CASE STUDIES

Submitted to the University of Madras

In partial fulfillment of the requirements for

the award of the degree

BACHELOR OF SCIENCE IN PSYCHOLOGY

MUTHUKUMAR. M

BSC-14-17

Under the Supervision of

Dr. KALYANI KENNETH

Head of the department

MADRAS SCHOOL OF SOCIAL WORK (AUTONOMOUS)

DEPARTMENT OF COUNSELLING PSYCHOLOGY

CHENNAI – 600 008

OCTOBER 2016

1
 CERTIFICATE-1

This is to certify that Case study -1 is a bonafide work done by Muthu

kumar, at DIRECT ,Egmore, Chennai –08, towards the partial fulfillment of the

requirements of B.Sc degree in Psychology during the academic year

2015 – 2008.

Date : Director,

Place : Chennai DIRECT,

Egmore.

2
 CERTIFICATE-2

This is to certify that Case study -1 is a bonafide work done by Muthu

kumar, at AARIT Recovery centre, towards the partial fulfillment of the

requirements of B.Sc degree in Psychology during the academic year

2015 – 2008.

Date : Director,

Place : Chennai AARIT,

Athipet.

3
 CERTIFICATE-3

This is to certify that Case study -1 is a bonafide work done by Muthu

kumar, at AAHSIANA hospital, anna nagar, Chennai –10, towards the partial

fulfillment of the requirements of B.Sc degree in Psychology during the

academic year

2015 – 2008.

Date : Director,

Place : Chennai Aashina hospital,

Anna nagar .

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 ACKNOWLEDGEMENT

I wish to express my sincere and profound sense of gratitude to

dr. Sarayana Anil, head of DIRECT, Dr. Sharath Varma, head of AARIT , Athipet,

Chennai and Dr. Sujai, head of AASHIANA, for her permission and

encouragement during my case study Period.

My sincere thanks to Dr. KALYANI KENNETH, for her support and

guidance during my case study period.

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TABLE OF CONTENTS

SL.No Topics Page No.

I Case Study-1 7

II Case Study-2 32

III Case Study-3 50

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CASE STUDY-1

7
PREAMBLE

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CHILDHOOD

Childhood is the age span ranging from birth to adolescence. According

to Piaget's theory of cognitive development, childhood consists of two stages:
preoperational stage and concrete operational stage. In developmental psychology,
childhood is divided up into the developmental stages of toddlerhood (learning to
walk), early childhood (play age), middle childhood (school age), and adolescence
(puberty through post-puberty). Various childhood factors could affect a person's
attitude formation.

EARLY CHILDHOOD

Early childhood follows the infancy stage and begins with toddlerhood when
the child begins speaking or taking steps independently. While toddlerhood ends
around age three when the child becomes less dependent on parental assistance for
basic needs, early childhood continues approximately through years seven or eight.
According to the National Association for the Education of Young Children, early
childhood spans the human life from birth to age eight. At this stage children are
learning through observing, experimenting and communicating with others. Adults
supervise and support the development process of the child, which then will lead to
the child's autonomy. Also during this stage, a strong emotional bond is created
between the child and the care providers. The children also start to begin kindergarten
at this age to start their social lives.

MIDDLE CHILDHOOD

Middle childhood begins at around age seven or eight, approximating primary

school age. It ends around puberty, which typically marks the beginning of
adolescence. In this period, children are attending school, thus developing socially

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and mentally. They are at a stage where they make new friends and gain new skills,
which will enable them to become more independent and enhance their individuality.

In psychology the term, early childhood is usually defined as the time period
from the age of two until the age of six or seven years.

DIRECT

DIRECT is a centre for child development. It was founded in 2002 with the
aim of bringing change to the field of disabilities in India. Since 2010, DIRECT as an
institute has been applying cognitive training techniques as a tool to help improve
memory, attention, perception, reasoning, planning, judgment general learning, and
overall executive functioning within the pediatric population.

Currently the organization offers diagnostics, therapies, research and training

within a clinical set-up. Cognitive and neurodevelopmental training, speech therapy,
expressive art therapy, special education and behavioural therapies, are provided to
address the developmental and clinical needs of children who would require therapy
for any of the following pediatric conditions:

• Neurological (Autism, Mental Retardation, etc.)

• Developmental (Downs Syndrome, Genetic disorders, etc.)
• Behavioral disturbances (ADHD, etc.)
• Learning disabilities (Dyslexia, Dysgraphia, etc.)
• Physical challenges (Cerebral Palsy, etc.)
• Childhood psychiatric disorders (Conduct disorder, Oppositional
Defiant disorder, Social-emotional disorders (Low self-esteem, Panic
disorder, Selective mutism, etc.)
• Communication disorders (Autism, Stuttering, etc.)

The organization uses an evidence-based method, to rehabilitate the child by

providing appropriate and focused therapies in a natural and enriching environment.
The organization is dedicated to improving the lives of children with challenges and
their families through clinically-linked and applied pediatric rehabilitation research.
The long-term hope is to bring together a transdisciplinary team of professionals
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who will become successful and contributing members to the future of disabilities and
in the field of diagnostics, assessments, intervention and research.

MISSION:

A unique transdisciplinary model providing quality child healthcare through

clinically linked and applied paediatric research.


VISION:

An organization dedicated to improving the health of children and to build an

inclusive community where all children and youth have equal opportunities to
succeed.

VALUES:

• The child and their therapeutic goals are of utmost importance

• The family as an integral part of a child's life
• Professional partnerships and working in tandem
• Employing qualified personnel
• Responsibility and accountability
• Integrity and commitment to the profession
• Open and honest communication
• Participation, growth and excellence
• Professionalism
• The equality and dignity of all people
• Inclusion. Child information

SPEECH SOUND DISORDER

Speech sound disorders is an umbrella term referring to any combination of

difficulties with perception, motor production, and/or the phonological representation
of speech sounds and speech segments (including phonotactic rules that govern
syllable shape, structure, and stress, as well as prosody) that impact speech
intelligibility.

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 Speech sound disorders can impact the form of speech sounds or the function
of speech sounds within a language. Disorders that impact the form of speech sounds
are traditionally referred to as articulation disorders and are associated with structural
(e.g., cleft palate) and motor-based difficulties (e.g., apraxia). Speech sound disorders
that impact the way speech sounds (phonemes) function within a language are
traditionally referred to as phonological disorders; they result from impairments in the
phonological representation of speech sounds and speech segments—the system that
generates and uses phonemes and phoneme rules and patterns within the context of
spoken language. The process of perceiving and manipulating speech sounds is
essential for developing these phonological representations.

Diagnostic Criteria

1. Persistent difficulty with speech sound production that interferes with speech
intelligibility or prevents verbal communication of messages.
2. The disturbance causes limitations in effective communication that interfere
with social participation, academic achievement, or occupational performance,
individually or in any combination.
3. Onset of symptoms is in the early developmental period.
4. The difficulties are not attributable tocongenital or acquired conditions, such
as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury,
or other medical or neurological conditions.

Diagnostic Features

Speech sound production describes the clear articulation of the phonemes (i.e.,
individual sounds) that in combination make up spoken words. Speech sound
production requires both the phonological knowledge of speech sounds and the ability
to coordinate the movements of the articulators (i.e., the jaw, tongue, and lips,) with
breathing and vocalizing for speech. Children with speech production difficulties may
experience difficulty with phonological knowledge of speech sounds or the ability to
coordinate movements for speech in varying degrees. Speech sound disorder is thus
heterogeneous in its underlying mechanisms and includes phonological disorder and
articulation disorder. A speech sound disorder is diagnosed when speech sound
production is not what would be expected based on the child's age and developmental

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stage and when the deficits are not the result of a physical, structural, neurological, or
hearing impairment. Among typically developing children at age 4 years, overall
speech should be intelligible, whereas at age 2 years, only 50% may be
understandable.

