Ignou national open Universi mapc first year internship report of ten cases across india., Study Guides, Projects, Research of Psychology

Download Ignou national open Universi mapc first year internship report of ten cases across india. and more Study Guides, Projects, Research Psychology in PDF only on Docsity! APPENDIX-I DECLARATION I….. hereby declare that I am a Learner of M.A. Psychology (Part II), July 2020 year, at the Study Centre Code xxx Regional Centre: xx, place, and I want to do my Internship (MPCE-015) at Psychology Clinic name on my own free will. I will adhere to the standards of the organisation and display professionalism during my internship. Signature of the Learner Date: Name of the Learner: Place: Enrollment No.: APPENDIX-III CONSENT LETTER (Agency Supervisor) This is to certify that the internship in MPCE-015 for the partial fulfilment of MAPC Programme of IGNOU was carried out by …,......., Enrollment No.XXXXXX, under my supervision. (Signature) Name of the Agency Supervisor: Designation: Address: NAME : ABC AGE/GENDER : 15 years/male RELIGION : Hindu DOMICILE : Bangalore EDUCATION :9th Std OCCUPATION:Student SOCIO-ECONOMICS-STATUS : Average FAMILY TYPE : Nuclear Family MARITAL STATUS : Unmarried MOTHER TONGUE : Hindi INFORMANT : Self and Parents RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS • Repeated hand washing • Checking on/off of switch • Counting of activities 1 YEAR • Increased worry Worsening for one month. ONSET: Insidious COURSE: Continuous PROGRESS: Improving PREDISPOSING FACTOR: Family history of OCD personality trait. PRECIPITATING FACTOR: Conflict with Father MAINTAINING FACTOR: Stress in daily life HISTORY OF PRESENT ILLNESS Patient was asymptomatic until 1 year ago. But his mother reported that he has had the tendency to worry about simple things since childhood. Initially he used to check whether electrical appliances were on or off repeatedly. He becomes doubtful once he has switched off and he comes back to the room and makes sure that the switch is off and this occurs two or three times. Gradually he has developed a new habit of repeated hand washing. The patient reports that his particular concern was with dirt and cleanliness of hand. Every time he returns home from outside he used to wash his hands two to three times. The patient reported that once he washes his hands he gets doubt that the dirt still remains in his hands. He used to get repeated thoughts and doubts in his mind after he has done some activity and he checks whether it’s complete or not. He is unusually concerned about trivial things like homework, class tests, and verbal arguments with his father. The patient reports that these repetitive behaviours are consuming his time. Due to these symptoms the patient was brought to the clinic. NEGATIVE HISTORY: - specific phobia - depression or any other mood disorders FAMILY HISTORY: Patient’s father’s sister has extreme cleanliness and perfectionism in her daily activities. Patient lives in a nuclear family. His mother reports that the patient has some conflict with his father. His Father is very aggressive by nature. Whenever he gets angry he uses abusive words towards the patient and his wife. He did not give enough money for his study purpose. Due to these issues, the patient is afraid of his father and he easily gets tensed in his father’s presence. The patient is more attached to his mother. PERSONAL HISTORY Birth and early Development: The patient was a full term baby, normal delivery in the hospital and mother’s age at the time of delivery was 25. Normal developmental milestone as reported. Presence of childhood disorder: No significant history of childhood disorder as reported. Scholastics and extracurricular activities: patients started schooling at the age of 4. He is studying in Gujarati medium and he is average in his academic performance. No problems with his peer groups and teachers were reported. He likes to play cricket. After studies he used to spend most of his time on the cricket ground. MENTAL STATUS EXAMINATION: General appearance & Behavior: The patient was 16 years old, lean body feature, physical age appearance as he stated. Wearing a tidy dress, well kept and well groomed. Eye contact was maintained throughout the interview. Attitude towards examiner: The patient was cooperative. Rapport was easily established. Motor Behavior: The patient was calm and sat comfortably in a chair . His facial expression conveyed anxiety. His psychomotor activity was within normal range. Speech: His speech was relevant, coherent, with normal reaction time. He spoke in a clear and audible tone. He spoke spontaneously and offered information willingly. Mood Subjective: “man teek he” Objective: Patient seems anxious. 1. Compulsive acts mainly concerned with cleaning ( Hand washing) to avoid potentially dangerous situations(Dirt). 2. Repeated checking to ensure whether the task is finished or not. CASE REPORT- 2 PSYCHODIAGNOSTIC REPORT NAME : STU AGE : 8 years GENDER : Male RELIGION : Muslim DOMICILE : Calicut EDUCATION : 3rd standard OCCUPATION : Student SOCIO-ECONOMICS-STATUS : Above Average FAMILY TYPE : Nuclear Family MOTHER TONGUE : Malayalam INFORMANTS : Self and Parents RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS - Forgetfulness - Difficulty in studies - Disciplinary problems in school 4 years - Difficulty in concentration - Restlessness ONSET: Insidious COURSE: Continuous PROGRESS: Deteriorating for last one year PRECIPITATING FACTOR: Neonatal complications PREDISPOSING FACTOR: Paternal uncle had ADHD in his childhood MAINTAINING FACTOR: Parental conflicts HISTORY OF PRESENT ILLNESS The patient’s behavior problems were initially noticed in the first standard and have been continuing till date. His teacher communicated to the parents that he exhibits difficulties focusing, sustaining attention and encountering ongoing classroom problems on a daily basis. His teacher reported that he is always fidgeting on his seat, throws items at other