Case Journal

CASE JOURNAL
Submitted at: U.D.A.P., University of Mumbai
Date: 30/11/2019
Submitted by: Srishti Bhatnagar
MA Part II Sem III

INDEX
SR. NO. CONTENT

1. Case history 1
MSE
Assessments
Case Conceptualisation
Protocols
2. Case history 2
MSE
Assessments
Protocols
3 Case history 3
MSE
Assessments
Protocols
4. Clinical experience
Name of the Hospital: J.J. Hospital
IPD NO.: 33
Name: S.A.
Age: 29 years
Sex: Male
Marital status: Married
Educational Qualification: 8th standard
Employment status: unemployed
Place of residence: Govandi
In/out patient: in patient
Informant: mother and father
Reliability: moderate
Chief Complaint:
“Neend nahi aati aur bhuk nahi lagti” the client complains of not being able to sleep and eat
for the past eight months.
ODP:
The client was first admitted to sion hospital three years back (used to talk to himself) Then
he was admitted to J.J. hospital two years back for 2 and a half months for ECT treatment.
Now he is again admitted into the J.J. hospital for the past one month. Past 8 months: not
feeling hungry and not been able to sleep. He is getting sleep and is feeling hungry after
medication was started. The client is very aggressive. He hit his sister and threw her child on
the floor. He is unable to sleep. He doesn’t feel hungry. He used to talk to himself. He used to
hear voices telling him what and what not to do. He has delusions of grandeur. He says that
“mere bag mein bahut paisa hai.” He stopped recognising his parents and hence was brought
to the hospital in restraints.
Past Medical History:

He hurt his head as he was involved in a bike accident.
Past Psychiatric History:
Sion Hospital: three years back (talks to himself)
J.J. Hospital: two years back
Developmental History:
Family History:
The client has one brother and two sisters. He’s the third child. All his siblings are married
and have kids. The client has good relations with them. The client said that he has good
relationship with his parents. His parents come to visit him in the hospital. The client has
been married twice. He divorced his first wife because it was an arranged marriage. His
second marriage was a love marriage. The client and his wife have a two year old son.
Currently his wife is staying at her maternal place in Kharghar due to something that
happened between her and the client. She took their son with her. The wife doesn’t know that
the client is in the hospital.
Educational History:
The client has studied till 8th standard. He doesn’t like to study so he left school. He had
friends in school. He is in still touch with them through whatsapp. His childhood best friend
is still in contact with the client too.
Occupational History:
The client works in the film line. He makes up sets that are required in movies and tv series.
Sexual History:
The client reported that he hasn’t masturbated. However he had his first sexual intercourse at
the age of 17 years with his first wife. At 18 years he started watching porn, every-day. He
claims to have had sex with his 8513 girlfriends. He has never been with prostitutes. He has
had no sexual complaints.
Stressors, habits and hobbies:

He didn’t get his love of his life at first. His friends forced him into drugs. The client takes
one chillum and 90ml alcohol, occasionally. The client’s wife went to her parent’s place with
their child. The client loves dancing, singing and playing carom.
Social Support:
The client has good social support. Both of his parents, mom and dad support the client.
Dreams: didn’t report any.
Suicide risk: no suicide risk was found.
M.S.E.
Appearance: The client was neat and well-dressed. He had an Injury on toe.
Behaviour: Cooperative towards the beginning. Later was resistant to answer or talk. He had
taken heavy medicines and was feeling sleepy.
Motor Activity: no disturbance observed as such in motor activity. However his hands were
trembling while doing ROR.
Speech:
a. Fluency: could speak hindi fluently

b. Amount: towards the beginning he gave long answers, later he was resistant and gave
one word answers.
c. Rate: normal. Not too fast and not too slow.
d. Tone: Low, irritated while doing ROR.
e. Volume: Very low
Mood:
He was feeling good about not taking drugs.
Affect:
Quality: Irritated (while doing ROR)
Quantity: Mild
Range: Restricted
Thought content:
He expressed that he was feeling guilty for taking drugs. Wants to go home and start a new
life.
Thought process:
Tangentiality was observed.
Perceptual Disturbances:
No perceptual disturbances were observed.
Cognition:
Alert: 
Orientation: 
Concentration: Hesitant to read numbers backwards. He was feeling sleepy.
Memory;
LTM: 
STM: 
Calculations: He didn’t answer.
Fund of knowledge: 
Abstract reasoning was not found to be fine.
Insight:
The client did not have insight.
The client’s history suggested signs of psychosis. So ROR was done to check reality testing.
Furthermore, MMPI was done to see what clinical psychopathology comes. TAT was done
because the client’s history showed interpersonal conflicts, so to bring those conflicts to the
front.
MMPI
Name: S
Age: 29 years
Sex: Male
Date of testing: 30.9.2019
Date of report: 2.9.2019
Test Administrator: Miss Srishti & Miss Juveria
MMPI was initially created to measure various personality traits. It deals with psychiatric,
neurological, psychological or physical symptoms of various psychological disorders.
MMPI REPORT TABLE
SCALES RAW SCORE T score

