MAPC 015 PSYCHOLOGY INTERNSHIP, Study Guides, Projects, Research of Psychology

Download MAPC 015 PSYCHOLOGY INTERNSHIP and more Study Guides, Projects, Research Psychology in PDF only on Docsity! CASE STUDY-A SOCIO DEMOGRAPHIC DATA Name: A Age: 24 years Gender: Male Marital Status: Unmarried Religion: Islam SES: Middle Class Occupation: Driver Domicile: Rural Informants: Patients, Mother Reliability: Reliable PRESENTING COMPLAINTS 1. Tension 2. Feeling dirty 3. Difficulty in swallowing the food 4. Palpitation of the chest 5. Irresistible desire to wash hands with soap, whenever he washes 6. Feels discomfort after eating porotta HISTORY OF PRESENTING COMPLAINTS The patient was absolutely normal till last year. He was working as a driver in Qatar. He could not cope with the situations at Qatar. He said that he became tensed there. So he left Qatar after 45 days. On the way back, he got down at Oman and there he felt that he will miss his flight to India. This incident made him more tensed. When he came home, he started to bath only with water from a house. He could not bath without using the water from house and soap. Also he started to wash his hands with soap whenever he washes hands due to an unhygienic feeling. A difficulty while swallowing 0 0 developed with him, and became tensed and restless after eating portals. He developed palpitation of chest. All these symptoms started after stopping bathing with the house. HISTORY OF PAST ILLNESESS 1. History of seizures after a fright while bathing in pond water. 2. No significant medical illnesses were reported. TREATMENT HISTORY One month before he consults a psychiatrist for tension. He took medicine and after two week he stopped medication. There is no other significant treatment history. PERSONAL HISTORY Normal institutional delivery. Normal birth weight. No maternal emergencies during birth. Mile stones were normal. Separation anxiety reported in the primary classes. Co-operative with the peer group. Studied up to the X standard, but failed in the final exam. He had also failed in the VIIth standard for once. Started smoking at the age of 16 years with friends. Friends offered him cigarettes. The habit of alcoholic drinking started at the age of 22 . But the drinking habit is occasional.nd He had also an occasional habit if betel chewing using pan parag. He had got a first prize in a short story writing competition conducted by Mathrubhumi weekly. He had also worked as an associate director for a tele film in a local channel. He had the habit of reading books. EDUCATIONAL HISTORY He studied up to the X standard, but he failed in the final exam. He had failed in theth VIIth standard for once. 0 0 SUMMARY AND DIAGNOSTIC FORMULATION The presenting complaints of the patient were tension, irresistible desire to bathe with water from the hose, difficulty in swallowing and palpitation in the chest. He was found anxious. His family and personal history all are normal and there is one significant psychiatric history in family, mother has mental illness , pre morbidly well adjusted and sociable. Science one year he became very anxious about hygiene. he started to wash his hands with soap . He frequently washing his hands due to an unhygienic feeling. And became tensed and restless after eating portals. He developed palpitation of chest. All these symptoms started after stopping bathing with the house. On MSE, he is having disturbances in the thought process such a feeling of contamination(obsession ) and a compulsion to bathe with water from a hose and tendency to wash hands with soap whenever he washes. Rest of the mental functions are normal. He was found to be anxious and restless. DIAGNOSIS Clinical feathers of patent meeting the DSM-IV-TR and ICD- 10 Diagnostic Criteria for Obsessive-Compulsive Disorder. (A- Either obsessions or compulsions (- Obsession -Contamination, compulsion- reaped washing of hand ); - At some point duringB the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable The obsessions or compulsions cause marked distress, are. C- time-consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. - The disturbance is not due to the direct physiological effects of a substanceD (e.g., a drug of abuse, a medication) or a general medical condition. E- no other axis -1 disorders). No other co-morbid disorders. MANAGEMENT 0 0 Well-controlled studies have found that pharmacotherapy, cognitive behavior therapy, or a combination of both is effective in significantly reducing the symptoms of patients with OCD. The decision about which therapy to use is based on the clinician's judgment and experience and the patient's acceptance of the various modalities. In this case Prognosis is good due to following factors Insight present, 24 years., Good family support., Acute onset and Patient’s age. 1. PHARMACOLOGICAL some medicines were prescribed. 