Bahria University

INTERNEE PSYCHODIAGNOSTIC REPORT

Identifying Information

Name T.K

Age 48 years

Birth order 3rd

Number of siblings 4

Education [Link]

Source Of Referral

The client referred by her sister with the complaints of disturbed sleep, low appetite, with the

delusions of grandiosity and persecutions. by the purpose of assessment and management with

following presenting complains.

Presenting Complains

Table 1

Presenting complaints according to client

Duration symptoms

Test Administered

 Bender Gestalt Test(BGT)

 Test of Non-verbal intelligence (TONI-4)

 Positive and Negative Syndrome Scale:

 Thematic Apperception Test(TAT)

Clinical Interview

Client came to the fountain house with the complaints of disturbed sleep, low appetite, with

the delusions of grandiosity and persecutions. Her sister reported that her brother died [Link]

the death of her brother she had prodromal symptoms like poor appetite and poor sleep and

aggressive behavior. In 1998 her father died the amount of symptoms was increased. Her sister

reported that she had many pre marital relationships. Her sister reported that She was taking
medicines from [Link] 2009 she got married her laws was not good people they stopped her

medicines and she got divorced In 2011 after that she again relapsed.

She reported that My degree will come from the sky, Zia ul Haq came to see me, when I was 8

months In my mother belly I have passed my CA degree, my sisters are not good they are bad

they want to harm me, they does magic. She was also suffering from hallucinations like my

mother had come to me and talks. She reported that my shoulder muscles are stretched. So from

2011 she was suffering from these symptoms. Client reported that she was doing smoking in

[Link] she stopped smoking in 2013.

She was living with her mother. Her mother died [Link] her mother died she went to her

sister house. She stayed there for 3 years. Her sister reported that during this period of time the

severity of symptoms increased because she stopped medicines she not taking medicines because

she had delusions that my sister wanted to harm me she wanted to kill me. In form of medicines

she wants to give me poison. After that her sister brought her in fountain house. Client had some

insight about her condition that there is problem. She wanted to change her behavior.

The client was the 3rd born. She had not good relationship with his family members. Her

relationship with her siblings was not good. Her interpersonal relationship was disturbed.

She had good promorbid personality. She liked to going outside. She had good relationships

with friends. She liked to go school. She had good relationships with teachers. She also had good

relationship with her siblings before these problems. After the death of mother her relationships

got worse with her siblings. Now she had no family support.
Behavioral Observation

The client was initially very cooperative. Her dress was well groomed. Her voice of tone

was normal. But she was very talkative. Her orientation about place, person and time was intact.

She has hallucinations and delusions, which are evident in her behavior, such as grandiosity,

persecutions and to meet her mother at night. She lacks some insight into her problem. Despite

her challenges, the client showed more passion and eagerness for upcoming sessions. This

newfound enthusiasm resulted in increased collaboration on her end.

When she was doing RISB she was saying this is very beneficial test for me because of this test

I expressed my all feelings. She exhibited a willingness to participate in numerous activities and

a great desire to improve herself. When she was writing TAT stories she was saying this is very

interesting. She was very excited.

Psychological Evaluation

Bender Gestalt Test BGT(Koppitz, 1975)

The Bender Visual-Motor Gestalt Test is a psychological test used by mental health

practitioners that assesses visual-motor functioning, developmental disorders, and neurological

impairments in children ages 3 and older and adults. The test consists of nine index cards

picturing different geometric designs. It is utilized as a measure of personality functioning and

neuropsychological impairment.
Quantitative interpretation

Table 2

Score of BGT

Raw score visual motor index percentile rank Descriptive term

28 98 45 Average

The total raw score was 28 which sh-owed visual motor index 98 and 45 percentile rank. The

descriptive rating is average age range. She rotated Test was completed in 10 minutes.

Qualitative interpretation

The subject obtained 98 score on BGT, which indicate that the subject has no

neuropsychological impairment and developmental disorders. The subject lies on the category of

“Average ”. The subject has normal personality and visual-motor functioning.

Test of Nonverbal Intelligence TONI-4(Brown, Sherbenou, & Johnsen,

2010).

The TONI-4 test, also known as the Test of Nonverbal Intelligence, is a widely used

psychological assessment tool designed to measure cognitive abilities without relying on verbal

skills. It is specifically used to assess intelligence in individuals who may have language,

cultural, or hearing impairments that could impact their performance on traditional verbal

intelligence tests.

Quantitative Interpretations
Table 4

Score of TON-4

Raw score Index score SEM Rank Descriptive term

24 86 3 17 Below avarge

The total raw score was 24 which showed visual motor index 86 and17 percentile rank. The

descriptive rating is below avarge range.

Qualitative interpretation

TONI-4 was administered on subject to get an understanding of his intelligence level. The

client scored 24 and percentile rank 17 and fell under the category of Below average. The lower-

than-average scores may indicate challenges in certain cognitive abilities assessed by the TONI-

4. These could include abstract reasoning, problem-solving skills, and nonverbal intelligence. It

is important to consider these results in the context of the individual's overall cognitive

functioning. Further assessment may be beneficial to explore specific areas of strength and

weakness and to guide interventions or support.

