad ; normal)
Perception: No Hallucination and illusion.

Cognitive Functioning:

Orientation: Oriented (time, place and person)

Attention and concentration:

• Digit span Test (forward -7 ; backward- 5)

• Serial Subtraction (9 seconds ; 20-1..)
Memory:

• Immediate Memory: Intact

• Recent Memory: Impaired
• Remote Memory: Intact.

Intelligence: Good font of general information.

Above average student during schooling.

Comprehension, arithmetic, abstraction and proverb: Good

Judgement:

• Personal: Good
• Social: Client’s behaviour in the hospital is well judged.
Test: Fire problem: Will pour water

Letter problem: will post it.

Insight: Present

Axis I: Adjustment disorder

Axis II: Decreased social Life

Axis III: Z63.0 : Problem in relationship with spouse/ partner.

Z73.3: Stress not elsewhere classified

Diagnosis:

F34 : Persistent mood (affective) disorders

F34.1: Dysthymia ( Differential diagnosis)

 CHAPTER 4

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