1

Internship Project Report

A Report Submitted in Partial Fulfilment of the

Requirements for the Award of the Degree of

Bachelor of Science
In
Psychology

By

Akhil Joy

20upsu4435

Department of Psychology

SACRED HEART COLLEGE,

EAST CAMPUS, THEVARA
(November 2022)
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Certificate

This is to certify that this is a bonafide report of the internship done by the

candidate ____________Akhil joy_________________ with Reg. no.

20upsy4435_______ during the year _______2022_________.

Faculty in-charge Head of the Department

Date: Date:

Examiner

Date:
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Declaration

I, ___Akhil Joy______, hereby declare that the internship report is an original

record of work undertaken by me for the award of the degree of Bachelor of

Science in Psychology. I have completed the internship under the supervision of

__________Ms. Anu___________________, Assistant/Associate Professor,

Department of Psychology and ______ Dr. Biji V, clinical psychologist.

Place: Sacred Heart College Signature:

Date: Akhil Joy

20upsy4435

Department of Psychology
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About the Organization

Mental Health Centre, Thiruvananthapuram is a reputed hospital for Psychiatry

in Kerala. It was established in 1870 by the Honorary Royal King of Travancore

and during that period the Mental Hospital took care of patients with Epilepsy,

Mental Retardation, and Psychiatric conditions. Later in 1985, the hospital was

renamed a Mental Health center. Now it is a 507 bedded hospital covering 36

acres with 34 wards, ponds, and trees. In the early years, there was no system of

patient care with a patient bystander. The patients who were admitted there was

rejected by Society and stayed there till the end of life. A hope and ray of light

entered in to that hospital by the visit of Mother Teresa in 1983. Her valuable

suggestions and ideas paved a way for Public Support and foundation for

various developmental activities within the hospital. Mentally ill patients from

all over the country are getting admitted there and receives excellent treatment

care. There are 15 doctors and staffs of different categories to render 24 hours

service to these patients. Among the various developmental activities,

rehabilitation for cured mentally ill patients is a prominent one. Twelve years

before, it started as a single tailoring unit and progressed various units and

activities like bread making unit, gardening unit, female rehabilitation unit,

sheltered workshop, agricultural unit.

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INTERNSHIP REFLECTIVE REPORT

NAME: Akhil Joy

DATE: 08/08/2022 TO 21/08/2022

REGISTRATION NUMBER: 20UPSY4422

NAME OF THE ORGANIZATION: Govt. Mental Health Centre, Trivandrum

ADDRESS: Peroorkada, Vattiyoorkavu Rd, Oolampara, Thiruvananthapuram,

Kerala. Pin: 695005

NAME OF THE SUPERVISOR: Dr. Biji V

DESIGNATION OF THE SUPERVISOR: Clinical Psychologist

NUMBER OF WORKING DAYS: 09

NUMBER OF DAYS PRESENT: 09

NUMBER OF DAYS 0

ABSENT:

REASON FOR ABSENCE: Nil

DEPARTMENT ASSIGNED: Clinical Psychology Department

WORK ASSIGNED:

Reporting time is at 8am. Group wise seminars were taken based on assigned topics.

OP posting, and observational studies with the psychologist were done on alternative days.

We were asked to learn the basic practical skills observing the senior interns. Ward visits and
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case studies were done. Before we leave, we were made discuss and share what we observed

and studied that particular day.

TASK COMPLETED
1. Presented Seminar on the Topic: Motivation

2. Successfully completed OP duty by giving out appointments to the visiting patients for

follow-ups and filling out their details in the log book.

3. Has taken 4 case studies of the patients visiting the Clinical psychologist and from the

wards.

4. We were asked to go for ward visits and were allowed to interact with harmless inpatients

and their bystanders and take their case histories and MSEs.

5. We were allowed to sit in to observe the counselling sessions conducted by the

Psychologist for the patients and to take notes.

6. We discussed about the cases we saw each day.

PERSONAL REFLECTION
The two weeks of internship made in me visible changes in my understanding about the field

of clinical psychology. The taboo still prevailing about the place where the institution is

situated, evoked a sense of shame in me to say others that I was doing my internship at

Mental health center, at Oolampara. But the days I spent there, the ward visits I made, and the

cases I attended made me realize that, God has made the opportunity for me to witness the

real-life situations of patients and their relatives. I began to think what I can personally

contribute for those people to ease their suffering. That was the time when I decided to be a

clinical psychologist.