Differential Diagnosis

Normal variations in speech. Regional, social, or cultural/ethnic variations of speech

should be considered before making the diagnosis.

Hearing or other sensory impairment. Hearing impairment or deafness may result

in abnormalities of speech. Deficits of speech sound production may be associated
with a hearing impairment, other sensory deficit, or a speech-motor deficit. When
speech deficits are in excess of those usually associated with these problems, a
diagnosis of speech sound disorder may be made.

Structural deficits: Speech impairment may be due to structural deficits (e.g., cleft
palate). Dysarthria. Speech impairment may be attributable to a motor disorder, such
as cerebral palsy. Neurological signs, as well as distinctive features of voice,
differentiate dysarthria from speech sound disorder, although in young children
(under 3 years) differentiation may be difficult, particularly when there is no or
minimal general body motor involvement (as in, e.g., Worster-Drought syndrome).

Selective mutism: Limited use of speech may be a sign of selective mutism, an

anxiety disorder that is characterized by a lack of speech in one or more contexts or
settings. Selective mutism may develop in children with a speech disorder because of
embarrassment about their impairments, but many children with selective mutism
exhibit normal speech in "safe" settings, such as at home or with close friends.

Signs and symptoms.

 omissions/deletions—certain sounds are not produced but omitted or deleted

(e.g., "cu" for "cup" and "poon" for "spoon");
 substitutions—one or more sounds are substituted, which may result in loss of
phonemic contrast (e.g., "dood" for "good" and "wabbit" for "rabbit");

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  additions—one or more extra sounds are added or inserted into a word (e.g.,
"buhlack" for "black");
 distortions—sounds are altered or changed (e.g., a lateral "s");
 whole-word/syllable-level errors—weak syllables are deleted (e.g., "tephone"
for "telephone"), a syllable is repeated or deleted (e.g., "dada" for "dad" or
"wawa" for "water");
 prosody errors—errors occur in stress, intensity, rhythm, and intonation.

Signs and symptoms may occur independently or as rule-based error patterns (e.g.,
deletion of final consonants, reduction of consonant clusters from two elements to
one, or substitution of fricatives and affricates with stops). In addition to these more
common error patterns, children might also present with idiosyncratic error patterns,
such as substituting many sounds with a favorite or default sound, resulting in
considerable homonymy. For example, shore, sore, chore, and tore might all be
pronounced as "door" (Grunwell, 1987; Williams, 2003a).

Influence of Dialect

Not all sound substitutions and omissions are speech errors. Instead, they may
be related to a feature of a speaker's dialect (a rule-governed language system that
reflects the regional and social background of its speakers). Dialectal variations of a
language may cross all linguistic parameters, including phonology, morphology,
syntax, semantics, and pragmatics. An example of a dialectal variation in phonology
occurs with speakers of African American English (AAE) when a "d" sound is used
for a "th" sound (e.g., "dis" for "this"). This variation is not evidence of a speech
sound disorder, but rather one of the phonological features of AAE.

SLPs must distinguish between dialectal differences and communicative disorders and

 recognize all American English dialects as rule-governed linguistic

systems;
 understand the rules and linguistic features of American English dialects
represented by their clientele;
 be familiar with nondiscriminatory testing and dynamic assessment
procedures, such as identifying potential sources of test bias, administering

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 and scoring standardized tests using alternative methods, and analyzing
test results in light of existing information regarding dialect use.

CAUSES

The cause of some speech sound problems is known; for example, speech
difficulties can be the result of motor speech disorders (e.g., dysarthria), structural
differences (e.g., cleft palate), or sensory deficiencies (e.g., hearing impairment).
However, the cause of articulation and phonological speech sound disorders in most
children is unknown.

Even so, a number of studies have identified risk and protective factors
associated with speech sound disorders in children.

Assessment

Screening

Screening is conducted whenever a speech sound disorder is suspected or as

part of a comprehensive speech and language evaluation for a child with
communication concerns. The purpose of the screening is to identify those who
require further speech-language/communication assessment or referral to other
professional services.

Screening typically includes:

 formal screening measures that have normative data and/or cutoff scores,
 informal measures, such as those designed by the clinician and tailored to
the population being screened (e.g., for older students, screening
procedures might include reading sentences and/or passages containing
speech sounds to be assessed or obtaining a conversational speech
sample),
 comprehension and production of spoken and written language (as age-
appropriate),
 hearing screening to rule out hearing loss as a possible contributing factor
to speech difficulties,
 screening of oral motor functioning,

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  orofacial exam to identify structural bases for speech sound disorders (e.g.,
submucous cleft palate, malocclusion, ankyloglossia) and to assess facial
symmetry.

Comprehensive Assessment

Individuals suspected of having a speech sound disorder based on screening

results are referred to an SLP for a comprehensive assessment.

Comprehensive assessment for speech sound disorders typically includes

 case history;
 oral mechanism examination;
 hearing screening;
 speech sound assessment (single-word testing and connected speech
sampling), including:
 severity,
 intelligibility,
 stimulability,
 speech perception;
 spoken-language testing, including:
 receptive and expressive language assessment,
 phonological processing;
 literacy assessment.

It is not appropriate to determine a standard score for any assessment that is

not normed on a group representative of the individual being assessed.

Treatment

Historically, the treatment of speech sound errors involved teaching the motor
skills needed for the articulation of speech sounds. Since the 1970s, speech sound
disorders have also been viewed from a linguistic or phonological perspective.

Some treatment approaches have traditionally focused on articulation

production and others have been more phonological/language-based. Articulation

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approaches target each sound deviation and are often selected by the clinician when
the child's errors are assumed to be motor-based; the aim is correct production of the
target sound(s). Phonological approaches target a group of sounds with similar error
patterns, although the actual treatment of exemplars of the error pattern may target
individual sounds. Phonological approaches are often selected in an effort to help the
child internalize phonological rules and generalize these rules to other sounds within
the pattern (e.g., final consonant deletion, cluster reduction). Both approaches might
be used in therapy with the same individual at different times or for different reasons.

The sequence of most treatment approaches for speech sound disorders are
reflected in the following phases of therapy:

Establishment—eliciting target behaviors and stabilizing production on a voluntary

level.

Generalization—facilitating carry-over of sound productions at increasingly

challenging levels (e.g., syllables, words, phrases/sentences, conversational speaking).

Maintenance—stabilizing target behaviors and making production more automatic;

encouraging self-monitoring of speech and self-correction of errors.

PURPOSE OF CASE STUDY

Case study is a study of a person that happens over a period of time. It helps to
understand the patient better. It helps us understand different people who are on the
same category as them. Not only do we learn about the individual but also the
category they belong to.

The purpose behind psychologist case studies are in seek in depth information
about the human brain, behavior, or cognitive thinking. The purpose of a scientists’
case study is to experiment between theories or come up with new theories. Scientists
are able to develop a hypothesis and go into detail through their research and
experimenting when processing through the case study type of their choice.

 Individual theories focus on an individual’s development and interactions with

a subject. Elaboration with that that object is delved and described in theory.
 Organizational theories pay detail to the organization hierarchy or statuses of
an institution or the purpose of an organization.

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 Social theories are more commonly used with sociologists because they focus
on the development or structure of communities, groups, or areas.
 These types of case studies have different purposes to satisfy and explain the
proper data according to each scientist. In even greater detail there are
specifics and details that make each have a special purpose.
 The purpose of an explanatory case study is to better show the data and
description of a casual investigation.
 Collective case study’s purpose is to show the detail of how a group of
individuals in a manner that shows all the data concisely.
 The purpose of a descriptive case study is to be able to compare the new
gatherings to the pre-existing theory.
 An exploratory case study is used to give more background information than
usual case studies, to better compare results, and to allow for the researchers to
dedicate more time into studying the information needed for their experiment
or case.
 Intrinsic case studies are based in the researcher’s personal interest or
curiosities. It serves the purpose of allowing a researcher to freely learn or
study what they please.
 An instrumental case study’s purpose allows for researchers to try
understanding the science behind an experiment or case.

