Reflective Report

Submitted in complete fulfilment of 30 days Internship Program

Submitted by:
FATHIMA MOHAMED RAFI
MSc. Clinical Psychology
Yenepoya (Deemed-to-be) University
Bangalore

Submitted to:
Ms. Kavya and Ms. Sreeja
Spandana Nursing Home
Rajajinagar, Bangalore-560010

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 CERTIFICATE

This is to certify that the report on an internship at Spandana Nursing Home, Rajajinagar, Bangalore,
was carried by Ms. Raksha R Naik, pursuing II semester MSc. Clinical Psychology specialization at
the Department of Psychology, Yenepoya (Deemed-to-be) University, Bangalore has successfully
completed 30 days internship under the supervision of Dr. Preethi.S (Neuro Psychiatrist), Dr.
Chandrashkar (Consultant Psychiatrist) and Ms. Kavya and Ms. Sreeja (Counsellors).

Dr. Preethi S
Neuropsychiatrist
Head of Spandana Nursing Home

Ms. Kavya, Ms. Sreeja

Counsellors
Mentors
DECLARATION

I hereby declare that this placement was carried out during the year 2024-25 under the supervision of
Dr. Preethi.S (Neuro Psychiatrist), Dr. Chandrashkar (Consultant Psychiatrist) and Ms. Kavya and
Ms. Sreeja (Counsellors), at Spandana Nursing Home, Rajajinagar, Bangalore.

Date: 14.08.2024
Place: Bangalore

Fathima Mohamed Rafi

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 ACKNOWLEDGEMENT

I take this opportunity to thank those who helped me during my internship and for that, I would like
to express my sincere gratitude to Dr. Preethi S, Neuropsychiatrist and Dr. Chandrashekar who
helped me and motivated me throughout the duration of my internship.

I would also like to express my gratitude to Ms. Kavya and Ms. Sreeja (Counsellors) who guided me
and provided me with extending various facilities which played an important role in completing this
internship, and spared their valuable time and assisted me despite their busy schedule.

I am extremely grateful towards the above-mentioned people for their guidance about psychiatric
approach for mental health in the program.
I also thank all the staff members for their constant aiding and help during this program.

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 CONTENTS
Particulars Page No.

Introduction 5-6

Psychiatry 7-10

Mental Disorders 10-21

Psychotherapy 21-24

Case Histories 25-32

l Case 1
l Case 2
Internship Experience 33

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 Introduction

Spandana Nursing Home is a specialized psychiatric facility that collaborates with other medical
departments to address the mental health needs of individuals and the community at large. Situated in
a serene location in Rajajinagar surrounded by trees, this longstanding center has been serving with
integrity for over five decades.

The name "Spandana" finds its roots in the vision of Dr. Mariappa Srinivasa, a Psychiatrist and
Director of the organization. Spandana aptly signifies "reciprocating to the emotional pulses" of
individuals with psychiatric illnesses, aimed at enhancing their quality of life.

In 1971, Dr. M Srinivasa, also known as (MS), established a small clinic that brought hope to
millions during a time when psychiatric illnesses were misunderstood as being caused by evil spirits
and other misconceptions. His genuine passion and compassion for helping people won the hearts
of many. By the late 1980s, the clinic transitioned to providing inpatient and nursing home care. His
goal is to provide cost-effective services, and the establishment of Spandana rehabilitation was
driven by the persistent demand for long-term rehabilitation services.

Apart from out-patient services, Spandana Nursing Home has 50 in-patient beds, 200 beds in long
term psychiatry rehabilitation, with 30 beds for the elderly along with 24x7 psychiatry emergency
with well-trained staffs.

Services and treatments offered are:

l Home Ambulance
l ECT
l RTMS
l Alcohol Aversion
l Ketamine Abreaction
l Narco Analysis
l Depression
l Mood Disorders
l Anxiety Disoders
l Schizophrenia
l Personality Disorders
l Eating Disorders
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l Sleep Disorders
l Sexual Disorders
l Dementia and Delirium
l Marital discord l Family therapy
l Psychotherapy

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 Psychiatry

Psychiatry is a medical specialty focused on the diagnosis, treatment, and prevention of mental
health disorders. It is a field that bridges the gap between neuroscience and psychology, applying
scientific understanding of the brain and human behavior to address a wide range of mental health
conditions.

Psychiatrists are medical doctors who have completed specialized training in mental health. They are
qualified to assess both the mental and physical aspects of psychological problems, allowing them to
provide a comprehensive approach to treatment. This medical background enables psychiatrists to
prescribe medications when necessary, distinguishing them from other mental health professionals
like psychologists or therapists.

The roots of psychiatry can be traced back to ancient civilizations. In ancient Egypt, Greece, and
Rome, mental illnesses were often attributed to supernatural causes or imbalances in bodily fluids.
Hippocrates, the Greek physician often referred to as the "Father of Medicine," was among the first
to argue that mental disorders had natural causes and should be treated as medical conditions.

During the Middle Ages in Europe, understanding of mental illness regressed, with many viewing it
as a form of demonic possession. This led to inhumane treatments and the isolation of those with
mental disorders. However, some Islamic scholars during this period maintained a more medical
approach to mental illness.

The modern era of psychiatry began to take shape in the late 18th and early 19th centuries. Philippe
Pinel, a French physician, is often credited with the "moral treatment" movement, which advocated
for more humane care of the mentally ill. He removed the chains from patients at the Bicêtre
Hospital in Paris, marking a significant shift in the treatment of mental disorders.

