FIELD WORK REPORT

DEPARTMENT OF PSYCHOLOGY

10th June 2023 to 2nd August 2023

Submitted By: Submitted To:

Amneet Kaur Dr. Rajesh Kumar
Roll No. 27412247810 HOD Psychology
Class: MA Semester-3
Session

Place:

Bhatia Neuropsychiatric Hospital Circular Road,

Medical Enclave, Amritsar.

Mentors: Psychiatrist : Dr. JPS Bhatia

Clinical Psychologist : Dr. Sheveta Sharma

 TABLE OF CONTENT

TITLE PAGE NO.

Certificate

Acknowledgement

Introduction

Profile of the Organisation

Psychopathology

Psychotherapies

About Disorders

Daily Activity Report

Case Study - I

Case Study - II

Case Study - III

Case Study - IV

Case Study - V

Learning Outcomes

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 ACKNOWLEDGEMENT

With greatful heart I would like to remember the persons who have helped
me during the course of my internship program. I wish to place on record my words
of gratitude to Dr. Rajesh Kumar, Head of the Department of Psychology and all
other staff for their support during the field work days.

I am thankful to Dr. JPS Bhatiya (Psychiatrist) Dr. Sheveta Sharma (Clinical

Psychologists), Dr. Nisha (Clinical Psychologists) for providing their valuable
guidance at all stages of their advice, suggestions, positive and supportive attitude.

I own my whole hearted thanks and appreciation to the entire staff of the
Bhatia hospital for their cooperation and assistance during course of my internship.

I hope that I can build upon the experience and knowledge that I have gained
and make a valuable contribution towards this course in coming future.

Thank you to all my teachers in Department of Psychology, Guru Nanak Dev

University and all mentors who helped me during my internship. Thank you for their
guidance and support.

Amneet Kaur

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 INTRODUCTION

An internship is a trained and supervised experience in a professional setting in

which the student is learning and gaining essential experience and expertise.
Internship is meant for introducing candidates cither full-time or part-time to a real
world experience related to their career goals and interests. It may, but does not have
to be related connected to one’s academic major or minor, Internships can be done
during the academic semester and or summer depending upon the spaced out
curriculum, There are several varieties of internship: some are paid some are not and
some offer credit towards graduation.

Internship is an excellent way to build those all important connections that are
invaluable in developing and maintaining a strong professional network for the
future. Internships provide real world experience to those looking to explore or gain
the relevant knowledge and skill required to enter into a particular career field.
Internship is relatively short term in nature with the primary focus on getting some
on the job training and taking what's learning in the classroom and applying it to the
real world. Interns generally have a supervisor who assigns Specific tasks and
evaluates their overall work. For internship for credit, usually a faculty sponsor will
work along with the site supervisor to ensure that the necessary learning is taking
place. Internship can be done by high school or college students to gain relevant
experience in 4 particular career field as Well as to get exposure to determine if they
have a genuine interest in the field.

An internship is a way to determine if the industry and the profession is the best
career option to pursue. Interns not gain practical work experience in a field that
students intend to pursue but also build experience in local, national and
international platforms.

It also assists students in making informed career decisions. Through daily activities
and Interpersonal interactions, interns are able to gather valuable information about
their field. They also get a chance to evaluate their own strengths and preferences
before they formally enter the job market. Such information can be helpful in
deciding if they have made the right career choice and can reinforce doubts or
resolves relating to their career goals.

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Internships may present a potential for an offer of full time employment.
Professional work experience is the most beneficial advantage that can be acquired
by completing an internship for students or fresh graduates, having this work
experience on their resume can be the best way to get the foot in the door. This can
result in more job offers as compared to individuals who lack such work experience.

OBJECTIVES OF INTERNSHIP

The main objective of the internship course is to facilitate reflection on experiences

obtained in the internship and to enhance understanding of academic material by
application in the internship setting. Internships will provide students the
opportunity to test their interest in a particular career before permanent
commitments are made. Apart from it is more important because:

1. Internship students will develop employment records or reference that will

enhance employment opportunities.
2. Internship will provide students the opportunity, to develop attitudes
conducive to effective interpersonal relationship,
3. Internship will provide students with an in-depth knowledge of the formal
functional activities of a participating organization.
4. Internship programs will enhance advancement possibilities of graduates.
5. Internship will help the trainees to develop skills and techniques directly
applicable to their careers.
6. Internship will provide students the opportunity to develop attitudes
conducive to effective interpersonal relationships.

PURPOSE OF INTERNSHIP IN PSYCHOLOGY

1. To develop facility with a range of diagnostic skills, including: interviews,

case history-taking, risk assessment, child protective issues, diagnostic
formulation, triage, disposition, and referral.
2. To develop further skills in psychological intervention, including:
environmental interventions, crisis intervention, short-term, goal-oriented
individual, group, and family psychotherapy, exposure to long-term
individual psychotherapy, behavioral medicine technique, and exposure to
psychopharmacology, case management, and advocacy.

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 3. To develop facility with a range of assessment techniques, including:
developmental testing (elective), cognitive testing, achievement testing,
assessment of behavior, emotional functioning, assessment of parent-child
relationship and family systems, and neuropsychological evaluation
(elective), Assessment training across will include both current functioning
and changes in functioning.
4. To develop facility with psychological consultation, through individual cases
and participation in multidisciplinary teams, including consultation to:
parents, mental health staff (e.g., psychiatrists, social workers) medical staff
(e.g., physicians, nurses, PT, OT, etc.), school systems, and the legal system.
Consultation training occurs in both the inpatient and outpatient setting, both
downtown and in the suburbs, and ranges.
5. To learn the clinical, legal, and ethical involved in documentation of mental
health services within a medical setting.
6. To learn to promote the integration of science and practice, related to
theories and practice of assessment, intervention, and consultation. Interns
are trained in empirically-supported treatments (e.g., parent training groups,
inpatient treatment protocols for school avoidance, eating disorders), and
behavioral medicine protocols (e.g., medical noncompliance, pain
management, headache treatment, toilet training).

PSYCHOPATHOLOGY

Psychopathology is the scientific study of mental disorders, including efforts to

understand their genetic, biological psychological and social causes; effective
classification schemes (nosology); course across all stages of development;
manifestations; and treatment. The term may also refer to the manifestation of
behaviors that indicate the presence of a mental disorder.

