SUMMER INTERNSHIP REPORT

(REPORT SUBMITTED FOR THE PARTIAL FULFILLMENT OF THE REQUIREMENT

FOR THE DEGREE OF MASTER OF ARTS IN CLINICAL PSYCHOLOGY)

SUBMITTED TO
DR. JYOTSNA SHUKLA
ASSISTANT PROFESSOR
AMITY INSTITUTE OF BEHAVIOURAL AND ALLIED SCIENCES
AMITY UNIVERSITY, UTTAR PRADESH
LUCKNOW.

SUBMITTED BY
ANJANA K R
M.A CLINICAL PSYCHOLOGY

SEMESTER 3
ENROLLEMENT NUMBER- A7403422001
AMITY INSTITUTE OF BEHAVIOURAL AND ALLIED SCIENCES
AMITY UNIVERSITY, UTTAR PRADESH
LUCKNOW.

AMITY INSTITUTE OF BEHAVIOURAL AND ALLIED SCIENCES

AMITY UNIVERSITY UTTAR PRADESH

LUCKNOW

2022-2024
 DECLARATION

I, Anjana K R hereby declare that this summer internship is done by me under the guidance of
Ms. Garima Singh (clinical psychologist) at Indian Mental Health Research Centre (IMHRC),
Lucknow.

Anjana. K.R

M.A Clinical psychology student

AIBAS, Amity University,

Lucknow
 ACKNOWLEDGEMENT

 I would like to express my gratitude to all those who have been guiding me out during
entire study.

IMHRC has been a source of great opportunity and knowledge and gave me a platform
that helped me gain additional insight about my course and its applicability. It also helped
me develop my communication skills, social skills and confidence level while interacting
with the patients and the clinical psychologist, at the centre.

 I express my sincere & profound gratitude to Prof S.Z.H. Zaidi , Director , AIBAS ,
Amity Institute of Behavioural & Allied Sciences, Lucknow, for giving me the
opportunity to do my field work at such a reputed centre.
 I am also thankful to Dr. Jyotsna Shukla (Assistant Professor) for her immense support
and guidance.
 I express my sincere thanks to Ms. Garima Singh (clinical psychologist) , Indian
Mental Health Research Centre(IMHRC), Lucknow. and Mr. Syed Sajid Husain
Kaszmi (clinical psychologist) for allowing me to do my summer internship there and
teaching me so much.
 I also thank the doctors and staffs at the centre for helping me throughout the internship.
 Finally I would like to thank my family and my classmates for providing me with the
morale and supporting me throughout the session

Anjana.K.R

M.A.Clinical psychology student

AIBAS, Amity University , Lucknow

 INDEX

SERIAL TOPIC PAGE

NO. NO.

1 INTRODUCTION

2 ABOUT THE ORGANISATION

3 OBSERVATION –GENERAL AND SPECIFIC

4 CASE HISTORY

5 CONCLUSION

6 KEY LEARNING

7
REFERENCES
 INTRODUCTION
As a part of my course, M A Clinical Psychology, the course and my syllabus suggested
to provide professional experience to students looking to gain the relevant knowledge and skills
required to enter a particular field of mental health care. It also enable the students to
understand the practical implications of working in a professional setup and develop
professional ethics. As a result i have been chosen to do my summer internship at Indian Mental
Health Research Centre (IMHRC) , Lucknow under the guidance of MS Garima Singh (clinical
psychologist).