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CASE STUDY

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DEMOGRAPHIC DETAILS

INITIALS : N.Y.

AGE :4

GENDER : Male

FATHER’S QUALIFICATION : B.E

FATHER’S OCCUPATION : Software Engineer

MOTHER’S QUALIFICATION : Masters in financial management

MOTHER’S OCCUPATION : Self employee

SIBLINGS : Twin sister

TYPE OF FAMILY : Nuclear.

SOCIO-ECONOMIC STATUS : Upper middle class

URBAN/RURAL : Urban.

CLINICAL DIAGNOSIS : Speech sound disorder.

INFORMANT

The information was provided by the child’s Parents.

PHYSICAL DESCRIPTION AND TEMPERAMENT:

N.Y. is a 4 year old boy. Since he has speech sound disorder. He shows the
physical features like short neck, slanting eyes, oddly shaped ears and poor muscle
tone. He also has slight sluggish walk. He is always smiling and greets the people he
recognizes with a happy face.

FAMILY BACK GROUND:

The subject N.Y. lives in a nuclear family setting. His father has completed
B.E. and is a software engineer in a well-known multinational company. His mother
has completed Masters in financial management and is running a business. They had

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an arranged marriage and are not related. His father was 32 years and mother was 28
years when he was born.

He has a twin sister. He has a very good relationship with his sister and he
enjoys spending time with her. Unlike N.Y. his sister is normal. N.Y. has a very good
relationship with his family.

MEDICAL HISTORY

The medical history of N.Y. shows that his mother was healthy when she was
pregnant. His mother had regular antenatal check-up. N.Y. is a premature child. He is
a blue baby, a blue complexion from lack of oxygen in the blood due to a congenital
defect of the heart or major blood vessels. He had asphyxiation, it is the condition of
being deprived of oxygen (as by having breathing stopped) sometimes by strangling.
In this case, umbilical cord strangled N.Y. Because of that his mother had to undergo
C-section and there was no birth cry for 2 seconds. The child has a fraternal twin who
weighed 2.5kg and N.Y. weighed 1.4kg while delivery. The mother had to undergo C-
section as N.Y. had low blood pressure.

Both N.Y, and his twin sister had breathing trouble for more than 20 days.
N.Y. was kept in ICU for 28 days. That time both N.Y. and his sister were infected.
They had jaundice, also known as icterus, is a yellowish pigmentation of the skin, the
conjunctival membranes over the sclera (whites of the eyes), and other mucous
membranes caused by high blood bilirubin levels.

After discharging from the ICU,N.Y’s weight became 900grams. There was
no breast feeding till the fifth day.

N.Y had frequent vomiting till 18 months. His digestive system had not
developed at that phase, his sugar level was very low then and he also had not eaten
the whole day.

DEVELOPMENTAL HISTORY

The parents have reported that the baby showed development delays in nearly
all motor and speech milestones. He was very active till the 3rd month when compared
to his twin sister. Even though, adaptive behaviour such as avoiding danger was

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achieved in the normative age. It is a good sign showing that he can be trained for
other adaptive behaviour like individual performance of daily care.

Motor Milestones

Norm Age achieved

Head control 02-04 months 5 months
Sitting 05-10 months After 1 year(post
physiotherapy)
Standing 10-14 months After 1 year(post
physiotherapy)
Walking 12-18 months After 1 year(post
physiotherapy)

Speech and language

Norm Achieved age

Babbling 06-08 months Achieved at 3 months, and
regressed.
First words 07-12 months Unclear after 4 years.

Adaptive behaviours

Norm Achieved age

Avoiding danger 03-04 years 4 years

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Personal/Social

Achieved age
Norm
Smiles at others 01-04 months 4 months
Responds to name 07-12 months 9 months
Feeds self 30-36 months 3.5 years
Dresses self 04-05 years Not attained yet
Toilet control 30-36 months Not attained yet

MEDICAL DIAGNOSIS:

N.Ys family had a vague doubt about his condition when he was about 1 year
old but did not pay much heed to it. They noticed that he had late and slow
development. Initially they thought that he has mild developmental delay. Then they
started to give him physiotherapy. Then his fine and gross motor skills developed like
a normal child.

But his speech was not developed. Then they took MRI scan. Then they came
to know that he has only speech developmental delay. But his cognition is way far
better then most of the normal kids. His family has no psychological or pathological
reports of any disorders.

SCHOOL HISTORY:

N.Y is studying in a inclusive school, where normal, special and gifted

children studies. N.Y is a happy child, who comes to class with a smile. He is in
Pre.k.g. Special activities were especially made for N.Y. So that he can learn the
things, whatever the normal kids will do.

GENERAL ASSESSMENT

N.Y has problems with fine motor skills. He is socially mature in comparison
to his peers. He may very much benefit from specialized education plans.

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OBSERVATION

PHYSICAL FUNCTIONING

 GROSS MOTOR SKILLS

N.Y has good gross motor skills though they are a bit slow and sluggish. He is
able to do drill exercises, throw a ball, able to lift small objects.He is being
given exercises to improve the precision of his gross motor skills by his
schools’ physiotherapist.
 FINE MOTOR SKILLS
N.Y is able to hold crayons. N.Y can do beading, stacking and peg boards
without difficulty.
 EATING HABITS
N.Y is a non-fussy eater and prefers fruits. He is used to a routine time table
and is given food at the particular time.
 SLEEP PATTERNS
N.Y sleeps at 12 pm and wakes up early as his school starts at 7.00 am. He
does take a mid-day nap. He usually has undisturbed sleep and wakes up with
a good mood.
 TOILET TRAINING
N.Y only had no control over his bowel movement as if yet.
 SELF CARE ABILITIES
N.Y brushes his teeth on his own. He brushes his teeth every morning, every
day. He eats on his own at school but at home, his mother feeds him.

DAILY ACTIVITIES:
He wakes up every day at 7.00 am, gets ready for his school, has his
breakfast and leaves home for his school. He travels by car with his parent. The
school starts at 8.30 am. Till 11.30 am they are indulged in academic activities. 10:30
they have a short snack break which is followed by activities. They are either made to
play games and do drills . The school gets over at 11.30pm. after he reaches home, he
sleeps for 1 and 1/2 hours after which he has his lunch. He then goes for special
education therapy after which he goes for occupational therapy and then speech

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therapy. when he reached home, he plays with his twin sister for sometime. At 9:30,
oral therapy starts wit his therapist who comes home. After which he sleeps.
COGNITIVE FUNCTIONING:
N.Y cognitive functioning is better when compared to other children. He is
able to identify colors, shapes, numbers, and alphabets. He is able to do 3 to 6 piece
puzzles. He is able to match words with their pictures. He is a visual learner.
LANGUAGE FUNCTIONING

As N.Y has speech sound disorder, he is unable to communicate through

words, so he uses gestures and actions to communicate his needs.

SOCIAL BEHAVIOR

N.Y is calm and likes interacting with others. He likes to share his belongings
with his friends. He tries to give everybody an equal and fair chance when playing
group games. He is very obedient to his parents and teachers. He finishes his activities
promptly. He also is quite easy to communicate with and does not hold any grudges.

EMOTIONAL FUNCTIONING

N.Y is empathicand thinks about how others would feel if he was going to be
angry at others. Whenever he gets hurt, he will start crying. Sometimes when his
things get misplaced, he starts to cry. He shows his happiness through his smile.

INTERVENTION

he goes for two therapies every alternative day. The therapies are:

1. Special education therapy

2. Speech therapy
3. Occupational therapy
4. Oral therapy

Special Education:

Special education therapy is therapy that focus mainly on educational

concepts. Special education therapy focuses also on behaviours. They also improve

25
the fine motor skills so that they will be able to write at the level of their grade and
gross motor skills so that they will be able to cope with outdoor play.