students and frequently leaves his seat during classroom instruction. He often comes home from school with incomplete worksheets. His mother stated, he has difficulty completing a particular work and keeps changing his activities. At home also he doesn’t sit anywhere for the required period of time, and fights with his younger brother. His mother as well reported that he got irritated quickly, showed tantrums and cries for silly things. He demands to satisfy his needs immediately and shows impatience and tantrums whenever it gets delayed or rejected. When he misbehaves, his parents usually employ physical and verbal punishment to enforce discipline. One year back he had a seizure attack associated with high grade fever. Recently his mother noticed, he has difficulty remembering both academic and other things. He forgets about homework and plans for the next day. He shows difficulty memorizing spellings, numbers and instructions after a few minutes. Also he started refusing to go to school. Every morning he starts crying and his mother literally needs to compel him a lot to make him get ready for school. Due to these symptoms the patient was brought to civil hospital by his Mother. His sleep, appetite and daily living activities were reported to be normal. NEGATIVE HISTORY No history suggestive of: - Delayed developmental milestones - Impairment in basic intellectual functioning - Language, motor, social disabilities - Repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. - Negative anticipation towards a specific object or situation. - Anxiety or apprehension towards specific situation - Involuntary voiding of urine by day/ by night. TREATMENT HISTORY The patient had a seizure attack one year back associated with high grade fever. He was admitted into the hospital for one week and took anticonvulsant medicines for one month. He doesn’t have any treatment history for the current symptoms. FAMILY HISTORY The information about grandparents was not available. Patient lives in a nuclear family in the urban Gandhinagar. His father runs a tailor shop and mother is employed in a textile shop. Inter personal conflict between parents was reported. They had several verbal arguments in front of the child. Sometimes his father beats his mother and it causes severe anxiety to the child. While they were fighting he got to know, their second child is an unwanted kid. His father physically and verbally abuses him as a disciplinary action. The patient reports that his father never takes them for outings or picnics and he refuses to buy toys for them. He was not letting him for extracurricular activities which he is interested in. He has severe conflict with his father and he often shows disobedience towards his father’s instructions. “Enikk schoolil ponda, teacher enne pichum” “Enik padipikunnathonnum shradhikkan patunnilla” Patient’s thoughts contain anxiety towards his academic activities. Cognitive functioning: Attention: Child’s attention and concentration was assessed by digit span test. He shows difficulty recalling numbers up to 4 digits forward and 3 digits backward. Attention was aroused and but not sustained for the enough time Orientation: patient is well oriented with time, place, person, month, and year. Immediate memory: His response towards the letter repeating task and digits repeating task was not consistent. Difficulty to recall letters and numbers were found. Immediate memory was found to be partially impaired. Recent memory: He was able to tell his school activities, dinner and breakfast he had on the previous day etc related questions. Recent memory was found to be intact. Remote memory: He was able to tell his and his brother’s birth date and other related questions. Remote memory was found to be intact. Abstraction: The child was able to tell the difference of apple and orange, and other related questions. Patient’s abstraction was found to be at conceptual level. Information: The patient was able to answer general knowledge questions like the prime minister of India, the capital of Gujarat and other related questions. It was found above average level of information. Comprehension: The child was able to tell the meaning of proverbs. And he could repeat the sentence asked by the interviewer. His comprehension was found to be intact. Vocabulary: The child was able to tell the names of birds and domestic animals. An average level of vocabulary was found. Calculation: The child was able to substitute and add three digit numbers. Patient’s calculation was found to be above average level. General Intelligence- Child’s abstraction, information, calculation, comprehension, and vocabulary were up to his education level. Judgment The child was able to give satisfactory answers to the questions such as his future plans, response towards given social situation and emergency situation. The patient’s personal, social and test judgment are intact. It was found up to his age level. Insight “Njan ellam marannupovunnu” The patient’s insight is at grade II. He believes he has problems in his memory but not in his behavior. When he misbehaves it’s because of others. DIAGNOSTIC FORMULATION Index patient, 8 years old, Hindu male, 3rd standard student, belonging to average socio- economic status, residing at Calicut, was brought by mother with chief complaints of forgetfulness, difficulty in studies, disciplinary issues in school, poor sitting tolerance since four years, worsening since 1year, with history of neonatal complications and single episode of seizure attack, was cooperative with the interviewer, showed motor restlessness and hyperactivity, speech was clear and relevant, mood was euthymic , affect was consistent to mood, not congruent to thought, In thought content anxiety towards academic activities were found, attention aroused easily and partially sustained, abnormality detected in immediate memory, judgment were intact and insight was found to be at grade II. PSYCHOLOGICAL ASSESSMENTS TEST ADMINISTERED ▪ Malin’s Intelligence