ABOUT THE ORGANISATION

INDIAN MENTAL HEALTH AND RESEARCH CENTRE (IMHRC), Lucknow is a unit of

IPYF (registered under Indian Trusts Act, 1882) dealing with psychological and behavioral
issues of children, adolescents, adults and geriatric population. It is a continuously growing
organization, one of its own kind, aiming at helping individuals lead a happy, meaningful
problem free life. It is based on the concept of holistic health aiming at a healthy mind, body
and soul. MHRC is run by specialized team comprising Psychiatrists, RCI licensed Clinical
Psychologists, Counselling Psychologists and Educationists.
IMHRC Lucknow, delivers medical and rehabilitative care for mental and behavioral
problems, particularly drug abuse disorders, psychotic disorders, schizophrenia, depression,
and anxiety. It is affiliated with Nischay Hospital De-Addiction and Rehabilitation Center,
Lucknow. The center also treats illnesses like epilepsy, eating disorders, bipolar disorder,
personality disorders, dementia, and bipolar disorder.
The hospital has two departments: OP and IP, each with 50 beds and basic amenities for
patients. Doctors Saurabh Jaiswal and Dr. Fousiya, mental health specialists, and other team
members with extensive experience offer patients in need full supervision and care.
Services and therapy provided at the center
1. Alcohol addiction treatment
2. Dual diagnosis treatment
3. Addiction treatment
4. Detox treatment
5. Individual psychotherapy
6. Couples therapy
7. Family therapy
8. Sex therapy
9. counselling
 GENERAL OBSERVATION
IMHRC is associated with Nischay Hospital, providing treatment, rehabilitation, psycho-
education, therapy, and counseling for inpatients and outpatients. Most of the inpatients
admitted to the center were treated for substance abuse and psychotic disorders. The center
combines medication with the use of different clinically proven techniques such as meditation,
yoga, exercise, and other activities for effective treatment. When a patient gets admitted to the
hospital, a complete case history, MSE (mental status examination), assessment, and necessary
tests will be conducted by the clinical psychologists and psychiatric nurse under the
prescription of the doctor. Accordingly, we will be deciding the treatment and management
plan for the patient.
Generally, for a patient, the treatment starts by focusing on his or her daily routines in the
beginning. All patients have to follow the daily routines at the hospital, which is as follows:

 Wake up in the morning - 6 30 AM

 Exercise and Yoga session
 Breakfast
 Medication
 Activities –which is specially focused on cognitive functioning like memory, thought
process and attention. Participating in activities gives leisure and energy for the
patients mentally and physically.
 Lunch
 Medication
 Jacobson’s Progressive Muscle relaxation(JPMR) session- focuses on tightening and
relaxing specific muscle groups in sequence
 Leisure time-patients can watch TV or read books and take rest.
 Tea time
 Counselling therapies used to happen in between as scheduled
 Dinner
 Bedtime

Doctor’s individual interaction and follow up used to happen twice in a week .Counsellors
clinical psychologists, and psychiatric nurses were present at all the time to observe and make
sure the patient’s improvement and participation in daily routine. They interact with the
patients and provide medication prescribed and conduct activities and JPMR session and
counselling.
 SPECIFIC OBSERVATION

First week was focused on rapport building with the patients, conducting activities, yoga,
meditation and JPMR sessions.
Rapport building: In a clinical set up building a positive and trustful relationship between the
care provider and the patient is very important for essential and successful treatment. It creates
a safe and supportive environment in which the client feels comfortable expressing their
thoughts, emotions, and concerns.
Activities for patients: The activities have been planned and conducted on patients like
drawing, mandala art making, write about yourself, writing on specific topics such as school
days, best memories of your life and playing musical chair, etc. The activities were conducting
to observe the participation of patients physically and mentally and focusing on the cognitive
orientation of the patient such as memory, attention, thought process etc.
Meditation and Yoga: Meditation and yoga can help in emotional, psychological and physical
wellbeing of the patient.it helps to reduce anxiety, tension and relax the body and mind. The yoga
sessions were conducting before breakfast which mainly focusing on breath-focused yoga called
pranayama commonly anulom vilom (Alternate Nostril Breathing), nadishodhana (alternate
nostril breathing) and om chanting.

Week 2 sessions were the follow up of the first week sessions and also learning about detailed
case history format, Mental Status Examination, provisional diagnosis using ICD 10 and also
common disorders were being treated at the center.

Case history
History taking in a psychiatry and psychology is important as it helps obtaining better
information, making a more accurate diagnosis, establishing a better rapport with patients and
working towards better adherence with management plan. It was observed and also done
detailed bio socio demographic data and history of present illness which is being taken during
the internship which helped to improve questioning skills, rapport building and provisional
diagnosis.
Mental status Examination
MSE helps to understand the current functioning of cognitive abilities of the patient.it is been
observed and taught standardized format of MSE in all areas of mental functioning.
Provisional diagnosis using ICD 10
Based on the detailed case history provisional diagnosis been done using ICD 10. When a patient
presents with symptoms, a healthcare professional may use ICD-10 codes as part of the provisional
diagnosis process provisional diagnosis is a temporary or preliminary diagnosis made by a healthcare
professional based on the patient's symptoms, medical history, and initial examination.
Common disorders observed at the center were
1. Mental and behavioural disorders due to psychoactive substance use: also known as
substance-induced disorders, are a group of conditions that arise as a result of the use
or withdrawal of psychoactive substances. These substances can include alcohol, drugs
(both illicit and prescription), and other chemical substances that affect the central
nervous system and can lead to changes in behaviour, mood, cognition, and
perception.it is been observed substance abuse cases many at the centre and could
observe and withdrawal state symptoms and comorbid conditions of the same
2. Psychotic disorders: it is a group of severe mental health conditions characterized by a
loss of touch with reality, often leading to hallucinations, delusions, disorganized
thinking, and abnormal behaviour. Schizophrenia, acute psychotic disorders and
delusional disorders were observed in patients at the canter .During the history taking
could also been observed that patients are also having the symptoms of depression and
anxiety.