1 Hs Hypochondriasis 18 79
2D Depression 24 62
3 Hy Hysteria 18 43
4 Pd Psychopathic deviate 25.4 68
5 Mf-M Masculinity- 25 48
Femininity
6 Pa Paranoia 13 61
7 Pt Psychasthenia 29 76
8 Sc Schizophrenia 39 85
9 Ma Hypomania 28.2 79
0 Si Social Introversion 20 45
Scale 1: Hypochondriasis
High scores on this scale mean stubborn, pessimistic, narcissist and ego-centric. Others might
perceive them as dull, unenthusiastic, ineffective and unambitious. They will use their
symptom related complaints to manipulate others. Their complaints are often vague and
diffuse and will often shift to various locations on their bodies. They often overuse the
medical system and their histories might reveal numerous visits to a wide variety of
practitioners. They refuse to believe assurances that their difficulties have no organic basis.
Scale 8: Schizophrenia
A high score suggests persons who have unusual and unconventional beliefs and may
experience difficulties concentrating and focusing their attention. In moderately elevated
protocols, they might merely be aloof, different, and approach tasks from an innovative
perspective. They may have philosophical, religious, or abstract interests, and care little about
concrete matters. Others might describe them as shy, aloof, and reserved progressively higher
scores would be likely to reflect individuals with greater difficulties in organizing and
directing their thoughts. They might have aggressive, resentful, and/or hostile feelings yet
cannot express their feelings. At their best they might be peaceable, generous, sentimental,
sharp witted, interesting, creative, and imaginative. Very high elevations suggest persons
with bizarre mentation, delusions, highly eccentric behaviors, poor contact with reality, and
possibly hallucinations. They will fell incompetent, inadequate, and be plagued by a wide
variety of sexual preoccupations, self-doubts, and unusual religious beliefs.
Scale 9: Hypomania:
There are cyclical periods of euphoria, increased irritability and excessive unproductive
activity. High scores on this scale means flighty ideas, poor focus and inflated sense of self-
importance and low impulse control. They tend to be deceptive, manipulative and unreliable.
CONCLUSION:
The common traits found were of aggression, hostility, eccentricity, low impulse control,
energetic and agitated. These traits were found in some way or the other in the scales that
showed elevation. The client’s protocol’s scores that show high scores on scales 1, 8 and 9
were seen to incorporate these traits.
CODE TYPE:
Two code types have been found:
The scoring of the clinical scale gives us the coding type of 18/81 i.e. hypochondriasis and
schizophrenia. In such a type the person presents a variety of vague and unusual complaints.
They may also experience confusion, disorientation and difficulty in concentrating. Their
ability to deal with stress and anxiety is extremely limited. They will experience interpersonal
relationships with a considerable degree of distance and alienation. They often feel
aggressive and hostile but will keep these feelings inside. Often when these feelings are
expressed it will be made in an extremely inappropriate, abrasive and belligerent manner.
Others will perceive this individual as eccentric or even bizarre. They will distrust others and
may disrupt their relationships by not being able to control hostility.
Elevation on scale 7 along with this code type depicts presence of fears and anxiety. This
type is frequently diagnosed as schizophrenia.
The other code type is 89/98 i.e. schizophrenia and hypomania. This code suggests that
people are highly energetic. They are emotionally labile, tense and disorganised with the
possibility of delusions of grandeur. Their goals and expectations will be unrealistic. They
will have severe symptoms related to insomnia. Serious psychopathology is supposed to be
present.
This type is often diagnosed with schizophrenia.
Validity scales
Scales Raw score T score