Positive and Negative Syndrome Scale:

Quantitative analysis.
Table 5
Showing the Client’s Score of Positive and Negative Syndrome Scale
Subscale Raw score %tile t. score Severity level
Positive 32 97 69 Much above average
Negative 12 5 34 Much below average
Composite 20 99 78 Very much above
average
General 32 21 42 Slightly below
Average
Anergia 4 4 32 Much below average
Thought 21 97 69 Much above average
disturbance
Activation 9 85 60 Slightly above
Average
Paranoid 8 58 52 Average
Depression 11 46 49 Average
Supplement 15

Qualitative Interpretation

The high score in positive symptoms indicates a significant presence of symptoms such as

hallucinations, delusions, and disorganized thinking. The severity level is much above average,

suggesting a notable impact on the individual's perception and thought processes. The low score

in negative symptoms indicates a deficit in areas such as motivation, emotional expression, and

social engagement. The severity level is much below average, suggesting challenges in areas

associated with diminished functioning. The composite score reflects an overall high severity

level, with very much above average functioning. This suggests a comprehensive impact of

positive and negative symptoms on the individual's mental health. The general psychopathology
score falls within the average range, indicating a moderate level of overall psychiatric symptoms.

This encompasses a broad range of symptoms beyond positive and negative features. The low

score in anergia suggests a significant lack of energy or motivation, contributing to a much

below-average level of functioning in this domain. The high score in thought disturbance

indicates a notable presence of disorganized thinking, reflecting a much above-average severity

level in this specific area. The activation score falls within the average range, suggesting a

moderate level of activation or energy levels in the individual. The elevated score in paranoid

symptoms suggests above-average severity in this specific domain, indicating a notable presence

of paranoid thoughts.

Thematic Apperception Test (Murray, H. A. (1943)

The individual associated with Card No 2 appears to have a primary need for achievement. The

presence of conflicts and the use of repression as a defense mechanism suggest an internal

struggle or tension related to pursuing this need. The individual experiences discomfort, possibly

stemming from the repression of certain thoughts or desires. Their perception of the environment

is characterized by a preference for a calm and natural setting, indicating a potential inclination

towards tranquility and simplicity. Card No 3GF suggests a primary need for affiliation and a

desire for social connection. However, conflicts arise, and the individual employs denial or

repression as defense mechanisms. This may result in uncertainties and social anxieties, leading

to confusion. The perception of the environment is marked by uncertainty, reflecting the internal

conflicts and anxieties associated with social connections. For Card No 4, the individual

expresses a need for attention or recognition. However, conflicts arise, leading to the use of

projection as a defense mechanism. The presence of sadness and confusion suggests that the

individual may project their internal struggles onto their external environment. Their perception
of the environment is marked by confusion, possibly influenced by the projection of unresolved

emotions. Card No 5 indicates a need for nurturance, suggesting a desire for care and support.

While specific conflicts and defense mechanisms are not outlined, the individual experiences

pressure, potentially related to unmet needs for nurturance. The perception of the environment is

not specified, requiring further details for a comprehensive interpretation. Card No 13GF

suggests a need for affiliation, emphasizing a desire for social connections

Tentative diagnosis

Complete review of the client’s presenting symptoms led to the clinical diagnosis of

295.90 (F20.9) Schizophrenia, Multiple episodes currently in partial remission.

Recommendations
 Take proper therapy sessions by her psychologists.

 Take proper medicines

 Muscle relaxation techniques

Treatment plan

Patient’s name T.M

Age 48

Presenting Complaints visual hallucination, Persuasion delusion,self

laugh. Self talk, stretched neck muscles

 Bender Gestalt Test (BGT)

Test administered  Test of Non-Verbal Intelligence (TONI)

 Positive and Negative Syndrome Scale

 Thematic Apperception Test

Tentative Diagnosis 295.90 (F20.9) Schizophrenia, Multiple episodes

currently in partial remission.

Short term goals

 Psychoeducation
 Family therapy
 Social Support and Rehabilitation
 Symptom Management:,
 Reality Testing(CBT)Socratic
Goals of therapy
questioning, In group reality testing
 PMR (For muscle relaxation )


Long term goals

 Reality testing
 Medication management

 Regular Follow-up and Monitoring

 Continued Support:
 Main therapies  CBT for Psychosis

Initial session (1-3  History

 Assessment

 Psycho education

Middle session 4-6  Reality testing

 Muscles relaxations

Session 7-8  Again reality testing

 Meditation

 Used different sheets of work

Case Conceptualization

Garety (2001) idiosyncratic case conceptualization model of schizophrenia.

 Biopsychosocial Triggers Emotions

Vulnerability Brother death Anger

Aunt had mental illness Drastic changes In
Father death
personality
Divorce

Mother death

Basic Cognitive Dysfunctional

anomalous Experience
Positive Symptoms
My degree will come from the
sky, Zia ul Haq came to see me. Appraisal of visual hallucination
Experiences as
my mother had come to me and Grandiose ,persuasion
External
talks delusions Symptoms

Reasoning and Attribution Biases

Maintaining Factor
Dysfunctional assumptions about self, world
and others Lack of family support

My degree will come from the sky, Zia ul Haq

came to see me.

Case formulation
• Predisposing Factor:

Aunt had mental illness

• Precipitating Factor
Presenting complains
• Brother death • Protective Factors:
 Delusions of grandiosity
• Father death and persecutions. Client compliance
 Hallucinations
• Divorce Some insight present
 Muscle pain
• Mother death

• Perpetuating Factor:

No family support