A detailed case history, Mental Status Examination, and daily activities been conducted during the
third week.

It is been observed and practiced various assessments and tests during the fourth week as follows

AUDIT
AUDIT (Alcohol Use Disorders Identification Test) is a comprehensive 10 question alcohol
harm screening tool.it was developed by the WHO (World Health Organization) and been
used in a variety of health and social care settings. If the patient has been consumed only
alcohol then we use AUDIT to score and give feedback to the patient about the rate or risk
involved in his alcohol consumption.
ASSIST

ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) developed by WHO
includes a series of questionnaire that screens all levels of risks includes in substance use in
adults. When the patient is has multiple drug used ASSIST used to conduct to explain the risk
factors associated with patient’s drug use.
BPRS
BPRS (Brief Psychiatric Rating Scale) used to measure the patient’s anxiety, depression, and
psychoses .This tool been used when the patient present with the symptoms of anxiety,
psychoses and depression.
Hamilton Anxiety Rating Scale-A
HAM-A was one of the first scales developed to measure the severity of anxiety symptoms and
still widely used today. According to the scoring the severity level of patient been ruled out.

Also used Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale (HAM-D) also
used as assessment tools during intervention

Also got familiar with the test Human Figure Drawing Test (HFDT) - the projective assessment
tool to elicit the patient’s overall personality ,feelings and cognition.
 CASE HISTORY-1

Identification of data/Socio demographic details

Name: M.Y
Age : 23yrs (05-06-99)
Gender: Male
Religion: Hindu
Nationality: Indian
Educational qualification: Pursuing B.Ed
Occupation: student
Marital status: unmarried
Socioeconomic status: middleclass
Place of residence: urban
Address :sultanpur,lucknow
Informants: Father
Reliability and adequacy of information: partially reliable and adequate

Presenting complaints
“jukham aur neend nahi aaraha tha, bhookh nahi lagrahiti’.
“13 days continuously smack liya tha”
‘pareshan thi’

Chief complaints
Loss of appetite
Low mood
Unaware of the place and situations
Loss of sleep
Use of smack (opioids)
Irritability

Mode of onset: insidious

Course: Episodic
Progress: improving

Predisposing factor: consumption of opioids social setting

Precipitating factor: breakup
Perpetuating factor: peer influence

History of present illness

According to the index patient Mr. M.Y (23 yrs old, male) ,he was maintaining well until
2022.,where he shifted to hostel for his B.Ed studies and under the peer influence he started
consuming smack orally during January month of 2023.During this period he was having an
affair with a girl and she left him because he was using smack .Between that he had to stay at
his home during February and march month so the availability of smack was not there .He
was irritated and isolated himself in his room at his home .After returning to hostel on April
he injected smack continuously for 13 days . According to the index patient after injecting
smack “mujhe kuch samach nahi pathe the aur mein bas sorahethe”. He did not feel good and
confessed to his mother regarding the same and she conveyed to his father. Father was angry
when he got to know about this and he has been taken him to this hospital. Patient was not
feeling hungry and were unable to sleep while he was admitted in the hospital.

Total duration of illness: 7 months

Biological functions:
Sleep: disturbed
Appetite: low
Negative history
 There is no history suggestive of brain injury or trauma
 There is no history suggestive of hearing voices not head by others and seeing images
or objects not seen by others.
 There is no history suggestive of paranoia or irrational fear
 There is no history suggestive of elevated mood
 There is no history of suggestive suicidal ideation

Treatment history
Could not be elicited

Past history
Could not be elicited

Family history
The members of family includes the patient’s father (S.Y,50yrs) who is a businessman and
primary earning member of the family .,mother(T.P.Y-Housewife) .patient has one elder
brother (P.Y ,27 yrs) working as a commando in army and a younger sister (RY, 21 yrs) who
is working as a teacher.
The patient has a cordial relation with his family members
No history of mental illness in the family as reported by the patient

genogram

Personal history
 Developmental history- could not be elicited
 Presence of early childhood history-could not be elicited
  Home environment-patient has cordial relation with his parents and siblings.
 Scholastic history-average student at school
 Vocational history- nil contributory
 Sexual and marital history-nil contributory

 Living conditions-the living condition of the patient family is stable and patient’s
father is the primary earning member of the family. Patient has a separate room at his
home.