F 12 73
L 09 74
K 16 51
The F scale in MMPI testing represents the extent to which the client is trying to answer in a
deviant way. High scores indicate an invalid profile. This might have been caused by clerical
errors in scoring, random responding, false claims by the client regarding symptoms. In the
current protocol the score is high.
The L score represents the lie score. It depicts the client’s need to present oneself in an
unrealistically positive light. In the current protocol the score is above average. It is elevated.
The client is trying to show himself in a favourable manner.
The K score is the correction score. It is similar to L score but has a subtlety to it. The client’s
score is average which indicates he was not being defensive and guarding.
Clinical Presentation
Scale 5 scores is average which suggests that the client has traditional macho interests. His
likings are similar to most men. Scale 0 scores are also average.
Conclusion:
The client got a type of 18/81 i.e. hypochondriasis and schizophrenia and 89/98
schizophrenia and hypomania. The client also got an elevation on the scale 7 i.e.
psychasthenia. High score means greater levels of self-doubt and are rigid and indecisive.
They have trouble with concentrating.
The client has bizarre sensory experiences like hallucinations, delusions and strange thoughts
as suggested by the Harris- Lingoes subscale SC6. This is supported by the client’s history
when the informant told that he heard a child cry and when he went to see the child the child
suddenly grew big. The client also feels he earns a lot of money and has a bag full of lots of
money. From the client’s history we can also see that the client is highly aggressive and
hostile as reported by the informants. He hit his sister and threw her sister’s kids. He bangs
his head on the tiles. The client tries to strangle people around. He also at a point stopped
recognising his parents. The client’s case history gives a little evidence of the findings on
this scale. However, the validity of this protocol can’t be established as the L and F scores are
elevated.
TAT
TAT Report (S.S)
Name: Mr. S.S
Age: 28
Sex: Male
Name of Administrator: Srishti B & Juveria K
Date of Administration: 30.09.2019
Date of Report: 02.10.2019
The Thematic Apperception Test is a projective personality test for ages 14 and above. It is
useful to gain information about family conflicts, emotional problems, authority,
interpersonal relationships, sexual problems. The test was administered to gain more
information about the client and the problems he is experiencing.
Test Behaviour Observations:
The client was cooperative while doing the test. At first he did not understand the instructions
which were cleared by the administrators. Towards the beginning he was not able to make
stories but later he got used to the testing procedure and got comfortable with the situation.
However, on card 3 the client identified the figures as a father and a son and started with a
story but refused to complete the story. This is because he recently had an argument with his
father which was projected on that card. The reaction time for most of the cards was 2 to 4
seconds, however, for card 12 the reaction time was 10 seconds because it was a sexual card.
The client's mother was around and so he was uncomfortable giving a story in front of her.
When she left, he was comfortable in giving the story.
Unconscious structure and needs:
The main themes reflected were loneliness, poverty, earning money and becoming famous,
conflict with parents, violence. The theme of loneliness was described on 4 cards. For
example, in card 1, the client described the story of a boy who is sitting with a sitar and is
feeling lonely. In card 8, the client described a ship and said that no one is there around. The
ship is sailing all alone. In card 11, the client described the story of a woman who wants some
love and is all alone. In card 13, the client described the story of a boy who is sitting alone
and waiting for someone so that he doesn't feel lonely.
Poverty and wish to earn money and become famous was reflected on 3 cards. For example,
the client described a poor family in card 2 where everyone is worried if they will get enough
food or money. In the last card the client described the story of a boy who lives in poor
conditions and works hard for his parents and becomes a big famous man.
Conflict with parents was described on 3 cards. For example, in card 3 the client described
the story of a father and a son where the son is ignoring the father. The client refused to
complete the story and was uncomfortable looking at the card. On card 5 the client described
the story of a mother and son who are upset with each other because the son has stopped
talking to the parents.
Violence was depicted in 3 cards. For example the client described the story of a mother
trying to strangle her own daughter because she is a girl and when she grows old they will
have to pay her dowry and so the woman is upset that a girl was born rather than a boy. On
card 7, the client described the story of a husband and a wife fighting where the man is again
trying to strangle his wife because she made a mistake.