The word psychopathology has as Greek origin: 'psyche' means "soul", 'pathos is
defined as "suffering", and 'logos' is the study of'. Wholly, psychopath logy is
defined as the origin of mental disorders, how they develop, and the symptoms they
might produce in a person.

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Patients with mental disorders are normally treated by psychiatrists, or
psychologists, who both specialize in mental health and diagnose and treat patients
through medication or psychotherapy. These professionals systematically diagnose
individuals with mental disorders using specific diagnostic criteria and
symptomatology found within the Diagnostic and Statistical Manual of Mental
Disorders or ICD.

PSYCHOTHERAPY

Psychotherapy is the use of psychological methods, particularly when based on

regular personal interaction, to help a person change and overcome problems in
desired ways. Psychotherapy aims to improve an individual's well-being and mental
health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts
or emotions and to improve relationships and social skills. Psychotherapy is a form
of treatment based on the systematic use of a relationship between therapist and
patient (as distinct from pharmacological or social methods) to produce change in
feelings, thinking and behaviour. The advantage of this definition is that it highlights
how the quality of the interpersonal relationship forms the basis for therapeutic
efficacy, whatever techniques are employed to this end. As with all interpersonal
relationships, communication is an intrinsic aspect of psychotherapy. The
predominant medium of communication involves the use of spoken language.
However, non-verbal means (e.g. body sculpting, drama, music, art and play) have
been employed for psychotherapeutic purposes as well.

The Goals of Psychotherapy

In general, the goals of psychotherapy are as follows:

1. removal of distressing symptoms;

2. altering disturbed patterns of behaviour;
3. improved interpersonal relationships;
4. better coping with stresses of life:
5. personal growth and maturation.

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Types of Psychotherapy

Psychologists generally draw on one or more theories of psychotherapy. A theory of

psychotherapy acts as a roadmap for psychologists: It guides them through the
process of understanding clients and their problems and developing solutions.

Approaches to psychotherapy fall into live broad categories:

Psychoanalysis and psychodynamic therapies: This approach focuses on changing

problematic behaviors, feelings, and thoughts by discovering their unconscious
meanings and motivations. Psychoanalytically oriented therapies are characterized
by a close working partnership between therapist and patient. Patients learn about
themselves by exploring their interactions in the therapeutic relationship. While
psychoanalysis is closely identified with Sigmund Freud, it has been extended and
modified since his early formulations.

Behavior therapy: This approach focuses on learning s abnormal behaviors.

a) Ivan Pavlov made it important contributions to behavior therapy by

discovering classical conditioning, or associative learning. Pavlov's famous
dogs, for example, began drooling when they heard their dinner bell, because
they associated the sound with food.
b) "Desensitizing" is classical conditioning in action: A therapist might help a
client with a phobia through repeated exposure to whatever it is that causes
anxiety.
c) Another important thinker was E.L. Thorndike, who discovered operant
conditioning. This type of learning relies on rewards and punishments to
shape people's behavior.
d) Several variations have developed since behavior therapy's emergence in the
1950s. One variation is cognitive-behavioral therapy, which focuses on both
thoughts and behaviors.

Cognitive therapy: Cognitive therapy emphasizes what people think rather than
what they do.

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 a) Cognitive therapists believe that its dysfunctional thinking that leads to
dysfunctional emotions or behaviors. By changing their thoughts, people can
change how they feel and what they do.
b) Major figures in cognitive therapy include Albert Ellis and Aaron Beck.

Humanistic therapy: This approach emphasizes people's capacity to make rational

choices and develop to their maximum potential. Concern and respect for others are
also important themes.

a) Humanistic philosophers like, Jean-Paul Sartre, Martin Buber and Soren

Kierkegaard influenced tins type of therapy.
b) Three types of humanistic therapy are especially influential. Client-centered
therapy rejects the idea of therapists as authorities on their clients' inner
experiences. Instead, therapists help clients change by emphasizing their
concern, care and interest.
c) Gestalt therapy emphasizes what it calls "organismic holism" the importance
of being aware of the here and now and accepting responsibility for yourself.
d) Existential therapy lotuses on free will, self-determination and the search for
meaning.

Integrative or holistic therapy: Many therapists don't tie themselves to any one
approach. Instead they blend elements from different approaches and tailor their
treatment according to each client's needs.

ABOUT THE HOSPITAL

Bhatia hospital was established in 2008 with the aim of providing world class
healthcare facilities to the patients. This is situated at #22, circular road, Amritsar,
Punjab.

Bhatia hospital is a ray of hope for the people who are engrossed in the darkness of
addiction. Team of hospital deals with all kinds of drugs, alcohol and substance
abuse. They work on the improvement of mental health and whole team consists of
renowned psychiatrists and psychologists. They believe in a peaceful environment,
where all patients in the house are treated with care and kindness.

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Bhatia hospital is today probably the only neuropsychiatric and De addiction in the
Amritsar Catering to the elite and affluent class of people afflicted and affected by
this ailment that is completely voluntary, which as a priority maintains the
anonymity and confidentiality of its clientele and tailor makes the treatment process
as per the individual making it client specific. The ambience provided is luxurious
and exclusive.

ABOUT THE DISORDERS/MENTAL ILLNESS

Mental disorders/Mental illness are diseases that affect cognition, emotion and
behavioral control and substantially interfere both with the ability of children to
learn and with the ability of adults to functions in their families, at work, and in the
broader society. Mental disorders tend to begin early in life and often run a chronic
recurrent course. Mental disorders are diagnosable conditions characterized by
changes in thinking, mood or behavior that can cause person to feel stressed out and
impair his or her ability to function. Mental illness is classified according to the
diagnostic and statistical manual of mental disorder, fourth edition (DSM IV),
published by the American Psychiatric Association (1994). The DSM uses a
multidimensional approach to diagnosing.

It assess five dimensions as follows:

Axis I Axis II Axis III Axis IV Axis V

Axis I Clinical Syndromes:

This typically includes the clinical disorders that may be four of clinical attention.
For example: Major depression episode, Sehizophrenic episode, Panic attack, Social
phobia.

Axis II Development disorder and personality disorders:

Development disorder includes the five Pervasive Development Disorder (PDD),

also known as Autism Spectrum Disorder (ASD), as defined by the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV). These include the Autistic
disorder, Rett's disorder & Childhood disintegrative disorder.