Mental Status Examination

 General appearance and behavior –The patient kept himself tidy, dressed
appropriately, cooperative and rapport was established.
 Attitude and relationship to examiner- patient was respectful, eye contact was present,
appeared interested.
 Motor behavior-Restlessness was present and was knuckling the fingers constantly
 Speech- speech was audible and clear with normal pitch.

Cognitive functions
Attention and concentration- attention was aroused and sustained
Orientation
Time -intact
Place -intact
Person-intact
Memory:
Immediate -intact
Recent-intact
Remote-intact
Thinking ability - Concrete, Functional, Abstract
Functional
General fund of information -average
Calculation- the patient was able to perform simple and complex mathematical calculation
Intelligence –average level of intellectual functioning

Affect
Subjective - ‘Mujhe accha mehsoos laga raha hai”
Objective – Distracted, Restlessness

Perceptual disorder -No abnormality detected.

Judgment
Test -satisfactory
Social -satisfactory
Personal -satisfactory

Insight
Grade III –Awareness of being sick but blaming to external factors.

Provisional diagnosis

F11.30 –mental and behavioral disorder due to use of opioids; withdrawal state,
uncomplicated
Assessment administered

S No Name of test Interpretation

1 ASSIST Moderate

Test behavior -The patient was cooperative during the test yet was distracted and looked
irritated.

Test findings – ASSIST- the assessment score indicates that the patient has moderate level
of risk of using opioids which will lead to health and other issues. The risk associated with
injecting opioids was present.

Impression – Based on the case history, Mental Status Examination and psychological
assessment the findings are indicative of substance use disorder comorbid withdrawal like
features.

Examiner Supervisor

Signature Signature
Date Date
 CASE HISTORY-2

Identification of data/Socio demographic details

Name: V.M
Age : 36 yrs
Gender: Male
Educational qualification: 10th pass
Occupation: Real Estate developer, social worker
Marital status: Married
Socioeconomic status: upper middle class
Place of residence: Urban
Address: Kanpur
Informants: patient
Reliability and adequacy of information: partially reliable and adequate

Presenting complaints
‘Sar pe dard “
“Sareer mein hath or per mein dard”
‘neend nahi aarahe hein”
Pareshan or gussah aarahe hein
“Alcohol aur sleeping pills use kar rahe the”

Chief complaints
Headache
Body pain
Nervousness
Anger issues
Anxious
Loss of sleep
Consumption of alcohol and sleeping pills

Mode of onset - insidious

Course- continuous
Progress -improving

Predisposing factor –Consumption of alcohol due to family history (Father was alcoholic)
Precipitating factor –suicide of a girl whom he used to help and been treated as a sister,
peer influence

Perpetuating factor – Loss of sleep

History of present illness

According to the index patient Mr. V .M (36 yrs , old ,male ) was maintaining well until 2020,
May where he was witnessed to the suicide of a girl whom he used to help and treated as a
sister. The patient is an active social worker and used to charity works and helping people in
need and had good political hold in the government. The girl who committed suicide was
suffering by tuberculosis and the patient used to help the family for the medical care of the girl.
According to the index patient he was unaware of the cause of suicide but when the suicide
happen he was the one who taken the girl from hanging and did the rites and ritual as soon as
possible. But the society was blaming him that the girl committed suicide because of him and
they had bad relation etc.” Society ka blaming aur mein apne haath se uthara meri behan ko
aur mujhe bahut dukh aur neend nahi aarahe the aur suicide karne ka man lag rahe the”. His
friends been asked him to have beer so that he will relaxed. There the patient started having
beer and he felt relaxed and continuously drank beer for six months and then switched to
whiskey. Without alcohol he was not able to sleep. After six months he was not able to sleep
after alcohol consumption and was feeling very anxious, depressed and when he tried to avoid
he felt nervousness. Then he switched to sleeping pills called “Alprox” (0.5 mg) and was
consumed around 15 to 20 pills a day. According to the index patient he used to consume both
alcohol and sleeping pills to get sleep and without any of these he is not able to sleep. Patient
also mentioned that “mujhe thoughts se bahar aane bahut mushkil hai aur lagatha hai ki sleep
paralysis hua hai,mujhe sun ne ke liye koi nahi hai”. The patient wanted to cure himself and he
came himself for the treatment.