The 19th century saw the establishment of psychiatry as a medical specialty. In 1808, Johann
Christian Reil coined the term "psychiatry." This period also saw the rise of asylum-based care,
which, while often flawed, represented an attempt to provide dedicated treatment facilities for the
mentally ill.

The practice of psychiatry encompasses a broad spectrum of mental health conditions, including
mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, eating

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disorders, and substance abuse problems. Psychiatrists also deal with more severe and complex cases
that may require hospitalization or intensive outpatient care.

Neurosis V/S Psychosis:

Neurosis is a term that originated in the field of psychoanalysis and was widely used in psychology
and psychiatry throughout much of the 20th century. It refers to a class of mental health disorders
characterized by chronic distress, anxiety, and maladaptive behaviors, but without a loss of touch
with reality or a severe impairment in daily functioning.

Sigmund Freud, the father of psychoanalysis, proposed that neurosis resulted from repressed
unconscious conflicts, often of a sexual or aggressive nature. While many of Freud's specific theories
have been disputed, his general concept of unconscious conflicts contributing to psychological
distress remains influential.

Individuals experiencing neurosis typically maintain their ability to test reality and are often aware that
their thoughts or behaviors are problematic. The term encompasses a range of symptoms including
excessive worry, irrational fears, compulsive behaviors, mood swings, and mild depression. These
symptoms often stem from internal conflicts, unresolved past experiences, or maladaptive coping
mechanisms developed in response to stress or trauma.

The severity of neurotic symptoms can vary widely, from mild distress that doesn't significantly
impact daily life to more severe manifestations that can interfere with work, relationships, and
overall quality of life.

Treatment for neurotic symptoms typically involves:

1. Psychotherapy (e.g., Cognitive Behavioral Therapy, Psychodynamic Therapy)
2. Medication (e.g., antidepressants, anti-anxiety drugs)
3. Mindfulness and relaxation techniques
4. Lifestyle changes
5. Support groups
The approach is often multifaceted, tailored to the individual's specific symptoms and needs. While
the term "neurosis" is less used clinically today, its legacy continues to influence contemporary
psychology, psychiatry, and popular understanding of mental health.

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Psychosis:
Psychosis is a mental health condition that causes people to lose touch with reality. During an
episode of psychosis, a person's thoughts and perceptions become disrupted, making it difficult for
them to distinguish what is real from what is not. Psychosis is not a specific disorder itself, but rather
a symptom that can occur in various mental illnesses.

The main symptoms of psychosis include delusions and hallucinations. Delusions are false beliefs
that are not based in reality, such as thinking someone is plotting against them or that the TV is
sending them secret messages. Hallucinations are false perceptions, such as hearing, seeing,
smelling, or feeling something that does not actually exist.

There is no single cause of psychosis. It appears to result from a complex combination of genetic
factors, differences in brain development, and exposure to stressors or trauma. Psychosis is often a
symptom of mental illnesses such as schizophrenia, bipolar disorder, or severe depression.

Psychosis can also be triggered by the use of certain drugs, alcohol withdrawal, brain injuries, brain
infections, and neurological conditions like Parkinson's disease or Alzheimer's disease. In some cases,
a highly stressful or traumatic event can lead to a brief episode of psychosis.

Is neurosis and psychosis the same?

While neurosis and psychosis are both mental health conditions, they are distinct in several key
ways:
l Severity: Neurosis is a milder condition that does not involve a complete detachment from
reality. Psychosis, on the other hand, is more severe and can lead to a complete loss of touch
with reality.
l Symptoms: Neurosis is characterized by distressing but manageable symptoms like anxiety,
depression, and obsessive thoughts. Psychosis involves more severe symptoms like
hallucinations, delusions, and disorganized thinking.

l Reality Testing: In neurosis, reality testing remains intact and the individual can distinguish
between reality and fantasy. In psychosis, reality testing is impaired, leading to distorted
perceptions of reality.
l Causes: Neurosis is often related to unresolved conflicts, stress, or learned behaviors. Psychosis
is more commonly linked to biological factors like genetics and brain chemistry imbalances.

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l Treatment: Neurosis is typically treated with psychotherapy and sometimes medications.
Psychosis often requires antipsychotic medications, psychotherapy, and in severe cases,
hospitalization.

Neurosis may appear in conditions like generalized anxiety disorder, obsessive-compulsive disorder,
phobias, and post-traumatic stress disorder (PTSD). Psychosis is a common symptom in conditions
like schizophrenia, schizoaffective disorder, delusional disorder, bipolar disorder with psychotic
features, and severe depression.

Mental Disorders

Mental disorders are health conditions that involve significant changes in a person's thinking,
emotions, or behavior. They can cause distress and make it difficult for the individual to function in
their daily life, including social, work, or family activities. Mental disorders are common, with over
20% of adults experiencing a diagnosable mental illness in any given year. They can affect people of
any age, with half of all chronic mental illness beginning by age 14.

Mental health disorders can impair cognitive functions such as concentration, memory, problem-
solving, and decision-making. Conditions like depression and anxiety can lead to difficulties in these
areas, making it challenging to perform everyday tasks effectively.

Mental health influences emotional responses to daily experiences. Good mental health allows
individuals to manage stress, regulate emotions, and experience a range of feelings in a healthy
manner. Poor mental health, on the other hand, can lead to mood swings, intense anxiety, or
persistent sadness that can significantly impact everyday emotions and behavior.