Though I was bit anxious in the beginning to interact with the patients, I gained confidence

very fast and could make effective interactions with the patients and their bystanders. Each
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day I complete my internship hours, I went back with great satisfaction that I could do

something great for the people who are really in need of assistance and support. That could

be the reason for me to be more enthusiastic each day even when some of the interns had to

take breaks to refresh themselves from the hospital atmosphere.

Lack of knowledge about abnormal psychology had made me in trouble. I really felt the need

of gaining knowledge about various disorder, their symptoms and treatments. The clinical

psychologist was one another factor that inspired me those days. She was a lady who is

selfless and altruistic in person and spared even public holidays and extra hours in consulting.

Her motherly approach to the patients and the commitment was praise worthy. The 2 weeks

internship at MHCT taught me things beyond text books and gave valuable experiences.

LEARNING OUTCOME
Gained knowledge about various major and common mental disorders like Schizophrenia,

Psychosis, Depressions, Manias, etc.

Had practical experience of dealing with the patients and their relatives.

Observing the psychologist, we learned how a counselling session takes place.

Improved patience and empathic skills.

Learned to be professionals in the interactions and dealings with others.

Understood the importance of mental health and the need to sensitize people about mental

health care.
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PSYCHOSIS
Psychosis is a combination of symptoms resulting in an impaired relationship with reality. It

can be a symptom of serious mental health disorders. People who are experiencing psychosis

may have either hallucinations or delusions.

Hallucinations are sensory experiences that occur within the absence of an actual stimulus.

For example, a person having an auditory hallucination may hear their mother yelling at them

when their mother isn’t around or someone having a visual hallucination may see something,

like a person in front of them, who isn’t actually there.

The person experiencing psychosis may also have thoughts that are contrary to actual

evidence. These thoughts are known as delusions. Some people with psychosis may also

experience loss of motivation and social withdrawal.

These experiences can be frightening. They may also cause people who are experiencing

psychosis to hurt themselves or others.

It’s important to get medical help right away if you or someone else is experiencing

symptoms of psychosis.

According to the National Institute for Mental Health (NIMH), there are warning signs that

may appear before psychosis develops. These can include:

 a sudden drop in school work or job performance

 trouble thinking clearly

 difficulty concentrating

 feeling paranoid or suspicious of others

 withdrawing from friends and loved ones

 an influx of strange, new feelings, or no feeling at all

 a disinterest in personal grooming

 difficulty separating reality from non-reality

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 trouble communicating

History Taking

Socio-Demographic Data
1. Name: N.D

2. Gender: Male

3. D.O.B: 24.09.1999

4. Age: 23

5. Educational Qualification: 10th

6. Marital status: Single

7. Occupation: Technician at K-Phone

8. Socio-Economic Status: Middle

9. Religion: Hindu

10. Nationality: Indian

11. Residence: Suburban

12. Mother Tongue: Malayalam

13. Type of family: Nuclear

14. Birth order: 2

15. Blood group: B+

16. Informants: Mother

17. Information: adequate, reliable

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18. Identification marks: Black mole on the chest, brown pigmentation in the right arm

Presenting/ Chief Complaints

The patient shows abusive behavior and has strong false beliefs which are illogical.

He is suspicious of his family members.

The course of the illness was continuous with a gradual mode of onset.

Family problems tend to be the precipitating factor.

There are no mood fluctuations or associated disturbances.

HOPI - History of present illness

The client was perfectly normal 5 years back. He gradually developed skepticism towards

his parents, especially his mother that they are planning against him and trying to take away

the properties belonging to him. He was affectionate with his aunty and he says that she, has

agreed to give the ownership of her properties to him. But afterward, their relationship

became worse. N.D attributes its cause to his mother that her intervention made their

relationship bad. After his aunt's death, N.D started showing behavioral changes such as

taking away the property documents and certificates of his brother. He believes that his

brother enjoys more preferences in his family. He claims that he was accused and was

arrested by the police for the offenses committed by his brother. He complains that he was

always intrigued by his mother in his personal affairs even at different workplaces.

Course of illness
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The course of the illness is continuous. The patient has a delusion against family all the time.

Associated Disturbances

There is no history of associated disturbances in sleep, appetite, and weight. The patient

maintains good personal hygiene.

Negative History

There is no h/o of disinhibited behavior. There is no h/o self-harm

Treatment History

No history of treatment was taken.

Past History

No known previous diseases or treatment.