Total duration of illness: 2 years 7 months

Biological functions:
Sleep - disturbed
Appetite – decreased appetite

Negative history
 There is no history suggestive of brain injury or trauma
 There is no history of hearing voices not head by others and seeing images or objects
not seen by others.
 There is no history suggestive of irrational fear

Treatment history
 Been treated for fracture in left hand from bike accident
 Liver fat treatment

Past history
Loss of sleep

Family history
 Father (S.M, 78 yrs) has been married twice.in first marriage the wife had
continuously seven miscarriages and he married to second women. The patient is the
son and his sister been born in second wife. She died due to he was 4 years old due to
medicinal reaction and first wife been brought up the kids .Father became alcoholic
used to consume opioids since after his second wife death and became irresponsible
and was so silent and never been talked to the patient. Because of fathers
 irresponsibility he had to quit his studies at 10th class.Relationship with father is
hostile.
 Non biological mother (S.M.I, 60yrs )also has very normal relationship with the
patient
 His younger sister(Ly) he made his sister married
 Wife (S.L,), housewife, the patient has hostile relation with his wife due to his extra
marital affair and it is been sorted now.it was an arranged marriage. Patient have two
kids one elder boy ( DV ,11 yrs) and younger girl ( BH, 10 yrs)

Genogram

Personal history
 Developmental history - no birth complications and normal delivery as reported by
the patient.
 Presence of early childhood history –could not be elicited
 Home environment – cordial but hostile relation with father
 Scholastic history-Average student at school
 Vocational history –Finished school at 10th and took responsibility of home. Ran a
printing shop then switched job to real estate. Doing social and political works also
aside. Cordial relation with staffs and coworkers. Hardworking person
 Sexual and marital history- married at the age of 19, arranged marriage
 Living conditions - no close relation with anyone at home. Hostile relation with
father. Cordial relation with children.no close relation with wife. The living condition
is good and the patient is the primary earning member of family.
 Mental Status Examination

 General appearance and behavior –The patient kept himself tidy, dressed
appropriately, cooperative and rapport was established.
 Attitude and relationship to examiner- patient was respectful, eye contact was present,
appeared interested.
 Motor behavior-Restlessness was present and was knuckling the fingers constantly
 Speech- speech was audible and clear with normal pitch.

Cognitive functions
Attention and concentration- attention was aroused and sustained
Orientation
Time -intact
Place -intact
Person-intact
Memory:
Immediate -intact
Recent-intact
Remote-intact
Thinking ability –Concrete, Functional, Abstract
Functional
General fund of information -average
Calculation- the patient was able to perform simple and complex mathematical calculation
Intelligence –average level of intellectual functioning

Affect
Subjective - “feeling good lag raha hai”, thoughts se bahar aana mushkil hai”
Objective – Anxious
Perceptual disorder -No abnormality detected.

Judgment
Test -satisfactory
Social -satisfactory
Personal -satisfactory

Insight
Grade III –Awareness of being sick but blaming to external factors.

Provisional diagnosis
F19.21 –Mental and behavioral disorder due to multiple drug, dependence
syndrome, currently abstinent, but in a protected environment
F51.0 –non organic insomnia

Assessment administered

S No Name of test Interpretation

1 ASSIST High

2 BAI Moderate anxiety

Test behavior -The patient was cooperative during the test

Test findings – ASSIST- the assessment score indicates that the patient has high level of
risk of using alcohol and sedatives which indicates at high risk of experiencing severe
problems in health ,social, financial, legal and relationship. And as a result the current pattern
of use are likely to be dependent.
BAI score indicates the patient has moderate level of anxiety.

Impression – Based on the case history, Mental Status Examination and psychological
assessment the findings are indicative of the multiple substance use disorder and dependence
syndrome is present.