Mental health plays a central role in an individual's overall quality of life. Poor mental health can
weaken one's sense of well-being and life satisfaction, making it harder to enjoy daily activities and
experiences.

There are many different types of mental disorders, including:

l Anxiety disorders, characterized by excessive fear and worry
l Mood disorders like depression and bipolar disorder
l Psychotic disorders such as schizophrenia
l Trauma-related disorders like PTSD
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l Substance use disorders involving alcohol or drugs
l Eating disorders like anorexia and bulimia
l Personality disorders affecting how a person thinks, feels, and behaves
l Neurodevelopmental disorders that emerge in childhood, such as ADHD and autism spectrum
disorder

The exact causes of mental disorders are often unclear, but they are believed to involve a
combination of factors:
l Genetic factors and differences in brain chemistry or structure
l Environmental stressors like trauma, abuse, or neglect
l Medical conditions affecting the brain, such as brain injuries or infections
l Substance use, including alcohol and recreational drugs
l Chronic medical conditions like diabetes or heart disease

Most mental disorders are treatable, often with a combination of medication, psychotherapy, and
social support. Effective treatments can help manage symptoms and improve quality of life for those
living with mental illness. However, many people with mental disorders do not receive adequate care
due to barriers like stigma, lack of access, or insufficient resources.

Mental disorders can have a significant impact on an individual's ability to function in their daily life.
Studies have shown that mood and anxiety disorders are associated with substantial levels of
disability, affecting social, emotional, and physical domains. Mood disorders tend to have the largest
impact on different areas of daily functioning, particularly social life.

Anxiety Disorders:
Anxiety disorders are a group of mental health conditions characterized by excessive fear, worry,
and apprehension that can interfere with daily life. They are among the most common mental health
issues, affecting millions of people worldwide. The symptoms can be debilitating and may manifest
in various forms, depending on the specific type of anxiety disorder.

Types of Anxiety Disorders

l Generalized Anxiety Disorder (GAD): This is characterized by persistent and excessive worry
about various aspects of life, such as work, health, and social interactions. Individuals with GAD

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 often find it difficult to control their anxiety and may experience physical symptoms like muscle
tension and fatigue.
l Panic Disorder: Individuals with panic disorder experience recurrent panic attacks, which are
sudden periods of intense fear that can include symptoms such as a racing heart, shortness of
breath, and feelings of impending doom. These attacks can occur unexpectedly and may lead to
a fear of future attacks.
l Social Anxiety Disorder (Social Phobia): This disorder involves an intense fear of social
situations, where individuals worry excessively about being judged or embarrassed. This can
lead to avoidance of social interactions, impacting personal and professional relationships.
l Specific Phobias: These are characterized by an intense, irrational fear of a specific object or
situation, such as heights, spiders, or flying. The fear experienced is disproportionate to the
actual danger posed by the object or situation.
l Agoraphobia: This involves a fear of being in situations where escape might be difficult, such
as crowded places or public transportation. Individuals may avoid leaving their homes or going
to places where they feel trapped.
l Separation Anxiety Disorder: While often associated with children, this disorder can also
affect adults. It involves excessive fear or anxiety about separation from attachment figures,
leading to significant distress.

The exact causes of anxiety disorders are not fully understood, but they are believed to result from a
combination of genetic, environmental, and psychological factors. Risk factors include:

l Genetics: A family history of anxiety disorders can increase the likelihood of developing one.
l Brain Chemistry: Imbalances in neurotransmitters may contribute to anxiety symptoms.
l Environmental Stressors: Traumatic events, prolonged stress, or significant life changes can
trigger anxiety disorders.
l Substance Use: Alcohol or drug misuse can exacerbate anxiety symptoms or lead to the
development of an anxiety disorder.

Effective treatment often includes a combination of psychotherapy, medication, and lifestyle

changes.
l Psychotherapy: Cognitive-behavioral therapy (CBT) is a common and effective form of
treatment that helps individuals identify and change negative thought patterns and behaviors
associated with anxiety.
l Medications: Antidepressants and anti-anxiety medications can help manage symptoms.
However, these medications are typically used in conjunction with therapy for best results.
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l Lifestyle Changes: Regular exercise, mindfulness practices, and stress management techniques
can also be beneficial in managing anxiety symptoms.

Mood disorders:
Mood disorders, also known as affective disorders, are a group of mental health conditions
characterized by significant disturbances in a person's mood, leading to persistent emotional states of
sadness, elation, or irritability. These disorders can significantly impact an individual's ability to
function normally in various aspects of life, including social interactions, work, and daily activities.

Types of Mood Disorders

The main types of mood disorders include:
1. Depressive disorders:
l Major depressive disorder (clinical depression)
l Persistent depressive disorder (dysthymia)
l Seasonal affective disorder (SAD)
l Disruptive mood dysregulation disorder (DMDD)
l Premenstrual dysphoric disorder (PMDD)
l Postpartum depression
2. Bipolar disorders:
l Bipolar I disorder
l Bipolar II disorder
l Cyclothymic disorder
3. Other mood disorders:
l Mood disorder due to a general medical condition
l Substance-induced mood disorder

The symptoms of mood disorders can vary depending on the specific type and severity of the
condition. However, some common symptoms include: l Persistent feelings of sadness,
emptiness, or hopelessness
l Loss of interest in activities once enjoyed
l Changes in appetite and sleep patterns
l Fatigue and lack of energy
l Feelings of worthlessness or excessive guilt
l Difficulty concentrating or making decisions
l Recurrent thoughts of death or suicide
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l Periods of elevated mood, increased energy, and impulsivity (in bipolar disorders)