Scale for Indian children ▪ NIMHANS specific learning disability index ▪ Conners abbreviated parent or teacher questionnaire. ▪ Children Apperception Test (CAT) TEST FINDINGS Malin’s Intelligence Scale for Indian children On MISIC, the Full Scale I.Q was found to be 125 which indicates superior level of intellectual functioning. The verbal scales reflect the child’s ability to work with abstract symbols, the amount and degree of benefit he has received from his educational background, verbal memory abilities and verbal fluency. The verbal I.Q was found to be 125 indicating superior level of verbal intelligence. On the verbal subtests, the raw scores and the corresponding Test Quotient (TQ), given in brackets were as follows: Information (14, 117) which indicates an above average level performance on verbal ability, intellectual curiosity and long-term memory. Comprehension (17, 135) indicates superior level of performance on social judgment, reality awareness and understanding. He can grasp the social rules and regulations very well and has knowledge about moral codes. Arithmetic (10, 115) indicating an above average level performance on numerical reasoning and speed of numerical manipulation. Similarities and Analogies (21,155) indicate a superior level of performance on abstract intelligence and verbal reasoning and in categorizing meaningful relationships. (D) Spelling Spelling skill was assessed by asking the client to listen to words and write the spellings of it. He was able to perform adequately at the 3rd standard list of words. Out of 15 words he committed 3 errors in writing spellings of standard 3rd. The child could relate the phonetic sounds of the words with their formation of spelling. Impression: Adequate III Arithmetic Test: His mathematical ability was assessed by asking her to solve the given sums and show appropriate calculations. He was able to solve the calculations as simple addition, subs traction, multiplication and division of the 3rd standard. Impression: Adequate Conners abbreviated parent or teacher questionnaire. The rating scale is used by the parent of the child to be assessed for the attention deficit and hyperactivity disorder. On scale the child scored 24, indicating moderate level of attention deficit and hyperactivity. Children Apperception Test (CAT) The Children’s Apperception Test is an apperceptive method which was administered to understand a child's relationship to important figures, needs, drives, attitude toward parental figures, fantasies about aggression etc. On CAT, the plots of the stories varied in nature which contain family gatherings, play time etc. The heroes in his stories are children, who are playful, impulsive, and helpless. Significant needs of the heroes are succourance ( need of to be nursed, supported, sustained, protected, loved, advised, guided, forgiven, consoled. To remain closed to a devoted protector.), Need of nurturance (to give sympathy and gratify the needs of a helpless, that is weak, disabled, defeated, lonely and sick), need of harm avoidance ( to avoid pain, physical injury, illness, and death, to escape from dangerous situation.), need of affiliation ( to draw near and enjoyably cooperate with an allied object, to please and win affection and remain loyal to friends). At times he introduces a few objects and situations into the story: rain, sharp objects, toys, strangers who can protect the child, which implies the need of aggression, freedom from restrictions, need of play and protection. He observes every minute objects in the stimulus picture and gives brief descriptions about them which indicate his creative thinking, imagination and curiosity. The child’s concept of the environment is varying with the adult figure in the story. With female figures, the environment seems supportive and friendly and with male figures the environment is aggressive and deprived. It also reveals the conflict between father figures and male adults. They are aggressive and selfish, with them the child facing insecurity, injury and neglect. Mother figures are supportive, guiding and friendly. The natures of anxieties which were elicited through the cards are physical harm, helplessness, separation, disapproval and deprivation. In most of the stories the hero (child) experienced some sort of these anxieties in different situations. His main defenses against his conflicts and fears are identification, and rationalization. His stories end up with morals those would be suggested by the adult figures, revealing the evidence of development of autonomous moral ideas. Overall outcome of the stories are also varied in nature. With the mother figures, the story ends positively and with father or male figures the stories end unhappily. Recurrent thoughts of insecurity, injury and helplessness were found in his story. He expressed an impressive level of imagination and stories are well articulated. Most of the findings are corroborated with the complaints and history of the child and very much related to the family dynamics and parenting styles in which he is getting brought up. IMPRESSION Based on the case history, clinical interview, findings on the MSE and psychological assessment, the case is diagnosed with F90. Hyperkinetic disorders MANAGEMENT PLANS • Parental counseling • Parental management training • Attention enhancement techniques CASE REPORT- 3 PSYCHODIAGNOSTIC REPORT NAME : EFG AGE : 28 years GENDER : Female RELIGION : Hindu DOMICILE :Calicut EDUCATION : Post Graduation (M. Com) OCCUPATION : Teacher SOCIO-ECONOMICS-STATUS : Above Average FAMILY TYPE : Nuclear Family MARITAL STATUS : Married MOTHER TONGUE : Malayalam INFORMANTS : Self RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS • Repeated negative thoughts • Fearfulness - Suicidal ideation - Epilepsy and head injury FAMILY HISTORY Patient is currently living with her husband and her parents. Her parents are retired teachers and husband is a software engineer. She has two younger siblings who were employed in the