Examiner Supervisor

Signature Signature
Date Date
 CASE HISTORY-3

Identification of data/Socio demographic details

Name: Mr. A.V
Age : 29 yrs
Gender: Male
Educational qualification: B.A
Occupation: unemployed
Marital status: unmarried
Socioeconomic status: Middle class
Place of residence: Urban
Adress: Topkhana , contt , Lucknow
Informants: Father
Reliability and adequacy of information: Not fully reliable and adequate

Presenting complaints

Ganja peete the or cigarette kabhi kabhi

Khane ka bhut man krta tha pine ke baad
Seene mai jalan hoti hai 4-5 din se
Papa se hathapayi hui thi
Papa dekh kr aisa lagta tha ki vo emotional blackmail kar rhe ho
Phele gussa bhut aata tha
Uljhan hoti hai
Haste rhete hai
Badhbadate rhete the
Ganja peete the or cigarette kabhi kabhi
Khane ka bhut man krta tha pine ke baad
Seene mai jalan hoti hai 4-5 din se
Papa se hathapayi hui the
Papa dekh kr aisa lagta tha ki vo emotional blackmail kar rhe ho
Phele gussa bhut aata tha
Uljhan hoti hai
Haste rhete hai
Badhbadate rhete the

Chief complaint
Consumption of cannabis and tobacco
Increased appetite
Feeling of burning of chest – 4-5 days
Low mood
Aggressive behaviour
Laughing randomly
Murmuring
Irritability
Walking at random
Hearing of voices not heard by others
Felt like someone else id taking about me.

Mode of onset -Insidious

Course -continuous
Progress -improving
Predisposing factor - consumption of cigarette and cannabis due to social setting and family
members (father and uncle)
Precipitating factor- peer influence and family conflict
Perpetuating factor - peer influence and strain home environment
Protective factor –could not be elicited
History of present illness
According to the index patient, Mr A.V is 29 years old, was maintaining well until 2015 after
which he started consuming cannabis and tobacco due to peer influence and family and also
consume alcohol occasionally . He was brought to the hospital in 2016 for the first time in
nirvan and currently in nischay hospital as he was having anger issues, increased in appetite,
randomly laughing, murmuring, irritability, felt burning in the chest, walking at random,
hearing of voices not heard by others and felt like someone else id taking about me.
He had strain relation with his father as well as has strain home environment as his elder sister
died due to pneumonia and was paralyzed, his mother died in covid. He had cordial relation
with his friends.
He first started with the consumption of tobacco in class 11-12th, then consumption of cannabis,
being graduated in 2015, had no job, conflict with father. Restriction for the studies and job
and felt frustrated having nothing in hand.
He is being aware of the fact that he has been admitted to more than one hospital and currently
in April came to the centre. He is been aware about his family members, their conflicts among
themselves. The last consumption of cannabis was in 2018-19. He use to drink occasionally.

Total duration of illness -8 years

Biological functions:
Sleep -stable
Appetite -increased

Negative history
 There is no history suggestive of brain trauma/injury
 There is no history suggestive of irrational fear
 There is no history suggestive of elevated mood
 There is no history suggestive of suicidal ideation

Treatment history
Nirvaan – 2016
Darpan
Nishchay hospital
Sandeep natural pathy
Jeevan joyti
Past history
Consumption of cannabis and tobacco
Depression
Anger issues

irritability

Family history
Father’s name – Mr suresh kumar verma(age 82years)

Mother’s name – late manjula verma

Elder sister’s name – late situ verma

Younger brother’s name – Mr piyush verma (age 28years) - job

Primary earning member - father and brother

There is history of mental illness in the family as reported by the patient – father’s brother’s
daughter

Genogram

Personal history
 Developmental history - no birth complication and normal delivery as reported by the
patient

 Presence of early childhood history - couldn’t be elicited

 Home environment - strain – due to consumption of alcohol occasionally by father
and uncle was a regular drinker and also use of abusive language in the house

 Scholastic history –average student

 Vocational history -unemployed
 Menstrual history -unmarried
 Sexual and marital history –NA
  Living conditions - the patient has father, and 1 siblings, belongs to a joint family and
his father and brother are the earning member in the family

Mental Status Examination

 General appearance and behaviour: the patient was well kept and tidy, dressed
appropriately, cooperative and rapport was established
 Attitude and relationship to examiner: the patient was respectful, partial eye contact
and interested
 Motor behaviour: the patient had fidgeting body movement with distractive
behaviour.
 Speech: the patient was audible with clear speech and with low to normal range of pitch

Cognitive functions
Attention and concentration –Attention was aroused and sustained.
Orientation
Time -intact
Place -intact
Person-intact