2. PSYCHOTHERAPY. Cognitive behavioral therapy and behavior therapy is as effective as pharmacotherapies in OCD, and some data indicate that the beneficial effects are longer lasting with CBT and behavior therapy. There is particular CBT modal for treatment of OCD called Exposure and Response Prevention Therapy (ERP), and other CBT and behavioral method also very effective in treatment of OCD. EXPOSURE AND RESPONSE PREVENTION THERAPY (ERP) ERP is widely used to treat many anxiety-based neurotic conditions. It has proven to be especially effective at treating obsessive-compulsive disorder. In ERP, the patient is repeatedly exposed to his fears, while being denied the opportunity to engage in any safety behaviors (compulsions) that normally would alleviate the patient's anxiety regarding exposure to those fears. This is a safe therapy that can normally be done through phone contact with a therapist (the nature of the treatment makes face-to-face contact unnecessary). If you would like to treat obsessive compulsive disorder (OCD) with ERP, there are a few simple steps you should learn. 0 0 CASE STUDY-B SOCIO DEMOGRAPHIC DATA Name : B Age : 29 yr Gender : Male Religion : Hindu Domocile : Rural Occupation : Teacher Marital Status : Un married Informants : Patient, Brother, and Father PRESENTING COMPLAINTS 1. Mood off 2. swelling in the abdomen 3. pain in the abdomen 4. Irritability 5. Suicidal thoughts 6. Desperate Mood HISTORY OF PRESENTING COMPLAINTS Complaints started 4 years back. He had a swelling in the abdomen and pain in the abdomen. He underwent endoscopy. He had difficulty in breathing while sleeping in the night. He became irritable and restless while taking classes in the college. He consulted a neurologist and he prescribed some medicines. He used to make conflicts with other family members and abuses them. He became irritable with the partners of his institution and withdrawn his share. When he had stopped the medicines advised by the neurologist, he became weak. He became so careless with money matters. He went to NIMHANS and consulted the doctors there. He was admitted there, but he could not cope with conditions there then he stopped medication. So he returned home and consulted another psychiatrist at Calicut. He started the habit of drinking alcoholic stimulants. Once he had made fights with 0 0 MEMORY Immediate- Present. (Digit forward test,) Recent- Present. (Recollecting recent event) Remote- Present. (Recollecting ) past event INTELLEGENCE Average General knowledge- Average. Abstract Thinking- Intact (proverb test) INSIGHT Awareness of illness-present Awareness of mentally ill- present Willingness to take treatment-present JUDGEMENT Personal- Present Social- Present. True emotional insight (grade – 6) VOLITION Present PSYCHOLOGICAL ASSESSMENT Beck Depression Inventory- score is 18(moderate depression) SUMMARY AND DIAGNOSTIC FORMULATION The patient is 29 years old year, unmarried male. The presenting complaints were swelling in the abdomen , pain in the abdomen mood off, suicidal thoughts, and irritability. The complaints started 4 ½ years back. He had a swelling in the abdomen and pain in the abdomen. He underwent endoscopy. He had difficulty in breathing while sleeping in the night. He became irritable and restless while taking classes in the college. His personal history all are normal and there is two significant psychiatric history in family, mother and Maternal grandmother mental illness (Mania) , pre morbidly well-adjusted and sociable. Mental statues examination showing presence of suicidal thought and anxious mood, rest of all mental function are normal. The Beck Depression Inventory has a score showing moderate depression (score -18) . 0 0 DIAGNOSIS Clinical feathers of patent meeting the DSM-IV-TR and ICD- 10 Diagnostic Criteria for Somatization Disorder with Psychiatric Symptoms. ( A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning, and The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering). MANAGEMENT Psychotherapy and Pharmacotherapy Somatization disorder is best treated when the patient has a single identified physician as primary caretaker. When more than one clinician is involved, patients have increased opportunities to express somatic complaints. Primary physicians should see patients during regularly scheduled visits, usually at monthly intervals. The visits should be relatively brief, although a partial physical examination should be conducted to respond to each new somatic complaint. Additional laboratory and diagnostic procedures should generally be avoided. Once somatization disorder has been diagnosed, the treating physician