Family History

The client belongs to a nuclear family with his mother, father, and younger brother. He had a

close relationship with his aunt who passed away one year back. His father and mother have a

school-level education. His father runs a small business and his mother is a housewife. His

younger brother is pursuing his degree. There is no history of any physical or psychiatric

illness in the family. The patient belongs to a middle-class family. The family has a normal

socializing pattern. Conflicts often happen between the patient and the family. The patient has

a poor relationship with his family members. The patient does not like his brother. He belies
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that his brother enjoys more preferences in the family. The patient believed that his

relationship with his aunt was worsened because of the intervention of his mother.

Personal History

Biological complications during Birth

the birth weight was 2.5 kg. There is no history of other pre-natal or post-natal complications.

Behavioral problems during childhood

Behaviours like bed wetting, nail biting, thumb sucking were normal. There is no history of

abnormal behaviours during childhood.

School History
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The patient joined the school in 2004. the patient has shifted schools for higher education.

The patient had an average academic performance and exhibited appropriate behaviors during

class.

Occupational History

The patient joined his first job in 2020. He has shifted jobs in between due to the intervention

of the family. There are no black marks in his career.

Social History

The patient shows poor social interaction. He had a small peer group. He has poor

relationships with his friends and family.

Pre-morbid personality

The patient has a confident, persistent, and independent attitude toward the self. The patient

has normal moods most of the time. He has an introverted personality. The patient is less

spiritual.

There is no usage of alcohol, tobacco, or drug abuse before the illness. The patient has a

hobby of reading.
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Mental Status Examination (MSE)

General appearance & Behavior:

The client was appropriately dressed and well-groomed.

Sitting posture, eye contact and body gestures are normal.

Nervousness and tremors are absent.

Comprehension is Appropriate

Good rapport was established

Appropriate facial expression

General attention and concentration are Appropriate

co-operative, attentive, frank attitudes towards examiner

Psycho-motor Activity:

Appropriate Eye-hand coordination

No Hyperactivity

Fine motor tripod grip is appropriate

Stupor is absent

Mania and depression are absent

Appropriate visuospatial ability

No tick moments are present

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Speech:

The voice is Appropriate and Audible with normal fluctuations of pitch.

The ease of speech is spontaneous and speaks only when questioned.

The patient has goal-directed speech.

There is an appropriate rhythm or flow of speech.

The patient has a normal reaction time.

Mood & affect:

The patient exhibits a normal mood but is irritated occasionally.

He reacts in an irritable manner when psychoeducation was given.

He is not willing to change his mind.

Mood congruency is observed.

Perceptual Process:

No perceptual disturbances are found.

Thought process:

The patient has a continuous flow of thought.

The patient has no tangentiality.

The content of his thoughts includes persecutory delusion against his family.

Cognitive functions
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Orientation:

Appropriate orientation of time place and person

Attention concentration is Normal

Immediate, recent, remote, and personal memory is Appropriate

Appropriate comprehensive, vocabulary and arithmetic intelligence ability

Appropriate Judgment of social and personal situations

Insight

Complete denial of illness

Case Summary

A 23-year-old was brought to consultation by his own mother for the reasons of showing

hatred and grudge against his family members. He wants his father mother and 2 brothers to

move away from the house as he believes that the house is owned by him.

The client was normal 5 years back. He had a good relationship with his aunt and he says that

she had agreed to give the ownership of the house and land to him. The relationship between

the client and his aunt ended up in a quarrel and he attributes its cause to the intervention of

his mother. Later on, he showed verbal and physical abusive tendencies towards his mother

and developed persecutory delusions and suspicions towards his family members. He took

away the property documents and the certificates of his own brother and refuses to give them

back. He wants his family members to leave the house. He was working and complains that

his mother intervenes in his workspaces and he had to leave the job.
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The patient was admitted in the de-addition ward and was given regular counselling and

psycho-education. He denies the abnormalities in his behavior and shows little interest in

accepting the remedial measures suggested by the psychologist. The client shows normal

behavior towards other inmates in the ward. His mother was given counselling to have

adequate emotional control. Improvements are observed in the behavior of the patient though

in a slow speed.

Provisional diagnosis

Psychosis NOS

Delusional disorder

Schizophreniform disorder
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ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a mental health condition that can cause

unusual levels of hyperactivity and impulsive behaviors. People with ADHD may also have

trouble focusing their attention on a single task or sitting still for long periods of time.

Many people experience inattention and changes in energy levels. For a person with ADHD,

this happens more often and to a greater extent compared with people who don’t have the

condition. It can have a significant effect on their studies, work, and home life.

Both adults and children can have ADHD. It’s a diagnosis recognized by the American

Psychiatric Association (APA). Learn about types of ADHD and symptoms in both children

and adults.