private sector. Patient reports her family members are supportive and the interpersonal relationship in the family is congenial. Her younger sister was diagnosed with schizophrenia 4 years back, with medication she improved a lot and is currently leading a normal life. PERSONAL HISTORY Birth and early Development: The patient had full term normal delivery. Her birth weight was normal. Developmental milestones were achieved within the time. Childhood disorders: No significant childhood disorders were reported. Scholastic and educational History The patient started her schooling at the age of five. She maintained average level scores in her academics. She completed her B.com and joined for masters. She discontinued her course due to her poor self confidence and other related issues. Occupational History: She started working as a teacher in a private coaching centre and she continued her job until a year before. She was satisfied with her job. Currently she is not working because of her above- mentioned problems. Marital and Sexual history She got married at the age of 20. It was a love marriage without parent’s permission. So the couple was abandoned by their relatives for many years. During this time they struggled a lot to manage their financial needs and social support. Recently her family members accepted their marriage and started to get along with them. The patient’s relationship with her husband was compatible. The spouse’s attitude towards her was lovable and caring. Their physical intimacy was normal and satisfactory before the symptoms started. Now she lost interest in sex and also worrying about having child. Premorbid Personality Patient was a friendly person and used to have good communication skills. She was anxious by nature and sensitive towards criticism since childhood. She used to seek perfection in her work. Her moral and religious values are high, also enjoys socialising with others. MENTAL STATUS EXAMINATION General appearance: The patient is 28 year old, average height and weight, physically age appropriate. Well dressed and well groomed. Eye contact was maintained throughout the interview. Attitude towards the examiner: The patient was cooperative and willing to talk with the interviewer. Rapport was established easily. Motor functioning: Patient was partially restless showing anxious gestures such as wiping out her sweat, drinking water, and taking long breath. Speech: Patient’s speech was audible, clear with normal reaction time. Her speech was relevant and goal oriented. Mood: Subjective: ipo ok aanu Objective: Patient’s mood is dysthymic Affect: It was inconsistent to her mood. She often experiences anxiety. Thought Stream: Patient’s stream of thought was normal. Form: No formal thought disorder was found. Content: In thought content extreme fear about height, anticipation towards future life events and guilt about her past was found. Cognitive functioning: Attention: Attention was aroused and sustained for enough time. Orientation: patient is well oriented with time, place, person, month, and year. Immediate memory: patient’s immediate memory was found to be partially impaired. She was not able to repeat digits in the proper sequence. Recent memory: Intact Remote memory: Intact General Intelligence: Abstraction: The Patient’s abstraction was found to be at a conceptual level. Information: The patient’s level of information was found to be satisfactory. Comprehension: The Patient’s comprehension is intact. Vocabulary: The patient’s vocabulary is satisfactory. Calculation: The patient calculation skill was found to be satisfactory. emotions more keenly than people who are not open to experience. She also has an average score of 25 on Extraversion. It indicates that she has the traits of both introverts and extroverts. She prefers to do things alone but is able to function very well in social situations although they might prefer to avoid them. Those who know such people would probably describe them as reserved, serious, retiring and loners. But it doesn’t mean that they lack social skills. On the scale of Agreeableness he has scored a low raw score of 20. Such individuals are sympathetic to others and eager to help them and believe that others will be equally helpful in return. These people are frank and sincere, but tend to put their own needs and interests before others. They hold their conflicts on their own but willing to forgive and forget. She also scored a high score of 26 on the scale of conscientiousness. It is also evident in the case history that she is neat, punctual and well organised. She is good in self discipline and generally finishes the tasks she starts. She is reasonably cautious and generally thinks things through acting. Sack’s Sentence Completion Test Sentence completion tests are semi-structured projective techniques administered to provide indications of attitude, beliefs, motivations or other mental states of the patient. On SCT, the patient's attitude towards family does not indicate any conflict except with her mother. The response shows mild issues with her mother that she keeps a distance with the patient. Her areas of sexual belief indicate moderate level of conflicts. Her sexual interests are markedly decreased after the occurrence of the current symptoms which cause distress to her. On fear rating, her response indicates severe fear of height. In the self concept area, her response reveals varying conflicts in each domain. She has a mild level of guilt because of her inability to make her husband happy due to her illness. Her attitude towards own abilities are realistic and exhibiting will power to overcome her fear. In the current scenario she perceives her future would be zero but she has the desire to make things work. SCT's response did not indicate any conflict in her interpersonal relationships. Her relationship with friends, superiors and colleagues seems good. Thematic Apperception Test (TAT) TAT were administered as semi-structured projective techniques were