About the Organization

Sir Ganga Ram Hospital is a 650 bed multi-specialty hospital with all disciplines working at
highest levels. The management of Sir Ganga Ram Hospital, New Delhi, India welcomes doctors
from all over the world for short-term medical training, observership or any other mode of
improving medical education or the skills of an individual.

Keeping in pace with the rapidly developing field of Clinical Psychology, Sir Ganga Ram
Hospital department of Psychiatry conducted a one month certificate course in ‘Clinical
Psychology’.

The program stressed on the practical aspect of Clinical Psychology and interventional
management.

This well-structured course covered the basic sciences, psychological conditions, different
approaches and schools of thought in psychology, ethical practice of a clinical psychologist,
interventional management and medicinal management of psychological conditions.

Didactic lectures were conducted by profound psychiatrists as well as clinical psychologists from
allied specialties like psychiatry, neurology, clinical psychology, counselling psychology and
internal medicine.

Key Learnings

The main objective of me being a part of an internship was to develop facility with a range of
diagnostic skills, including: interviews, case history-taking, risk assessment, child protective
issues, diagnostic formulation, triage, disposition, and referral ; to develop further skills in
psychological intervention, including: environmental interventions, crisis intervention, short-
term, goal-oriented individual, group, and family psychotherapy, exposure to long-term
individual psychotherapy, behavioral medicine technique, and exposure to psycho
pharmacology, case management, and advocacy. Before I set out on my internship at Gangaram
Hospital my two main learning goals were to get more insight into the field of clinical
psychology and to gain confidence in my work abilities. I think that I achieved my learning goals
defined at the beginning of the summer. While not as hands on as I anticipated, my internship
was a wonderful learning experience and I really valued the time I spent at the hospital. I
definitely saw what working in a clinical psychology field entails and how it is different from
any other working environment. There is a strict level of confidentiality, especially when dealing
with child clinical psychology. I always had to remember to keep data with participant’s names
separate from the data with numbers as well as to only upload information that was non-
identifying.
I feel that I also achieved my second learning goal of gaining a sense of independence and higher
responsibility. I tried to be as professional as possible in all of my interactions and attempted to
figure things out on my own before asking for clarification. That being said, I had to learn that it
is ok to ask questions and to do so in a confident manner without self-blame. My goal was to
appear mature and to not be seen as merely “the intern.” The hospital was an incredibly warm
and welcoming place and I definitely got a chance to socialize with everyone outside of just a
working relationship.

My internship this summer definitely helped me clarify my interest in working in a clinical psych
field. I feel like my interest was really sparked whenever I was reading through the psychological
measures given to participants or attending weekly seminars. I listened to talks that were on
various topics in the field such as pediatric clinical psychology in a hospital setting and new
approaches to looking at the role of parental behavior in anxiety. There is a lot of new and
exciting work being done and it is inspiring to see so many people work furiously to ensure that
the lives of individuals are improved.

Skills Acquired
 How to put my knowledge and skills into practice

From conducting comprehensive research, to designing intervention plans, my knowledge of

clinical psychology and psychological theories was transformed into a series of practical
techniques and skills that I can now implement in real-life clinical scenarios, all thanks to my
internship.

 The benefits of networking

During my internship, I learned how to communicate and build relationships with the people I
worked with. I learned how to introduce myself, talk about my interests, knowledge and skills
with clinical psychologists and psychiatrists, as well as how to ask questions and gain a better
understanding of the field not only in the co-working space, but also outside of it. This process
overall helped me develop my professional network and emphasised the importance of creating
these connections.

 Understanding workplace culture

Culture influences communication, and as an Indian student, I learned that every company or
organisation has its own culture. It’s essential to observe others and learn how they engage and
interact with co-workers, or help them with projects and tasks. I quickly learned that whenever
something is unclear for me, or I don’t understand, it’s fine to ask for clarification.