Memory:
Immediate -intact
Recent -intact
Remote-intact

Thinking ability- Concrete, Functional, Abstract

Concrete

General fund of information -average

Calculation –patient was able to do simple calculation
Intelligence –below average level
Affect
Subjective –
‘teek lag raha hai..bahut neend aarahahai”
Objective
Disinterested and sleepy

Perceptual disorder - auditory hallucination was detected

Judgment
Test -satisfactory
Social -satisfactory
Personal -satisfactory

Insight
Grade III –Awareness of being sick but blaming to external factors

Provisional diagnosis
F19.26 –Mental and behavioural disorder due to multiple drug, dependence
syndrome- currently abstinent, but in a protected environment
Assessment administered

S No Name of test Interpretation

1 BPRS Moderate to severe

2 HFDT Psychotic tendencies

with different feature
Test behavior- the patient was cooperative and respectful yet he had shivering legs,
distractive and fidgeting while the conduction of the assessments.

Test findings - the test findings are indicative of psychotic tendencies.

Large dominant male drawn by male is indicative of self- inflation and belittling attitude
towards females; it can also be reflective of possible depression. Bottom placement along
with omission of fingers is suggestive of feelings of interpersonal inadequacy and inferiority.
Left placement is indicative of uncertainty, apprehensiveness, and concern with past events.
Gross disproportion as well as transparencies in the figure is indicative of impairment in
reality testing. Figure with a blank outline is suggestive of emotional withdrawal, poor insight
as well as poor reasoning ability. Display of internal organ is reflective of somatic concerns
and internal pathology. Light lines along with omission of hands is indicative of generalised
anxiety and depressive tendencies along with timidness and poor self-concept. Naked figure
with genitalia is indicative of graph motor difficulties, sexual conflicts, and/or regression.
Omission of eyes in the figure is indicative of voyeuristic tendencies, ineffectiveness, and
visual hallucinations. Omission of mouth as well as arms is indicative of oral dependency,
need for affection, guilt, and suspicion. Omission of legs and feet has been associated with
problems with psychological mobility, possible dependence, and cognitive dysfunction.
Stereotyped figure is indicative of fantasy projection of the self, either self-aggrandizing or
self-deprecating.

Overall findings are suggestive of impairment in reality testing, depressive tendencies,

generalized anxiety, emotional withdrawal, poor self-concept, possible dependency and
feelings of inadequacy

Impression
Based on case history, mental status examination and psychological assessment, the
findings are indicative of psychotic disorder comorbid with hallucinatory features.

Examiner Supervisor

Signature Signature
Date Date
 CASE HISTORY-4

Identification of data/Socio demographic details

Name: D.K.Y
Age : 29 yrs
Gender: Male
Educational qualification: 9th class
Occupation: Farming
Marital status: Unmarried
Socioeconomic status: lower middle class family
Place of residence: rural
Address :Tamanjappur , Gonda
Informants; Patient
Reliability and adequacy of information: Partially reliable and adequate

Presenting complaints
Ganja liya hai 2013 se phir 2020-21 mai lagataar peete the kabhi kabhi 4-5 din mai bhi lelete
the
Piche peet mai dard hota hai
Mummy roti hai to body mai pain hota hai
Hichkki aati hai
Awaz sunai deti hai behen bulati hai
Behen or mummy se samne baat krte hai

Chief complaints
Consumption of cannabis (ganja) - 2013
Irrelevant talk
Restlessness
Low mood
Back pain
Visual hallucination of mother and sister
Auditory hallucination of mother and sister
Disturbed appetite

Flat emotions

Mode of onset: insidious

Course: continuous
Progress: improving

Predisposing factor: Consumption of ganja due to social setting

Precipitating factor: Peer influence
Perpetuating factor: Peer influence, self-involvement

History of present illness

According to the index patient, Mr D.K.Y is 29 years old, was maintaining well until 2021 after
which he started hearing of voices and images of mother and sister not heard or seen by others,
usually had back pain or sometime bodily pain. He had been admitted before in 2022 and then
in January 2023 in gonda hospital and then on 16 may he was brought to the hospital.
The patient was totally unaware of the fact that for what reason he was brought into the hospital.
He had stable sleep and disturbed appetite.
He was been into cannabis (ganja) consumption before due to peer influence in 2013 on 10-20
days of gap of duration and later 4-5 days of duration in the consumption of cannabis.
He had cordial relation with his family and friends, has cordial home environment. According
to the patient, his father was very short tempered and usually been into violent behaviour with
his mother. His father died due to blood cancer.
He use to work in some hotel and at the same time do part time job, later after his father’s
death he look after his farming in lucknow.currently the family is facing financial problem in
house.

