Sukoon foundation (rehabilitation centre)

In the heart of Noida's Sector 105, Sukoon Foundation Rehabilitation Center stands as a beacon

of hope and healing for individuals navigating the challenging path of addiction recovery.

Committed to fostering holistic well-being, Sukoon Foundation integrates evidence-based

practices with compassionate care. The center offers a serene and supportive environment, where

individuals find solace and strength to embark on their journey towards recovery. With a

multidisciplinary approach, Sukoon Foundation addresses the physical, psychological, and social

dimensions of addiction, guiding individuals towards sustained sobriety and a renewed sense of

purpose. The dedicated team of professionals at Sukoon Foundation strives to create a

therapeutic space where individuals can reclaim their lives and build a foundation for lasting

recovery.

Roles and responsibilities

In my role as a facilitator for group sessions, my responsibility was to create a dynamic and

supportive environment where participants can engage in psychoeducation on addiction and

mental health. I guided discussions, ensuring that everyone has the opportunity to share their

experiences and insights. Stress reduction techniques were introduced collectively, fostering a

sense of community and shared coping strategies. On an individual level, I took on the crucial

responsibility of conducting one-on-one sessions. In these sessions, I worked closely with

participants to develop personalized treatment plans, addressing their unique needs and

challenges. These individual sessions became a confidential space for exploring the root causes

of addiction, identifying triggers, and collaboratively devising effective coping mechanisms.

CASE STUDY 1

Name: V.J.

Age: 38

Gender: Male

Marital Status: Married

Occupation: salesperson

Religion: Hindu

Socioeconomic Status: Middle-class

Informant : the client was the sole informant and the information provided was reliable and

could be corroborated through multiple interviews.

Chief complaint

“mujhe sharab ki lat lagi hui hai 12 saalo se”

“mujhe neend nahi aati hai (3-4 saslo se)”

“mujhe gussa jaldi aa jata hai”

History of Presenting Illness

Presenting Complaint:

V.J., a 38-year-old married Hindu male from the middle class, seeks therapy for a 17-year

history of alcoholism. The primary concern is his escalating alcohol use, characterized by

obsession and dependence, leading to detrimental effects on his relationships with others.
Onset and Progression:

The disorder exhibits an insidious onset and a progressive course over the 17-year period. V.J.

reports an increase in alcohol consumption, with an evolving pattern marked by compulsion and

dependence, contributing to the persistent nature of the condition.

Precipitating Factors:

V.J.'s compulsive drinking is linked to his entry into the workforce at the age of 21. He describes

this as a means to build confidence, suggesting a functional aspect to the initial alcohol use. The

stressors associated with the workplace environment may have acted as precipitating factors,

leading to the reliance on alcohol as a coping mechanism.

No history of trauma or any other physiological disorders.

Family History

V.J.'s family history plays a significant role in understanding the contextual factors contributing

to his alcoholism. Coming from a joint family, it is noteworthy that both his grandparents were

alcoholics, setting a familial precedent for substance use. This familial pattern extends to his

maternal uncles, all of whom struggle with alcoholism. One maternal uncle exhibits traits of

epilepsy and antisocial behavior, while another faces the dire consequence of cancer attributed to

alcohol consumption. On the paternal side, the trend continues, with both paternal uncles and his

father also being alcoholic.

Family tree
 Descriptive account of family

Father: retired (73age)

Mother: housewife (56 age)

Sisters: both married and staying with their own families

Family life and relationship: client views his relationship with all his family members

to be warm, but he mentions his relationship with his father to be strained and calls him

to be his trigger..

Personal history

Early development and scooling:

V.J. doesn’t recalls any developmental issues or illness during his childhood. He recognizes his

school life to that of any young child, full of sports, friendships and playful behavior.

Educational and Occupational Background:

V.J. embarked on his professional journey at the age of 21. The initiation of his work life

coincides with the reported onset of compulsive drinking, suggesting a potential link between

occupational stressors and the development of maladaptive coping mechanisms.

Marital History:

At the age of 27, V.J. entered into an arranged marriage, a significant cultural aspect.

Unfortunately, this union ended in divorce due to violent behavior towards his spouse,

underscoring the detrimental impact of his alcoholism on intimate relationships. Subsequently,

he remarried and has a child, indicating ongoing familial responsibilities amid the persistent

struggle with alcohol.

Sexual History:

During adolescence, V.J. engaged in a considerable amount of sexual activity, self-identifying as

a 'sex addict.' This aspect of his personal history highlights potential challenges in impulse

control and may contribute to the overall clinical presentation.

Premorbid personality

Premorbidly, V.J. likely exhibited a strong family attachment, as indicated by his warm

relationship with his mother. However, the strained relationship with his father, identified

as a 'trigger,' suggests potential difficulties in navigating family dynamics. V.J. may have
 displayed mood instability, describing his mood as anxious and aggressive even before

alcohol consumption.