 Enthusiasm is invaluable

As an intern, I discovered it’s essential to be enthusiastic and open to learning new skills, asking
for more work and being curious to learn and ask questions. This attitude will show that we
enjoy being part of the team and that we're keen to help. Having curiosity and enthusiasm also
means that, as an intern, we get a lot out of what we’re doing, which opens lots of opportunities.

 Keeping a journal is great for personal growth

During my internship, I had a journal and took notes every day about new things I learned,
feedback I was given by my manager, strengths and weaknesses I noticed, and things I wanted to
research and learn more about. This helped me understand myself more and identify the areas
that I needed to improve in.

 How important good communication is

Communication is the key to success in a professional environment. I learned that it’s important
to communicate with my manager via phone, email or SMS if I have questions or if I don’t know
how to work on a task. Asking for help and clarification is better than pretending you’ve
understood what you need to do, no matter what. However, I also found that if you can Google
something, then do. Avoiding asking questions if you can find answers elsewhere is part of being
a good communicator – keep in mind that everyone’s time is valuable. As an intern, good
communication will help with productivity, efficiency, engagement, and growth.

 The benefits of taking on feedback

Asking for and receiving professional feedback is very important. It is essential to take note of
both the positive and negative points for the future, so you can grow and excel in your career. I
learned that sometimes asking for feedback or receiving feedback is difficult to hear, but it will
have a significant impact on your future career and success.

 Learnt more about possible career paths

  Gained valuable experience that can be added to my resume
 Earned academic credit

CASE STUDIES

1 Severe Depressive Episode with Psychotic Symptoms

PERSONAL INFORMATION:
Name: Mohit Kaushal
Age: 28
Marital status: Married
Gender: Male
Occupation: Software engineer
Education: Btech
Religion: Hindu
Mother tongue: Hindi
Location of residence: Karol Bagh
Socioeconomic status: Middle class
Informant: wife
Reliability: Reliable and consistent
CHIEF COMPLAINTS
According to the client:
The client reported that whenever he’s alone he feels that someone is talking to him and scolding
him for everything he does. He feels that he has done something very wrong and people want to
harm and reprimand him for his wrongdoing.
According to the informant:
Wife reported that he has not been sleeping and eating well. He sits alone in a room most of time
and talks to himself. The symptoms started 2 months ago when the client’s father died in an
accident. After the accident, he didn’t talk with anyone for a long time and slowly started
behaving differently. She mentioned that the client has a fear that people want to harm him. He is
also suspicious of his wife and blames her for conspiring with others to harm him. He also feels
that other people are talking about him.