should listen to the somatic complaints as emotional expressions rather than as medical complaints. In psychotherapy settings, patients are helped to cope with their symptoms, to express underlying emotions, and to develop alternative strategies for expressing their feelings is very effective for somatization disorder, Pharmacological treatment is effective in patients without coexisting mental disorders, anti-depressant and benzodiazepines can be given on a short term basis for associated depression and anxiety. It mainly consists of; psychotherapy of somatization disorder mainly consisting  Supportive psychotherapy  Behavioral modification  Relaxation therapy 0 0 Case study: c SOCIO DEMOGRAPHIC DATA Name : C Age : 42 yrs Sex : Male Marital status : Married Education : 10th Standard Religion : Muslim Socio economic Status : Middle class Occupation : Driver Residential Area : Urban Family type : Nuclear Informant: Informant was patient Wife, information was reliable and adequacies CHIEF COMPLAINTS: Lack of sleep. Irritability. Violent and destructive behaviour. Excessive talk. Aggressive Poor appetite. Over importance to religious activity. (Duration Since two week) 0 0 GENERAL APPEARANCE: Well dressed, eye contact is maintained. Report is easily established. PMA is accelerated. Interpersonal and attitude towards Examiner is co-operative. SPEECH AND SOUND: Speech is Spontaneous, Pressure of speech, Output is Increased and quick reaction time. MOOD AND EFFECT: Subjective mood : “I feel happy” Objective effect : Euphoric THOUGHT: Stream : An accelerated flight of ideas. Content : Grandiose ideas, ideas of religiosity. Possession : Normal Form : Normal PERCEPTUAL DISTURBANCE: Nil ATTENTION AND CONCENTRATION: Digit forward test score is 5 and Digit back ward test scoe is 4. Attention is raised and sustained. MEMORY: Immediate- Present. (digit forward test, ) Recent- Present. ( recollecting recent event) Remote- Present.( recollecting past event ) INTELLIGENCE: GK : Average Arithmetic : Average Comprehensive : Average ABSTRACT THINKING Conceptual: ORIENTATION: Oriented to time, place and person. 0 0 JUDGMENT: Test : satisfactory Social : Satisfactory Personal : Satisfactory INSIGHT : Absent( complete denial- grade -1) DIAGNOSTIC FORMULATION: The patient is brought to the OPD with the complaints of lack of sleep, poor appetite, irritability, over activity, talkativeness and over religious activity. His MSE also shows that he was accelerated psychomotor activity, grandiose ideas, religiosity and flight of ideas. The illness is found as episodic. Base on ICD-10 criteria F31.1 the above mentioned symptoms show that the patient is affected by bipolar affective disorder, current episodic mania. ( DSM- IV TR:- A-Currently (or most recently) in a manic episode. B-There has previously been at least one major depressive episode, manic episode, or mixed episode. C-The mood episodes in Criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified) TREATMENT PLAN Treatment of patients with mood disorders should be directed toward several goals. First, the patient's safety must be guaranteed. Second, a complete diagnostic evaluation of the patient is necessary. Third, a treatment plan that addresses not only the immediate symptoms but also the patient's prospective well-being should be initiated. Although current treatment emphasizes pharmacotherapy and psychotherapy addressed to the individual patient, stressful life events are also associated with increases in relapse rates. Thus, treatment should address the number and severity of stressors in patients' lives. Overall, the treatment of mood disorders is rewarding for psychiatrists.. Because the prognosis for each episode is good, optimism is always warranted and is welcomed by both the patient and the patient's family. Mood disorders are chronic, however, and the psychiatrist and psychologist must educate the patient and the family about future treatment strategies. The primary method of treatment for bipolar disorder is pharmacological intervention - 0 0 medications. The prescriptions for treatment are usually specific to mania or depression. Mood stabilizers are one of the most important groups of medications for bipolar disorder. Lithium was the first medication used to treat bipolar disorder, and it also can be used as an add-on treatment for clinical depression. in addition with lithium other druge such as Olanzapine (Zyprexa)Risperidone (Risperdal)Clozapine (Clozaril) also using the treatment of bipolar disorder. Psychotherapy is often recommended for people taking mood-stabilizing drugs, mostly to help them take their treatment as directed. Group therapy often helps people and their partners or relatives understand bipolar disorder and its effects. Individual psychotherapy may help people learn how to better cope with problems of daily living . 