Hobbies: the client enjoys watching cricket and he reckons his memory to be his

strength.

There is no past history of any mental or physical disorder that required long-term

treatment and medications.

Mental status examination

General appearance: the client is well groomed and sitting in upright posture. He is quick to

respond but his voice trembles while discussing his past experiences or relationship with his

family.

Psychomotor activity

There was no noticeable increase or decrease in the psycho-motor activity of the client.

Speech

The speech was coherent and comprehensive. It made sense and appropriate words were used to

answer the questions, along with normal reaction time.

Thoughts

There was no retardation of thought, nor did he show signs of compulsive or delusional thoughts.

The thought showed no signs of psychological symptoms of disorders except preoccupation with

alcohol. The form and flow of the thought was appropriate

Mood
The client showed minimal change in mood from going to stable neutral state to showing anxiety

at certain time during the interview. The intensity of the anxiety would go from low to moderate

while discussing the thoughts of going out of rehabilitation centre. It was appropriate and

congruent.

Perception

The perceptual skills of the client was that of an average individual. There were no signs of

hallucination of any kind, nor did he report experiencing such events at any point in his life.

Cognitive functions

1. Orientation

(What is the day today? Tuesday ,What time of the day is it? It’s around 3, What season

is it? Summers, When did you last eat? 1 p.m.)

The orientation is intact

2. Attention and concentration

Repeat the numbers after I have completed the series? Accurate to moderately accurate

answer

Reverse score from 20 to 1, subtracting 3 each time- 17 seconds

Attention and concentration is intact

3. Memory

Immediate memory: intact

Recent memory: what did you do in last 24 hours: intact

Remote memory: intact

 Memory is intact

4. Intelligence

(Name of our prime minister? Mr. Narendra Modi, Capital of our country? Delhi

River that flows in Bhagalpur? Ganga,what do you do when you feel cold?Wear a jacket)

Intelligence is intact

5. Judgment

What are your future plans? manager

What will you do if someone falls in front of you and you are running late? Obviously

help them

What will you do if there is a fire at your house? Take everyone out, call for help but if

it’s small put it out

Judgment is intact.

Insight is intact in the client. He understands that his symptoms are of emotional nature.

Diagnosis

F10.20 severe alcohol use disorder (in initial remission in controlled environment)

The client is provided with the diagnosis of severe alcohol use disorder as he fulfils six
diagnostic criteria for the disorder making it severe alcohol use disorder. The client has been
taking alcohol for 12 years in large amounts, there has been attempts to control alcohol use in the
past, there is an urge to use alcohol, it has affected the social functioning, need for increased
amount of alcohol intake to achieve intoxication are some of the symptoms are fulfilled.

Differential diagnosis

F10.10 mild alcohol use disorder

 The diagnosis was considered as it is accurately aligning with the clinical picture of
alcohol use disorder however, the diagnostic criteria limits it to 2-3 symptoms which is not the
case for the client.

F10.20 moderate alcohol use disorder

The diagnosis was considered as it is accurately aligning with the clinical picture of
alcohol use disorder however, the diagnostic criteria limits it to 4-5 symptoms which is not the
case for the client.

Non-pathological use of alcohol

Most alcohol drinkers are not necessary diagnosed with alcohol use disorder even if they
use it on a daily basis with some occasions of intoxication. One of the essential features of
alcohol use disorder is repeated and significant impairment in functioning caused by heavy
dosage of alcohol intake.

Case Summary

V.J. is a 38-year-old, married, male, Hindu, from middle-class, and is seeking therapy a 17-year
history of alcoholism. His increasing alcohol use, which is marked by obsession and dependence,
has harmed his relationships with other people. It is a disorder with insidious onset and
progressive course. There was no history of trauma or any physical illness. He comes from a
joint family with both his grandparents being alcoholic. He has four maternal uncles all being
alcoholic, with one having epilepsy and antisocial traits, another having cancer due to alcohol
consumption. His paternal uncles (two) along with father are alcoholic as well. He has a warm
relationship with his mother but finds his father to be a ‘trigger’. He started working at the age of
21, which was described as a reason for compulsive drinking (to build confidence). He was 27
years old, had been married in an arranged marriage, and was later divorced for violent
behaviour towards his spouse. He then got married again and had a child. His emotional
dysregulation and violent tendencies are evident even before he drinks as he describes his mood
as anxious and aggressive. Furthermore, V.J. admits to having engaged in a lot of sexual activity
as a teenager, calling himself a ‘sex addict’ suggesting that he may have had trouble controlling
his impulses. The client is able to manage his hygiene, attentive and co-operative with optimum
eye contact. There is no increase or decrease in psycho-motor activity. Speech is relevant with
suitable reaction time. He had organized thought with no obsessions or but there is ideas of guilt.
At an objective level his affect is recorded as congruent and appropriate, with no labiality. The
client describes his mood to be anxious and aggressive. There has never been any experience of
hallucination or experiences of dissociation. The client had intelligence, orientation, attention
and concentration of an average person. He also had intact judgment about himself, others and
life. He has insight into his illness and realizes that it is a mental disorder that has physiological
and psychological implications.