The exact causes of mood disorders are not fully understood, but they are believed to involve a
combination of genetic, biological, environmental, and psychological factors. Risk factors may
include:
l Family history of mood disorders
l Brain chemistry imbalances
l Stressful life events or trauma
l Chronic medical conditions
l Substance abuse

Mood disorders are treatable, and effective treatment often involves a combination of psychotherapy,
medication, and lifestyle changes. Some common treatment approaches include:
l Cognitive-behavioral therapy (CBT)
l Interpersonal therapy
l Antidepressants, mood stabilizers, and other medications
l Regular exercise, stress management, and healthy lifestyle habits

Psychotic Disorders:
Psychotic disorders are a group of serious mental illnesses that cause people to lose touch with
reality. They are characterized by symptoms like delusions, hallucinations, disorganized thinking and
speech, and abnormal behavior.
The main types of psychotic disorders include:
l Schizophrenia: Causes changes in behavior and symptoms like delusions and hallucinations
that last longer than 6 months
l Schizoaffective disorder: Involves symptoms of both schizophrenia and a mood disorder
l Delusional disorder: Characterized by delusions but no other psychotic symptoms
l Brief psychotic disorder: Involves a sudden, short period of psychotic behavior, often triggered
by a stressful event

The core symptoms of psychotic disorders are hallucinations and delusions:

l Hallucinations are false perceptions, such as hearing, seeing, smelling, tasting, or feeling
something that does not actually exist

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l Delusions are false beliefs that persist even when shown to be untrue, such as thinking someone
is plotting against you or that the TV is sending secret messages Other common symptoms
include:
l Disorganized thinking and speech
l Confused thinking
l Strange, possibly dangerous behavior
l Lack of motivation
l Mood disturbances
l Social withdrawal
l Neglected personal hygiene

Psychotic disorders are treatable, often with a combination of medication and psychotherapy:
l Antipsychotic medications help control symptoms like hallucinations and delusions
l Cognitive behavioral therapy (CBT) can help change distorted thought patterns
l Family therapy and social skills training provide support and coping strategies l
Hospitalization may be needed in severe cases to ensure safety

Eating Disorders:
Eating disorders are serious mental illnesses characterized by abnormal eating behaviors that
negatively impact a person's physical and mental health. These disorders involve disturbances in
eating habits or weight-control behaviors, often accompanied by intense preoccupation with body
shape and weight.

The most common types of eating disorders include:

1. Anorexia Nervosa: Characterized by self-starvation, intense fear of weight gain, and distorted
body image, leading to significantly low body weight.
2. Bulimia Nervosa: Involves recurrent episodes of binge eating followed by compensatory
behaviors like purging, fasting, or excessive exercise to prevent weight gain.
3. Binge Eating Disorder (BED): Characterized by recurrent episodes of eating large quantities of
food in a short period, often when not physically hungry, without compensatory behaviors.
4. Avoidant/Restrictive Food Intake Disorder (ARFID): Involves a persistent failure to meet
appropriate nutritional and/or energy needs, not due to lack of food availability, a culturally
sanctioned practice, or other medical conditions or mental disorders.

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Eating disorders can have severe physical, psychological, and social consequences. Symptoms may
include:
l Preoccupation with food, weight, or shape
l Distorted body image
l Restrictive eating or avoidance of certain foods
l Binge eating
l Purging behaviors like vomiting or laxative misuse
l Compulsive exercise
l Mood disturbances
l Social withdrawal
Long-term effects can include malnutrition, electrolyte imbalances, heart problems, osteoporosis, and
even death.

The exact causes of eating disorders are not fully understood, but they likely involve a combination
of genetic, biological, psychological, and sociocultural factors. Risk factors may include:
l Family history and genetics
l Trauma or stressful life events
l Certain personality traits like perfectionism
l Societal pressures and idealization of thinness
l Coexisting mental health conditions like depression or anxiety

Eating disorders are treatable, and recovery is possible with proper medical care and support.
Treatment often involves a combination of:
l Psychotherapy, such as cognitive-behavioral therapy (CBT)
l Nutritional counseling and meal planning
l Medication, when appropriate
l Family therapy
l Inpatient or outpatient treatment, depending on the severity

Personality Disorders:
Personality disorders are a class of mental disorders characterized by enduring maladaptive patterns
of behavior, cognition, and inner experience that deviate from cultural norms and cause significant
distress or impairment in functioning. They involve long-lasting, disruptive patterns of thinking,
behavior, mood and relating to others.

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There are 10 specific types of personality disorders, grouped into three main clusters based on
descriptive similarities:
Cluster A (odd or eccentric disorders)
l Paranoid personality disorder
l Schizoid personality disorder
l Schizotypal personality disorder
Cluster B (dramatic, emotional or erratic disorders)
l Antisocial personality disorder
l Borderline personality disorder
l Histrionic personality disorder
l Narcissistic personality disorder
Cluster C (anxious or fearful disorders)
l Avoidant personality disorder
l Dependent personality disorder
l Obsessive-compulsive personality disorder

Personality disorders usually begin in the teen years or early adulthood and are influenced by a
combination of genetic, biological, and environmental factors like abuse or trauma. Symptoms vary
by disorder but often involve problems with self-perception, emotional regulation, interpersonal
functioning, and impulse control.