ADHD Symptoms

A wide range of behaviors are associated with ADHD. Some of the more common ones

include:

 having trouble focusing or concentrating on tasks

 being forgetful about completing tasks

 being easily distracted

 having difficulty sitting still

 interrupting people while they’re talking

Signs and symptoms can be specific to different aspects of ADHD, such as hyperactivity,

impulsivity, or difficulty focusing.

A person who is experiencing hyperactivity and impulsivity may:

 find it difficult to sit still or remain seated, for example, in class

 have trouble playing or carrying out tasks quietly

 talk excessively

 find it hard to wait their turn

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 interrupt others when they’re speaking, playing, or carrying out a task

History Taking

Socio-Demographic Data

1. Name: A.S

2. Gender: Male

3. D.O.B: 21.12.1010

4. Age: 11

5. Educational Qualification: 6th std

6. Marital status: single

7. Occupation: Nil

8. Socio-Economic Status: Lower

9. Religion: Inter-caste

10. Nationality: Indian

11. Residence: Rural

12. Mother Tounge: Malayalam

13. Type of family: Nuclear

14. Birth order: 1

15. Blood group: O+

16. Informants: Mother

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17. Information: inadequate, unreliable

18. Identification marks: Black mole on face

Presenting/ Chief Complaints

Symptoms like behavioural changes, destructive behaviour, over-aggression, and stealing

were presented. The course of the illness was continuous with a gradual mode of onset.

Diurnal variations like irritability and aggression were shown. The patient has a habit of

running away from his house. Difficulty in studies and concentration were also presented.

HOPI - History of present illness

The patient’s family is not healthy. He has an alcoholic father, a mother, and a younger

sister. Imitating his father, the patient started showing destructive and aggressive behavior

in school and at home, especially towards his sister. Throwing things and physically

abusing the sister became a daily routine of the patient. His disobedient behavior made his

mother use severe punishments and corrective measures. The patient on such occasions

used to run away from the house and the mother had to seek police intervention to find him

back. The dysfunctional family situation is found to be the precipitating factor of the illness.

He likes his father more than his mother and tries to follow his lifestyle. The performance of

the patient in his academics is very poor. He has difficulty maintaining concentration and

attention. The habit of stealing is also noticed.

Course of Illness
The course of the illness was continuous. The patient showed aggressive behaviour most

times of the day. The patient also showed attention deficits in almost all activities.
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Associated Disturbances
The patient showed no disturbances in sleep and appetite. He had the normal weight for his

age. The patient showed difficulty in learning and attention. The patient showed an

appropriate level of personal hygiene.

Negative History
No history of mood disorder.

Treatment History
The patient had h/o consulting the school counsellor.

He also had h/o consulting a psychiatrist referred by the school Counsellor. The patient had a

history of taking medicines for brain damage and also for seizures when 4-year-old.

Past History
The patient had a history for having seizures at the age of 4. The patient had been taking

medicines for the same.

Family History
The patient has a nuclear family consisting of his mother, father, and younger sister. His

mother has completed her degree and works in a private company. His father works abroad.

His sister is studying in the third standard. his family has a middle socio-economic status.

The family has a normal socializing pattern.

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The patient has a dysfunctional family. There has been a continuous conflict between his

parents. His father is an alcoholic and often abuses his mother. They are separated but not

divorced. The patient never wants his parents to be together. The patient likes his father more.

The patient’s mother often beats him for his acts. He shows no affection to his younger sister

and often abuses her the way in which his father abused his mother.

Personal History

Biological Complications During Birth

There were conflicts between his parents during the prenatal and postnatal stages of his life.

His father used to physically abuse his mother even during her pregnancy time. The mother

had a traumatic pregnancy period.

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Behavioural Problems During Childhood

There were no mannerisms. Sleep disturbances, thumb sucking, and nail biting were absent.

Bedwetting was present only to a normal extent.

School History
The patient joined his first grade in 2016. There is a history of shifting school due to

aggressive and disobedient behaviour shown at school. The patient had poor academic

performance. The patient showed aggressive behaviour during the classes. There had been

school refusals.

Social History

The patient had a smaller friendship circle. He had a poor relationship with friends and

family. There is no history of peer pressure.

Pre-morbid personality
The patient had a positive and confident attitude towards himself. The patient often showed

irritable mood. He had an introverted style of personality.

The patient had poor relationship with his peers and family.

He had a hostile attitude towards his sister.

The uses of religion and spirituality were poor.

Most time of the day the was engaged in using the mobile phone.