The equipment that is used during special education therapy is mainly puzzles
and peg boards. They occasionally use crayons and pencils to help tune the fine motor
skills.

N.Y identifies three letter words and match them to the corresponding
pictures. He able to perform better in therapy when given one on one attention.

Occupational Therapy

Occupational therapy is a client-centred health profession concerned with

promoting health and wellbeing through occupation. The primary goal of
occupational therapy is to enable people to participate in the activities of everyday
life. Occupational therapists achieve this outcome by working with the people and
communist to enhance their ability to engage in occupations they want to, they need
to, or are expected to do, or by modifying the occupation or the environment to better
support their occupational engagement.

The occupation therapist of N.Y helped him work on his fine motor skills so
he can grasp and release toys and to develop a good handwriting. And also addresses
Hand-Eye coordination, like hitting a target etc.

Speech Therapy

The treatment of speech and communication disorder. The approach used

varies depending on the disorder. It may include physical exercise to strengthen then
muscle used in speech (Oral Motor Work), speech drills to improve clarity and sound
production practice to improve articulation.

N.Y during the speech therapy session communicates more verbally than
using gestures and hand movements/actions. Later the therapist reads a book to N.Y,
based on which he is asked questions and he has to brief the therapist.

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Oral Motor Therapy

Oral Motor Therapy uses variety of exercises to develop awareness, strength,

coordination and mobility of the oral message. It is always used as a component of
feeding therapy.

Oral motor therapy has been used to improve N.Y’s muscle tone of the face
and to reduce tongue thrust (protrusion of the tongue from the mouth).

RECOMMENDATION

The psychologist suggests that N.Y treatment may include speech therapy,
occupational therapy, oral motor therapy. More familial support might benefit him.
Psycho-education about Speech Sound Disorder to the extended family members may
also be helpful. Speech-language therapy to improve the slight lisp in speech can also
be provided.

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INTROSPECTION

REPORT

28
 SM is a very submissive child ; he is naughty and playful.

 SM loves drawing, and most of his free time doodling.

 SM likes to be independent, doesn’t like when dominant by others.

 SM likes playing cricket .

 NA’s parents were very helpful.

 The parents didn’t hesitate to answer any questions.

 The institution was very helpful with the case study and let us choose who we

wanted to observe.

 The institution helped with a better understanding of the child and gave more

helpful information of the child.

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 REFERENCES

1. American Psychiatric Association (2013). Diagnostic and Statistical Manual

of Mental disorders, e.5. Washington, DC: APA Press.

2. Hurlock, E. B. (1956). Child development: Elizabeth B. Hurlock. New York.

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3. Speech-Language Therapy. (n.d.). Retrieved August 5, 2016, from
http://kidshealth.org/en/parents/speech-therapy.html#

4. What is Special Education? (n.d.). Retrieved August 5, 2016, from

https://teach.com/what-is-special-education/

5. www.asha.org

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CASE STUDY 2

32
 PREAMBLE

MIDDLE AGE

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 Middle age is the period of age beyond young adulthood but before the onset
of old age. Various attempts have been made to define this age and it can vary
between cultures and historic or previous definitions of this stage of life.

This time period in the life of a person can be referred to as middle age. This
time span has been defined as the time between ages 40 to 60 years old. Many
changes occur between young adulthood and this stage.

There is not a specific age or markers of transitioning between young

adulthood to middle adulthood. The maturing process is viewed as completed and
gives way to the aging process. The body may slow down and the middle aged might
become more sensitive to diet, substance abuse, stress, and rest. Chronic health
problems can become an issue along with disability or disease. Approximately one
centimetre per decade of height may be lost. Emotional responses and retrospection
vary from person to person. Experiencing a sense of mortality, sadness, or loss is
common at this age.

AARIT

Sharadh Verma, the Founder of AARIT, was himself in active addiction for
over 2 decades. It was his determination and desire to overcome his addiction which
brought about a miraculous change in his life.

A change for the better. During the early years of his recovery, he felt strongly
that he has to share with others what he has received and that was the only way for
him to keep what he has received.......... HIS RECOVERY! AARIT is Sharad's
mission to bring his message of hope and health to addicts.

PROGRAM OF AARIT

People, at AARIT believe that an addict CAN recover. All that is required is a
strong desire to CHANGE the way you think! At AARIT, we show you how to
address your fears and deal with them in a simple yet irrefutable manner leading to a
healthy generation of self-esteem.

At AARIT, we provide a 'Home Away from Home' for a duration endeavoring in

bringing together the family. We follow a structured system of approach consisting
of:

34
  Detoxification done by experienced psychologists, psychiatrist, nurses and
Doctor
 Examination and Treatment by General Physician and Psychiatrist
 12 Step recovery program
 Reinforcement of 12 Step recovery program by experienced members and
Specialist
 Group Therapy sessions by Specialists
 Recreation and Entertainment
 Exercise and Fitness
 Safety and Security
 Counselling :
 Individual client-centered counselling
 Family counselling
 Motivational Enhancement towards identifying the personal skills-set
and towards encouraging smooth transition back to
work/professionalism and positivity.
AARIT TEAM

Under the able guidance of our founder Sharad Verma, a dedicated multi-
disciplinary team works round the clock in providing specialized and customized care.

Team members:

 Trainer and Supervisor

 General Physician
 Psychiatrist
 Psychologist
 Social Workers
 Therapists
 Nurse
 Cook
 Security Personnel

35
FACILITIES

AARIT recovery centre provides a modernized program with the following in-
house facilities

 24*7 Warden supervision

 Medical assistance
 A/C and non A/C rooms
 Well balanced meals recommended by nutritionist: veg & non-veg
 Spacious area for indoor and outdoor activities
 TV lounge
 Conference area
 Detox room
GOALS:

 To establish a rehabilitative and therapeutic centre for individuals addicted to

alcohol, drugs, gambling, food and many other vices under a client-centered
professional setting.
 To provide a comprehensive package of counseling and therapy for the addict
as well as the family to heal their disrupted lives and allow them a new
beginning.
 To inculcate a spiritual awareness in them and direct them towards a path
leading to better understanding, clarity in decision making and positive
functioning.
 To provide vocational training and aid in placements for the recovering
addicts in professions suitable for them.
SERVICES OFFERED :
 12 Step, Alcohol anonymous & Narcotics ananymous Meetings,
 Alcoholism Treatment,
 Corporate Program,
 Depression,
 Detoxification,
 Drug Addiction Treatment,
 Family Services,

36
  Gambling Addiction,
 Nasha Mukti Kendra,
 Occupational Therapy,
 Out Patient,
 Relapse Prevention,
 Residential Rehabilitation,
 Smoking Cessation,
 Substance Abuse Counselling,
 Women,
 Yoga and Meditation,
 Youth Substance Abuse

SUBSTANCE ABUSE DISORDER

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

(DSM-5), no longer uses the terms substance abuse and substance dependence, rather
it refers to substance use disorders, which are defined as mild, moderate, or severe to
indicate the level of severity, which is determined by the number of diagnostic criteria
met by an individual.

Substance use disorders occur when the recurrent use of alcohol and/or drugs
causes clinically and functionally significant impairment, such as health problems,
disability, and failure to meet major responsibilities at work, school, or home.
According to the DSM-5, a diagnosis of substance use disorder is based on evidence
of impaired control, social impairment, risky use, and pharmacological criteria.

The following is a list with descriptions of the most common substance use
disorders :

ALCHOHOL USE DISORDER (AUD)

Excessive alcohol use can increase a person’s risk of developing serious health
problems in addition to those issues associated with intoxication behaviors and
alcohol withdrawal symptoms. According to the Centers for Disease Control and
Prevention (CDC), excessive alcohol use causes 88,000 deaths a year.