The main needs and drives are that of affiliation, achievement, aggression, rejection,
acquisition. The need for achievement and acquisition go hand in hand. For example, in card
14th the client described the story of a boy who was poor, worked hard to earn money and
became famous.
The need for aggression was seen in 3 cards. In two cards strangling was involved. In one a
mother was strangling her daughter and in the other a husband was strangling his wife.
The need for rejection was mostly expressed towards parental figures. For example, in card 3
the son is in tension and his dad is asking him what is wrong but the son keeps quite and
doesn't answer his father.
Conception of the world and significant persons:
The client's conception of the environment reveals the following themes: poverty, aggression,
lonely, affiliation, lack of human support. For example, in card 2 the client described a poor
family where the members of the family were worried about their future and whether they
will get enough food or not. This describes a poor environment. In card 7, the client described
the story of a husband and wife where the husband is the aggressor and is inflicting harm to
his wife. This shows the press of aggression. In cards 9 and 10 the client described two
women who are in love with one man, which shows that the environment of the hero has
people who love him. In card 13, the client described a boy who is waiting for someone
which reflects an environment where there is lack of human support.
Integration of ego:
Reality testing: The client’s sense of reality seemed intact as there was accuracy in perceiving
cards he articulated his own personal needs on the cards. His level of organizing the
information was observed to be moderate.
Judgement: The client had below average understanding of how to handle relationships
interpersonally. The client’s judgement as depicted by the stories was seen to be near
average.
Sense of self-esteem: The client was seen to be hopeful for the future and want to work for it.
The regulation of control of drives: it was observed that the client had nearing moderate
control of drives.
Thought process: among the responses of all the cards, the responses given were based on the
picture. They were mostly original and concrete.
Nature of anxieties: the client displayed the anxiety of getting their needs met, physical
harm/punishment, disapproval, being deserted & lonely.
Defence mechanisms: the defence mechanism used was isolation.
The overall maturity: The overall maturity of the client was moderate.
Intelligence: The client’s intelligence was moderate.
Summary of Findings
The client’s stories were concrete. The needs prominently articulated across cards were of
affiliation & aggression. This is in line with the client’s history. The client loves his wife and
his child. He misses him. However, the client is also really aggressive. He hit his sister and
his sister’s kids. He was brought to the hospital in restraints. His environment is seen as that
of love and loss. Loss is seen because his wife went to her parent’s place with their child. The
findings of TAT are supported by the client’s history.
ROR
Name: S.S.
Age: 29
Sex: M
Test Administrator: Miss Srishti and Miss Juveria.
Date of testing:
CC: “Neend nahi aati, bhookh nahi lagti”.
Test behaviour observations: The client appeared neat and clean. He was properly dressed.
His behaviour was appropriate. While handling the cards his hands were trembling. He was
cooperative and giving responses nicely.
Number of responses: the total no of responses given on all the cards were 17 which is
above the minimum possible responses required. Hence the protocol was valid for
consideration.
Name: S.S.
Age: 29
Sex: M
Date of testing:
CC: “Neend nahi aati. Bhookh nahi lagti.”
also taking a lot of time to respond. His reaction time was unusually higher.
consideration.
Processing
Those with avoidant styles have a tendency to economize and avoid complexity. This does
not mean that the processing effort is inadequate. It simply reflects the cautious or
conservative orientation that is consistent with the avoidant style. The influence of the
avoidant style is very substantial and the limited processing effort might create a potential for
adjustment problems. (Step 1 potential finding 2)
More effort has been invested in processing than might be expected. (Step 2 potential finding
2a)
W: M
It indicates that the person is striving to accomplish more than maybe reasonable in light of
the current functional capacities. If this tendency occurs in everyday behaviours, the
probability of failure to achieve objectives is increased, and the consequent impact of those
failures can often include the feelings of frustration. (Step 4: finding 1)
Scanning efficiency is similar to that of most people. (Step 5 potential finding 1)
DQ Distribution
It suggests that the quality of processing is probably adequate, but more conservative and
economical than is typical. This finding is most common with avoidant style, and suggests
that the style is very dominant in directing the psychological activities of the individual. (Step
7: finding 5)
Mediation
There is a moderate level of mediational dysfunction. It indicates ignored or distorted