HISTORY OF PRESENT ILLNESS

Patient was very restless and agitated. He was not able to answer anything. He kept repeating ‘I
want to be normal’. Patient was accompanied by his wife. According to his wife he became quiet
and distant after his father’s death. He couldn’t sleep well so he took sleeping pills which helped
him in getting sleep. Recently, he stopped going to office and remained in his room for most of
the time. From the last 2 days he is not sleeping and has been talking to himself. He suspects that
others including his wife are trying to harm him because he has done something bad. His wife
also mentioned that he has been aggressive towards others and suspects that people are talking
about him.
Mode of onset: insidious
Duration of illness: 2 months
PAST PSYCHIATRY AND MEDICAL HISTORY
Client does not have any prior psychiatric or medical history
BIOLOGICAL FUNCTIONING
Sleep: disturbed
Appetite: low
Sexual interest and activity: low
Energy: low
NEGATIVE HISTORY
No history of head injury, epilepsy, seizures.
FAMILY HISTORY:
There is no consanguinity between parents of the client. Patient lives with his mother and wife.
He got married 2.5 years ago. He does not have a child. He is a software engineer whereas his
wife is a school teacher.
PERSONAL HISTORY
Birth order: only child
Birth and development history: normal delivery and milestones were achieved on time, no
childhood disorder present.
Behavior: The client has been very introverted since childhood. He didn’t have many friends
growing up. He talked very less and focused on his studies. He does not share much with anyone
and talks very less with his mother and wife. He prefers to go on solo trips.
Academic History: The client was very good in academics. He felt anxious when he had to talk
or give presentations in front of people. He once fainted in school because he was asked to give a
speech.
Occupational History: Client has been working as a software engineer in MNC from 6 years.
Sexual History: Data not available.
PRE-MORBID PERSONALITY: The client was an introverted, anxious person but otherwise
remained happy and enjoyed the company of his family and close friends.
ALCOHOL AND SUBSTANCE HISTORY: Occasionally consumes alcohol
MENTAL STATUS EXAMINATION
GENERAL APPEARANCE & BEHAVIOR: General appearance was untidy. He hadn’t combed
for two days. Today he didn’t brush and bathe. He was staring at one place and constantly
blinking. Client was lean and looked unhealthy. no eye contact maintained. Rapport could not be
established with the client and there was rude attitude towards the examiner. Client was not
cooperative.
MOVEMENT AND BEHAVIOR: Slow psychomotor movement was observed from the client.
He was staring at one place and movement was slow. But he was blinking constantly.
SPEECH: Thought block was absent. monotonous pitch was observed. Speed was increased and
reaction time was slow.
THOUGHT:
Delusion: present
Client says, “people are trying to harm me”.
PERCEPTION
Hallucination is absent.
COGNITIVE FUNCTIONS:
• oriented to time, place and person.
• Attention & Concentration around but not sustained
• Memory: Immediate memory: intact
Recent memory: intact
Remote memory: intact
• Abstract thinking impaired.
• Intelligence is impaired
• General fund of knowledge: adequate
JUDGEMENT:
Personal: Impaired
Social: Impaired
INSIGHT: slight awareness of being sick and needing help but denying it at the same time.
PSYCHOLOGICAL ASSESSMENTS CONDUCTED: Beck’s Depression Inventory

DIAGNOSIS
The client is diagnosed with major depressive episode with psychotic symptoms. Because he had
symptoms of depression (sadness, anger, feeling of sadness and hopelessness. Low on
socialization and self-care) and psychosis- aggression, agitation, restlessness, delusions, social
isolation, anxiety, persecutory delusions etc.
TREATMENT PLAN The psychiatrist advised his wife to get him admitted in Sir Ganga Ram
Hospital where he may be kept under observation for a few days to bring down his agitation.
After that based on his progress, medication and psychotherapies will be advised.