Predisposing Factors:

Family History of Alcoholism: The extensive family history of alcoholism, spanning multiple

generations on both maternal and paternal sides, serves as a significant predisposing factor.

Genetic influences and learned behaviors within the family may contribute to V.J.'s susceptibility

to alcohol use disorder.

Emotional Dysregulation: V.J.'s premorbid personality indicates emotional dysregulation, with a

mood described as anxious and aggressive even before alcohol consumption. This emotional

vulnerability may have predisposed him to seek maladaptive coping mechanisms.

Precipitating Factors:

Work Stress and Coping Mechanisms: The onset of compulsive drinking at the age of 21

coincides with the initiation of his professional life. Work-related stressors may have acted as

precipitating factors, leading V.J. to turn to alcohol as a coping mechanism to manage the

challenges associated with his career.

Strained Relationships, Particularly with Father: The strained relationship with his father,

identified as a 'trigger,' could be a significant precipitating factor. Interpersonal challenges and

emotional distress within the family context may have contributed to the escalation of alcohol

use.

Perpetuating factors

Patterns of excessive Drinking: An ongoing obsession and dependence accompanying excessive

drinking serves as a perpetuating element. Once started, this maladaptive coping mechanism may

reinforce itself, which could result in a vicious cycle of increasing alcohol consumption.

Impulsivity and Risky Behaviours: Adolescents who engage in excessive sexual activity and who

identify as "sex addicts" are more likely to continue engaging in risky behaviours. These

inclinations may help people continue to drink alcohol as a coping mechanism for their

impulsivity.

Protective factors:

Insight and Self-awareness: Despite the challenges, V.J. demonstrates insight into his condition,

realizing that alcoholism is a mental disorder with physiological and psychological implications.

This self-awareness can be considered a protective factor, as it may enhance his receptiveness to

therapeutic interventions.

Warm Relationship with Mother: The warm relationship with his mother provides a source of

social support. Positive family dynamics, particularly with a supportive figure, can serve as a

protective factor in the treatment process.

Prognosis

V.J. has certain environmental risks like indulgence of alcohol by his family members. He comes

from a culture where alcohol use is not disregarded. He also has continuous availability of
alcohol in his environment and has used alcohol in response to stress at work. Alcohol use also

runs in family and since he has close relatives he has chances of higher severity of alcohol

related disorder. He has been consuming alcohol since a very young age, which increases his risk

of developing a severe and chronic addiction. He also has impulsive and aggressive traits which

could prolong the course of illness. Such factors make for a poor prognosis of addiction

treatment. However, V.J.'s motivation to overcome his addiction significantly impacts his

prognosis. Since he is willing to commit to the therapeutic process and make positive changes in

his life, his chances of recovery are higher. The support he receives from his family, friends, and

community plays a vital role. Since V.J. has a loving relationship with his mother, wife and

child. It will act as a good prognosis factor for his treatment.

CASE STUDY 2

Name: A.J.

Age: 30

Gender: Male

Marital Status: Married

Occupation: bank employee

Religion: Hindu

Socioeconomic Status: Middle-class

Informant : the client was the sole informant and the information provided was reliable and

could be corroborated through multiple interviews.

Chief complaint

“mujhe smack lete 3 saal ho gae”

“mujhe papa ki death guilt bhot pareshan karta hai”

History of Presenting Illness

Presenting Complaint:

A.J., a 30-year-old married Hindu male from the middle class, seeking therapy for a 3-year

history of addiction (smack). The primary concern is his obsession with smack consumption,

characterized dependence, leading to effects on his relationships with others.

Onset and Progression:

The disorder exhibits an acute onset and a progressive course. A.J. reports an increase in smack

consumption, with an evolving pattern marked by compulsion and dependence, contributing to

the persistent nature of the condition.

Precipitating Factors:

A.J. identifies his father’s death to be the cause of his substance abuse.

No history of trauma or any other physiological disorders, but her does suggests symptoms of

epilepsy, though couldn’t be verified.

Family History

A.J. lives in a joint family, where his father would abuse cigarettes. His father died 4 years ago

(2019) due to epilepsy. His grandmother dies 10 years before that (2009) due to epilepsy as well.

He has a warm relationship with his mother, wife and children along with uncles and aunts. He

has strained relationship with one of his cousins.