Personality disorders are diagnosed by mental health professionals based on long-term patterns of
functioning and symptoms. Treatment typically involves psychotherapy, especially
cognitivebehavioral and dialectical behavior therapy, to help the individual gain insight, manage
symptoms, and improve relationships and functioning.

While personality disorders are relatively common, affecting around 9% of adults, many people with
these conditions do not recognize their behaviors as problematic or seek treatment on their own.
However, with proper diagnosis and care, those with personality disorders can learn to manage their
symptoms and live fulfilling lives.

Trauma-related Disorders:
Trauma-related disorders are mental health conditions that develop in response to experiencing or
witnessing traumatic events. These disorders can significantly impact an individual's emotional and
psychological well-being, leading to various symptoms that disrupt daily life.
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Types of Trauma-Related Disorders
The main trauma-related disorders recognized in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) include:
1. Post-Traumatic Stress Disorder (PTSD): This disorder can develop after experiencing or
witnessing a traumatic event. Symptoms include flashbacks, nightmares, severe anxiety, and
uncontrollable thoughts about the event.
2. Acute Stress Disorder (ASD): Similar to PTSD, ASD occurs in the aftermath of a traumatic
event but lasts for a shorter duration, typically from three days to one month. Symptoms include
intrusive memories, dissociation, and avoidance of reminders of the trauma.
3. Adjustment Disorder: This disorder involves difficulty coping with a significant life change or
stressor, such as a divorce or job loss. Symptoms can include anxiety, depression, and behavioral
issues that arise shortly after the event.
4. Reactive Attachment Disorder (RAD): This disorder primarily affects children who have
experienced severe neglect or disruption in their early attachment relationships. Symptoms
include difficulty forming emotional bonds and inappropriate social behaviors.

5. Disinhibited Social Engagement Disorder (DSED): Also seen in children, DSED is

characterized by overly familiar behavior with strangers and a lack of reticence in approaching
unfamiliar adults.
6. Unspecified Trauma- and Stressor-Related Disorder: This category is used when symptoms
of a trauma-related disorder are present but do not meet the full criteria for any specific disorder.

Common symptoms across trauma-related disorders include:

l Intrusive thoughts or memories of the traumatic event
l Flashbacks or nightmares
l Avoidance of reminders of the trauma
l Heightened arousal, such as difficulty sleeping or concentrating
l Emotional numbness or detachment
l Irritability or anger outbursts
l Anxiety and depression

Trauma-related disorders can arise from various traumatic experiences, including:

l Physical or sexual abuse
l Natural disasters
l Combat exposure
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l Serious accidents
l Sudden loss of a loved one
Certain factors can increase the risk of developing a trauma-related disorder, such as having a history
of mental health issues, lack of social support, or experiencing multiple traumatic events.

Treatment for trauma-related disorders typically includes psychotherapy and, in some cases,
medication. Effective therapeutic approaches may include:
l Cognitive Behavioral Therapy (CBT): Helps individuals process trauma and change negative
thought patterns.
l Eye Movement Desensitization and Reprocessing (EMDR): A specialized therapy that helps
individuals process and integrate traumatic memories.
l Supportive therapy: Provides emotional support and coping strategies.

Substance Use Disorder:

Substance use disorder (SUD) is a medical condition characterized by an individual's inability to
control their use of substances, such as drugs or alcohol, despite facing significant negative
consequences. This disorder can manifest in various ways, impacting a person's daily life,
relationships, and overall health.
The symptoms of SUD can be grouped into four main categories:
l Impaired Control: This includes taking larger amounts of the substance than intended,
unsuccessful attempts to cut down or control use, and experiencing cravings or strong urges to
use the substance.
l Social Problems: Individuals may fail to fulfill major obligations at work, school, or home due
to substance use. They may also continue using substances despite having interpersonal or social
problems caused or worsened by their use.
l Risky Use: This involves using substances in dangerous situations, such as driving under the
influence, and continuing use despite knowing it causes physical or psychological problems.
l Drug Effects: Symptoms include developing tolerance (needing more of the substance to achieve
the same effect) and experiencing withdrawal symptoms when not using the substance.

The development of substance use disorder is influenced by a combination of genetic, environmental,

and psychological factors. Risk factors include:
l Family history of substance abuse

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l Early initiation of substance use
l Mental health disorders
l High levels of stress or trauma
l Social and environmental influences, such as peer pressure

Effective treatment for substance use disorder often involves a combination of approaches, including:
l Psychotherapy: Cognitive-behavioral therapy (CBT) and other therapeutic modalities can help
individuals understand their behaviors and develop coping strategies.
l Medication: Certain medications can help manage withdrawal symptoms, reduce cravings, and
prevent relapse.
l Support Groups: Participation in support groups, such as Alcoholics Anonymous (AA) or
Narcotics Anonymous (NA), can provide ongoing support and encouragement.
l Detoxification: In some cases, medically supervised detoxification may be necessary to safely
manage withdrawal symptoms.