used to bring to the surface her conflict, attitudes, needs, environmental pressure and her feelings towards them etc. The plots of the stories are partially structured and organised. She tried to express her thoughts in an exaggerated manner. In most stories, her main character identification level is not adequate. The heroes in her stories are fearful, confused, dependent, and experiencing self doubt. But they are determined to work to overcome their obstacles in life. The content of her stories are mostly based on relationships, women’s struggle in their lives. She was able to notice all essential details of the pictures. Her description about the stories clearly reflects her fear of being rejected, difficulty to make decisions. She was preoccupied with thoughts of being perfect and right. Analysis of her description about the stories suggests that her dominant needs are need for Achievement, and affiliation. They are strongly corroborated by her case history. Dominant press of the client is press of absement, blame avoidance and affiliation Most of her ended up with more than one climax, which contain both good and bad outcome, which indicates her confusions and striving of being socially acceptable. In her stories significant conflicts were Achievement Vs Inadequacy and Affiliation Vs Rejection, which are evident in cards 1, 2, 7MF and 8GF. The main defences that she uses are denial and rationalisation. Her most dominant anxieties are disapproval, loss of love and deprivation. The ego of the subject has become weak and is not functioning smoothly. The basic traits of her personality are tender mindedness, over sensitivity and agreeableness. IMPRESSION Based on the case history, clinical interview, findings on the MSE and psychological assessment, the case is diagnosed with F41.1 Generalised anxiety disorder comorbid with F32.1 Moderate depressive episode. CASE REPORT- 4 PSYCHODIAGNOSTIC REPORT NAME : HIJ AGE : 24 years GENDER : male RELIGION : Hindu DOMICILE :Calicut OCCUPATION : Student SOCIO-ECONOMICS-STATUS : Above Average FAMILY TYPE : Nuclear Family MARITAL STATUS : UnMarried MOTHER TONGUE : Malayalam INFORMANTS : Father RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS L Suicidal Thoughts 4. Incremental Walking The client i s asked to count each step thereby bringing presence of mind in him and productive physical activity. 5. Genital Muscle Relaxation Technique It involved the contraction of genital muscles and withholding it for a specified period and releasing it . and hence, the genital muscles come under voluntary control of the client and enhance the sexual behaviour. 6. imagery Guidance ("Om" Khar) The- client was asked to imagine his favourite God and chant in order to remove his guilt feelings and fear of death. 7. Candle Gazing It increases the concentration of the client and able to focus on the task at hand. This also increases assertiveness of the client 8. Laughter Therapy The client was asked 10 laughs for 30mins. This released neuro chemical i n the brain and made him feel happy. 9. Tossing the Coin Tossing a coin and guessing the result makes the client realise that the outcome of an event is beyond our control and therefore accept the life events as it comes and go ahead with life irrespective of the past. 10.Skipping Skipping brings coordination between mind and body. lt increases concentration and provides a sense of achievement. CASE REPORT- 5 PSYCHODIAGNOSTIC REPORT Name: MN Age: 11 yrs Gender:Female Marital Status :Unmarried Religion :Hindu Socioeconomic Status:Upper Class Occupation :Student Domicile :Urban Informant :Father Reliability :Reliable Chief Complaints 1. School Phobia 2. Excessive sweating 3.Obsessive Thoughts 4.Anger 5.Emotional Instability Complaint by Family l . Breaks things and adamant 2. Refuses to go to school 3. The schooling is not challenging to her and it is of no use 4. Changes cloth three to four times before going to bed 5. Gets annoyed soon for no reason History of Present illness: The above symptoms have been reported by the client since last 1 month after being shifted to new school due to professional transfer of her father.The new school has a system or seating arrangement in which a boy and girl sit alternatively. This creates anxiety in her. History of previous illness: Nil Medical History: Nil Personal History: SOCIO-ECONOMICS-STATUS : Middle class FAMILY TYPE : Nuclear Family MARITAL STATUS : UnMarried MOTHER TONGUE : Malayalam INFORMANTS : Father RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS 1. Addicted to Gadgets and porn movies 2. Obsessive thoughts 3. Excessive Anger 4. Emotional Instability Complaints by Family 1. Breaks things and adamant 2. Refuses to go to school 3. Does not concentrate on studies 4. Uses abusive words 5. Gets annoyed soon for no reason History of Present illness: The above symptorns have been reported by the client since las1 2 year after being criticised by a lady teacher in front of classmates. This created an emotional trauma in him. History of Past illness: NIl Medical History: Nil Personal History: He is the only child in his family. His parents show excessive love. He got annoyed when his class teacher slapped him on the cheek and scolded him in front of girls. Educational History He started schooling at the age of 5. He excelled in his studies up to 9th standard and his performance decreased from SSLC onwards. Sexual History: Nil MENTAL STATUS EXAMINATION General Appearance ● Dressed neatly ● Proper Eye contact is maintained ● Psychomotor activity is normal Speech: Normal Attention and Concentration: Normal Diagnosis: Aversion to girls, poor self concept. (R45. 