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Axis III Physical conditions:

It plays a role in the development, continuance of Axis I and II disorders. Physical

conditions such as brain injury or HIV/AIDS that can result in symptoms of mental
illness are included here.

Axis IV Severity of Psychosocial stressors:

Events in a person's life, such as death of loved one, starting a new job, college &
even marriage can impact the disorders listed in Axis I & II. These events are both
listed and rated for Axis IV.

Axis V Highest level of Functioning:

It contains the global assessment of functioning, which is a numerical scale that

measures the level of functioning of the clients. The scale ranges from O (inadequate
information) to 100 (high functioning with no symptoms of mental illness present).

TYPES OF MENTAL ILLNESS

There are many different types of mental illness. Some of the main groups of mental
health disorders are:

1. Mood Disorders : Depression or Bipolar disorder

2. Anxiety Disorders

3. Personality Disorders

4. Psychotic Disorders : Schizophrenia

5. Eating Disorders

6. Trauma related disorders : Post-traumatic stress disorders

7. Substance Abuse Disorders

MOOD DISORDERS

A mood disorder is a type of mental illness that affects a person's emotional state.
It's a mental illness in which a person has protracted periods of excessive happiness,
misery or both. Mood problems can alter person's behavior and impair person
capacity to cope with everyday tasks such as work or school. Mood disorder is a

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wide term that encompasses all sorts of depression and bipolar disorders, both of
which have an impact on mood.

Types of Mood disorders

The diagnostic and statistical manual of mental disorders (DSM V) divides mood
disorders into two categories: bipolar disorder and associated disorders and
depression disorders. The following are the most common forms of mood disorders:

1. Major depressive disorder

2. Bipolar I disorder
3. Bipolar II disorder
4. Cyclothymic disorder

Symptoms of Mood disorders

The following are the most common symptoms of a mood disorder are:

1. Ongoing sad, anxious

2. Feeling of hopeless or helpless
3. Having low self-esteem
4. Feeling worthless
5. Thoughts about death or suicide
6. Relationship problems
7. Trouble sleeping

Causes of Mood disorders

There is no single factor that alone causes mood disorders. Some factors that can
play a role include:

1. Genetics
2. A family history of mood disorders
3. Having other mental health conditions
4. Chronic health conditions
5. Taking certain mediations

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Treatment of Mood disorders

Treatments for mood disorders can include psychotherapy, also known as talk
therapy, as well as medications to help regulate chemical imbalances in the brain.

 Cognitive behavior therapy (CBT) is a common form of therapy used to treat

many types of mental disorders, including depression and bipolar disorder.
 Medications: Antidepressants are used to treat both depression and certain
types of bipolar disorder.

SCHIZOPHRENIA

Schizophrenia is a condition that seriously affects a person's physical and mental

health. This is because it destroys brain function and affects thinking and memory.
Schizophrenia is a serious mental disorder in which people interpret reality
abnormally. Schizophrenia can cause hallucinations, delusions and highly disturbed
combinations of thoughts and behaviors that interfere with daily functioning and can
bad to disability. Schizophrenia typically begins at different ages. It usually starts
between the ages of 15 and 25 for men and 25 to 35 for women. It also tends to
affect men and women equally.

Symptoms of Schizophrenia

The symptoms of Schizophrenia may fall into three main categories:

1. Positive symptoms: Hallucinations, delusions, distorted perceptions, beliefs

and behaviors such as heaving voices or seeing things that does not exist.
2. Negative symptoms: Loss or diminished ability to initiate a plan, speak,
express emotions or find pleasure.
3. Disorganized symptoms: Confused and disordered thinking and speech,
trouble with logical thinking and sometimes strange behaviors and abnormal
movements.

Causes

The causes of schizophrenia is unknown, but researchers believe that a combination

of genetics, brain chemistry and environment contributes to the development of the
disorder.

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  Genetics: Schizophrenia is not caused by just one genetic variation, but a
complex interplay of genetics and environmental condition influences the
Schizophrenia. Heredity also plays a key role in developing schizophrenia
which is more than six times higher if you have a close relative, such as a
parent or sibling, with the disorder.
 Environment: Exposure to the virus or malnutrition before birth has been
shown to increase the risk of schizophrenia, especially in the first and second
semesters. Recent studies also suggest a link between autoimmune disease
and the development of psychosis.
 Brain chemistry: Problems with certain brain chemicals, including
neurotransmitters called dopamine and glutamate, can contribute to
schizophrenia. Neurotransmitters allow brain cells to communicate with each
other. A network of neurons may also be involved.
 Drug use: Several studies suggest that the use of psychoactive drugs in teens
and young adults may increase the risk of schizophrenia. Increasing evidence
suggests that smoking marijuana increases the risk of psychological incidents
and long-term mental experiences.

Treatment of Schizophrenia

Treatment with medications and psychosocial therapy can help manage the
condition. In some case hospitalization may be needed.

1. Medications: Medications are the consistence of schizophrenia treatment

and antipsychotic medications are the most commonly prescribed drugs. The
goal of treatment with antipsychotic medications is to effectively manage
signs and symptoms at the lowest possible dose. Antipsychotics like -
Aripiprazole, Asenapine, Laurasidone are used.
2. Psychosocial Interventions: These may include :
 Individual therapy
 Social skills training
 Family therapy

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Most individuals with schizophrenia require some form of daily living support.
Hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep
and basic hygiene.

OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder (OCD) is characterized by the occurrence of

unwanted, intensive obsessive thoughts and distressing images which are usually
accompanied by compulsive behaviors. Compulsive behaviors are carried out either
to undo or neutralize the obsessions or to prevent the occurrence of some dreadful
event. According to DSM-5, obsessions involve persistent and recurrent intrusive
thoughts, images or impulses that are experienced as disturbing, inappropriate and
uncontrollable. People who have such obsessions actively try to resist or suppress
them or to neutralize them with some other thought or action. Compulsions can
involve either overt repetitive behaviors that are performed as lengthy rituals.
Compulsions may also involve more convert mental rituals. OCD lower functional
impairment and thus it is often considered to be one of of the most disabling mental
disorders.

Symptoms of Obsessive-Compulsive disorder

People with OCD may have symptoms of obsessions, compulsions or both:

Obsessions are related thoughts, urges or mental images that cause anxiety. They
may involve such as:

1. Fear of germs or contamination

2. Fear of losing or misplace something
3. Worries about harm coming towards yourself or others
4. Unwanted forbidden thoughts involving sex or religion
5. Aggression thoughts towards yourself or others.