2. Bipolar Affective Disorder

PERSONAL INFORMATION:
Name: Mr. ABHINAV KUMAR
Age: 26
Marital status: unmarried
Gender: Male
Occupation: Student
Education: BBA
Religion: Hindu
Mother tongue: Hindi
Location of residence: Vasant Kunj
Socioeconomic status: Upper Middle Class
Informant: father and uncle
Reliability: Reliable and consistent but inadequate
CHIEF COMPLAINTS
According to the patient: “I have no problem. My mind is super-fast and no one can match it.”
According to the informant: “he has become very aggressive and started abusing people. He had
fights with his friends and brother. He thinks that he is very intelligent and look down on others.”
HISTORY OF PRESENT ILLNESS
The onset of the illness is acute. The client was apparently well a week ago. Three days before he
got to know that he cleared his entrance exam in IIM Ahmedabad. He had been very ecstatic
about it. Later in the evening he got aggressive with his younger brother who jokingly said that
he may have cheated in entrance exams. He responded to him saying that his mind is super-fast
and he does not cheat like his brother does.
Next day while returning back home, at the bus station station, he abused his best friend and
asked him to jump off in front of the bus and even tried to push him. Next day he again abused
his friend, got aggressive and kept repeating that no one can match him. His father decided to
bring him to the hospital. Currently there is no significant change in his sleep pattern, he is able
to maintain his personal hygiene however his energy level has increased whereas his appetite has
decreased since the past 2 days.
PAST PSYCHIATRY AND MEDICAL HISTORY
The patient does not have any kind of past illness/psychiatric illness.
Treatment History: NIL
BIOLOGICAL FUNCTIONING
Sleep: disturbed
Appetite: decreased
Energy: very Active
FAMILY HISTORY The patient family is a nuclear family. His father is a bank manager and
brother is pursuing his graduation. Family atmosphere is good. The client’s financial status is
also good.
PERSONAL HISTORY
Birth order: first born, he has one younger brother.
Birth and development history: Birth history was normal, Birth cry was present, Birth weight 2
kilo, Developmental milestones achieved in time, no emotional or physical problems were
present in childhood.
Behavior during childhood: The patient was good in academics and used to participate in
extracurriculars. He had many friends growing up and is an extrovert.
Sexual history: Not elicited
Premorbid personality: The patient was extrovert and had many friends, he never showed any
kind of resistance earlier or aggressiveness
MENTAL STATUS EXAMINATION
GENERAL APPEARANCE & BEHAVIOUR: The client seemed tidy and was wearing a
checkered shirt and pant, hair was properly made, he was well dressed and groomed
Behaviour was restless. He was wringing his hands and was uncooperative, hyperactive, restless.
Attitude towards examiners- uncooperative, Rapport could not be established.
MOVEMENT AND BEHAVIOUR: Agitation was present and the patient was constantly
moving his hands.
SPEECH: Rapid, pressure of speech was observed
productivity–high
Reaction time was increased
MOOD/AFFECT: Mood - irritable, euphoric
Affect- broad–congruent with mood
PERCEPTION: No perceptual disturbances were observed.
THOUGHT:
Content- Ideas of grandiosity
Form- flight of ideas, rapid thinking, tangentiality (where the patient does not come to the point)
COGNITIVE FUNCTIONS:
• The client is oriented to time, place and date
• Attention & Concentration is aroused and sustained
• Memory:
Immediate memory: intact
Recent memory: intact
Remote memory: intact

JUDGMENT:
Personal: Intact
Social: Intact
INSIGHT: Level 1 - complete denial of the illness
PSYCHOLOGICAL ASSESSMENTS CONDUCTED: MOOD DISORDER
QUESTIONNAIRE
INTERPRETATIONS: The patient was diagnosed with bipolar affective disorder, current
episode hypomanic. The patient exhibited symptoms of increased energy and activity,
talkativeness, decreased need for sleep, irritability and currently experiencing hypomanic
episode.
TREATMENT PLAN: He was prescribed mood stabilizers. He was asked to come after a week.
Based on his condition he will be given various psychosocial treatments such as cognitive
behavior therapy, interpersonal therapy etc.