0 0 The patient was poor in social relations. He had the history of substance abuse. FAMILY HISTORY: Family Tree: 68 years 60 years, 46 years 44 yr 39yr 35yr Index patent is second child in his family and belongs to financially lower class family, He living with family members, .They are cooperative and loving. There is no History of psychiatric illness reported in family and no history of mental retardation, epilepsy, suicide among other family members. MENTAL SATUS EXAMINATION. GENERAL APPEARANCE: Well dressed, personal cleanliness is good. Body posture is appropriate, eye contact is sustained. Attitude towards examiner is cooperative. Report is established. PMA is normal. SPEECH AND SOUND : Audible, normal reaction time but not good oriented. MOOD AND AFFECT: Subjective mood : “ I feel happy”. Objective mood : Restricted. PERCEPTUAL DISTURBANCES: 0 0 Auditory hallucinations : Third person hallucination. THOUGHT: Stream : Poverty of thought content circumstantially. Content : Delusion of references, delusion of control. Possession : Thought broadcasting. Form : Normal. MOOD : Incongruent ATTENTION AND CONCENTRATION Digit forward test score is 5 and Digit back ward test score is 3 . It means attention is aroused but not sustained. MEMORY: Immediate : Intact Recent : Intact Remote : Intact INTELLIGENCE: General Knowledge : Below average Arithmetic : Below average Comprehension : Below average ABSTRACT THINKING : Conceptual ORIENTATION : Oriented to time ,place and person. JUDGMENT : Test : Satisfactory Social : Satisfactory 0 0 Personal : satisfactory INSIGHT : partially present ( grade – 3) DIAGNOSTIC FORMULATION: The index patient was brought with the chief complaints of sleep disturbances, irritability, talking to self and his MSE shows that the patient has delusion of reference, delusion of control, thought broadcasting etc. He has perceptual disturbances and third person. Based on the ICD-10 criteria, f.20 the index patient meeting diagnosed criteria of schizophrenia. TREATMENT PLAN: Antipsychotic medications are the mainstay of the treatment for schizophrenia, and also clinical research has found that psychosocial interventions, including psychotherapy, can augment the clinical improvement. Just as pharmacological agents are used to treat presumed chemical imbalances, nonpharmacological strategies must treat non-biological issues. The complexity of schizophrenia usually renders any single therapeutic approach inadequate to deal with the multifaceted disorder. Psychosocial modalities should be integrated into the drug treatment regimen and should support it. Patients with schizophrenia benefit more from the combined use of antipsychotic drugs and psychosocial treatment than from either treatment used alone. By adding behavioral treatments for schizophrenia to a medical treatment regimen, the rate of relapse is further reduced, to only 25%. A variety of types of psychotherapy are available to schizophrenics. Cognitive therapy, psycho education, and family therapy can all help schizophrenics deal with their symptoms and learn to operate in society. Social skills training is of great importance, in order to teach the patient specific ways to manage themselves in social situations. 0 0 The patient understood her condition. Her family relations was good. She was more attached to her father. FAMILY HISTORY Family tree 48 years 45 years 21years 16 years Index patient is the first child in family. No family history of psychiatric illness and no other history of mental retardation, epilepsy, substance abuse were reported among family members. MENTAL STATUS EXAMINATION GENERAL APPEARANCE Looks comfortable but sad face. Self care is good and eye contact is average. poor Psychomotor activity She is cooperative and support is established. SPEECH AND SOUND : Volume is low. Speech output is slow. MOOD AND AFFECT: Subjective mood : “I am not happy” Objective affect : Depressed PERCEPTUAL DISTURBANCES : Auditory hallucination. THOUGHTS: Stream : Retarded Content : Hopelessness, suicidal ideas .somatic ideas Possession : Nil Form : normal 0 0 ATTENTION AND CONCENTRATION Digit forward test score 4 and Digit back ward test score is 3. It shows the attention and the concentration is poor. MEMORY: Immediate : Impaired Recent : Intact Remote : Intact INTELLIGENCE: GK : Average Arithmetic : Average Comprehensive : Average ABSTRACT ABILITY : Conceptual ORIENTATION : Oriented to person, place, time. JUDGEMENT: Test : Satisfactory Personal : Satisfactory Social : Satisfactory INSIGHT : Partially present( grade-5) PSYCHOLOGICAL ASSESSMENT – Beck Depression Inventory (BDI) Beck Depression Inventory score is 33 (scores