Family tree
 Descriptive account of family

Father: dead

Mother: housewife (67 age)

Younger brother: married

Family life and relationship: client views his relationship with all his family members

to be warm, but he mentions his relationship with his cousin to be strained.

Personal history

Early development and schooling:

A.J. doesn’t recalls any developmental issues or illness during his childhood. He recognizes his

school life to be fun and cheerful.

Educational and Occupational Background:

A.J. embarked on his professional journey at the age of 19. The initiation of his work life

coincides with the reported onset of compulsive drinking, suggesting a potential link between

occupational engagement with clients leading to social drinking, which then turned to smack

intake.

Marital History:

At the age of 21, A.J. entered into an arranged marriage, a significant cultural aspect. He ha a

child from this marriage of age 4 years. He has a very supportive wife and maintains a good

relationship with his child.

Sexual History:
Since V.J. married at a very young age and he has been faithful with his wife. His sexual

relationship has been with his wife and of consensual nature.

Premorbid personality

A.J. exhibits a strong family attachment, as indicated by his warm relationship with his

mother, wife and child. However, the relationship with his father, could be identified as a

dependent relationship. A.J. has reported to have a stable mood, with very few outburst in

his life.

Hobbies: the client enjoys watching cricket and he reckons his memory to be his

strength.

There is no past history of any mental or physical disorder that required long-term

treatment and medications.

Mental status examination

General appearance: the client is well groomed and sitting in upright posture. He is quick to

respond but his voice trembles while discussing his relationship with his father.

Psychomotor activity

There was no noticeable increase or decrease in the psycho-motor activity of the client.

Speech

The speech was coherent and comprehensive. It made sense and appropriate words were used to

answer the questions, along with normal reaction time.

Thoughts
There was no retardation of thought, nor did he show signs of compulsive or delusional thoughts,

except preoccupation with smack. The form and flow of the thought was appropriate

Mood

The client showed minimal change in mood from going to stable neutral state to showing anxiety

at certain time during the interview. The intensity of the anxiety would go from low to moderate

while discussing about his father. It was appropriate and congruent.

Perception

There were no signs of hallucination of any kind, nor did he report experiencing such events at

any point in his life.

Cognitive functions

1. Orientation

(What is the day today? Tuesday ,What time of the day is it? It’s around 12 p.m., What

season is it? Summers, When did you last eat? 1 p.m.)

The orientation is intact

2. Attention and concentration

Repeat the numbers after I have completed the series? Accurate to moderately accurate

answer

Reverse score from 20 to 1, subtracting 3 each time- 18 seconds

Attention and concentration is intact

3. Memory

Immediate memory: intact

 Recent memory: what did you do in last 24 hours: intact

Remote memory: intact

Memory is intact

4. Intelligence

(Name of our prime minister? Mr. Narendra Modi, Capital of our country? Delhi

River that flows in Delhi? Yamuna ,what do you do when you feel cold?Wear a jacket)

Intelligence is intact

5. Judgment

What are your future plans? manager

What will you do if someone falls in front of you and you are running late? I will help

them

What will you do if there is a fire at your house? put it out

Judgment is intact.

Insight is intact in the client. He understands that his symptoms are of emotional nature

and can be controlled.

A.J., a 30-year-old married Hindu male from a middle-class background, seeks therapy for a 3-

year addiction to smack. The onset and progression of his substance abuse coincide with his

father's death four years ago, whom he attributes as the precipitating factor for his addiction.

There was no recollection of any long-term physical illness, no trauma as well. A.J. comes from

a joint family with a warm relationship with his mother, wife, and child, but reports strained ties

with a cousin. His educational and occupational history reveals a potential link between work

engagement and the initiation of compulsive drinking leading to smack intake. The mental status

examination indicates A.J.'s general appearance as well-groomed, with coherent speech, intact
cognitive functions, and a stable mood, albeit anxiety during discussions about his father.

Despite the addiction, A.J. maintains insight into the emotional nature of his symptoms. The case

summary underlines the complex interplay of familial, occupational, and emotional factors

contributing to A.J.'s substance abuse, emphasizing the need for a comprehensive therapeutic

approach.

Diagnosis

F11.2 Severe opioid use disorder

Precipitating Factors:

Father's Death: The death of A.J.'s father appears to be a significant precipitating factor, leading

to the initiation and escalation of smack consumption. A.J. identifies this event as the cause of

his substance abuse, indicating a link between the loss and his coping strategy.

Perpetuating Factors:

Compulsive Drug Use Pattern: The ongoing and escalating pattern of A.J.'s smack consumption,

marked by compulsion and dependence, acts as a perpetuating factor. This cycle sustains the

substance use disorder over time.

Occupational Link: The initiation of compulsive drinking coinciding with the start of his

professional journey suggests an occupational link, potentially contributing to the perpetuation of

substance use as a coping mechanism.