Compulsions are behaviors that you feel like you need to do over to try to reduce
your anxiety or stop the obsessive thoughts. Some common compulsions include:

1. Excessive cleaning and/or handwashing

2. Repeatedly checking on things, such as whether the door is locked or the
oven is off

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 3. Compulsive counting
4. Ordering and arranging things in a particular, precise way

Treatment of OCD

The best practice guidelines for OCD recommend is Cognitive-Behavioural Therapy

(CBT) and antidepressant medications. Whereas many people will benefits from
using one or the other, those with moderate to severe forms of OCD often do best
when both treatments are combined.

Psychological Treatment : CBT

Cognitive Behavioural Therapy (CBT) is widely considered the best psychological

treatment for OCD. Specially a form of CBT called exposure and response
prevention (EFP), is the most commonly used therapy in major health care settings.

Medications in the treatment of OCD: Selective Serotonin Reuptake inhibitors

(SSRIs) is a large class of antidepressant that work very specifically on the serotonin
neurotransmitter system. These include the following:

1. Fluoxetine
2. Sertraline
3. Paroxetine
4. Citalopram

SUBSTANCE ABUSE DISORDERS

Substance abuse refers to a pattern of significant use of any substance or drug or

medicine for mood-altering purposes. Substance or drug abuse is use of a drug in
amounts or any methods which are harmful to the individual or others. It is an illness
that affects an individual's brain and behavior and leads to an incapability to manage
the use of a legal or illegal drug or medication.

CONCEPT OF SUBSTANCE ABUSE

A drug is any chemical substance which when consumed bodily functions and leads
to cognitive, affective and behavioral changes. Examples of drugs include alcohol,
tobacco etc.

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Substance use refers to consumption of psychoactive substances without
experiencing any negative consequences. He/she is doing it for social, experimental
or recreational use.

Substance Misuse is a situation where a person experiences negative consequences

on consuming substances.

Substance Abuse is a state where an individual continuously uses it with negative

consequences such as physical, social or legal harm.

Harmful use of substances refers to a pattern of drug use or consumption which is

already causing damage to health.

Drug Dependence is a cluster of physiological, behavioral and cognitive phenomena

in which the use of a substance takes on a higher priority for a person as compared
to other behaviors.

Drug addiction is also known as substance use disorder. It is an illness that affects an
individual's brain and behavior and leads to an incapability to manage the use of a
drug or medication.

Harmful effects of substance abuse

 Failure to meet responsibilities

 Health issues
 Disabilities
 Impaired control
 Social issues such as poor adjustment, bullying etc.
 Alteration in one's decision
 Distortion of insight
 Altering the reaction timing
 Danger of accident and damage

Sometime people think that

 It is a voluntary behavior
 Person using it is weak and immoral
 Willpower is enough to stop drug abuse

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  It can be stopped at anytime
 Teens are too young to get addicted
 Persons gets addicted to drugs only after using it for longer period of time
 Drug increases creativity
 It is a disease and there is nothing that can be done about it
 Single use of drugs won't let one addicted
 It helps to release one's stress

Progression of Substance abuse

Experimentation
Dependence or
and recreational Harmful use
Addiction
use

Commonly used drugs and their consequences

 Alcohol leads to euphoria, mild stimulation, relaxation, lowered inhibitions,

drowsiness, loss of coordination of senses etc.
 Tobacco leads to increased blood pressure and heart rate.
 Cannabis leads to euphoria, relaxation, slow reaction time, distorted sensory
perception, impaired balance and coordination, anxiety, panic attacks etc.
 Opioids leads to pain relief', euphoria, drowsiness, sedation, weakness.
dizziness, nausea, confusion, dry mouth, itching, sweating, constipation etc.
 Inhalants or Solvents leads to stimulation, loss of inhibition, headache,
nausea, slurred speech, loss of motor coordination etc.
 Cocaine or Amphetamine leads to increased heart rate, blood pressure, body
temperature, feelings of exhilaration, mental alertness, tremors, reduced
appetite, irritability, anxiety, panic, violent behavior etc.
 Sleep Medications (benzodiapincs) leads to sedation, drowsiness, reduced
anxiety, feelings of well being, lowered inhibitions, slurred speech, poor
concentration, confusion, dizziness, impaired coordination and memory etc.
 Heroin (smack, brown sugar) leads to euphoria, drowsiness, impaired
coordination, confusion, nausea, feeling of heaviness, arrested breathing etc.

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Reasons of Substance Use/Abuse

Let us do brain storming about the reasons which are responsible for substance
use/abuse. The expected answers will be...

 To rebel against parents or authorities

 As a recreational activity
 To express independence
 To handle low self-esteem
 To cope with academic stress
 To deal with family stress and issues
 For immediate gratification
 Due to peer pressure etc.

Risk factors of Substance Abuse

Following factors puts a person at risk of consuming substance.

 Personality factors - aggressive people arc at a higher risk of using drugs.

 Psychological factors - high novelty seeking, curiosity, impulsivity, low
harm avoidance, high reward sensitivity etc.
 Familial factors - lack of supervision, conflicts within the family, history of
drug abuse in family etc.
 Drug availability - easy access to drugs through family or friends.
 Peer group - peer pressure and use of drugs among peer groups.
 Behavioral factors - anxiety, depression, conduct problems (frequent lying,
destroying school property etc.).
 Lack of social support - poor family support, unhelpful peer groups and
community etc.
 Abusive factors - being a victim of physical, emotional or sexual abuse may
increase the risk for drug use. Social factors - poor social skills and lack of
coping skills.
 Media influence such as television, movies, web series etc. plays a major role
in observational learning.