of 30 to 63 indicate severe depression.) DIAGNOSTIC FORMULATION: Patent’s case history shows that she has reported Decreased appetite, Crying .Decreased self care. Decreased talk. Decreased psychomotor activity. Decreased socialization. Increased sleep. Thre is no past personal and family history of psychiric. Her MSE reported thought disterbenses( suicidal ideation - Hopelessness, suicidal ideas .somatic ideas) and digressive mood also. BDI score also showing sever depression (33) According to ICD-10 F31.3, the index patient is diagnosed as affected by depression with psychotic features, ( ICD-10- Depressed mood, loss of interest and enjoyment, and 0 0 increased fatiguability are usually regarded as the most typical symptoms of depression, and at least two of these, plus at least two of the other symptoms described above should usually be present for a definite diagnosis. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks. An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely.) TREATMENT PLAN Treatment plan of this patient is combination of psychotherapy and pharmacotherapy .There are a number of different psychotherapies for depression, which may be provided to individuals or groups. Psychological treatment of depression (psychotherapy) assists the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems. Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. In depression case Cognitive therapy using different techniques like Dysfunction thought record form, activity schedule, imagery, role play act. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression. Cognitive therapy also has proved beneficial in treating patients who have only a partial response to adequate antidepressant therapy. Good evidence has shown that cognitive therapy reduces relapse rates in patients with depression, and some evidence has shown that cognitive therapy is effective for adolescents with depression. 0 0 On WAPIS she obtained a total scaled score of 60 with the corresponding IQ being 109 suggestive of Average Level of Current Intellectual Functioning. II NIMHANS Battery of Specific Learning Disability ATTENTION a) Digit cancellation test for single and double digits On Digit cancellation test for single and double digits, it was seen that the child was able to cut all the digits correctly in a sequence suggesting that her attention span was adequate. LANGUAGE a) Oral Reading (English) It was adequate to her grade level except that the prosody was lacking. b) Copying (English) It was not adequate to her grade level. She was seen to omit letters while copying the text. Her pencil holding was incorrect but the posture was correct. c) Spellings (English) It was not adequate to her grade level. She was clear with the concept of phonetics, blends and double letters; but lacked the concept of silent words and tended to make errors in words involving rules of spellings. d) Comprehension (English) Her level in comprehension was II grade level below her current level. She was able to comprehend the meaning of the text and the question on her own. She was also able to answer direct and inferential questions but needed assistance in framing them in her own language. Her critical and creative abilities were poor. e) Expressive Writing (English) 0 0 Her level in expressive writing was II grade level below her current level. She wrote very simple sentences and they were grammatically incorrect. Complexity of ideas and sentences as expected of her grade was absent. The passage written by her lacked organization. Her vocabulary and divergent thinking was limited. MEMORY a) Auditory Memory for Sentences It was below II grade level. She could remember up to 2 commands only in English Language. She was seen to engage in word substitution and omission as the length of the sentence increased and when it contained words unfamiliar to the child. b) Visual Memory On Bender Visual Retention Test (BVRT), she drew 9 out of 10 figures correctly. Significant impairment was not seen in her visual memory. PERCEPTUAL MOTOR FUNCTIONING a) Test of Visuo-Motor Integration (TVMI) On TVMI, the child was able to draw all the shapes correctly. Significant deficits were not seen on it. b) Bender Gestalt test (BGT) The child was able to draw all the shapes correctly. Significant deficits were not seen on it. Impression The test findings on WAPIS suggest that the child has an IQ of 109 suggestive of Average Level of Current Intellectual Functioning. On , the childNIMHANS Battery of Specific Learning Disability was found to have specific learning disability in the area of comprehension and expressive(Dyslexia) writing in English Language. Deficits were also seen in her auditory memory. Recommendations 0 0  She needs to be made clear with the concept of silent letters and rules of spelling.  