Protective Factors:
Supportive Relationships: A.J. benefits from a supportive family environment, particularly with

his mother, wife, and child. These relationships may act as protective factors in the treatment

process, providing emotional support and stability.

Insight into Emotional Nature: A.J.'s insight into the emotional nature of his symptoms,

acknowledging the guilt associated with his father's death, is a protective factor. This awareness

can enhance his receptiveness to therapeutic interventions.

Prognosis

A.J.'s prognosis may be compromised by certain challenging factors. The ongoing and

escalating pattern of smack consumption, marked by compulsion and dependence, poses a

significant obstacle to recovery. The potential occupational link to substance use, initiated during

his professional journey, suggests that work-related stressors may continue to contribute to

perpetuating the disorder. Additionally, the strained relationship with a cousin may present

challenges in building a robust support system. If A.J. struggles to break the cycle of compulsive

drug use and address the complex interplay of emotional and occupational factors, his prognosis

may be less favorable. A.J.'s prognosis appears promising due to several favorable factors.

Firstly, his insight into the emotional nature of his symptoms and acknowledgment of the guilt

associated with his father's death suggest a level of self-awareness that can enhance his

engagement in treatment. The presence of a supportive family, including a warm relationship

with his mother, wife, and child, provides a crucial foundation for emotional support during the

recovery process. A.J.'s stable mood and intact cognitive functions further indicate a potential for

successful engagement in therapeutic interventions. With comprehensive treatment addressing

both the substance use disorder and underlying emotional factors, coupled with ongoing family

support, A.J. has a good prognosis for achieving sustained recovery.

Case 3

Socio-Demographic Information

Name – N. K

Age - 25

Gender – male

Marital status - unmarried

Occupation – Graphic Designer

Socio-economic status – Middle class

Religion – Hindu

Informants –

Client only.

Information is reliable but needs more working

Inadequate information to reach proper diagnoses

Chief Complaints

According to Client

For the past five years, I have been using alcohol. I tried many times to leave, but I always ended

up having a relapse.

Ab yahan hu to neend bhi nahi aati ache se bs saari raat sochta rehta hu jo kuch bhi maine kia
Bahot tang hu kaam se bhi nikal dia itni baar smjhaya lekin mai smjha nahi

Onset – Insidious

A course of Illness - fluctuating

History of Present Illness

A 25-year-old graphic designer from Chandigarh, single and working in a local company, has

been using alcohol for the past five years. What started as occasional party drinking has escalated

into a daily routine, causing concerns about its impact on both physical and mental health.

Despite multiple attempts to quit, relapses have been persistent, leading to the recent loss of his

job and strained relationships with friends and family. Recognizing the detrimental effects on his

life and goals, the client is seeking professional help to break free from the cycle of addiction and

regain control over his well-being.

PAST HISTORY

There was a history of anxiety issues when the client was hunting for a job.

FAMILY HISTORY

The family is characterized as a nuclear unit, where the father assumes the main head role. The

parenting style within this structure is predominantly authoritarian, suggesting a structured and

directive approach in upbringing. Despite the authoritative parenting, the client shares positive

relations with siblings, fostering a supportive family dynamic. It's noteworthy that there is a

family history of generalized anxiety disorder in the client's mother, indicating a potential genetic

or environmental predisposition to anxiety-related concerns within the family. However, apart

from this anxiety disorder history, there is no reported family history of other psychiatric or

medical illnesses

PERSONAL HISTORY

The client's childhood history reveals no delays in developmental milestones, and there were no

reported illnesses during this period. In terms of school history, the client actively participated in

extracurricular activities while maintaining an average performance in studies. Their sexual

history indicates an adequate amount of sexual activity with one partner at a time. As marital

history is not applicable, this concise overview provides key insights into the client's

developmental, academic, and sexual experiences, contributing to a comprehensive

understanding of their background..

Occupational History

The client has been actively employed since 2019, demonstrating a commendable performance

record. In the workplace, their demeanor towards others is marked by cooperativeness, indicating

a positive attitude and effective collaboration with colleagues. Throughout their job tenure, the

client has experienced two shifts, suggesting adaptability to changing work environments and

schedules. These aspects of the client's professional life contribute to a well-rounded

understanding of their work history, performance, and interpersonal dynamics in a work setting.

PREMORBID PERSONALITY

The client's social relations are characterized by a strong attachment to their family, particularly

sharing concerns with their sister. Engaging in intellectual pursuits, the client finds joy in reading

books and expressing creativity through painting. Their mood is consistently calm, optimistic,

and stable. In terms of character, the client exhibits a curiosity for learning, adaptability to

change, a love for social interaction, and self-confidence, reflecting an extroverted nature.