The patient had normal biological functions and habits like eating, sleeping and excretory

functions.
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Mental Status Examination (MSE)

General appearance & Behaviour:

The patient has appropriate dressing and is well-groomed with appropriate body

gestures.

Sitting postures are appropriate and eye contact is present.

Nervousness and tremors are absent.

Correct responses to the questions asked are given but at a slow pace.

The patient had depressed facial expressions occasionally.

Rapport was established quite hard and had a hostile and inattentive attitude towards

the examiner.

Had low attention and concentration.

Psycho-motor Activity:

Eye-hand coordination and fine motor tripod grip is appropriate.

The patient is hyperactive

Stupor, mania, depression, and tick movements are absent

Visuospatial ability is normal.

Speech:

Patient has an appropriate voice with abnormally soft intensity.

Pitch has normal fluctuations.

The patient is hesitant, slurring and speaks only when questioned.

Have a goal-directed speech with low reaction time.

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Mood & affect:

The patient has a positive and normal mood.

Irritability and restlessness is observed

Reactivity is slow and he is mood congruent.

Perceptual Process:

No perceptual disturbances are observed.

Thought process:

Stream is present.

Tangentiality is observed. He shifts his attention from one topic to other.

Delusion is absent.

Cognitive functions:

The patient has an appropriate orientation of time, place, and person.

The patient has difficulty in maintaining attention and concentration.

He has normal immediate, recent, remote, personal and impersonal memory.

He has an appropriate abstract ability.

The patient has a poor vocabulary, comprehension skills, and arithmetic ability.

Judgment of social and personal situations is normal.

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Insight
Slightly aware of illness.

Case Summary
An 11-year-old boy was brought to the hospital with complaints of misbehaviour in school

and at home. He is the first child of a middle-class nuclear family settled in a town area. He

has a broken family with his parents separated but not legally divorced. At present, his father

works abroad. The patient’s father is an alcoholic and used to abuse his mother verbally and

physically. The patient’s mother had to suffer this torture even during her pregnancy period.

The patient loves his father and tries imitating him. He started physically abusing his younger

sister the way his father did to his mother. Aggressive and disobedient behaviors were

noticed even at school. He used to run away from his home as his mother used to give severe

punishments for his misbehaviours. The history of intervention of the police to find him back

is reported.

The boy is a slow learner and has difficulty in keeping attention and concentration. He

showed poor academic performance. He had to shift his schools for the misconduct. He is

often restless and loses focus very quickly. He would jump from one task to other unless

compelled or reminded to keep doing it. He has a relatively small friendship circle.

The patient is admitted in the pay ward for children. He maintains a warm relationship with

the children there. Regular counselling sessions are given. Different tasks like drawing,

colouring, etc were given on regular sessions to improve his attention. Improvements in

concentration and focus is found.

Provisional Diagnosis
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Attention Deficit Hyperactivity Disorder (ADHD)

Oppositional Defiant Disorder (ODD)

SCHIZOPHRENIA

Schizophrenia was divided into five subtypes, including disorganized schizophrenia, paranoid

schizophrenia, residual schizophrenia, undifferentiated schizophrenia, and catatonic

schizophrenia per the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). In

2013 the American Psychiatric Association (APA) combined all the subtypes under the

general category of schizophrenia. "Catatonia" is a word that has undergone multiple

definitions and loosely is associated with multiple psychomotor abnormalities and behavioral

dysregulation.

Features of catatonia had been described since the 1800s by prominent physicians such as

Kahlbaum and even Kraepelin, who defined catatonia within the larger definition of dementia

praecox. There exist many suggested theories elucidating the etiology of catatonia. Kahlbaum

has ultimately been credited with the understanding that symptoms such as stupor and

catalepsy were part of a larger syndrome of psychomotor abnormalities, which he termed as

"catatonia." This can be a part of a larger schizophrenic illness or even a bipolar affective

illness or medical illness.

The advent of DSM-V has placed catatonia in its own category with schizophrenia as a

specifier. Further, there are three types of catatonia that have been classified, including

akinetic, hyperkinetic, and malignant catatonia.

Symptoms

Catatonia can show up in many different ways. A core sign is that you don’t move normally,

even though you are physically able.