Neurodevelopmental Disorders:
Neurodevelopmental disorders are a group of conditions that affect the development and functioning
of the nervous system, particularly the brain and spinal cord. These disorders typically manifest in
early childhood, often before a child starts school, and can persist into adulthood. They are
characterized by significant impairments in personal, social, academic, or occupational functioning.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
neurodevelopmental disorders are classified into several categories:
1. Intellectual Disability: This involves deficits in general mental abilities that impair adaptive
functioning in daily life.
2. Communication Disorders: These include difficulties in speech and language, affecting the
ability to communicate effectively.
3. Autism Spectrum Disorder (ASD): A complex disorder characterized by challenges in social
interaction, communication, and repetitive behaviors.
4. Attention-Deficit/Hyperactivity Disorder (ADHD): Marked by persistent patterns of
inattention and/or hyperactivity-impulsivity that interfere with functioning or development.
5. Neurodevelopmental Motor Disorders: These include conditions like developmental
coordination disorder and tic disorders, affecting motor skills and coordination.
6. Specific Learning Disorders: These involve difficulties in learning and using academic skills,
such as reading, writing, or mathematics.
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Symptoms of neurodevelopmental disorders can vary widely but may include:
l Problems with language and speech
l Impaired motor skills
l Abnormal behaviors and social skills deficits
l Difficulties with learning and memory
l Poor emotional regulation

The exact causes of neurodevelopmental disorders are not fully understood, but they are believed to
result from a combination of genetic, environmental, and biological factors. Potential risk factors
include:
l Prenatal exposure to toxins, drugs, or alcohol
l Low birth weight
l Complications during pregnancy or birth
l Genetic predispositions

While neurodevelopmental disorders are often lifelong conditions, various interventions can help
manage symptoms and improve functioning. Treatment options may include:
l Behavioral therapies to address specific challenges
l Educational support and individualized learning plans
l Medication to manage symptoms, particularly in ADHD
l Occupational and speech therapy to improve communication and motor skills

Early diagnosis and intervention are crucial for improving outcomes for individuals with
neurodevelopmental disorders, allowing them to develop skills and strategies to navigate their
challenges effectively.

PSYCHOTHERAPY

Psychotherapy, often referred to as "talk therapy," is a treatment method for mental health issues that
involves structured conversations between a trained therapist and a patient. The primary aim of
psychotherapy is to help individuals understand and manage their thoughts, emotions, and behaviors,
ultimately improving their mental well-being and quality of life. Throughout history, individuals

21
have sought the guidance of trusted confidants, religious leaders, and healers to address emotional
and mental distress.

Some of the earliest documented evidence of therapeutic practices can be found in ancient Egyptian,
Greek, and Roman civilizations. For example, Sigmund Freud's psychoanalytic theory was
influenced by the ancient Greek concept of catharsis, which involved the purging of emotions
through storytelling and dramatic performances.

The Development of Psychotherapy as a Discipline:

While informal therapeutic practices have existed for centuries, psychotherapy emerged as a formal
discipline in the late 19th century. The origins of modern psychotherapy can be traced back to the
work of several key figures:
1. Sigmund Freud (1856-1939): Freud developed the first comprehensive system of psychotherapy,
known as psychoanalysis. He believed that mental disorders were caused by unconscious
conflicts and that bringing these conflicts into consciousness could alleviate symptoms.
2. Alfred Adler (1870-1937) and Carl Jung (1875-1961): Adler and Jung were early followers of
Freud but later developed their own theories, known as individual psychology and analytical
psychology, respectively.
3. Wilhelm Reich (1897-1957): Reich began developing body psychotherapy in the 1930s,
focusing on the connection between physical and emotional experiences.
4. Aaron Beck (1921-2021): Beck developed cognitive therapy in the 1960s, which focused on
changing negative thought patterns to improve mood and behavior.
5. Albert Ellis (1913-2007): Ellis developed rational emotive behavior therapy (REBT) in the
1950s, which emphasized the role of irrational beliefs in emotional distress.

Over the past century, psychotherapy has continued to evolve and diversify. Some key developments
include:
l The emergence of various schools of thought, such as psychodynamic, humanistic, behavioral,
and cognitive-behavioral therapies.
l The integration of psychotherapy with other fields, such as medicine, social work, and
education.
l The increasing emphasis on empirical research and evidence-based practices to support the
effectiveness of psychotherapy.

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l The development of new techniques and modalities, such as mindfulness-based therapies,
acceptance and commitment therapy, and eye movement desensitization and reprocessing
(EMDR).

Today, psychotherapy is practiced by a wide range of mental health professionals, including

psychologists, psychiatrists, social workers, and counselors. It is an effective treatment for a variety
of mental health conditions, including depression, anxiety, trauma, and relationship issues.

Some of the most common types of psychotherapy are:

1. Cognitive Behavioral Therapy (CBT)
CBT is a widely used, goal-oriented therapy that focuses on the relationship between thoughts,
feelings, and behaviors. It helps individuals identify and change negative thought patterns that
contribute to emotional distress and maladaptive behaviors. CBT is effective for treating anxiety
disorders, depression, phobias, and addiction. Sessions often include homework assignments to
reinforce learning and practice new skills.

2. Psychodynamic Therapy
Rooted in the theories of Sigmund Freud, psychodynamic therapy explores how unconscious
thoughts and childhood experiences influence current behavior and emotions. This approach
emphasizes self-reflection and self-examination, helping individuals understand their internal
conflicts and emotional struggles. It can be beneficial for those dealing with unresolved issues from
the past, relationship problems, and emotional difficulties.

3. Dialectical Behavior Therapy (DBT)

DBT is a specialized form of cognitive-behavioral therapy designed to help individuals with
emotional regulation and interpersonal effectiveness. It is particularly effective for those with
borderline personality disorder and includes both individual therapy and group skills training. DBT
focuses on teaching skills for managing intense emotions, improving relationships, and reducing
selfdestructive behaviors.