3. Moderate Obsessive Compulsive Disorder

PERSONAL INFORMATION:
Name: Namita Manro
Age: 53
Marital status: widow
Gender: Female
Occupation: Housewife
Education: Graduate
Religion: Hindu
Mother tongue: Hindi
Location of residence: Rithala
Socioeconomic status: Upper Middle Class
Informant: Son
Reliability: Reliable and consistent
CHIEF COMPLAINTS
According to informant: The client was reported to be forgetful. She worries a lot and gets
panicky very often. She washes her hands and performs her tasks very slowly. She spends most
of the time in kitchen where she would keep washing utensils and cleaning the floor of the
kitchen. She also spends a lot of time in the bathroom to bathe and use the toilet. If guests come
over at home she gets panicky.
HISTORY OF PRES ENT ILLNESS
The client started to show the symptoms one year ago when she started to forget things. she feels
that something is falling (dust) so she washes her hands very frequently. She has two sons, one
of them is currently living separately with his wife and the other one got divorced and lives with
the client herself. She worries a lot about her second son. She reports that praying helps her a lot
and she does not have any thoughts of washing or cleaning at that time. Even though she was not
very social, she had two close friends whom she used to meet but recently she has lost interest in
everything and does not want to meet anyone. She has arthritis and finds it difficult to do chores
but she says that she cannot help but panic and do the work whenever guests come over at her
place.
PAST PSYCHIATRY AND MEDICAL HISTORY
Patient has arthritis and diabetes and no history of medical illness.
TREATMENT HISTORY
She takes medicine for arthritis and diabetes but for stress or anxiety she never took any help.
BIOLOGICAL FUNCTIONING Sleep: disturbed
Appetite: Normal
Sexual interest and activity: could not be elicited
Energy: low
NEGATIVE HISTORY No history of head injury, epilepsy, seizures, trauma, no elation of mood
or depersonalization or de-realization.
FAMILY HISTORY There is no consanguinity between parents of the client. The client’s
parents have died. The client’s younger brother lives in same city. The client has 2 sons. One of
them is married and live separately whereas the other son is divorced and lives with his mother.
FAMILY INTERACTION PATTERN: The communication in the family is seen normal. There
is good cohesiveness in the family. There is seen negative expressed emotions from the family
towards the client.
PERSONAL HISTORY
Birth order: first child
Birth and development history: normal delivery and milestones were achieved on time, no
childhood disorder present.
Behavior during childhood Client shared good bond with her parents. In school she felt isolated
and had low self esteem. She had very few friends growing up. She was overweight and felt that
she is not as good looking as her cousin. As a result, she had low self confidence. She was good
in academics. Her parents encouraged her to focus on her household chores instead of studying
because they deemed it to be useful for her after marriage and not her qualification.
Academic History: The client was good in academics. However, she never participated in any
social activity because she thought she was overweight and people will might fun of her. Her
hobbies were reading and writing.
Occupational History: No occupational history
Sexual History: She shared a good relationship with her husband.
PRE-MORBID PERSONALITY: The client has always been introverted, organized and
systematic in nature. She finds it difficult to talk with strangers. Client is very religious and prays
2 to 3 hours in a day.
MENTAL STATUS EXAMINATION
GENERAL APPEARANCE & BEHAVIOR: is neatly dressed, normal gait and gesture was
present. Client was overweight. The client is in touch with the surroundings. Proper eye contact
is maintained. Rapport could be established with the client and there was positive attitude
towards the examiner. The client was comprehensive to simple rules from the clinician and was
cooperative for the session.
MOVEMENT AND BEHAVIOR: Slow psycho-motor movement was observed.
SPEECH: The speech was normal. Intensity and speed of communication of the client was
normal. There was no pressure of speech and it was coherent and goal directed.
MOOD / AFFECT: • Subjectively: “I am anxious”, • Objectively: the client is anxious and tired
The depth or intensity of mood is casual. The mood is stable. They are congruent to the thought
and communicable and appropriate to the situation
THOUGHT:
Content: The patient has preoccupation of illness.
PERCEPTION: No perceptual disturbances could be elicited from the client.
COGNITIVE FUNCTIONS: • The client is oriented to time, place and date
• Attention & Concentration is aroused and sustained
• Memory:
Immediate memory: intact
Recent memory: intact
Remote memory: intact
• Abstraction: intact
• General fund of knowledge: adequate
JUDGMENT:
Personal: Intact
Social: Intact
INSIGHT: The client had true emotional insight.
PSYCHOLOGICAL ASSESSMENTS CONDUCTED THE YALE–BROWN OBSESSIVE
COMPULSIVE SCALE (Y-BOCS).
INTERPRETATION: Patient exhibited symptoms of OCD (obsessive compulsive disorder). The
client washes hands frequently and worries about germs. Because of this she was having
difficulty working but still couldn’t help cleaning because of the fear of germs.
TREATMENT PLAN: She was advised do physical activity and relaxation. Along with
medicines she was advised to start taking psychotherapy.