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Symptoms of Substance Abuse

Performance Symptoms

 Excessive absenteeism
 Lower productivity
 Lower grades in school
 Deteriorating work quality like incomplete homework, class assignments
 Poor morale
 Increased minor accidents, mistakes
 Multiple reports of theft

Behavioral Symptoms

 Sudden change in attitude, work or behavior (I don't care attitude)

 Sudden deterioration of long friendships and relationships Explosive
arguments and disagreement over pity matters
 Frequent hangover symptoms
 Secretive behavior
 Being erratic, forgetful, indecisive
 Deterioration in personal appearance and hygiene Hyperactivity, Easy
excitability & Restlessness
 Frequent borrowing of money, financial issues

Physical Symptoms

 Blood spots and bruises on skin

 Bloodshot or watery eyes
 Runny or irritated nose, cough, sore throat
 Speech pattern changes, slurred speech
 Tremors or jitters
 Constant scratching of skirt, picking skin or hair
 Poor body coordination, poor senses
 Easily fatigued or constantly fatigued

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Psychological Symptoms

 Unexplained change in personality or attitude

 Sudden mood changes
 Irritability
 Anger outburst or laughing at nothing
 Periods of unusual hyperactivity or agitation
 Lack of motivation
 Inability to focus
 Appearing fearful or withdrawn

Intervention of Substance Abuse

The prime objective of substance abuse treatment is intended at:

 Discontinuing drug-seeking and its abuse

 Avoiding difficulties of drug withdrawal
 Rehabilitation
 Maintaining self-denial
 Regular treatment with therapies
 Preventing relapse.

Intervention strategies involve developing rapport, screening for substance use,

decide mode of intervention and follow upto prevent relapse.

Life Skills and Drug Refusal Skills has to be developed for prevention of substance
abuse.

 Preventing the situation since it is the best way to stay away from in any
abuse
 Identifying risk situations or drug abuse since it can serve as triggers to use
drugs
 Saying 'NO' or clearly denying to intake drugs with the help of assertiveness
 Problem solving with the help of brain storming
 Replacing negative thinking with positive ones.
 Be assertive & Say No to Drugs

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INTERNSHIP PERIOD

Day 1

 Go to centre of internship and observe Miss Aman when she does

counselling of new patients and follow up.
 Miss Aman gave the general idea about writing case history.
 Observe the patient with Miss Aman after that Miss Anushri gave the idea
about the test that apply on patients.
 On first day, they just gave the overview about the all work that done during
entire internship.

Day 2

 The Day 2nd started at 10:00 am. I visited to centre and sit with Miss Aman
and observe her how she handle the patients.
 She gave the general idea about the writing case history and also tell us about
the questions that put while taking case history.
 Then joined the group session of patients in which JPS Bhatia describe about
relapse risk factor.

Day 3

 Started off with Miss Aman. I sit with Miss Aman and observe the daily
routine follow up and new patient.
 I observe the alcoholic patient at that time and counselling session of the
patient. Miss Aman shows the case history of Alcoholic patient.
 Then I attend the meeting session of Shaveta Sharma in which she tells about
the how to deal with emotional pain.

Day 4

 Again my day started by observing the OPD patients. I check the patient of
obsessive compulsive disorder (OCD) with Miss Anchal.
 After the counselling session of OCD patient Miss Anchal discuss about the
problems of OCD patients and how to deal with them.
 Then in meeting session, patients told about problems they face during
treatment.

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  Then the Shaveta Sharma gave lecture on Mental health problems and
discuss about the coping skills that deal with mental problems.
 Then in evening time, meditation session is going on. In which we learnt
about the meditation.

Day 5

 In fifth days, I sit with Miss Aman and check IPD patients they discuss with
us problems of addictive and psychotic patients.
 Observe that how to build a repo with patient that patient easily trust to
consoler and tell the whole problem with consoler.
 Activities like carrom board, Jumbo was done with patients.

Day 6

 I again sit with Miss Aman and she tell about Mental Health Examination.
She gave a form in which all the questions are written that see during MSE.
 The following points of MSE are:

Attitude Perception

Behavior Orientation

Speech Memory

Affect Insight

Mood

 Then attending the meeting and attend meditation session.

Day 7

 Seventh day was my last day in OPD.

 Here I done all the activities that I do form day first. Again sit with Miss
Aman & observe the patients and counselling session of the patients.
 Then attending the meeting session and attend the meditation session and
then done with activities.

22
Week 2

 I visited the hospital and in this week I sit with other interns in the therapy
room.
 Here I do work under Miss Anushri. Miss Anushri discuss about the tests
that applied on patients.
 Tests like:
 Beck Anxiety Inventory
 Sentence completion test
 Beck depression inventory
 International personality disorder examination are applied on patients
 Along with other interns, I learn how to apply these tests and the relaxation
technique like JPMR are learnt.
 Attending the meeting session in which JPS Bhatia gave lecture about the
alcoholic patients and the problem faced alcoholic patients and their families.
 In this week, I work along with interns and observe all the things like how to
apply tests, how to do relaxation techniques, how to take history.

Week 3

 In this week, firstly the Miss Anushri and Miss Nisha allotted us the rooms
and the test that apply on patients.
 Firstly, I apply all the test like BDI, BAI, IDPE or patients and interpreted &
scoring the test. Then taking case history of patients & Miss Anushri
counselling the patients, I observe her.
 Activities like Jumbo, carrom board etc. are played with patients.
 Relaxation techniques, JPMR are done so that the patients feel relaxed.
 Attending meeting of patients in which I described about depression, anxiety
& the solutions to cope up with them.
 JPS Bhatia gave lecture on substance abuse and problems that faced by
patients after consuming the drugs.

23
 CASE HISTORY - 1

DEMOGRAPHIC DATA

Name: XYZ

Age: 44

Marital Status: Married

Gender: Male

Occupation: Medical Officer

Education: M.B.B.S

Religion: Sikh

Mother Tongue: Punjabi

Location of Residence: Batala

Informant: Father

Chief Complaints

According to client “I feel depressed due to daily life activities then I drunk alcohol
and now I drunk regularly from 3-4 days and the episodes of drunk moderate”.