4. Humanistic Therapy
Humanistic therapy emphasizes personal growth and self-actualization. It focuses on the individual's
capacity for self-awareness and personal development. Techniques include client-centered therapy,
where the therapist provides a supportive and non-judgmental environment, and Gestalt therapy,
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which emphasizes present-moment awareness and emotional expression. This approach is often used
for individuals dealing with low self-esteem, anxiety, and depression.

6. Interpersonal Therapy (IPT)

IPT is a time-limited therapy that focuses on improving interpersonal relationships and social
functioning to alleviate symptoms of depression and anxiety. It addresses issues such as grief, role
disputes, and social isolation. By enhancing communication skills and exploring relationship
dynamics, IPT helps individuals develop healthier connections with others.

6. Behavioral Therapy
Behavioral therapy focuses on modifying specific behaviors that contribute to psychological distress.
Techniques may include reinforcement, exposure therapy, and desensitization. This approach is
particularly effective for treating phobias, obsessive-compulsive disorder (OCD), and other anxiety
related conditions.

7. Family Therapy
Family therapy involves working with families to improve communication and resolve conflicts. It
addresses issues that affect the family unit, such as mental illness, addiction, and relationship
problems. By involving multiple family members, this approach fosters understanding and support
within the family system.

8. Group Therapy
In group therapy, individuals meet with a therapist and other participants to discuss their experiences
and challenges. This format provides support, encouragement, and feedback from peers facing
similar issues. Group therapy can be particularly effective for those dealing with addiction, trauma,
and social anxiety.

24
 Case no: 1

SOCIO DEMOGRAPHIC DATA

1. Name– Mrs. R.D.S

2. Age – 35-year-old
3. Gender- female
4. Education- Diploma in Nursing
5. Marital Status- Married
6. Occupation- Nurse
7. Socioeconomic Status- Lower Middle class
8. Informant-Husband

9. PRESENTING COMPLAINTS:

• Decreased sleep
• Decreased appetite
• Low mood
• Negative thoughts
• Decreased interest in work duration: 1 month (increased- 1week)
• Sweating, palpitation and fatigue
• Wandering behavior
• Mood disturbances
• Feeling of insecurity
• Anger and irritable.

History of present illness (HOPI):

Duration: since past 1 month.
The patient R.D.S was doing well until 1month back. From the past one month the patient started
feeling insecure, low mood, loss of energy and not able to work and started experiencing sweating,
palpitations and fatigue. The patient also reported she cannot sit at one place for a long time, and she
feels like wandering around when she experiences disturbed mood. The patient is said to be angrier
and the symptoms have worsened from past one week as reported by the husband (informant).

Stressor: Nil
Treatment history:
• Venlafaxine 37.5mg
• Lorazepam 2mg

Negative history: None

Past history:
Past psychiatric history: consulted in BBMP hospital on 06/08/2019and under medication for
depression and Anxiety.

25
Family history:

Details of family functioning: Nuclear family

Social support: Family

History of illness in the family: none

Personal History:
l Birth and development- Normal
l Antenatal period- Unknown
l Birth history- Normal
l Postnatal history- Normal
l Physical health during infancy- Normal
l Immunization schedule- Taken on time
l Developmental milestones- Normal
l Motor- Normal
l Adaptive- Unknown
l Speech- Normal
l Childhood health- Normal

26
Behavioral-
(Nail biting, enuresis, sleepwalking): None
• Emotional problems (temper tantrums, stammering): anger outbursts.
• Home atmosphere during childhood: none
• Emotional problems in adolescence: none
• Home atmospheres during adolescence: good

Educational history: Unlettered.

Occupational history:
Present Job: nurse
Job satisfaction- Not satisfied at work since 1 month

Premorbid personality:
(1) Social relations: Normal
(2) Intellectual activities: Normal
(3) Mood: Calm
(4) Character: Good
(5) Attitude to work and responsibility: Normal
(6) Interpersonal relationships: Normal
(7) Energy and initiative: Less active
IMPRESSION: Premorbidly well adjusted

Habits:
l Food pattern: 3 meals a day
l Sleeping pattern: decreased sleep
l Excretory function: normal
l Alcohol Consumption- NO
l Tobacco consumption- NO
l Opium consumption- NO

Mental Status Examination (MSE):

1. General Behavior: Normal gait, adequate eye contact and normal behavioral functioning.
2. Psychomotor Activity: normal
3. Talk: Relevant, Spontaneous speech with normal tone, pitch and rate.
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4. Thought: obsession under thought possession and depressive cognitions under thought content
present , no disturbances found in thought stream and thought form.
5. Mood: subjective:disturbed and anxious
6. Perception: No hallucinations, delusions.
7. Cognitive Functions:
8. Attention and concentration: Normal.
9. Orientation: Well oriented.
10. Memory: Immediate, recent and remote memory reported to be normal.
11. General Information: Adequate knowledge of general information.
12. Intelligence: Average.
13. Abstractibility: Average.
14. Judgement: Sound judgment about personal, social and test situations.
15. Insight: Level V, fully present.

Final Diagnosis: Mixed anxiety and Depressive disorder.

Case no: 2

Name– Mr. N.A

Age and Gender- 27-year-old male
Education- Unlettered
Marital Status- Unmarried
Occupation- None
Socioeconomic Status- Lower Middle class
Informant- Self

Presenting complaints:
l Sleep Attacks: Acute onset and episodic course
l Irritability: Acute onset and continuous course.
l Lability in Mood: Acute onset and continuous course.
l Guilty: Gradual Onset and episodic course.
l Aggressive Behaviour: Acute Onset.