37
The definitions for the different levels of drinking include the following:

Moderate Drinking—According to the Dietary Guidelines for Americans,

moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for
men.

Binge Drinking—SAMHSA defines binge drinking as drinking 5 or more

alcoholic drinks on the same occasion on at least 1 day in the past 30 days. The
National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking
as a pattern of drinking that produces blood alcohol concentrations (BAC) of greater
than 0.08 g/dL. This usually occurs after 4 drinks for women and 5 drinks for men
over a 2 hour period.

Heavy Drinking—SAMHSA defines heavy drinking as drinking 5 or more

drinks on the same occasion on each of 5 or more days in the past 30 days.

Excessive drinking can put you at risk of developing an alcohol use disorder in
addition to other health and safety problems. Genetics have also been shown to be a
risk factor for the development of an AUD.

TOBACCO USE DISORDER

According to the CDC, more than 480,000 deaths each year are caused by
cigarette smoking. Tobacco use and smoking do damage to nearly every organ in the
human body, often leading to lung cancer, respiratory disorders, heart disease, stroke,
and other illnesses.

CANNABIS USE DISORDER

Marijuana is the most-used drug after alcohol and tobacco in the United
States.

Marijuana’s immediate effects include distorted perception, difficulty with

thinking and problem solving, and loss of motor coordination. Long-term use of the
drug can contribute to respiratory infection, impaired memory, and exposure to
cancer-causing compounds. Heavy marijuana use in youth has also been linked to
increased risk for developing mental illness and poorer cognitive functioning.

38
 Some symptoms of cannabis use disorder include disruptions in functioning
due to cannabis use, the development of tolerance, cravings for cannabis, and the
development of withdrawal symptoms, such as the inability to sleep, restlessness,
nervousness, anger, or depression within a week of ceasing heavy use.

CRITERIA FOR ALCHOHOL USE DISORDER ( DSM 5 ) :

Under DSM–5, the current version of the DSM, anyone meeting any two of
the 11 criteria during the same 12-month period receives a diagnosis of AUD. The
severity of an AUD—mild, moderate, or severe—is based on the number of criteria
met.

The Eleven Symptoms of Alcohol Use Disorder

• Alcohol is often taken in larger amounts or over a longer period

than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or
control alcohol use.
• A great deal of time is spent in activities necessary to obtain
alcohol, use alcohol, or recover from its effects.
• Craving, or a strong desire or urge to use alcohol.
• Recurrent alcohol use resulting in a failure to fulfill major role
obligations at work, school, or home.
• Continued alcohol use despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of
alcohol.
• Important social, occupational, or recreational activities are given
up or reduced because of alcohol use.
• Recurrent alcohol use in situations in which it is physically
hazardous.
• Alcohol use is continued despite knowledge of having a persistent
or recurrent physical or psychological problem that is likely to have
been caused or exacerbated by alcohol.
• Tolerance, as defined by either of the following: a) A need for
markedly increased amounts of alcohol to achieve intoxication or

39
 desired effect b) A markedly diminished effect with continued use
of the same amount of alcohol.
• Withdrawal, as manifested by either of the following: a) The
characteristic withdrawal syndrome for alcohol (refer to criteria A
and B of the criteria set for alcohol withdrawal) b) Alcohol (or a
closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.
PURPOSE OF CASE STUDY

Case study is a study of a person that happens over a period of time. It helps to
understand the patient better. It helps us understand different people who are on the
same category as them. Not only do we learn about the individual but also the
category they belong to.

The purpose behind psychologist case studies are in seek in depth information
about the human brain, behaviour, or cognitive thinking. The purpose of a scientists’
case study is to experiment between theories or come up with new theories. Scientists
are able to develop a hypothesis and go into detail through their research and
experimenting when processing through the case study type of their choice.

 Individual theories focus on an individual’s development and interactions with

a subject. Elaboration with that that object is delved and described in theory.
 Organizational theories pay detail to the organization hierarchy or statuses of
an institution or the purpose of an organization.
 Social theories are more commonly used with sociologists because they focus
on the development or structure of communities, groups, or areas.
 These types of case studies have different purposes to satisfy and explain the
proper data according to each scientist. In even greater detail there are
specifics and details that make each have a special purpose.
 The purpose of an explanatory case study is to better show the data and
description of a casual investigation.
 Collective case study’s purpose is to show the detail of how a group of
individuals in a manner that shows all the data concisely.

40
 The purpose of a descriptive case study is to be able to compare the new
gatherings to the pre-existing theory.
 An exploratory case study is used to give more background information than
usual case studies, to better compare results, and to allow for the researchers to
dedicate more time into studying the information needed for their experiment
or case.
 Intrinsic case studies are based in the researcher’s personal interest or
curiosities. It serves the purpose of allowing a researcher to freely learn or
study what they please.
 An instrumental case study’s purpose allows for researchers to try to
understand the science behind an experiment or case.

41
CASE STUDY

42
DEMOGRAPHIC DETAILS

Initial : B

Date of Birth : 15.06.1975

Age : 41 years

Sex : Male

Ordinal Position : Fourth child to his parents

Education : B.Sc. IT, M.Sc. Statistics

Languages Known : English, Tamil

Type of family : Nuclear family

Urban/ Rural : Urban

Religion : Hindu

Siblings : 2 sisters and 1 brother

diagnosis : Substance Use Disorder

PERSONAL HISTORY :

Mr B is a male who is 41 years old who was born on 15 of June 1975. He has
a bachelor degree in IT and master degree in statistics from Trichy. After finishing his
PG, he shifted to Chennai at the year 1997. He stayed in Chennai from 1997 to 2006.
He was doing a course in SSI which is a computer science institute and also worked
as a professor with an income of Rs.1000 per month. His second job was in city bank
with salary of Rs.10,000 which had shift timings. The next job that he got was in HCL
for the timing 11pm-7am was in Anna Nagar.

43
FAMILY:

Mr B has 2 elder sisters of ages 49 and 45 years and one elder brother of age
43 years. He has a wife and he got married in the age of 29. B’s wife is 36 years old.
He has 2 daughters who is 10 years and 6 years old. His native is Trichy. B’s
grandfather was an alchoholic.

BIRTH HISTORY :

Mr B is a normal baby who had normal birth. He was a full term baby. There
was no complication during his birth.

ADDICTION HISTORY :

B is was studying for his masters degree in statistics when he started drinking
because he thought it was fun. His first drink was when he was 21 years old. He had
a habit of drinking once or twice a week. And in 2003 he started drinking regularly.

Due to shift timings in the work, he started drinking after work which was
during the afternoon because he couldn’t sleep properly. He was able to do so only
after drinking. 2002 to 2006 he was working with the company HCL where he drank
after work.

The mother came to know about his drinking habits and was worried so she
started giving lesser amounts of money. He also caught hold of his debit cards. The
HCL had partnership with a local bank nearby and whenever employee wanted
money, the bank gave it to them if they showed an id proof. With that source, he
started drinking again.

B slowly started lying to parents about his alcohol consumption. The parents
started searching for alliance for him. In 2004 he got married and he continued his
drinking even after that.

In 2006 he resigned his job to go to UK. He started bringing alcohol to his

house. He had pre-diabetic warnings and took medications for it. His BP levels
increased as his drinking levels increased. He started taking BP tablets.

44
 In 2009 his amount of consuming alcohol increased. Later his wife caught
hold of all the cards and gave him money only on request. His first daughter was
scared of him and mentioned once that she doesn’t want this father.

He started bringing all the office pressure to home and couldn’t manage the
pressure and began to fight and argue with his wife. He became more obese. His
health conditions became worse and got abdominal pain and had high palpitations and
breathing became difficult for him.

His wife wanted her daughter to go to Grammar school in London. So they

were preparing for that. During that time B’s health condition became worse. His wife
told him that if she takes care of B, then she can’t help her daughter to go to school. If
she helps her daughter, his health will get more worse, then he will die. After his
death they can’t live without him in London. So it will be waste of preparing her
daughter for that school. So she asked him to go to Chennai for treatment.