History of present illness

The client started drinking alcohol at the age of 22 years in friend circle and with
relatives just for taste. After that the severe episodes started in 2014. At this time
period, the client drinking too much alcohol and then in 2016 he was taken to
Hermitage where he stayed for 2 months. Then for 4 years was a clean period in
which client stopped drinking alcohol but now from 2-3 year again he started
drinking too much alcohol. Now he regularly drinking alcohol for 3-4 days then take
break for 1-2 day and again started drinking. The client drink alcohol for overcome
the obstacles which come in his life and mostly he drink for sleeping. Now client
drink alcohol 2-3 bottle per day and drink regularly near about 2-4 days in extremely
case when he was tensed. There are some past experiences in client life which made
the client upset and to overcome that he started drinking. When he drink alcohol,

24
after that he does not work properly but when he does not drink then he think that
he does not live his life properly then the client physically and mentally torture.
Physically the client have legs pain, have no energy and mentally he does not seek
any pleasure from his life. The client is diabetic patient and he have too much
tension about his health. According to client, in the starting time in hospital, he
reported symptoms of experience drossiness, restlessness, no pleasure, legs pain. In
2006, the client was married after the marriage of 2-3 month, they had a divorced
because the girl cheated on him and took all jewellery, money from his house. Then
he is unable to forget this incident and to overcome this he started taking alcohol.
Due to this Trauma, he was tensed, depressed also and now sometimes this incident
make him tensed, depressed. Due to these experiences the client become depressed
also and he also tenses about his daughters. According to client, when he was
hearing the bad news related to girls then he tenses about his own daughters and then
too overcome this he started drinking.

Mode of Onset: Indigenous

Course of illness: Fluctuating

Past Psychiatry and Medical History

Patient has diabetes and higher blood pressure.

Treatment History

Client took medicines of diabetes and sleeping pills also. He was treated at
Hermitage in August 2016 where he admitted for 1 month and after some gap he
again admitted for 5-6 days.

Biological Functioning

Sleep : Very poor

Appetite: Decreased

Energy: Low

Negative History

There is negative history of high blood pressure and diabetes:

25
  The client experienced emotional trauma. The cousin brother of client was
died in 9 September 2003 in domestic accident. The client had too much
attachment with cousin brother due to his death the client feel helpless.
 Second, the client was married with a NRI girl in 2006 and she cheated with
client due to which the client faced problems like stressed, irritable,
frustrated.

According to client, due to these reasons he feel himself depressed, tensed.

Family History

Client belongs to a nuclear family. The relation of client with father and mother is
good but sometimes his mother get angry on client for alcohol. He is married and
relation between client and his wife is good. The client has two daughters and the
client has one younger sister who lives in Canada and has positive relationship with
sister. There is no family history of alcoholic addiction.

Personal History

Birth Order: Ist Child

Birth and Development History: Not available

Academic History: The client was very good in academic till 12 class. He has much
interested in physics and mathematics but by pressure of parents he go for medical
stream and after that he was very weak in academic and passed at a margin. Now,
the client is M.B.B.S. and the relationship with teachers, fellows and friends were
good.

26
Sexual History: Client is married and according to client he had no gender
identification disorder and he had no history of sexual relationship with others.

Occupational History: The client has a long occupational history. He worked as a

teacher in ielts center. Then he worked as a doctor in Hartej Hospital where he has
sometimes day and sometimes the might shift.

Pre-Morbid History: The client was extrovert, social and had good relations with
his friends, teachers and co-workers. Before 2014, he was energetic and more
episodes of alcohol he loose interest in daily activities and have less energy.

Mental Status Examination

General appearance behaviour: He was good wearing t-shirt and lower and the
hair was properly well groomed. The client maintains eye contact. Attitude towards
the examiner was cooperative and attentive.

Movement and Behaviour: The psychomotor movement is normal.

Speech: Speech is normal. The intensity/tone is normal and productivity is also

normal. The client speech is goal-directed. The rate of speed is normal but the
quality of speech was emotional.

Mood/Affect: The mood of client is anxious and depressed.

Thought: The client thought process was logical and goal directed, appropriate and
was relevant with the situation.

Thought content

Homicidal Ideation: Patient has never had homicidal ideation.

Suicidal Ideation: Patient has never had suicidal ideation.

Perception

Delusion: No

Hallucinations: No

Cognitive Functions

Orientation: The client is oriented to time, place, person and self.

27
Memory: The client memory was good. He was able to recall the event from the
past easily.

Attention and concentration is aroused and sustained.

Judgement

Personal : Intact

Social: Intact

28
 CASE HISTORY - 2

DEMOGRAPHIC DATA

Name:

Age: 24

Marital Status: Unmarried

Gender: Male

Occupation: Student

Education: M.B.A

Religion: Hindu

Mother Tongue: Marathi

Location of Residence: Nagpur

Informant: Mother

Chief Complaints

According to client, he had suffered from the suicidal thoughts since two months
ago.

History of present illness (HOPI)

According to client, in 2022 he had fought with his friend circle and he left the
group. Due to this he suffered from suicidal thoughts when he started think about
them. The client started overthink about their friend circle and then the suicidal
thoughts come in his mind. Due to suicidal thoughts, he feel depressed, irritated and
aggressive. The client first time try to commit suicide before two month in which he
take over dose of medicine near about 14-15 tablets at one time and second time he
eaten rat kill poison. The reason behind this suicide his female friend. He fought
with his friend and then she did not listen to him and blocked him without listening
the client and then the client overthink about and try to commit suicide.

According to informant, the client had relation with girl and there are some conflicts
between them due to which the client feel tensed and have suicidal thoughts.

29
Mode of Onset: Indigenous

Duration of illness: One Month

Associated disturbance: Lack of sleep, stress

Past Psychiatry and Medical History

The client does not have any kind of past history illness/psychiatric illness.

Treatment History

In past, the client had gone to Chawan Hospital, Pune and then Sudhir Mahajan
Hospital, Nagpur for his treatment.

Biological Functioning

Sleep : Not sleeping well when suicidal thoughts come

Appetite: Low

Energy: Low

Family History

Client belongs to a nuclear family. There is positive relation with mother but some
conflicts between father and the client. The client has two younger sister from which
one is married and live in Japan and second line in Pune for her job. There is good
relation between client and his sisters.

Personal History

Behaviour during childhood: Not available

30
Academic History: The client was very good in academic. From first to 10th class
he has ranked first but after that he started loosing interest and become average
student. He had good relationship with his peer group and teachers during the school
life.

Pre-Morbid History: The client was introverted till his graduation then after
graduation he explored and he become extroverted. He was good relation with
teachers, friends but now he has not positive relation with his friends due to some
conflicts.

Mental Status Examination

General appearance behaviour: He was good wearing t-shirt and lower but he was
restless, less energetic. The attitude towards examiner was cooperative.

Movement and Behaviour: The psychomotor movement is normal.

Speech: The rate, tone of speech was low. The quality of speech was emotional was
low and reaction time was slow.

Mood: The mood was irritable, anxious, depressed.