To enhance her comprehension skills, she needs to practice several unseen passage with emphasis on inferential, creative and critical abilities and she should be encourage to frame answers in her own language.  To help build her expressive writing skill, she should be encouraged to write more complex sentences beginning from her current level by gradually adding difficult words and more complex ideas. Her grammatical concepts need to be revised.  She should be taught exercises to enhance her auditory memory.  As per the CBSE guidelines, the child should be given extra-time in exams to help her perform to her optimum level.  Her marks for spellings should be ignored, unless they are grossly wrong or are those of technical terms.  It is essential to praise her for her achievement, no matter how small they may be, as this is likely to improve her self-concept and confidence level.  Focus should be on assessing her, based on her conceptual knowledge.  She needs to continue going to a regular school. She needs to be taught effective study skills and compensatory strategies to deal with the difficulties experienced by her in the above mentioned areas. 0 0 ATTENTION b) Digit cancellation test for single and double digits On Digit cancellation test for single and double digits, it was seen that the child was able to cut all the digits adequately on her own suggesting that her attention span and concentration level is adequate. LANGUAGE f) Oral Reading (English) It is below II grade level. Finger tracing; letter substitution and addition and mispronunciation was present. Her reading was hesitant and laborious. Posture was inadequate and the prosody was absent. g) Copying (English) It was below II grade level. She was seen to copy letter by letter and took long to copy the text. She was unable to maintain adequate spacing between the lines. Her pencil holding was incorrect and she was seen to use lot of pressure while writing. Her posture was inadequate. h) Spellings (English) It was adequate to her grade level. i) Comprehension (English) It was below II grade level. She was seen to comprehend the meaning of the question and the text on her own. She was able to answer simple direct questions. But, in questions, where she had to infer the answer, she tended to look for key words while answering them and tended to copy the exact line containing those key words as an answer. Her inferential, creative and critical abilities were poor. j) Expressive Writing (English) It was below II grade level. She wrote simple sentences and they were grammatically incorrect. She was unable to generate ideas as expected of her grade level. MEMORY 0 0 c) Auditory Memory for familiar and unfamiliar words It was adequate to her grade level. d) Auditory Memory for Sentences It was adequate to her grade level. She could remember up to 2 commands in English Language. e) Visual Memory On Bender Visual Retention Test (BVRT), she drew 9 figures out of 9 correctly. Her performance is not suggestive of any impairment in her visual memory. PERCEPTUAL MOTOR FUNCTIONING c) Test of Visuo-Motor Integration (TVMI) On TVMI, the child was able to draw all the shapes correctly. No deficits were seen. d) Bender Gestalt test (BGT) She was able to draw all the figures correctly. No deficits were seen. III Grade Level Assessment Device for Children with Learning Problems in Schools LANGUAGE a) Oral Reading (Hindi) It is below II grade level. Finger tracing; matra omission and addition; word substitution and mispronunciation was present. Her reading was hesitant and laborious. b) Copying (Hindi) It was below II grade level. She was seen to copy letter by letter and took long to copy the text. She was unable to maintain adequate spacing between the lines. Her pencil holding was incorrect and she was seen to use lot of pressure while writing. Her posture was inadequate. c) Spellings (Hindi) 0 0 It was below II grade level. She was not clear with the concept of matras and half-letters, blends and concept of bindu and chandrama bindu. d) Comprehension (Hindi) It was below II grade level. She was able to comprehend the meaning of the question on her own and was able to answer simple direct questions. In questions, where she had to infer the answer, she tended to look for key words and thereby copying the exact line containing those key words as an answer to the question. Her inferential, creative and critical abilities were poor. k) Expressive Writing (Hindi) It was below II grade level. She wrote simple sentences and they were grammatically incorrect. She was unable to generate ideas as expected of her grade level. ARITHMETIC a) Arithmetic Computation It was adequate to her grade level except