81) CASE REPORT- 7 PSYCHODIAGNOSTIC REPORT NAME : QRS AGE : 66years GENDER : male RELIGION : Hindu DOMICILE :Calicut OCCUPATION : Nil SOCIO-ECONOMICS-STATUS : Middle class MARITAL STATUS : Married MOTHER TONGUE : Malayalam INFORMANTS : Son RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS 1. Fear of death 2. Heart palpitation RELIGION : Hindu DOMICILE :Calicut OCCUPATION : Student SOCIO-ECONOMICS-STATUS : Middle class MARITAL STATUS : UnMarried MOTHER TONGUE : Malayalam INFORMANTS : sister RELIABILITY AND ADEQUACY : Reliable and adequate. Chief Complaints: I. Unrealistic goals 2. Anger 3.Abusing family members 4.Poor social skills 5.Breathing problem 6. Poor memory Complaints by Family I . Does not respect anybody in the family 2. Demands bulk of amount for unrealistic goal 3. Cries when he is alone History of Present Illness: The above symptoms have been reported by the client for the last 4 years and consulted 6 doctors for counselling. History of Past illness: Nil Medical history: Under the treatment for stomach problems such as poor digestion and lack of appetite due to acidity. Personal History: He was born as the 2nd child in his family. He lost his father when he was 5 years old and he is under the control of his grandparents. He is forced to get married soon by his grandmother to get his ancestral property. And his mother is being neglected by his grandparents leading to conflicts in him. Educational History: He started schooling at the age of 5. He excelled in his studies and joined for BE in Sathyabama University, Chennai. He was forced to discontinue the course by his mother due to family issues. and joined for BCA in AVS college,Salem. This created trouble in him. Sexual History: Failed intercourse with his ex-lover due to anxiety. MENTAL STATUS EXAMINATION General Appearance • Dressed Neatly • Proper Eye contact is maintained. • Psychomotor activity was normal Speech: Slurred Attention and concentration: Distracted Diagnosis: the client is diagnosed to be suffering from anxiety about future and social anxiety. (F40.10 Social phobia, unspecified) CASE REPORT- 9 PSYCHODIAGNOSTIC REPORT NAME : XYZ. AGE : 26 years GENDER : Male RELIGION : Hindu DOMICILE :Kasaragod EDUCATION : B.Tech Mechanical. OCCUPATION : fraud Analyst in IT SOCIO- ECONOMICS-STATUS : Above Average FAMILY TYPE : Nuclear Family MARITAL STATUS : Unmarried MOTHER TONGUE : Malayalam INFORMANTS : Self, parents and Mother’s elder sister RELIABILITY AND ADEQUACY : Reliable and adequate. CHIEF COMPLAINTS • Low mood • Excessive worry • Adjustment issues with roommates • Headache 15 years • Difficulty in breathing • Decreased sleep PERSONAL HISTORY Birth and early development: patient’s mother reported that she was 35 and his father was38 at the time of his birth. There was no complication of pregnancy and delivery reported and he was born by cesarean section. His birth weight was normal. Developmental milestones were reported as within normal range for language and both fine motor and gross motor development. Childhood history: There was no serious disease reported in the patient's early childhood. At the age of 11, he was bullied by his classmates for a long period. After that he experienced low mood, deflation in self confidence, difficulty in socializing with others, excessive worry with multiple somatic symptoms during the exam. Also he had difficulty sleeping. This issue has continued in his adolescence. Scholastic history: The patient started his schooling at the age of four. He maintained high grades throughout his academics. He was well disciplined and obedient in school. He completed his graduation in mechanical engineering and joined for masters in NIT, but he discontinued his course after six months because he got a job through campus placement. He had several adjustment issues and conflicts with his friends throughout his school and college. He prefers indoor games rather than outdoor plays even if want to but he believes that he can’t perform well in front of others. He plays chess, and won championship in his inter college meet. Occupational history: 2016 he started his career in the field of mechanical industry as a junior engineer. In the beginning of his job, he was excessively worried about the timing of the office hours, next day schedules, projects and presentations. He also had adjustment issues with his colleagues and roommates. After 6 months he left his job and went to Delhi for the preparation of a competitive exam for a Government job. He could not qualify the exam because of his ongoing emotional problems and adjustment issues. He is currently working in the IT sector as a fraud analyst. He is not satisfied with his job because it is not related to the mechanical field, the one in which he did his graduation. Sexual history: Patient hit his puberty at the age of 13. He reports, as a coping mechanism he uses to masturbate whenever he gets anxious or worried, by watching some porn videos. This behavior has increased recently. Premorbid personality: The patient was shy in nature and he would blush easily. He was responsible and obedient in both school and home. MENTAL STATUS EXAMINATION General appearance: The patient is 26 year old, average height and weight, physically age appropriate. Well dressed and well groomed. Maintained proper eye contact throughout the interview. Attitude towards the examiner: The patient was cooperative and willing to talk with the interviewer. Rapport was established easily. Motor functioning: Patient’s motor functions were normal. Speech: Patient’s speech was audible, clear with normal reaction time. He used to speak with increased speed, and the speech was relevant and goal oriented. Mood: Subjective: ‘kurach nervous aanu’ Objective: Patient’s mood is anxious. Affect: It was consistent with his mood. Thought Stream: Patient’s stream of thought was normal Form: No formal thought disorder was found. Content: “I want to play cricket with others, but I fear that I can’t play well and my friends will judge me” “I always get doubts before I talk in a friend circle and I start evaluating my performance” “My hair falls made me lot of distress and I took treatment” “I fell down and get cramps in my hip, so I can’t play cricket well” Patient has anticipation towards his anxiety evoking situation and preoccupation with somatic symptoms. Cognitive