He came to Chennai on 24.08.2016 for treatment, he was admitted in AARIT

recovery centre.

INTERVENTION

COUNSELLING PROVIDED

Identifying that the major cause for the several problems observed as, addiction,
depression, anxiety, trust issues, low self esteem and inferiority complex , the most
suitable strategy seemed to be the client-centered approach of Carl Rogers. This
approach which strongly emphasizes on unconditional acceptance and a helping
relationship lets the client take centre stage and the Psychologist as a passive member
who initiates, mediates and terminates the discussion.

He also can have group therapy sessions in the rehabilitation center. That may
increase his confidence level.

It was made known to the client that his addiction towards alcohol never give any
kind of help in his life. But at the same time he need to accept it and he has to move
on from the situation for his betterment. The client was constantly fed with positive

45
thoughts of his self worth and uniqueness as an individual who could easily come up
in life by acceptable and appropriate means.

INTROSPECTION REPORT

46
It is remarkable that B took control over his life and chose to admit himself a AARIT
recovery center so that his daughter would have a better future. B should have been
more careful during his initial stages. Even though he wasn’t, he now wants to and is
trying to get better. When he gets out of the center, he should report his expenditure to
his wife and let her handle the finance until he is confident that he will not relapse

47
REFERENCES

48
1. www.buppractice.com/node/12351
2. www.samhsa.gov/disoders/substance-use
3. www.simplypsychology.org/Erik-Erikson.html
4. www.verywell.com/dsm-5-criteria-for-substance-use-disorders-21926

49
CASE STUDY 3

50
PREAMBLE

51
ADOLESCENCE

The transitional period between puberty and adulthood in human development,

extending mainly over the teen years and terminating legally when the age of majority
is reached; youth. The process or state of growing to maturity. A period or stage of
development, as of a society, preceding maturity.

The adolescent is newly concerned with how they appear to others. Superego
identity is the accrued confidence that the outer sameness and continuity prepared in
the future are matched by the sameness and continuity of one's meaning for oneself,
as evidenced in the promise of a career. The ability to settle on a school or
occupational identity is pleasant. In later stages of Adolescence, the child develops a
sense of sexual identity. As they make the transition from childhood to adulthood,
adolescents ponder the roles they will play in the adult world. Initially, they are apt to
experience some role confusion—mixed ideas and feelings about the specific ways in
which they will fit into society—and may experiment with a variety of behaviors and
activities (e.g. tinkering with cars, baby-sitting for neighbors, affiliating with certain
political or religious groups). Eventually, Erikson proposed, most adolescents achieve
a sense of identity regarding who they are and where their lives are headed.The
teenager must achieve identity in occupation, gender roles, politics, and, in some
cultures, religion.

AASHIANA

AASHIANA was first known as AASHA institute of living. The founder of AASHA
institute of living was Dr. Gopalakrishnan. Later AASHA institute of living was
changed to AASHIANA hospital. It was then taken over by Dr. SujaiSubramaniam

52
FACILITIES:

 Psychometric assessments
 Alcohol De-addiction
 Cognitive Behavioural Therapy
 Therapies
 Psychiatrists
 General Physician Doctors
 Psychologist Doctors
 De Addiction Centres
 Psychotherapy Doctors
 Inpatient and Outpatient facilities
 Counselling :
 Family counselling
 Marital counselling
 Old age counselling

Address: Building No. 1201, 6th Avenue, Anna Nagar, Chennai, Tamil Nadu 600040

Phone: 044 2628 8039

MILD DEPRESSION

The word depressed is a common everyday word. People might say "I'm
depressed" when in fact they mean "I'm fed up because I've had a row, or failed an
exam, or lost my job", etc. These ups and downs of life are common and normal.
Most people recover quite quickly. With true depression, you have a low mood and
other symptoms each day for at least two weeks. Symptoms can also become severe
enough to interfere with normal day-to-day activities.

About 5 in 100 adults have depression every year. Sometimes it is mild or

lasts just a few weeks. However, an episode of depression serious enough to require
treatment occurs in about 1 in 4 women and 1 in 10 men at some point in their lives.
Some people have two or more episodes of depression at various times in their life.

53
Symptoms

Many people know when they are depressed. However, some people do not
realise when they are depressed. They may know that they are not right and are not
functioning well but don't know why. Some people think that they have a physical
illness - for example, if they lose weight.

There is a set of symptoms that are associated with depression and help to
clarify the diagnosis. These are:

Core (key) symptoms

 Persistent sadness or low mood. This may be with or without weepiness.

 Marked loss of interest or pleasure in activities, even for activities that you
normally enjoy.

Severity of depression

The severity of depression can vary from person to person. Severity is generally
divided as follows:

 Severe depression - you would normally have most or all of the nine
symptoms listed above. Also, symptoms markedly interfere with your normal
functioning.
 Moderate depression - you would normally have more than the five
symptoms that are needed to make the diagnosis of depression. Also,
symptoms will usually include both core symptoms. Also, the severity of
symptoms or impairment of your functioning is between mild and severe.
 Mild depression - you would normally have five of the symptoms listed
above that are required to make the diagnosis of depression. However, you
are not likely to have more than five or six of the symptoms. Also, your
normal functioning is only mildly impaired.

54
  Sub threshold depression - you have fewer than the five symptoms needed to
make a diagnosis of depression. So, it is not classed as depression. But, the
symptoms you do have are troublesome and cause distress. If this situation
persists for more than two years it is sometimes called dysthymia.

Causes

The exact cause is not known. Anyone can develop depression. Some people
are more prone to it and it can develop for no apparent reason. You may have no
particular problem or worry, but symptoms can develop quite suddenly. So, there may
be some genetic factor involved that makes some people more prone than others to
depression. 'Genetic' means that the condition is passed on through families.

An episode of depression may also be triggered by a life event such as a

relationship problem, bereavement, redundancy, illness, etc. In many people it is a
mixture of the two.

Women tend to develop depression more often than men. Particularly common
times for women to become depressed are after childbirth (postnatal depression) and
the menopause.

Treatment options for mild depression

The following are the commonly used treatment options for people with mild
depression. They are also used for people with long-standing subthreshold depression
that has shown no signs of improving. Some people prefer one type of treatment to
another. So, personal preference for the type of treatment used should be taken into
account when discussing the best treatment for yourself with your doctor.

A guided self-help programme

There are various pamphlets, books and CDs which can help you to
understand and combat depression. The best are based on the principles of CBT, as
described earlier. Ideally, a guided self-help programme is best. That is, a programme
where the materials are provided by a trained practitioner such as a doctor and where

55
a practitioner monitors your progress. A self-help programme takes some motivation
and effort to work through - a bit like doing homework. A typical guided self-help
programme consists of 6-8 sessions (face-to-face and via telephone) over 9-12 weeks.

Computer-based CBT
Computer- and internet-based self-help CBT programmes are recent
innovations. They are supported by a trained practitioner who monitors progress. A
programme typically takes place over 9-12 weeks and you are given tasks to try out
between sessions.

Group-based CBT

This is CBT but in a group setting of 8-10 participants. Typically, it consists of

10-12 weekly meetings.

Group-based peer support

This is an option for people with depression who also have an ongoing
(chronic) physical problem. This allows sharing of experiences and feelings with a
group of people who understand the difficulties and issues facing group members.
Typically, it consists of one session per week over 8-12 weeks. Ideally, it should be
supported by a facilitator who has knowledge of the physical health problem and
reviews progress with people taking part in the group.

Antidepressant medicines
Antidepressant medication is not usually recommended for the initial
treatment of mild depression. However, an antidepressant may be advised for mild
depression in certain circumstances. For example, in people:

 With mild depression that persists after other treatments have not helped.
 Whose depression is associated with a physical illness.
 Who have had an episode of moderate or severe depression in the past.