Thought Process: The client thought process was disorganized.

Thought content

Suicidal Ideation: The client had an active suicidal ideation. He had always an
suicidal thoughts.

Homicidal Ideation: The client have no homicidal idea to harm other.

Delusion: No

Obsession/compulsions: No

Phobias: No

Perception: No hallucinations or delusions.

Memory/Concentration: The client have good short term intact and long term
intact.

Orientation: The client is oriented to time, place and date.

31
 CASE HISTORY - 3

DEMOGRAPHIC DATA

Name: XYZ

Age: 38

Marital Status: Married

Gender: Male

Occupation: Advocate

Education: B.A., LLB

Religion: Sikh

Mother Tongue: Punjabi

Location of Residence: Kasbha Mehta Chonk

Informant: Cousin Brother

History of present illness

According to client, he started taking drugs in 2009. Firstly, he started taking first
time, then started drinking alcohol and sometimes he taking sleeping pills. From
2014-2020 he does not taking any drug but sometimes he drinking alcohol.
According to client, when he does not taking any drug, he felt bad, redness of eye,
sweating and restlessness but after taking drug he felt inactive.

According to client, before 2009 he had a relationship with a girl and that was the
best time of his life. When he emotionally attached with a girl whom he decided to
marry in future, that time the parents of both not agree with them. The parents
refused for their marriage and this was the worst time of their life. At this time,
client started taking drug because he was unable to move forward in life and he
started taking alcohol. At present, he married with a girl but he is not happy with
that girl because his life would not listen him due to that he upset and feel depressed
and he started taking alcohol, heroine. According to client, mostly he used to taking
heroine and he taking 2 gram heroine per day. Now he wants to quit the drugs and
he has come to the hospital with his own will.

32
Past Psychiatry and Medical History

Null

Biological Functioning

Sleep : Normal

Appetite: Less

Energy: Less

Sexual Interest: Less

Treatment History

In January 2023, patient admitted in Bhatiya Hospital for treatment of his addiction.

Negative History

Nil

Family History

The client belongs to a nuclear family. The relation with father and mother is good.
The client is married and the relation with his not good due to which he client
become unhappy. The client has one daughter and one son.

Personal History

Birth Order: First and only child

Academic History: The client was good in academic. He was a good student and
always got good grades. The client's relationship with his teachers, fellows and
friends were good and he uses to respect everyone. However, he participated in
activities.

33
Occupational History: The client has been working as a advocate in Batala.

Pre-Morbid Personality: The client was extroverted.

Mental Status Examination

General appearance: Appearance is neatly dressed. The client was restless, less
energetic. The attitude towards examiner was cooperative.

Movement and Behaviour: The psychomotor movement is normal.

Speech: The rate, tone of speech was normal. The quality of speech was emotional
and less energetic.

Perception: No perceptual disturbances are seen from the client.

Cognitive Functions: The client is oriented to time, place and data.

Immediate Memory: Intact

Recent Memory: Intact

Insight

34
 CASE HISTORY - 4

DEMOGRAPHIC DATA

Name:

Age: 35

Marital Status: Married

Gender: Female

Occupation: Housewife

Education: 10th

Informant: Sister

Chief Complaints

According to patient, she had not feeling well. All time she feel like stressed,
irritated.

History of present illness

Client was very restless and agitated. According to client, she became quiet, distant,
irritated, restless after her mother death. Her mother died in 2020. Before that she
was good but after her mother death she became restless, quiet, irritable. The client
had some issues with her mother-in-law due to which she feels disturbed and she
also feel sometimes bad for fight with her mother-in-law. From last 1-2 month she
has been aggressive, irritated and when she was irritated, she wants to live lonely
and was not talk to anyone for 10-15 minutes. The client mostly depend upon her
brother. Each and every decision she depend upon brother. According to informant,
the client become very restless and irritated. She loose interest in daily activities.
She also wants that every time she wants lonely. No one talks with her, especially
when she become irritated. After 10-15 minutes she become her normal state.

Past Psychiatry and Medical History

The client has thyroid.

35
Treatment History

The client takes medicines for thyroid but for stress she never took any help.

Biological Functioning

Sleep : Normal

Appetite: Normal

Sexual Interest: Normal

Energy: Low

Negative History

The client has no history of head injury epilepsy, blood pressure. The client has only
thyroid and there is an emotional trauma that is related to her mother. The client
mother died in 2020. According to client, after her mother expired she feel lonely,
depressed, stressed.

Family History

Client belongs to a nuclear family. She is married and now her husband lives in
Purathkal. She has one daughter and one son. The relation of client with her family
is positive but she have some disputes her mother-in-law due to which she feels
disturbed.

Personal History

Birth Order: 2nd child

Behaviour during childhood: Not known

36
Academic History: The client was good in academic. She was done her study till
10th standard and at that time she has good relationship with her teachers and
friends.

Sexual and Marital History: Client is married. She had no gender identification
disorder and she had no history of sexual relationship with others. She had no extra
marital sexual relationship.

Pre-Morbid Personality: Client had good relations with family members. She is
introverted. She had less social interaction. She has loss self-esteem and love self
confidence. Most of the time, she depends upon her brother for decisions.

Mental Status Examination

General appearance and Behaviour: She was good wearing cloths but
surroundings was not neat and clean. Behaviour was restless. She looks like fatigue
but still she was cooperative with examiner.

Movement and Behaviour: Patient was constantly moving his hands.

Speech: Rapid, Pressure of speech was observed.

Mood: Irritable, Tensed

Perception: No perceptual disturbances are seen from the client.

Cognitive Functions: The client is oriented to time, place and data.

Attention and concentration is aroused.

Memory:

Immediate Memory: Intact

Recent Memory: Intact

Insight

37
 CASE HISTORY - 5

DEMOGRAPHIC DETAILS

Name:

Age: 33

Sex: Female

Religion: Hindu

Education: M.A., [Link].

Mother Tongue: Punjabi

Location of Resident: Punjab

Socio-economic status: Middle class

Informant: Sister

Chief Complaints

According to the patient she had not feeling well. According to informant the patient
had been talking to self, increased activity, reduced sleep and reduced appetite. She
have symptoms of halogenations like hearing voices and seeing something.