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Common symptoms include:

 Not moving

 Not talking

 Sluggish response

 Staring

 Parroting someone’s movements or speech over and over

 Tapping feet or other repeated movements

History Taking
Socio-Demographic Data

19. Name: V.K

20. Gender: Female

21. D.O.B: 14.03.1967

22. Age: 55

23. Educational Qualification: School

24. Marital status: Widow

25. Occupation: Nil

26. Socio-Economic Status: Middle

27. Religion: Hindu

28. Nationality: Nationality

29. Residence: Sub-Urban

30. Mother Tounge: Malayalam

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31. Type of family: Nuclear

32. Birth order: 1

33. Blood group: O+

34. Informants: Daughter

35. Information: Adequate, Reliable

36. Identification marks: Brown patch on the right side of the face

Presenting/ Chief Complaints

The patient had symptoms of anxiousness, catalepsy, mutism, and violent behavior.

The illness was progressing with a gradual mode of onset.

Poor self-care.

There are no known precipitating factors.

There is an associated disturbance of low appetite and disturbed digestion.

HOPI - History of Present Illness

The patient started showing disturbances in her daily functioning around her thirties. This

gradually developed as major impairments with negative symptoms like mutism and reduced

body movements. The patient used to stand still without any reaction for several minutes. The

continuous flow of speech and thoughts are lost. self-care of the patient is reported to be very

poor. The patient had a history of being violent often. She fears that something bad would

happen to her. Compulsion is required in order for her to respond. There is no known

precipitating factor. The mode of onset was gradual.

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The course of the illness

During the initial stages, the course of the illness was episodic. The patient showed catatonic

symptoms and mutism with intervening periods of normalcy. The patient sometimes showed

violent behavior.

Associated Disturbance
The patient has a low appetite and refuses to take food. Has digestion and constipation issues.

The patient has poor self-hygiene.

Negative History

No perceptual disturbances are found.

Treatment History
History of treatment for violent and catatonic behavior. The patient was admitted in a private

mental health center. Medications were taken. Violent behavior was reduced but the patient

was referred for in-patient treatment.

Past History
No history of other physical illness.

History of violent and catatonic behavior. Medications were taken.

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Family History
The patient has two daughters. Her husband passed away two years back. She is the only

daughter of her parents. Her elder daughter is married. The younger daughter is pursuing her

post-graduation. She has one grandchild. She has a poor interrelationship with her family.

There are conflicts in the family. There is no history of physical or psychiatric illness in the

family.

Personal History
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Biological Complications During Birth

Pre-natal and Post-natal complications are unknown

Behavioral Problems During Childhood

Behavioral problems during childhood are unknown

Occupational History
History of doing hand looming and embroidery during her thirties

Social History

Poor interpersonal relationship

Pre-morbid Personality
The patient shows no attitude towards self. She always has an apathetic mood. There are no

other hobbies. There is no history of uses of alcohol, tobacco or drug abuse.

Mental Status Examination (MSE)

General appearance & Behavior:

The patient has appropriate dressing and is well-groomed but not self-cared.

Sitting posture is appropriate.

Eye contact and body gestures are absent with Apathetic and blank facial expressions.
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Tremors are present but Nervousness is absent.

Rapport was low and had an inattentive and indifferent attitude towards examiner.

General attention and concentration were low.

Psycho-motor Activity:

Hand-eye coordination and fine motor tripod grip is appropriate

Hyperactivity, mania, depression and tick movements are absent.

The patient has stupor.

Visuospatial ability is normal

Speech:

The patient has a low voice with abnormally soft intensity and a monotonous pitch.

The patient has an inappropriate flow of speech and is mute, slurring and speaks only when

questioned repeatedly.

The patient has a goal-directed speech with low reaction time.

Mood & affect:

Subject: Apathetic

Objective: Normal mood, Blunted affect, Flat affect

Reactivity and relatedness are absent

Perceptual Process:

No known perceptual disturbances.

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Thought process:

Stream is absent and circumstantiality is present.

Possession, content and delusion are absent

Cognitive functions:

The patient has an inappropriate orientation of time, place, and person.

The patient has appropriate attention concentration.

The patient has normal immediate, recent, remote, personal and impersonal memory.

The patient has a normal abstract ability.

The patient has normal comprehensive, vocabulary and arithmetic intelligence.

Judgment of social and personal situation is normal.

Insight
Slightly aware of illness needed treatment

Case Summary
A 55-year-old woman was brought to hospital by her daughter for complaints of a significant

deterioration in her ability to communicate and function normally. She had mutism along

with a refusal to drink or eat. The onset of the symptoms was gradual with positive symptoms

of fear, violent behaviour over a span of 3-4 years. But then her condition gradually

deteriorated over years to negative symptoms and catatonia. Her daughter remembers no
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precipitating factors for the illness. The details were collected from the daughter as the patient

is incapable of providing reliable information.

The patient refuses to move and do activities. She likes walking out but has great fear of

accidents that might happen. Repeated questioning and compulsion is required for responses.