translations of areas that have rather obvious features. This represents some sort of reality
testing problem (Step 1, finding 6)
The effectiveness of the mediational activity is impeded at times by the interference of

ideational sets or strong affects. (Step 2, finding)
Events of mediational dysfunction occur no more frequently than for most people. (Step 3,
potential finding 4)
The interference to mediation is related to self-image issues. (Step 3A, potential finding 4
The acceptable responses are likely to occur when the cues for those responses are obvious.
The probability of less conventional responses occurring in situations that are simple and/or
precisely defined is minimal even if some problems in processing have been noted. (Step 4,
No firm conclusions can be drawn. (Step 5, potential finding 1)
There is a substantial likelihood of more atypical or even inappropriate behaviours than might
be expected. The proneness toward unconventional behaviours is most likely to be induced
by forms of mediational dysfunction and problems in reality testing (Step 6, Potential finding
4)
Ideation
Avoidant introversives are ideationally oriented, but they differ substantially from the .true
introversive. Although they are prone to delay decisions while considering various options,
the- domination of the avoidant style usually causes the process to be less thorough and their
conceptual activities are likely to be marked by much more simplicity. Usually, they prefer to
keep feelings at a more peripheral level during problem solving and/or decision making, but
they are more vulnerable to emotional intrusions in their thinking when confronted with
complexity or ambiguity. They generally favour systems of logic that are uncomplicated and
they usually avoid engaging in trial-and-error explorations whenever possible. This coping
orientation can be reasonably effective when circumstances arc routine and unambiguous,
provided that the conceptual thinking is reasonably clear and consistent. (Step 1: finding 2)
They appear most often in the protocols of individuals who have an avoidant coping style.
The person tends to react quickly to reduce the irritations created by the intrusions of
peripheral thoughts. (Step 5 potential finding 2)
The thinking is peculiar or disturbed. (Step 10, potential finding 4)
Controls
It can be assumed that ordinarily the individual's capacity for control and tolerance for stress
is similar to that of most others (Step 1, Potential finding 1)
The person has more limited available resources. He is more vulnerable to becoming
disorganized by many of the natural everyday stresses of living in a complex society. They
function most effectively in environments that are well structured and reasonably free of
ambiguity. (Step 2, potential finding 6)
The subject's capacities for control and stress tolerance may be overestimated. (Step 4,
The need states are not being experienced in typical ways, or that they are being acted on
more rapidly than is the case for most people. (Step 5, potential finding 3)
Affect
An avoidant-introversive style exists. It can be assumed that the person usually is disposed to
keep feelings at a more peripheral level during problem solving and decision making.
However, presence of the avoidant style can reduce the overall effectiveness of this ideational
orientation. Introversives usually avoid trial-and-error behaviours and rely more on internal
evaluations rather than external feedback when making decisions. (Step 2: finding 7)
The individual seems as willing as most others with their particular coping style (or age in the
instance of children) to process and become involved with emotionally toned stimuli.
Usually, when emotional stimuli are processed some response or exchange is required.
Therefore, people who have difficulties with control often find it more beneficial to avoid
emotional stimuli reducing demands made on them. (Step 6, potential finding 1)
It can be assumed that the person controls or modulates emotional discharge about as much
as most adults. (Step 9, finding 1)
Self-perception
The individual's estimate of personal worth tends to be negative. Such individuals regard
themselves less favourably when compared to others. (Step 3, Potential finding 3)
The person may be less involved with self-awareness than is usually the case. People, such as
this are often more naive about themselves than might be desirable. (Step 4 potential finding
1)
It is reasonable to presume that the self-image of the person is based more on experience than
imagination. (Step 7a, finding 1)
Interpersonal perception and behaviour
The individual is not as interested in others as much as most people. It can be assumed the
person has a reality based perception of others (Step 7, potential finding 5)
The person usually anticipates positive interactions among people and is interested in
participating in them. The specific patterns of interaction ordinarily will be defined by other
features of the person, especially coping styles and self-image. (Step 8, potential finding 3)
SUMMARY OF THE FINDINGS:

The client has certain reality testing problems. He has peculiar and disturbed thinking. The
person has a negative self-image. The person controls or modulates emotional discharge
about as much as most adults. The client has hallucinations and delusions. However, he has
been on medication for the past one month which seems to have its impact on the client as his
reality testing was not majorly impaired.
CASE CONCEPTUALISATION:
The client is married. He has a child. He has good social support. His mother especially
supports him. The client has complaints of not being able to sleep and reduced appetite. The
client’s illness began 3 years ago. He was taken to Sion Hospital and was admitted there. His
symptoms were that he used to talk to himself at night. He was then afterwards taken to JJ
hospital and admitted. He was given medicines to continue. However, he stopped taking pills
on his own because his wife said that they’re just giving him medicines to prove him mental
and not give him property. He relapsed and was brought to JJ hospital again this year one
month before. He was brought in restraints as he was very aggressive and couldn’t recognise
his parents. The client’s mother and father have reported that the client has hallucinations
delusions. The client’s father reported that one night while he was coming home he said that
he heard a voice, of a child crying. He went to check it out and suddenly he saw the child
growing big. His father also reported that he says that he hears someone telling him to do this
and that. His mother reported that he says there is a bag kept there which has lots of money
and that bag is mine.
Client’s stressors include that he was not able to marry his first love. He had an arranged
marriage. He didn’t like it. He took a divorce and married another woman whom he had
started to love. His wife has been telling him that his family is giving him medicines to prove
that he is mental so that he doesn’t get a share in the property. He and his wife had an
argument. Soon after, the wife went to her parent’s place along with their child. His wife
doesn’t know he is admitted in the hospital. He wishes to get out of the hospital and earn for
his child.
From client’s MMPI we established the following; the client has bizarre sensory experiences
like hallucinations, delusions and strange thoughts as suggested by the Harris- Lingoes
subscale SC6. From the client’s history we can also see that the client is highly aggressive
and hostile as reported by the informants. He hit his sister and threw her sister’s kids. He
bangs his head on the tiles. The client tries to strangle people around.
From client’s TAT we interpreted
From the client’s ROR report we interpreted that the client has certain reality testing
problems. He has peculiar and disturbed thinking. The person has a negative self-image. The
person controls or modulates emotional discharge about as much as most adults.
The client’s case history is supported by the assessment reports. The client has reality testing
problems, although not majorly impaired as he has been on medication for the past one
month. However reality testing problem indicates psychosis. In MMPI, Schizophrenia came
to be the most elevated scale. The client has bizarre sensory experiences like hallucinations,
delusions and strange thoughts. This is supported by the client’s history when the informant
told that he heard a child cry and when he went to see the child the child suddenly grew big.
The client also feels he earns a lot of money and has a bag full of lots of money.
The client’s stressors are that his wife is currently not living with him. She left after they had
an argument about something. She took their son with her. The client wants to get out of the
hospital and earn money. He wants to do something for his child.
Differential Diagnosis:
Major depressive or bipolar disorder with psychotic or catatonic features:
If hallucinations and delusions occur exclusively during a major depressive or manic episode
then a diagnosis of schizophrenia will not be given.
Schizoaffective Disorder:
If a major depressive or manic episode occur concurrently with active phase symptoms and
mood symptoms be present for a majority of the total duration, then diagnosis of
schizoaffective will be given.
Schizophreniform and Brief Psychotic disorder:
The duration for these disorders is shorter than mentioned in Criterion C of Schizophrenia.
Delusional Disorder:
This can be distinguished by the absence of other symptoms found in Schizophrenia.
Schizotypal Personality Disorder:

It may be distinguished by the sub-threshold of symptoms that are associated with persistent
personality features.
OCD and body dysmorphic disorder:
These are distinguished by their prominent obsessions, compulsions, preoccupations with

body appearance or odour, hoarding or body focused repetitive behaviours.
PTSD:
This is characteristic of symptom features relating to reliving and re-enacting to the event are
required to make the diagnosis.
Diagnostic Features:
(According to DSM V coding note; 295.90) [According to ICD 10; (F20.9)] Schizophrenia
No single symptom is pathognomonic of the disorder but a constellation of symptoms must

be present. At least two criterion A symptoms should be present for a considerable amount of
time for at least 1 month, one of these should be Criterion A1, A2 or A3. The client had
Delusions (A1) and Hallucinations (A2). It involves impairment at least in one major area of
life as per Criterion B (disturbed interpersonal relationships and occupational setting). Some
signs of the disturbance must persist at least for 6 months to fulfil Criterion C (3 years).
Specifier: First episode currently in partial remission.
Course & Prognosis:
The client’s symptoms began 3 years back. The course has been one of exacerbations. There
has been no remission found till date. The symptoms do subside for a few days but not
completely to fulfil it as remission. When he’s taking medication his symptoms have
diminished expression. The client’s history shows that he has good social support from his
parents, especially his mother. The client is also married however she is not currently living
with him. The client’s symptoms are positive symptoms. These factors show that the
prognosis for the client is good.
Treatment Implications:
Treatment for schizophrenia implies;