History of present illness

The patient had not feeling well when one day she come back from the college, she
started abusing her family members unexpectedly. Client was symptomatic after
college days. In 2014, her father had died after that she had take all family
responsibility. She had also very tensed about future. In 2015, she had been
complete her own studies then she tries to find government job but she can't
succeed. According to Informant, she have been feelings of Jealousness in college
days. In 2021, she got arrange marriage. She was unable to make goods relations
with husbands, that's she was divorced after 2 month's of marriage. After her divorce
she got depressed. The first episode of illness started when client was 22 years old.
Hearing voices and seeing things had been started at the college days.

38
Past Psychiatry and Medical History

The first episode of illness started when client was 22 years old. Patient was taking
treatment from different places and was hospitalized twice for 10 and 15 days.
Client had take treatment at ............. hospital, when she has fist showed symptoms.
She was given ECT once but no improvement was found.

Biological Functioning

Sleep : decreased

Appetite: decreased

Sexual Interest: decreased

Energy level: decreased

Negative History

The client have no negative history of trauma, head injury, epilepsy, seizures, blood
pressure and diabetic.

Family History

The client belongs to a nuclear family. She was second born child. Interpersonal
relationships were cardinal.

Personal History

Birth Order: 2nd child

Birth and development: Delivery was normal and client was born in hospital. No
birth defects.

Behaviour during childhood: No history of maternal deprivation. The client had

temper Tantrum during childhood. She was goal oriented.

39
Academic History: Clients formal education was started at the age of 5 years. She
had good relationship with his peer group and teachers during the school life. She
had no school phobia. She was disciplined student in class.

Sexual and Marital History: She had no gender identification disorder. She had no
psychosexual dysfunctions. She had no extra marital sexual relationship.

Pre-Morbid Personality: Client had good relations with family members, friends
and superiors. She is ambivert. She had less social interactions. She has good self
confidence. She never abused drugs and alcohol.

Occupational History: Client worked as a teacher in tuition centres. Now, she had
no job due to illness and she had no job satisfaction.

Mental Status Examination

General appearance: General appearance is well dressed. Hygiene was poor. She
maintains eye contact. Gait and Pasture is normal.

Attitude: Facial expression was apathetic. Attitude towards the examiner was
cooperative and attentive.

Behavior and Movement: No unusual movements or psycho-motor changes.

Speech: Rate of speech is very slow. The client speaks very soft.

Affect and Mood: Client states she feels “depressed and anxious”.

Thought Processes: Client was lack of goal disorganized and completely

disorganized about his future.

Thought Content

Suicidal ideation: There is unavailable suicidal ideation data.

Homicidal ideation: Client has never had homicidal ideas.

Delusion: Patient has delusion of reference and persecution.

Obsessions/Compulsion: Patient has a habit of frequent cleaning. If any item is not

placed symmetrically in front of the patient, then causes a lot of tension and stress.
Patient also has irrational thoughts.

40
Orientation: Patient orientation is not good patient is unable to judge time and is
not aware of what is going on around. Patient is aware of place and self.

Memory/Concentration: She doesn't have good short term intact (memory) and
also doesn't have a good long term intact.

41
MENTAL STATE EXAMINATION (MSE)

Appearance and behaviour

Appearance is described as well groomed/dishevelled, how they are dressed,

demeanour in interview, level of eye contact. In males -shaving. As appropriate,
physical behaviour such as restlessness, motor activity [retardation/overactivation
Level of co-operation, any evidence of aggression or hostility. Overfamiliarity, for
instance touching interviewer inappropriately.

Speech

Rate ranges from "poverty of speech" with few utterances to "pressure of speech",
spontaneity with little or no spontaneous utterances to circumstantiality with over
inclusion of detail, volume: from low to high, rhythm: monotonous, without
variation or inflection; staccato, with frequent pauses between fluent speech, and
normal., tone: ranges from low to high.

Mood

Described subjectively, i.e. the patients own perception, and objectively, i.e. outside
observation by interviewer. Comment also on congruity with presentation.
Described as mildly/moderately/severely depressed, normothymic [i.e. "even" or
"normal"] or mildly/moderately/severely elated, or labile - when mood abruptly
changes from one state to another.

Affect

Overall emotional tone as objectively observed during interview. Reactivity to what

is being discussed - i.e. being appropriately distressed describing upsetting
occurrences, laughing or smiling if appropriate.

Thought form and content

Refer to psychopathology lecture on Blackboard for definitions used. Thought form

is how the person's thoughts are expressed in their speech. Thought content relates
to the actual thoughts described.

Thought form ranges from easily understandable, coherent speech to loosening of

associations to incomprehensible "word salad". Thought content refers to delusions,

42
overvalued ideas, preoccupations, and obsessions. Refer to lecture material on
Blackboard on psychopathology.

Perception

Abnormal perceptions refer to illusions and hallucinations. Please refer to

psychopathology material for definitions. The most commonly encountered
hallucinations in psychiatry are auditory. Need to assess if a true hallucination
(occurring in external space and not subject to control by the individual). If auditory
hallucinations present, the quality (happening in internal or external space, whether
any control is exerted by the person, whether they are first/second person, whether
they comment on the person's thoughts or actions, whether they command the
person to do things (important from risk assessment point of view)

Risk

A vital part of history taking in clinical practice. Risk to self - self-harm/suicide.

Distinguish between thoughts, planning, intent. Refer to psychopathology lecture on
Blackboard. Risk to others. Other risks (self-neglect, carer abuse etc). This important
theme is further developed in MDSA40150 Final Year Psychiatry.

Cognition

Need to assess orientation in time, place and person, and gross tests of long and
short term memory. If indicated, Folstein's MMSE and other tests to be performed.

Insight

Not "all-or-nothing." Can be broken down into acceptance of their being a problem,
it being psychological/psychiatric in nature, acceptance that help is needed and
agreement with recommended help of treating team.

43
 LEARNING OUTCOMES
This 21 days of internship program has been taught me alot. I leant alot of things
like how to deal with clients of different mental disorders, know about different
kinds of test that apply on patients. This period provided me with new horizons to
grow.

I learnt about Mental status examination, about different kinds of disorders about
how to do counselling of patients. I leant about tests like BAI, BDI, IPOE and may
other different tests. By applying these tests I examine the mental health of patients.
Other than from this I learnt about relaxation technique i.e. JAMR which help the
patients to relax.

In my internship period, I got alot of exposure and leant about alot of disabilities.

[Link]

[Link]

[Link]

44