Self-care was decreased to the point of passing urine in clothes. In approximately 3 years, the

patient family consulted a psychiatrist in the nearby private hospital. There is no history of

other physical or psychiatric illness in the family. There is a history of taking treatment for

violent and catatonic behaviour confirmative diagnosis of catatonic schizophrenia was made.

For further treatment the patient was admitted in MHC, Trivandrum.

Provisional Diagnosis
Catatonic Schizophrenia

Schizophrenia
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POSTPARTUM DEPRESSION
Postpartum or perinatal depression is a form of depression that occurs following the birth of a

baby. It’s a relatively common but serious medical condition, affecting up to 1 in 7 new

mothers after birth.

Postpartum depression can make one feel empty, emotionless, and sad. It can cause changes

in mood, exhaustion, and a general sense of hopelessness for a long time after birth.

People should not take postpartum depression lightly. It’s a serious disorder, but various

treatment programs can help people overcome it.

Many people feel sad, empty, moody, or fatigued within a few days of giving birth, a

condition nicknamed “baby blues.” But postpartum depression goes well beyond that, lasting

for weeks after you give birth. Its symptoms can be severe and interfere with your ability to

function.

Symptoms of postpartum depression can vary from person to person and even from day to

day. While symptoms can develop any time after childbirth, they often start within 1 to 3

weeks after having a baby.

Postpartum depression can make you feel disconnected from your baby. You may feel as

though you don’t love your baby. These feelings are not your fault.

Other indications of postpartum depression include:

 feeling sad or crying a lot

 feeling overwhelmed

 having thoughts of hurting the baby or yourself

 not having an interest in the baby

 having no energy or motivation

 feeling worthless, guilty, or like you are a bad parent

 sleeping too much or too little

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 change in relationship with food

 feeling anxious

 having chronic headaches, aches, pains, or stomach problems

History Taking

Socio-Demographic Data
37. Name : DP

38. Gender : Female

39. D.O.B :

40. Age : 26

41. Educational Qualification : College

42. Marital status : Married

43. Occupation : NIL

44. Socio-Economic Status : Middle

45. Religion : Hindu

46. Nationality : Indian

47. Residence : Sub-urban

48. Mother Tounge : Malayalam

49. Type of family : Nuclear

50. Birth order : 2nd child

51. Blood group : B+ve

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52. Informants : Brother

53. Information : Adequate, reliable

54. Referred by : Brought by CPO Manju for observation due to order from court

55. Identification marks : Black mole on the top of the index of the finger

Black mole on the left of the eye brow

Presenting/ Chief Complaints

The patient presented symptoms of depressed feelings and suicidal attempts

The course of the illness was progressing with a sudden onset after the delivery of her child.

Killed her own child throwing it in to the well.

There were no known associated disturbances in sleep and appetite.

HOPI - History of present illness

The patient started experiencing discomfort with postpartum. The patient delivered her baby

on 21st June 2022 under a C- section. Gradually the patient started losing her comfort. The

mode of onset was a sub-acute one. The delivery was the precipitating factor. The new

responsibility as a mother was stressful. A strong thought began to develop that she was not

taking proper care of her child. Sadness and gloominess developed and the patient began to

cry alone at times. 28 days after the delivery the patient made a suicide attempt. She was

hospitalised and was subjected to psychological counselling. 56 days after the delivery the

patient increased thoughts and she threw her baby in to a well. The patient was arrested and

produced before court.

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Course of Illness
The course of illness was continuous. The patient was feeling stressful and gloomy

continuously. Symptoms like loosing interest in activities was prominent during initial stage.

Later symptoms like crying alone was developed.

Associated Disturbance
No other disturbances. Sleep and appetite were normal.

Negative History
No h/o of depressed mood

No h/o trauma

Treatment History
The patient was given psychological counselling due to the suicidal attempt.

Past History
No history of any physical or psychiatric illness

Family History
The patient has a nuclear family with her mother, father and an elder brother. She is married

to a small family with her husband , mother in law and father in law. Both her parents and in-

laws have an school level education. Her brother is a graduate and works in company as an

accountant. Her husbands runs a business. The patient have good relationship with all the
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members of her family. Her brother and husband are supportive. There is no history of

physical or psychiatric illness in the family. The family have a middle socioeconomic

condition. Family have a normal socializing pattern. There is a friendly atmosphere among

the members of the family. The patient was treated well by the family members. She had

more attachment towards her mother during her childhood, she also have an affectionate

relationship with her brother. After her marriage she was closest and have a confiding

relationship with her husband.