56
Second-line treatment
For mild depression, the above treatments often work well and symptoms
improve. However, if symptoms do not improve much with the above treatments, it is
usual to move on to treatments usually advised for moderate or severe depression, as
discussed earlier. That is, an antidepressant and a more intensive psychological
treatment such as individual one-to-one CBT.

Social Phobia

Social phobia is a strong fear of being judged by others and of being

embarrassed. This fear can be so strong that it gets in the way of going to work or
school or doing other everyday things.

Everyone has felt anxious or embarrassed at one time or another. For example,
meeting new people or giving a public speech can make anyone nervous. But people
with social phobia worry about these and other things for weeks before they happen.

People with social phobia are afraid of doing common things in front of other
people. For example, they might be afraid to sign a check in front of a cashier at the
grocery store, or they might be afraid to eat or drink in front of other people, or use a
public restroom. Most people who have social phobia know that they shouldn't be as
afraid as they are, but they can't control their fear. Sometimes, they end up staying
away from places or events where they think they might have to do something that
will embarrass them. For some people, social phobia is a problem only in certain
situations, while others have symptoms in almost any social situation.

Social phobia usually starts during youth. A doctor can tell that a person has
social phobia if the person has had symptoms for at least 6 months. Without
treatment, social phobia can last for many years or a lifetime.

Signs and symptoms

People with social phobia tend to:

57
 Be very anxious about being with other people and have a hard time talking to
them, even though they wish they could
 Be very self-conscious in front of other people and feel embarrassed
 Be very afraid that other people will judge them
 Worry for days or weeks before an event where other people will be
 Stay away from places where there are other people
 Have a hard time making friends and keeping friends
 Blush, sweat, or tremble around other people
 Feel nauseous or sick to their stomach when with other people.

Causes

Social phobia sometimes runs in families, but no one knows for sure why
some people have it, while others don't. Researchers have found that several parts of
the brain are involved in fear and anxiety. Some researchers think that misreading of
others’ behavior may play a role in causing social phobia. For example, you may
think that people are staring or frowning at you when they truly are not. Weak social
skills are another possible cause of social phobia. For example, if you have weak
social skills, you may feel discouraged after talking with people and may worry about
doing it in the future. By learning more about fear and anxiety in the brain, scientists
may be able to create better treatments. Researchers are also looking for ways in
which stress and environmental factors may play a role.

Treatment

Social phobia is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT)

is especially useful for treating social phobia. It teaches a person different ways of
thinking, behaving, and reacting to situations that help him or her feel less anxious
and fearful. It can also help people learn and practice social skills.

Medication. Doctors also may prescribe medication to help treat social phobia. The
most commonly prescribed medications for social phobia are anti- anxiety

58
medications and antidepressants. Anti-anxiety medications are powerful and there are
different types. Many types begin working right away, but they generally should not
be taken for long periods.

Antidepressants are used to treat depression, but they are also helpful for
social phobia. They are probably more commonly prescribed for social phobia than
anti-anxiety medications. Antidepressants may take several weeks to start working.
Some may cause side effects such as headache, nausea, or difficulty sleeping. These
side effects are usually not a problem for most people, especially if the dose starts off
low and is increased slowly over time.

A type of antidepressant called monoamine oxidase inhibitors (MAOIs) are

especially effective in treating social phobia. However, they are rarely used as a first
line of treatment because when MAOIs are combined with certain foods or other
medicines, dangerous side effects can occur.

It’s important to know that although antidepressants can be safe and effective
for many people, they may be risky for some, especially children, teens, and young
adults. A “black box”—the most serious type of warning that a prescription drug can
have—has been added to the labels of antidepressant medications. These labels warn
people that antidepressants may cause some people to have suicidal thoughts or make
suicide attempts.

Anyone taking antidepressants should be monitored closely, especially when

they first start treatment.

Another type of medication called beta-blockers can help control some of the
physical symptoms of social phobia such as excessive sweating, shaking, or a racing
heart. They are most commonly prescribed when the symptoms of social phobia occur
in specific situations, such as “stage fright.”

PURPOSE OF CASE STUDY

A case study is a report of descriptive information on data of research of an

experiment, project, event or analysis. There are case studies that are particular to

59
psychologists, scientists, and sociologists. Within those types of case studies there are
individual theory, organizational theory, and social theory.

In Psychology, a Case study is a study of a person that happens over a period

of time. It helps to understand the patient better. It helps us understand different
people who are on the same category as them. Not only do we learn about the
individual but also the category they belong to.

The purpose behind psychologist case studies are in seek in depth information
about the human brain, behavior, or cognitive thinking.

 Individual theories focus on an individual’s development and interactions with

a subject. Elaboration with that that object is delved and described in theory.
 Organizational theories pay detail to the organization hierarchy or statuses of
an institution or the purpose of an organization.
 Social theories are more commonly used with sociologists because they focus
on the development or structure of communities, groups, or areas.

These types of case studies have different purposes to satisfy and explain the
proper data according to each scientist. In even greater detail there are specifics and
details that make each have a special purpose.

 The purpose of an explanatory case study is to better show the data and
description of a casual investigation.
 Collective case study’s purpose is to show the detail of how a group of
individuals in a manner that shows all the data concisely.
 The purpose of a descriptive case study is to be able to compare the new
gatherings to the preexisting theory.
 An exploratory case study is used to give more background information than
usual case studies, to better compare results, and to allow for the researchers to
dedicate more time into studying the information needed for their experiment
or case.
 Intrinsic case studies are based in the researcher’s personal interest or
curiosities. It serves the purpose of allowing a researcher to freely learn or
study what they please.

60
 An instrumental case study’s purpose allows for researchers to try
understanding the science behind an experiment or case.

CASE STUDY

61
DEMOGRAPHIC DETAILS

Name : AN

Age : 19

Gender : Male

Education : B.Com

Religion : Hindu

Language : Malayalam, English

Socio-economic status : Upper middle class

Family : Nuclear

Diagnosis : Mild depression without somatic symptoms

features social phobia

62
PRESENT COMPLAINTS

 Reduced self-confidence and has pessimistic view about his life

 Has feelings of worthlessness, helplessness and hopelessness
 Feels lonely and doesn’t gets along with others
 Feels others are avoiding him and discussing about him
 Lacks concentration and forgets things

Family history

AN’s father is 50 years old and is doing Business. His mother is 40 years old
and is a Housewife. He has a younger brother who is studying 6th std. He maintains a
cordial relationship with his family members. There is a history of mental illness
reported in patient’s paternal uncle who was under treatment (currently he is left
untreated). There is a history of mental illness reported in patient’s maternal
grandmother, who was a divorcee, has attempted suicide and is under treatment.
There is also a history of mental retardation (mild) reported in patient’s maternal
uncle. History of addiction to smoking was reported in patient’s father

Case History

AN was normal until his 2nd year of college. He studied in a private CBSE
school in Chennai. He was an average scorer and secured around 72% in all his
exams. He was an ambivert in nature and had his own close set of friends. During his
11th and 12th standard he moved to a state board school. He moved to state board
mainly to get better scores and he missed most of his friends who were continuing in
the same board of education. During this period he became close with one of his
classmate who studied with him till 10th standard. They became very close and he
started developing feelings for her.

Finally one day she insisted on them meeting personally. They met in a local
coffee where she expressed her feelings towards him and they got into a relationship.
Initial few days of the relationship was happy and beautiful. But slowly After a year

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AN started developing possessive characteristic towards his girlfriend. In this same
period his girlfriend started moving away from him.

She rarely texted him and said she was busy with her studies. This pattern
continued till the end of their 12th standard. The results came 2 months after the
examination and he ended scoring very poor marks. He again tried to get in contact
with his girlfriend but she still avoided him. Both of them got into different colleges
and during a cultural meet he met his girlfriend with another boy.