Healthy habits are evident in their lifestyle, including a balanced diet, occasional alcohol

consumption, and a consistent pattern of good-quality sleep. These aspects provide a

comprehensive insight into the client's social, intellectual, emotional, and lifestyle dimensions,

contributing to a holistic understanding of their well-being.

MENTAL STATUS EXAMINATION

1. GENERAL BEHAVIOUR:

a. Dressing – adequate

b. grooming – well-groomed
 c. Posture – normal

d. eye contact – good

e. attitude towards the examiner – cooperative

2. PSYCHOMOTOR ACTIVITY: The psychomotor activity was normal.

3. SPEECH:

Relevance – relevant (goal-directed)

Coherence – coherent

Volume – normal

tone – normal

tempo- normal

reaction time- normal

4. THOUGHT:

Flow - normal

Form - oriented

Possession- thought echo (you are alone because you are at fault)

Content- overvalue idea (the constant worry of being unable to fit in the group and

balance personal and professional life.)

5. MOOD:

Euthymic
6. PERCEPTION:

There were no issues related to perception.

7. CLINICAL ASSESSMENT OF COGNITIVE FUNCTIONS

1. Orientation:

 Time

 Place

 Person

The client is oriented

2. Attention and Concentration:

a) Memory- forward recall

5-7-3-4-1-7 - correct

5-3-8-7-6-1-5-8 - correct

1-6-4-9-5-2-9-7-6-3 – correct

b) Backward recall

8-5-1-6-7-8-3-5 – correct

3-6-7-9-2-5-9-4-6-1 – incorrect

c) Serial subtraction 100- 40, a gap of 7- correct

 Optimum level of concentration

3. Memory

a. Recent memory- Address recall #23 Shanti enclave, New Delhi, India – recalled

correctly

b. Remote memory- questions asked about the year of passing 10th and date of birth of

mother- responded correctly

intact memory

4. Intelligence-

a.) General Information

Question – the name of the Prime minister-

Answer - Shree Narendra Modi

Question – Name any 5 Rivers

Answer Ganga, Yamuna, Ravi, Chenab, Godavari

B) Comprehension-

What will you do when you feel cold?

Ans- I will wear warm woollen clothes and drink something warm.

Why should we be away from bad company?

Ans- It has a negative influence on us

C)Arithmetic-

1. How much are 4 rupees and 5 Rupees? Ans- Rs9

2. I borrowed 6 rupees from a friend and returned 2 rupees; how much do I still owe him?

Ans- Rs 4

d) Abstraction- the client was instructed - I will give you some words. You have to tell me in

what way they are alike, what is

Similarities- Apple-Mango

And- yes, fruits

Eye-Ear

And- yes, sense organs

Differences- the client was instructed –will present some pairs of words. Listen carefully and

tell me how they are different from each other.

Stone- Potatoe

Ans- non-edible- edible

Fly- Butterfly

Ans- small-big

e) Proverbs

The client was well-versed in proverbs, so she was asked some of the sayings.

Proverbs-

Q- slow and steady wins the race

 And- when you achieve success through effort, time doesn’t matter.

Q- Empty vessels make more noise

Ans- those with less knowledge make more noise.

f) Judgment

Q. When your house catches fire, what will you do?

I will call the fire brigade and will help my family evacuate.

Intact judgement

INSIGHT

Insight present

Case 4

Name: M.P
Sex: Male

Age: 15

Educational qualification: 9th std., school student

Date: 22nd September, 2023

Trainee status: Msc. Clinical Psychology

Socio-economic status: middle class

Address: Gali no.3, near Fortis medical store, sector 21, Sagarpur, Janakpuri.

INFORMANT: The client is the prime and the only informant in this case study. He has come
voluntarily to discuss his issues of day-to-day life. He seems to have sufficient insight into his
issues and provided sufficient information, corroborated by his mother, with no need of further
investigation.

COMPLAINTS

● Anxious while meeting new people.

● Anxious while publicly speaking.

● Fear of being judged by people.

Symptoms intensity increasing since 2 years

Main reason of consultation: the client experiences trouble participating in co-curricular

in school.

Family History

The client is a part of joint family, living in a nuclear structure for most part of his life. The
grandfather is currently suffering from Alzheimer’s at the age of 94. The clients has an uncle
(63) who has a son (22), both of whom show signs of disturbed or abnormal mood. They are
living with the grandfather. The client’s parents show no signs of such dysfunction. The client is
the younger one among two sibling. His brother shows signs of anxiety while meeting new
people.

Family tree

Descriptive account of family

Father: fuel station staff (56 age)

Mother: housewife (56 age)

Older brother: college student (21 age) presents anxiety and stress signs

Family life and relationship: it is a family of four living in a two bedroom setting, the
family is cohesive and warm in their nature however, the client is overly protected by the
mother. The client has a healthy relationship with his brother. The parents show little
understanding of the symptoms.