Personal History

Biological Complications During Birth

There were no history of prenatal and post natal complication.

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Behavioral Problems During Childhood

There was no sleep disturbances. Behaviours like thumb sucking, nail biting were absent.

There were no features of anxiety. Bedwetting was normal.

Appropriate self care was taken.

The patient had good relationship with her parents, siblings and peers.

School History

Joined 1st grade in 2001. The patient have not shifted schools. The patient showed an

average academic performance And appropriate behaviour During class. The patient had no

difficulties in learning. She was like to by her teachers. The patient had a good friend circle

and maintained good relationships with her peers.

Occupational History

The patient have no history of occupation

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Sexual History

The patient’s menstruation was normal. The had satisfying sexual relationship in marriage

Pre-morbid Personality

Patient had confident and positive Attitude towards self

Patient had Normal mood

Uses of alcohol/ tobacco/ drug abuse, before illness was Absent

The patient had a hobby of reading.

The patient had normal eating, sleeping and excretory funtions. -

Mental Status Examination (MSE)

General appearance & Behaviour:

The patient has Appropriate dressing style and is well groomed

Sitting posture is appropriate and eye contact is present along with appropriate body gestures

Nervousness and tremors are absent and rapport was established easily

Patients had correct response to questions and cooperative Attitude towards examiner

Normal Attention and concentration

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Psycho-motor Activity:

Appropriate hand eye coordination and fine motor tripod grip

Stupor and mania are absent

Depression is present

Hyperactivity is absent

Appropriate visuo spatial ability

Tick movements are Absent

Speech:

Patient have a low voice with a normal pitch

Intensity is audible and soft.

Speaks only when questioned and have Goal directed speech

Reaction time is appropriate

Mood & affect :

Patient have a worthless response towards her behaviour and have a depressed mood

Reactivity and relatedness are present

Perceptual Process :

Hallucination and Illusion are absent

Thought process :

Stream and tangentiality is absent. The patient have a thought of retaining back the life.

Delusions are absent

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Cognitive functions:

The patient have normal Orientation and attention.

The patient have normal immediate, remote, recent, personal and impersonal memory

The abstract ability is normal

The patient have normal comprehensive, vocabulary and arithmetic intelligence ability.

Judgement of social and personal situation is normal

Insight

Have an illness due to unknown factor

Case Summary

The patient was a 26-year-old mother who had been married for 2 years. She lived

with her husband and in-laws in a small town. She had given birth to her first child 2 months

previously. She was referred to the hospital by the court for observing her mental health. She

was arrested by the police for the death of her daughter.

The patient had chief complaints of having a depressive moods and suicidal attempt.

Her labour had been uneventful and she underwent a C-section. Because mental health after a

delivery was viewed in her area and town as normal, her mental health was not given any

attention.
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For about half a month after birth, patient felt normal but then she began to exhibit

unusual behaviour. She became reclusive and reduced speaking to anyone at home. She

began to loose interest in her daily activities. She started to believe that she is not taking care

of her child. Each time when the child cries, this thought grew stronger. The rest of the family

however seemed indifferent to her condition. No other disturbances. Sleep and appetite was

normal.

28 days after the delivery, the patient made a suicide attempt. She was then

hospitalized and was given psychological counselling. 56 th day after the delivery while her

baby began to cry she was unable to control her thoughts and she threw her baby into the well

in their house. She called out for her father in law as soon as she threw her baby.

The patient has History any psychological or physiological Illness in the family. She

had a normal childhood and school history. Her relationship with her family members were

good.

She has been under treatment for around two months. The patient has been taking

antidepressants and is given regular counselling.

Provisional diagnosis
Postpartum depression

Depression with psychotic symptoms

Major depressive disorder.

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REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5thed.), CBS publishers and distributors.

Angel, T. (2021, October 13). Everything You Need to Know About ADHD. Healthline.

https://www.healthline.com/health/adhd

Carey, E. (2021, December 16). Psychosis. Healthline.

https://www.healthline.com/health/psychosis

Pietrangelo, A. (2022, March 31). Everything You Need to Know About Postpartum

Depression: Symptoms, Treatments, and finding help. Healthline.

https://www.healthline.com/health/depression/postpartum-depression

Schizophrenia. (n.d.). National Institute of Mental Health (NIMH).

https://www.nimh.nih.gov/health/topics/schizophrenia

What is Catatonic Behavior in Schizophrenia? (2019, December 5). WebMD.

https://www.webmd.com/schizophrenia/mental-catatonic-schizophrenia-overview
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