functioning: Attention: Attention was aroused and sustained for enough time. Orientation: patient is well oriented with time, place, person, month, and year. Immediate memory: Intact Recent memory: Intact Remote memory: Intact General Intelligence: Abstraction: The Patient’s abstraction was found to be at a conceptual level. Information: The patient’s level of information was found to be satisfactory. Comprehension: The Patient’s comprehension is intact. Vocabulary: The patient’s vocabulary is satisfactory. Calculation: The patient calculation skill was found to be satisfactory. General Intelligence- Patient’s abstraction, information, calculation, comprehension, and vocabulary were up to his education level. Judgment The patient’s personal, social and test judgment are intact. Insight “I want to resolve all my problems without medicines” Millon Clinical Multiaxial Inventory (MCMI) - III MCMI is based on Theodore million’s evolutionary theory, which is an objective personality test, which also measures clinical features. It was considered important to study the personality characteristics as well as the presence of any clinical pathology of the patient. AXIS I: CLINICAL SYNDROMES The features and dynamics of following Axis I clinical syndromes indicate several enduring and pervasive aspects of the subject's personality makeup. Anxiety (Scale A): The person is primarily phobic and more specifically in social situations. He may have experienced a generalized state of tension, manifested by inability to relax, readiness to react and be easily started. Somatic discomforts such as breathing difficulty, palpitation are also characteristic. There may also be worrisome-ness, hyper alertness to one’s environment. Other scales that need mention are: Bipolar: Manic scale (Scale N): He may experience periods of superficial elation, restlessness over activity and distractibility, impulsiveness and irritability. There could also be unselective enthusiasm, excessive planning for unrealistic goals, decreased need for sleep, and rapid and labile shifts of mood. Dysthymia ( Scale D): The patient with high score on the D Scale remain involved in everyday life but have been preoccupied over a period of years with feeling of discouragement or guilt, lack of initiative, behavioral apathy, low self esteem and frequently expressed futility and self deprecatory comments. There may be period of tearfulness, suicidal ideation, a pessimistic outlook towards the future, social withdrawal, poor appetite or over eating, chronic fatigue, poor concentration, a marked loss of interest in pleasurable activities, a decreased effectiveness in performing routine life tasks. Among the severe clinical syndromes, he has obtained the highest score on Scale CC (Major Depression). Patient with high score on this scale are usually incapable of functioning in normal environment, are severely depressed and expressed a dread of the future, suicidal ideation, and a sense of hopeless resignation. There may be somatic symptoms like decreased appetite, fatigue, weight loss or gain, insomnia and early rising. AXIS II: CLINICAL PERSONALITY PATTERNS The following paragraph refers to those enduring and pervasive personality traits that underlie this patient’s emotional, cognitive and interpersonal difficulties. Rather than the large transitory symptoms that make up Axis I clinical syndromes, these concentrate on his more habitual and maladaptive methods of relating, behaving, thinking and feeling. He has obtained the highest score on the scale 2B (Depressive). The MCMI- III profile of this patient suggests that there may have been a significant loss, a sense of giving up and a loss of hope that joy can be retrieved. There is an inability to experience pleasure. He also obtained significant scores on scale 2A (Avoidant). These individuals experience few positive reinforcement from themselves or others. They are vigilant and always on guard, ready to distance themselves from anxious anticipation of life’s painful or negatively reinforcing experiences. Their adaptive strategy reflects fear and mistrust of others. They maintain a constant vigil to prevent their impulses and their longing for affection from resulting in a repetition of pain and anguish they have experienced with others. Only by active withdrawal can they protect themselves. Despite their desires to relate to others, they have learned that it is best to deny these feelings and to keep a good measure of interpersonal distance. Another scale that has a mentionable, though not prominent, score is scale 7 compulsive. These individuals have been intimidated and coerced into accepting the demands and judgments on them by others. Their prudent, controlled and perfectionist ways derive from conflict between hostility towards others and fear of social disapproval. SACK’s Sentence Completion Test. Sentence completion tests are presentations of the beginning of sentences which then requests that the subjects complete the sentence anyway they would like. It is administered to provide indications of attitude, beliefs, motivations or other mental states of the patient. Sentence completion test reveals the patient has a moderate level of conflict with his self concept. He has severe doubts about his own ability and a moderate unpleasant attitude about his past. He has guilt about his wrong decisions in his career. His fear rating shows a severe level of anxiety in socializing with others, public speaking and decision making. He has a moderate level of conflict in his interpersonal communication area, especially with his colleagues and friends and also has mild levels of issues towards women. The test does not indicate any conflict related to his family relationship, attitude towards his superiors, future and goal setting. Thematic Apperception Test (TAT) TAT were administered as semi-structured projective techniques were used to bring to the surface his conflict, attitudes, needs, environmental pressure and his feelings towards them etc. On