that she was not clear with the concept of fractions. She was also seen to make several careless mistakes. b) Arithmetic Reasoning It was below II grade level. She was unable to comprehend the meaning of the reasoning sums and was unable to elicit the computations involved. Impression The test findings on suggest that the child has an suggestive of Average Level ofMISIC IQ of 108 Current Intellectual Functioning. On NIMHANS Battery of Specific Learning Disability, the child was found to have specific learning disability (Dyslexia) in the area of reading, copying, comprehension and expressive writing in English Language. On Grade Level Assessment Device for Children with Learning Problems in Schools, the child was found to have specific learning disability (Dyslexia) in the area of reading, copying, spelling, comprehension and expressive writing in Hindi Language and in Arithmetic reasoning. 0 0 I SSCT Her responses on SSCT reveal that although she shares a loving relationship with her mother and is very attached to her. But unlike, mother she appears to have ambivalent feelings towards her father , where she wishes him to be more wise and to believes that he had taught her the basic coping skills, then her life would have been far more better than what it presently is. She further appears to think that her family is a bit different from other in general and from last few months she thinks that her family members have begun to consider her as an irresponsible person. According to her, most females should be independent, self-reliant and having a mind of their own. However she thinks that most women are basically shallow and too dependent on men. She revealed that this aspect of women is the one she dislikes the most. She feel guilty for ruining her marital relationship because of lack of adequate understanding about interpersonal skills. However, she strongly desires a stable and a healthy relationship with her husband. She does not seem to like people who are dominating and thinks that her friends do not probably miss her, when she is not there. Although she appears to enjoy freedom at work place but seems to find it difficult to trust her colleagues as she feels that they may take credit for her work. Her greatest fear appears to be the fear of being left alone or abandoned by others, where she feels that her husband may leave her alone forever. She believes that her true potential has been untapped. When faced with difficulties she is likely to feel anxious and tends to sulk and becomes passive. She seems perplexed and uncertain about her future. II TAT The client’s responses on TAT suggested that she is an individual with average intelligence (presence of internal consistency and logical development of stories; average vocabulary) whose emotional maturity level seems to be adequate (identified with the same age but opposite gender; stories are in logical harmony with the facts of the stories). 0 0 Treatment was started before one year. First she took medicine from general medicine. Then she consulted a psychiatrist at Mysore, and start medication. Six month before she consult a clinical psychologist at Kannur for psychotherapy. She took two psychotherapy session and discontied the psychotherapy. PERSONAL HISTORY BRITH AND EARLY DEVELOPMENTS: Patent’s Birth and early development are normal . no significant event reported in child hood. EDUCATIONAL HISTORY: She is above average student . In plus two she scored good mark. Then she joined the BBM course. The patient’s report that in the classroom she felt loneliness. Most of the time she was alone in class. PRE MORBID PERSONALITY: She was having good interpersonal relationship with her family. She was religious and basically she was deserved, socially less active and lonely type. HOME ATMOSPHERE IN CHILDHOOD AND ADOLESCENCE: 0 0 The patient understood her condition. Her family relations was good. She was more attached to her father. FAMILY HISTORY Family tree 48 years 45 years 21years 16 years Index patient is the first child in family. No family history of psychiatric illness and no other history of mental retardation, epilepsy, substance abuse were reported among family members. MENTAL STATUS EXAMINATION GENERAL APPEARANCE Looks comfortable but sad face. Self care is good and eye contact is average. poor Psychomotor activity She is cooperative and support is established. SPEECH AND SOUND : Volume is low. Speech output is slow. 0 0 increased fatiguability are usually regarded as the most typical symptoms of depression, and at least two of these, plus at least two of the other symptoms described above should usually be present for a definite diagnosis. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks. An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely ) 0 0 completely.) TREATMENT PLAN Treatment plan of this patient is combination of psychotherapy and pharmacotherapy .There are a number of different psychotherapies for depression, which may be provided to individuals or groups. Psychological treatment of depression (psychotherapy) assists the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems. Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. In depression case Cognitive therapy using different techniques like Dysfunction thought record form, activity schedule, imagery, role play act. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression. Cognitive therapy also has proved beneficial in treating patients who have only a partial response to adequate antidepressant therapy. Good evidence has shown that cognitive therapy reduces relapse rates in patients with depression, and some evidence has shown that cognitive therapy is effective for adolescents with depression. 0 0 Case Study :F Sociodemographic Information Name Rita No. of Sessions One Age 18 Years Date of Testing 28-12-12 Class XII School Navy Children School, Chanakyapuri Father’s Name Mr.Jagdish Address 14/4, Railway Colony, Sarojini Nagar, 0 0 Digit Symbol 45 11 Block Design 42 15 Picture Arrangement 16 10 Object Assembly 24 10 TOTAL 60 0 0 On WAPIS she obtained a total scaled score of 60 with the corresponding IQ being 109 suggestive of Average Level of Current Intellectual Functioning. II NIMHANS Battery of Specific Learning Disability ATTENTION a) Digit cancellation test for single and double digits On Digit cancellation test for single and double digits, it was seen that the child was able to cut all the digits correctly in a sequence suggesting that her attention span was adequate. LANGUAGE a) Oral Reading (English) It was adequate to her grade level except that the prosody was lacking. b) Copying (English) It was not adequate to her grade level. She was seen to omit letters while copying the text. Her pencil holding was incorrect but the posture was correct. c) Spellings (English) It was not adequate to her grade level. She was clear with the concept of phonetics, blends and double letters; but lacked the concept of silent words and tended to make errors in words involving rules of spellings. d) Comprehension (English) Her level in comprehension was II grade level below her current level. She was able to comprehend the meaning of the text and the question on her own. She was also able to answer direct and inferential questions but needed assistance in framing them in her own language. Her critical and creative abilities were poor. e) Expressive Writing (English) 0 0 Her level in expressive writing was II grade level below her current level. She wrote very simple sentences and they were grammatically incorrect. Complexity of ideas and sentences as expected of her grade was absent. The passage written by her lacked organization. Her vocabulary and divergent thinking was limited. MEMORY a) Auditory Memory for Sentences It was below II grade level. She could remember up to 2 commands only in English Language. She was seen to engage in word substitution and omission as the length of the sentence increased and when it contained words unfamiliar to the child.0 0 0 0 Case Study: G Sociodemographic Information Name Roshini No. of Sessions Two Age 10 Years Date of Testing 02-09-12 and 03-09-12 Class V School Amity International School. Pushp Vihar Father’s Name Mr. Vikas Seth Address H-17, Maharani Bagh, First Floor, New Delhi Informant Child’s parents Reason of Referral The child came with her parents with the chief complaints of poor academic performance, poor spellings, difficulty comprehending languages, tendency to forget easily, tendency to make several calculation and sign errors in mathematics, inability to adequately comprehend reasoning sums and poor grammatical concepts. The parents further reported that the child had a full term cesarean delivery. The birth cry was immediate and all her developmental milestones were on time. However, the mother had thyroid during her pregnancy and it went undiagnosed. At the age of 2 years, the child developed allergy towards dust and had asthmatic attacks. She was given steroids for the same. For the same, she had been admitted nearly 4 times from the time of 2 years till 5 years of age. Since, last 5 years she has not had any attack and has been reportedly doing well. An interaction with the child revealed that she is a pleasant child who enjoys drawing. In order to gain a better understanding of the difficulties she is facing in her academics, an assessment for Specific learning Disability was done. Test administered To assess the child’s current functioning, the following test was administered: 0 0