On asking her friends who he was, they said he was her boyfriend and they
were in a relationship for past 1 year. This highly hurt AN and he cornered his
girlfriend and asked her what’s been happening and who the other guy was. AN and
the other guy got into a huge fight in the college premises. He was badly injured and
the girl too confessed that the other guy was her boyfriend and she didn’t have any
feelings towards AN.

His trust was completely broken and he felt so embarrassed in front of others.
These were also the reasons for him to develop mild depression and social phobia. He
was admitted into AASHIANA for psychological counselling and psychiatric
treatment.

MENTAL STATUS EXAMINATION

The patient was neatly dressed and well groomed. He was able to follow the
instructions. He was co-operative for the interview and throughout the assessments.
Eye contact was maintained. Good rapport was established. His speech was relevant
and coherent with low tone and volume. His attention and concentration was aroused
and sustained throughout the assessment. His psychomotor activities were adequate.
His mood was subjectively and objectively sad and anxious. In the content of thought
he feels sad and anxious about future. There was no perceptual disturbance. His
Abstract reasoning was adequate. His test judgement, personal and social judgement
was adequate. His insight was at level III.

TESTS ADMINISTERED

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 1. Standard Progressive Matrices (RPM)
2. NEO - Five Factor Inventory (NEO-FFI)
3. International Personality Disorder Examination (IPDE)
4. Symptoms Sign Inventory (SSI)
5. Beck’s Depression Inventory (BDI)
6. Depression Anxiety and Stress Scale (DASS)
7. Sentence Completion Test (SCT)
8. Rorschach Inkblot Test

TEST FINDINGS

 On RPM, the patient has got a percentile of 97, a grade of I and the corresponding
IQ was 124, which indicates Intellectually Superior.

 On NEO-FFI, the patients score is as follows:

Dimensions Actual Score T Score Interpretation

Neuroticism 31 68 Very High

Extroversion 30 55 Average

Openness 22 41 Low

Agreeableness 25 36 Low

Conscientiousness 21 28 Very Low

The interpretation of,

 N+ O- indicates that his Style of Defenses is Maladaptive, i.e. he may tend to use
primitive and ineffective defenses such as Repression, Denial, and Reaction
formation. He may lack insight into the distressing affects they experience and
because they cannot verbalize their feelings, they may be considered alexithymic.
 N+ A- indicates that his Style of Anger Control is Temperamental, i.e. he may fly
into a rage over a minor irritant, and he may seethe with anger for long periods of

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 time. He may be deeply involved in himself and take offense readily, and he may
often overlook the effects of his anger on others.
 N+ C- indicates that his Style of Impulse Control is Under controlled, i.e. he may
be at the mercy of his own impulses. He may be particularly susceptible to
substance abuse and other health risk behavior.
 O- A-indicates his Style of Attitudes is Resolute Believers, i.e., he may have
strong and unchanging beliefs about social policies and personal morality.
Because he might view human nature with considerable skepticism, he supports
strict discipline and a get-tough approach to social problems. He may expect
everyone to follow the rules.
 O- C-indicates that his Style of learning is Reluctant scholars, i.e. academic and
intellectual pursuits are not might be his strength or preference. He may need
special incentives to start learning and to stick with it. He may have problems
maintaining attention.
 A- C-indicates that his Style of Character is Undistinguished, i.e. he may tend to
be weak-willed and is likely to have some undesirable habits he may find difficult
to correct.

 On IPDE, he has got significant scores on Anxious, Dependent, Anakastic,

Borderline and Impulsive Personality Disorder.
 On SSI, he has got significant score for Depression, Obsessions and Compulsions,
Schizophrenia and Melancholia.
 On BDI, his total score was 30 indicating moderate Depression.
 On DASS, he has got severe score for Depression, Moderate scores for Anxiety
and Stress.

 On SCT, in the family area, he feels anxious of missing his mother in future. He
wishes his father to quit smoking. In the area of self concept, he has fear of
standing before a crowd and his fear sometimes forces him to give up. He feels
guilty of being a pessimistic person. The worst thing he ever did was anticipating
regarding future. With regard to attitude towards own ability, his greatest
weakness is being not confident about himself. His future looks bad for him

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Rorschach findings indicate that the patient’s basic intelligence is average or above
average and adapts an intratensive style of personality. There is a presence of negative
emotions. The protocol indicates features of depression. There is no positive finding
suggestive of impaired reality testing, unusual thought pattern and impaired
meditational functioning or overall psychosis

INTERVENTION

PSYCHOPHARMACOTHERAPY

Psychopharmacotherapy is the use of medications in the treatment of

psychiatric disorders. These medications are frequently referred to as psychoactive or
psychotropic medications. The medications used in psychopharmacotherapy are
usually prescription medications.

Most psychoactive/psychotropic medications are developed for the treatment

of psychiatric disorders such as depression or schizophrenia. However, some
medications developed for other purposes have been found to be helpful in psychiatric
disorders. For instance, anticonvulsant medications, developed for the treatment of
seizure disorders, have also been found to be helpful in managing bipolar mood
disorders.

PSYCHOEDUCATION

Psychoeducation refers to the process of providing education and information

to those seeking or receiving mental health services, such as people diagnosed with
mental health conditions (or life-threatening/terminal illnesses) and their family
members. Though the term has been in use for most of the 20th century, it did not
gain traction until movements addressing the stigmatization of mental health concerns
and working to increase mental health awareness began in earnest.

COGNITIVE BEHAVIOURAL THERAPY

The CBT approach to treating depression can be divided into its cognitive and
behavioral components. In the cognitive component of treatment, therapist and patient

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learn to identify the distorted negative thinking that causes negative emotions. Then
they question the veracity of these thoughts and come up with alternative balanced
thoughts. They also learn about the patient's core beliefs underlying the daily
automatic negative thinking. For example, a depressed patient may have the core
belief "I am a loser;" when he gets some less than ideal feedback at work he starts
having rather drastic thoughts like "I won't be able to finish this task," or "the work I
am doing is worthless," or "I'm going to get fired." Almost simultaneously with these
negative thinking he starts feeling down, with very low motivation and energy. When
he starts undergoing CBT treatment he learns to come up with more balanced
thoughts, like "I'm not doing as good a job as I could, but it's not terrible either" or "If
I don't improve this level of productivity I could end up getting fired, but I know I can
improve it." As a result of this more realistic assessment of the situation, the patient
will not feel so depressed. Furthermore, therapist and patient will have the opportunity
to question the underlying core belief "I am a loser." Where did that idea come from?
What evidence is there for or against it?

In the behavioral component of treatment, the therapist helps the patient assess
how the different daily activities have an impact on the patient's mood and how some
of them can improve symptoms of depression. Therapists usually help patients
develop an action plan, based on the behavioral activation approach.12 In this
approach the therapist and patient create a list of activities and then they order them
from less to more difficult to achieve. As the patient goes from easier to harder
activity his feeling of mastery improves as depression lessens.

Practicing CBT skills with exercises at home is an essential component of

treating depression with CBT. Repeatedly applying these skills to stressful situations
makes a more rational approach more automatic and negative emotions less intense.

RECOMMENDATION

The psychologists recommend him to do more physical activity, mindfulness

practices, light therapy, cognitive behavioral therapy, and mindfulness-based
cognitive therapy.

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INTROSPECTIVE REPORT

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Thought this case study, I have learnt and have received more insight about the

disorder and the going about of a case study. I realized how much work and time must

be put into a case study and time that should be dedicated to researching on the

disorder so that you would understand the client at a better level.

The hospital was a very nice structured house and has several staff working

there. I was asked to wait and when we got to met the head of the clinic, she was very

rude and told us that I can’t do my research there because of our degree. She was very

harsh and wasn’t willing to help us out. Finally she made us wait and told us to come

the next morning. The next morning, there was another lady. She helped me to get a

case and she was helping and gave us the case requirements and wished me the best.

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