Personal history

Prenatal factors: there was no nutritional deficiencies or any disease in mother during
pregnancy. There was no exposure to substance or medication that would be harmful to
the child.

Perinatal factors: it was a normal labor with normal delivery, with no difficulties.

Child at birth: weight is not known, the cry was normal, presence of slight jaundice.

The jaundice was treated in the first week with no other noted difficulties for the first four
weeks
 The immunization has no record but the mother recalls having the client vaccinated for
most of the known diseases.

Developmental history: there was no developmental delay reported by the mother. It

was a typical course with all milestone achieved same as most of his peer members. The
mother recalls having met all the motor, social, cognition and speech milestones met at
the approximate time of the presented inquiries. She recalls that he was able to have
mastery over his mother-tongue (Hindi language) before the age of 3.

Temperamental and personality traits

The client is described as slow to warm up. He is known to withdraw from a new
situation or people and takes time to adapt to new environments. He often shows
excessively shyness when meeting new people or is the center of attention. The client
had a childhood with little to no misconduct which is worthy of notice. He often spends
his time playing video games or watching television. He is rarely out of his house playing
with his friends.

Schooling: the client was admitted in school at the age of 4. He is an average student
with little participation in extra-curricular activities. He experiences bullying from his
classmates in verbal form, i.e. name calling, because of his “feminine” demeanor and
gestures.

Hobbies: the client enjoys watching cricket and he reckons his memory to be his
strength.

There is no past history of any mental or physical disorder that required long-term
treatment and medications.

HISTORY OF PRESENTING ILLNESS

The client approached the treatment with a set of symptoms which were causing him
distress and hindering his daily functioning. He addressed the fact that while doing
certain tasks like presenting in front of an audience, he would get sweaty, his voice would
tremble, with certain difficulty in breathing. Such symptoms, he exclaimed, were present
 in more intensity and frequency than any of his peers or classmates. He also pointed out
that whenever he feels uneasy he often notices tremors in his voice.

According to him the chronology of his symptoms are as follows:

1. Trembling voice
2. Sweating in palm
3. Difficulty in breathing

Onset: the onset of the symptoms could be categorized as acute as they seem to appear
when the client is anticipating a speech before an audience or conversation with a
stranger.

Precipitating factors: since the symptoms have increased in the past few years and the
fears seems to be about meeting strangers or presenting himself in front of strangers, it
could be that the symptoms have worsened as he is being scrutinized by peers for not
acting in a way that a male child is expected to behave. He could also have been affected
by the symptoms that his brother experiences while communicating with others.

Course of the illness: the history of illness seems to be continuous with sweating and
difficulty as an addition to the symptoms previously suffered.

There is no history of confusion, disorientation or memory loss.

Mental status examination

General appearance: the client is well groomed and sitting in upright posture. He is quick to
respond but his voice trembles while discussing his interactions or relationship with others,
outside his family.

Psychomotor activity

There was no noticeable increase or decrease in the psycho-motor activity of the client.

Speech

The speech was coherent and comprehensive. It made sense and appropriate words were used to
answer the questions, along with normal reaction time.
Thoughts

There was no retardation of thought, nor did he show signs of compulsive or delusional thoughts.
The thought showed no signs of psychological symptoms of disorders except preoccupation with
failure to present oneself to others.

Mood

The client showed minimal change in mood from going to stable neutral state to showing anxiety
at certain time during the interview. The intensity of the anxiety would go from low to moderate
while discussing the thoughts of presenting oneself to strangers.

Perception

The perceptual skills of the client was that of an average individual. There were no signs of
hallucination of any kind, nor did he report experiencing such events at any point in his life.

Cognitive functions

6. Orientation

(What is the day today? Tuesday ,What time of the day is it? It’s around 5, What season
is it? Summers, When did you last eat? 3 p.m.)