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History of present illness:
The client reported that the sleep attacks first occurred one month ago, and he is unable to resist
them. He stated that he had requested to see the psychiatrist and irrespective of the decrease in
dosage, he is unable to resist the sleep attacks. The client stated that he experiences irritation
occasionally and has experienced this over the past one month. He said that he attempts to control his
irritation by lying down but fails to control the feelings. Furthermore, he stated that his mood ranges
in extremes. He experiences intense mood swings that last for a couple of minutes and fade away.
However, he said that the mood swings occur repetitively. Also, the client reported that he felt guilty
of his actions and was constantly reminded of the harm he has done to himself and his family. He
mentioned that his feelings of guilt had intensified over the past week. Lastly, the client stated that he
had aggressive tendencies and aggressive behavior that he had experienced lately.

Stressors: Nil

Past History:

The client had no major medical pattern reported. However, the client reported multiple substance
abuse including cannabis and benzodiazepines. He stated that he started consuming cannabis in
2012 and had been admitted to the facility of CARE for the fifth time now. His first admission to
the facility was in 2012 wherein he stayed here for a period of 3 months. The second admission
was in the year 2013 lasting for 3 months. Similarly, he was admitted to the facility in 2016 and
2017 for a period of 3 months respectively.

He stated that he consumed cannabis as he had difficulty in falling asleep. The client reported that
he was caught by the police having cannabis in possession.

Furthermore, he had been involved in various physically abusive fights with strangers that
resulted in the client being jailed four times in the past. The client reported that he did not
experience any withdrawal symptoms over the past few years. He stated that environmental
factors such as the places where he would consume cannabis and peers were the major causes
for relapse. He was unable to resist the craving of the drugs when he was with his peers.

Family history:

29
Details of family functioning:

The client reported that he is very close to his family which includes his father, mother and a
younger sister. He stayed with his family and was not majorly involved in the decisions made.
His sister is married, and his mother takes care of the house. He reported that there was no
family history of substance abuse or medical illness. He stated that his father was the leader of
the family, and the client would help him in the business occasionally.

History of illness in family: Nil Personal

history:

l Birth and development- Normal

l Antenatal period- Unknown
l Birth history- Normal
l Postnatal history- Normal
l Physical health during infancy- Normal
l Immunization schedule- Taken on time
l Developmental milestones- Normal
l Motor- Normal
l Adaptive- Unknown
l Speech- Normal
l Childhood health- Normal

Behavioral-
(Nail biting, enuresis, sleepwalking): None
• Emotional problems (temper tantrums, stammering): None
• Home atmosphere during childhood: Unknown
• Emotional problems in adolescence: Unknown
• Home atmospheres during adolescence: Unknown

30
Educational history: Unlettered.

Occupational history: Nil

Premorbid personality:
1. Social relations: Emotionally cold, Negative attitude towards self and others
2. Intellectual activities: Normal
3. Mood: Irritable mood swings, unable to express feelings
4. Character: Good
5. Attitude to work and responsibility: Normal
6. Interpersonal relationships: Not good
7. Energy and initiative: Less active

Habits:
l Food pattern: 3 meals a day
l Sleeping pattern: More than 12 hrs. of sleep
l Excretory function: normal
l Alcohol Consumption- YES
l Tobacco consumption- NO
l Opium consumption- NO
l Cannabis consumption-YES

Mental Status Examination (MSE):

16. General Behavior: Normal gait, adequate eye contact and normal behavioral functioning.
17. Psychomotor Activity: Below Average level of activity.
18. Talk: Relevant, Spontaneous speech with normal tone, pitch and rate.
19. Thought: Normal stream and form, no possession/ abnormal content.
20. Mood: Euthymic as observed; occasional irritability and lability of mood as reported.
21. Perception: No hallucinations, delusions.
22. Cognitive Functions:
23. Attention and concentration: Normal.
24. Orientation: Well oriented.
25. Memory: Immediate, recent and remote memory reported to be normal.
26. General Information: Adequate knowledge of general information.
31
27. Intelligence: Average.
28. Abstractibility: Average.
29. Judgement: Sound judgment about personal, social and test situations.
30. Insight: Level V, fully present.

Final Diagnosis: The client has psychoactive substance use disorder. No other past/family history of
physical/psychological disorders present. This reflects a diagnosis of F12. F1x.21 - Mental and
Behavioral disorders due to use of Cannabinoids as per the ICD 10.

32
 Internship Experience

Before embarking on my internship, I set two primary learning objectives: to deepen my understanding
of clinical psychology and to build confidence in my professional abilities. While the experience was
not as hands-on as I had initially expected, it turned out to be an incredibly enriching learning
opportunity, and I truly appreciated the time I spent in the hospital setting. I gained valuable insights
into what a career in clinical psychology entails, recognizing how distinct it is from other professional
environments, particularly in terms of the stringent confidentiality requirements, especially when
working with children.

I believe I successfully met my second goal of fostering independence and taking on greater
responsibility. I made a conscious effort to maintain professionalism in all my interactions and sought
to resolve challenges independently before reaching out for clarification.

This internship provided me with invaluable experience that has significantly shaped my perspective
and enhanced my skill set. The advanced practical exposure I received was instrumental in helping me
grasp the professional standards and approaches within the field.

Overall, this experience has been not only beneficial but also realistic and practical, equipping me with
a wealth of applied knowledge regarding psychological disorders, their interventions, and diagnostic
processes. I am especially thankful for the guidance and support of my mentors, the staffs and
psychiatrists who played an important role in providing this learning experience.

33