Total duration of illness: 2 to 3 years

Biological functions:
Sleep: Disturbed
Appetite: Low appetite

Negative history
 There is no history suggestive of brain trauma/injury

 there is no history suggestive of irrational fear

 There is no history suggestive of elevated mood

 There is no history suggestive of suicidal ideation

Treatment history
Admitted for consumption of cannabis with psychotic features at Nischay hospital – January 2023

Past history
Visual and auditory hallucination

Family history
Father’s name – late bikhari yadav(age 70years) .Died due to blood cancer.in 2016

Mother’s name – mrs pyari yadav(age 65years)

Elder sister’s name – mrs ramrati(age 33years) – married

Elder sister’s name – ms anita (age 30years) - married

Primary earning member - patient himself after the death of his father

No history of mental illness in the family as reported by the patient

Genogram

Personal history
 Developmental history –No birth complication and normal delivery as reported by the
patient
 Presence of early childhood history-could not be elicited
 Home environment- cordial.
 Scholastic history – average student at school. Left school at 9th standard after father’s
death.
 Vocational history-patient had done Multiple jobs such as working in hotel ,lorry
driving, and farming
 Menstrual history –nil contributory
 Sexual and marital history- nil contributory
 Living conditions- the patient has mother and siblings, belongs to a nuclear family
and patient himself is the earning member in the family. Earlier father and mother has
a strain relations. The patient had a girlfriend name ranjana yadav.

Mental Status Examination

 General appearance and behaviour: the patient was well kept and tidy, dressed
appropriately, cooperative and rapport was established
 Attitude and relationship to examiner: the patient was respectful, maintained eye
contact and interested
 Motor behaviour: the patient had hand movement with distractive behaviour.
 Speech: the patient was audible with clear speech and with low range of pitch
Cognitive functions
Attention and concentration –Attention was aroused and sustained
Orientation
Time –intact
Place-intact
Person-intact

Memory:
Immediate –impaired
Recent -intact
Remote-intact

Thinking ability- concrete, functional, abstract

Concrete

General fund of information

Average
Calculation
Patient was able to perform simple mathematical calculations.

Intelligence
Below average

Affect
Subjective – Ab sahi lag raha hai
Objective – anxious
Perceptual disorder –visual and auditory hallucination present

Judgment
Test -satisfactory
Social-satisfactory
Personal -satisfactory
Insight
Grade II –Denial of being sick but aware at the same time
Provisional diagnosis
F12.50 – mental and behavioural disorders due to use of cannabinoids , psychotic
disorder – schizophrenia like
Assessment administered

S No Name of test Interpretation

1 HAM-A Mild to moderate

2 BPRS Moderate
3 HFDT Psychotic tendencies
with anxiety and
depressive feature.

Test behavior: the patient was cooperative and respectful yet he had shivering hands,
distractive behaviour and fidgeting during the conduction of the assessments. The patient was
not ready to draw and made excuse that “mujhe picture banana nahi aathi hai” after then he
draw the human figure.

Test findings: the test findings are indicative of psychotic tendencies.

Impression: based on case history, mental status examination and psychological
assessment, the findings are indicative of psychotic disorder comorbid with schizophrenic
features.

Examiner Supervisor

Signature Signature
Date Date
 CONCLUSION

The summer internship at IMHRC was truly an eye opening and a great insight towards the
profession which I chose. Having a good knowledge on theory as well as practice will make
you the one who can be the true mediator to the patient for their healing.
I have also learned the importance of rapport building and detailed case history. I also observed
different types of disorders and learned different types of assessments. An accurate empathy,
questioning skills, active listening, deep theoretical and practical knowledge can help an
aspiring student in the psychology field to facilitate psycho education and mental care.
 KEY LEARNING
The following are the key learning’s that were gained during the Summer Internship Program/
Study:

 Learnt and observed the role of a clinical psychologist.

 Learned how to establish rapport with the patients and their caregivers.

 Learned how to deal with different kind of patients and handle them properly.

 Learned how to take case histories, and Mental Status Examination (MSE), of the patient.

 Learned about different types of mental disorders, their symptoms, and treatments.

 Learned how to provide psych education to the patients as well as the family members.
 REFERENCES
 A short text book of psychiatry –Neeraj Ahuja -7th edition
 ICD -10 –classification of mental and behavioural disorders

 https://imhrc.org