TAT, almost all stories are about the person’s past life mistakes, and their current struggle and also the determination to make things better. The heroes in his story are honest, hardworking but confused, lonely and have distorted self images. The significant needs found were the need for achievement (to accomplish something difficult, to overcome obstacles and attain high standard and excel one’s self.), need for affiliation (to draw near and enjoyably cooperate with an allied and to please and win affection) need of counteraction (to master or make up for a failure by restriving, to overcome weakness and fear) and need of harm avoidance (to escape from dangerous situation and take precautionary measures.) The current environment is threatening and deprived for them and they are striving to overcome their obstacles. There are several interpersonal conflicts that are revealed with friends and colleagues. The natures of anxieties are disapproval, loneliness and helplessness. The main defense mechanisms used in his stories are rationalization and intellectualization especially towards his past life mistakes and guilt. He has a strong superego and most acts are seen clearly as crime and punishment. Recurrent thought of past life mistakes such as his wrong decision in career choices and the optimistic view of counteraction against his failures was evident in his story The overall outcomes of the stories are positive and happy. Even if the heroes past and present are threatening and helpless, they are struggling to make things better. The outcomes indicate that the subject has an optimistic view of life and has an appropriate direction towards his goals. IMPRESSION Based on the case history, clinical interview, findings on the MSE and psychological assessment, this case is suggestive of F40. Social phobia with F41.2 mixed anxiety and depressive disorder. medicines. As per the recommendation of the general physician she went to 3-4 psychiatrists in different private hospitals and took medication of antidepressants but reported no significant improvements. NEGATIVE HISTORY No history suggestive of - No history schizophrenia - No history of recurrent depressive disorder - No history of substance abuse. FAMILY HISTORY According to the informant (husband) there is no history of mental disorder, genetic disorder, unnatural death and other chronic illness in their paternal and maternal family. Patient had some conflict with her brother-in-law’s wife when they were living in the joint family. Patient’s relationship with family members is good and they are very supportive. But she was worried about her son’s marriage and the patrician of their inherited property among children. The details of grandparents were not available. PERSONAL HISTORY Birth and early development: according to the informant’s report the patient was full term normal delivery. All development milestones were normal. Childhood disorder: No childhood disorders were reported. Scholastic History: The patient has studied up to 4th standard. Marital and sexual History: She has been married for 29 Years. Her age at the time of marriage was 15 and her husband was 29. They had love and arranged marriage and have two children (boys). They get along with each other and have no significant emotional conflict. She was very attached to her husband. Sexual life was satisfactory for both of them until she got diseased. PREMORBID PERSONALITY The patient was anxious by nature. She was sensitive towards criticism and got angry very easily. Informants report that she was very good at household work, socializing with others, and good at decision making also shows good memory skills. MENTAL STAUS EXAMINATION Appearance: The patient is 45 years old, middle aged women appearing older than her actual age, she is obese, wearing loose salvarkameez, tidy and groomed hair. She partially maintained eye contact. Attitude towards the examiner: The patient was defensive at first and partially cooperated for the interview after many verbal prompting. Also she was distractible at times. Rapport was established with difficulty. Motor behavior: she was restless and showing painful gestures. She used to press her stomach tightly and also repeatedly put her finger in her mouth. When her husband tries to stop her she pushes him away and cries loudly. Speech: verbatim: “palleelerthaaytt vejja” “inte kajj vidu” The patient’s speech was in very low tone and delayed reaction time. She repeatedly complains about her stomach pain along with crying. She is hesitant to respond to any other question and only gives answers when questioned. Her speech is relevant to the context. Mood/affect: verbatim: “ichch jeevikkanda, aarkkum enne maanda” subjective: sad Objective: The patient appeared depressed and weeping spells were present. Mood was consistent to thought and congruent to affect Thought: Her stream of thought was normal Form: Verbatim: “ pallel entho und, atheduth theree” Impression: Illogical thinking was present Content: Verbatim: “odukkathe palleelethaan, ich jeevikanda” “ya Allah, enne ang edtholee” Impression: Patient’s thoughts contain somatic preoccupation with precipitating factors of surgery. She was extremely anxious about her health. She was producing a death wish as the emotional response of her painful experience. Delusion: patient has primary delusional ideas. She was showing hypochondriacal delusion ideas. Cognitive functions: Orientation: patient’s orientation with time,place, person, date, day, month, year is present. Attention and concentration: attention is difficult to arouse and not sustained for enough time. She remains calm for half a minute but after that she starts crying again. Memory: Immediate memory: could not be elicited because patient was not responding Recent memory: intact Remote memory: intact. Abstraction: could not be elicited because the patient was not cooperating. General information:all the general information we could not elicit because the patient was not cooperating.