The orientation is intact

7. Attention and concentration

Repeat the numbers after I have completed the series? Accurate to moderately accurate
answer
Reverse score from 20 to 1, subtracting 3 each time- 17 seconds
Attention and concentration is intact
8. Memory
Immediate memory: intact
Recent memory: what did you do in last 24 hours: intact
Remote memory
Memory is intact
9. Intelligence
 (Name of our prime minister? Mr. Narendra Modi, Capital of our country? Delhi
River that flows in Bhagalpur? Ganga,what do you do when you feel cold?Wear a jacket)
Intelligence is intact
10. Judgment
What are your future plans? Event manager
What will you do if someone falls in front of you and you are running late? Obviously
help them
What will you do if there is a fire at your house? Take everyone out but if it’s small put it
Judgment is intact.
Physical examination
Smart watch used
Heart rate: 89 bpm
Height 5’11
Weight 48kg
Insight is intact in the client. He understands that his symptoms are of emotional nature.
Summary
The client was born without any difficulties during delivery and developed according to
the norm. It is a joint family structure with history of mood disturbances, no physical
illness. There was no history of TBI. The mental status examination confirmed that all the
cognitive functioning is intact along with thoughts and perception, which confirms the
absence of psychosis. The history and mental status exam shows some mood
disturbances, namely feelings of anxiety which leads to certain physiological symptoms,
like, sweating, increased heart rate, difficulty in breathing, which are always in presence
or anticipation of some stressor.
Bio-psycho-social Formulation
predisposing precipitating perpetuating protecting
Genetics Social expectation Mothers Familial support
History of mood and peer scrutiny overprotectiveness and warm
disturbance in relationship
family
Diagnosis
Differential diagnosis:
F 40.00 Agoraphobia
F 40.10 social anxiety disorder
The client shows some signs and symptoms of anxiety however, he doesn’t fulfils any
criteria of anxiety disorder. The client shows some of the symptoms the severity of which
is still to be verified and further explored, of social anxiety disorder, according to DSM-
5. Such symptom are fear of evaluation by strangers, anxiety about social situations, with
overprotective mother as a risk factor. This makes him vulnerable to develop one of the
anxiety disorders in future.
Treatments plans
The treatment plan for the probable anxiety disorder could be Mindfulness treatment,
Cognitive Behavioral therapy and REBT.
CASE STUDY 5

Demographics:

Name: V.K.

Age: 35

Gender: Male

Marital Status: Married

Religion: Hindu

Socioeconomic Status: Middle-class

Informant: the client was the sole informant and the information provided was reliable and

could be corroborated through multiple interviews.

Chief complaint

“I have been alcoholic for 5 years”

History of presenting illness

The disorder displays an insidious onset and a progressive course. V.K. reports increasing

alcohol consumption, marked by compulsion and dependence.

Precipitating factor: Work-related stress and marital discord contribute to alcohol abuse.

There are no additional symptoms or evidence of traumatic injury.

Family history
Within V.K.'s family, the relationships are characterized by a mix of closeness and strain.

Despite the shared struggle with alcoholism among male members, there is a sense of warmth.

V.K. maintains a particularly close and supportive relationship with his mother, who, as a

housewife, played a central role in the family. The loss of V.K.'s father due to alcohol-related

complications has left a void, leading to a complex emotional dynamic. While V.K. has a

nurturing relationship with his wife and children, there's a noted strain in his connection with one

of his brother, perhaps stemming from divergent life paths or historical disagreements.

Genogram

Personal history

During the early years and school days, the client didn't face any significant issues. His

professional journey began when he was 24 years old, and it coincided with the start of increased

alcohol consumption. He had sexual encounters with his partner who was to be their wife. Later,

at the age of 28, he entered into a love marriage. However, the challenges in their marital life
seemed to contribute to a further rise in his alcohol intake. This brief overview highlights the

connection between pivotal life events, such as starting a job and navigating challenges in

marriage, with the escalating pattern of alcohol use.

Premorbid personality

The client exhibits a notable dependence, particularly within relationships. His mood generally

remains stable, but occasional outbursts may occur in response to stress. Engaging in reading and

sports serves as outlets for their interests and leisure activities.

Reflections

Month 1 Reflection:

Embarking on this journey at Sukoon Foundation has been an emotional and enlightening

experience. In our first month together, the power of shared vulnerability became apparent

during group sessions. As we delved into psychoeducation and stress reduction techniques, there

was a sense of collective understanding and support. Witnessing each participant's commitment

to change has filled me with hope and a shared determination to overcome the challenges of

addiction. This initial phase has laid the foundation for a community bound by compassion,

resilience, and a shared vision of lasting recovery.

Month 2 Reflection:

Entering our second month at Sukoon Foundation, the sense of shared experiences among

participants has deepened. Group sessions transformed into spaces where not only knowledge

but personal stories and coping strategies are shared. The evolving dynamics have created a

community where the revelations and setbacks of each individual resonate with all. In the

intimate setting of individual sessions, the stories I've heard have strengthened my resolve to

guide and support each person on their unique journey. The connections forged within this centre

have become a source of inspiration and solidarity, fostering an environment of mutual growth

and understanding.

Month 3 Reflection:
The third month at Sukoon Foundation has brought a profound sense of connection and growth.

Our collective journey has formed bonds within the group have become a source of strength for

all. As we explored deeper facets of psychoeducation and stress reduction, the emotional

investment from participants has been truly touching. Witnessing the integration of these tools

into daily life has created an atmosphere of calm and introspection. In individual sessions, the

trust and openness shared by participants have allowed for a more profound exploration of

personal narratives and the identification of pathways to recovery. Looking back on these three

months, I'm filled with gratitude for the shared experiences, resilience, and growth within the

Sukoon.