Pharmacotherapy: Antipsychotics diminish psychotic symptom expression and reduces
relapse rate, if taken the whole course.
Hospitalisation: Hospitalisation is done for stabilization of medications. Another reason to

hospitalize patients is that they could be aggressive or be having self-harming behaviours so
it’s also done for the patient’s safety.
Name of the Hospital: J.J. Hospital
OPD NO:
CASE HISTORY 2
Name: J.A.A
Age: 25
Sex: Male
Native place: Gorakhpur
Current place: Kalyan
Occupation: Currently unemployed
Informant: Brother
Reliability: Moderate
C.C.:
The client reported his C.C as “ghabrahat hoti hai. Dimagi tension. Cheezein todne ka mann
karta h.” he feels restless, feels that people may harm him. He has anger outbursts, sleep
disturbances and irritability.
O.D.P:
The problem started around 10 years back. He had sleep disturbances then. He was not able
to sleep due to tension. His delusions and other symptoms began 4 years back. He is currently
in the active phase. There hasn’t been any remission. He was first admitted in Suryamukhi
hospital. He was there for two months. His medicines were continued after he was
discharged. His symptoms reduced a little after taking medicines but he wasn’t completely
symptomless. He was then taken to Ajay Clinic in Kalyan where his treatment was going on.
Finally when there was no improvement he went to J.J. Hospital. The client symptoms
include aggression, delusions of persecution, delusion of reference, irritability, confused
thoughts, made no eye contact and displayed no emotional expression (flat effect) and apathy.
He was first admitted into Suryamukhi Hospital for two months. He then went to Ajay Clinic
in Kalyan. And currently is getting his treatment from J.J. Hospital.
Developmental History:
The client’s delivery was normal. There were no complications. The mother did not take any
substance during the pregnancy and was healthy. The client did not have any delay in
meeting the developmental milestones. The client reported that he got his beard and
moustache for the first time when he was 10 years old.
Family History:
The client has three brothers and one sister. He is the second child. He is more close to his
mother than his father. He claims to have good relationship with his parents as well as his
siblings. The client has hit his mother. There is no record of any psychiatric history in the
family. The client is married. The client has three sons; 8year old, 5 year old and three year
old. The client and the wife live in a nuclear family. The client strangled his wife two months
back. The client hasn’t faced any kind of abuse from the family.
Medical History:
The client once had a bike accident. He was taken to the hospital. There is no sign of
organicity.
The client’s school life was fine. He didn’t face much trouble in school and had friends. His
relationship with his teachers and peers were okay. He only studied till 12th class. He failed
12th and dropped out.
He worked at a bakery. Then he worked as a mechanic in Padrauna. Then he started working
in bhiwandi. His work was to put patri line. But he has been jobless for the past five months
now.
Sexual History:
The client reported he hasn’t masturbated. He hasn’t watched porn. He doesn’t know about
prostitutes. He didn’t face any problems with having sex with his wife. Sexual relations are
fine between them.
Substance abuse:
The client has no record of substance abuse.
Stressors, Hobbies & Habits:
The stressor for the client is that he currently has no job. He has problems because he is not
able to sleep. Tension doesn’t let him sleep. His father keeps telling him to get a job and why
he doesn’t have one. This is the source of his tension. He reported his hobbies as working. He
loves doing work. He doesn’t like sitting idle. He wants that he should be indulged in some
work and doesn’t like anyone telling him what to do and how to do. The client takes gutka
once a day.
Suicide risk:
The client has not harmed himself. There is no report of suicide.
Appearance: The client was neat and well-dressed.
Behaviour: he was taking too long to respond as he would take long pauses.
Motor Activity: Tremors. He did not make eye contact.
Speech:
a. Fluency: Staccato
b. Amount: Poverty of speech
c. Rate: Too slow.
d. Tone: Monotonous
e. Volume: Very low
Mood:
“Thik lag raha hai.”
Affect:
Quality: Flat
Quantity: Low
Range: Flat
Thought content:
Themes of persecution and reference were there.
Thought process:
Thought blocking was observed.
No perceptual disturbance was found.
Cognition:
Alert: the client didn’t seem to be alert
Orientation: The client was oriented.
Concentration: Hesitant to read numbers backwards. He was feeling sleepy.
Memory: both, immediate and long term memory was found to be fine.
Calculations: He didn’t answer.
Fund of knowledge was found to be fine.
Abstract reasoning: was not found to be fine.
Insight:
The client did not have insight.
Rationale of the tests done

ROR was done to check reality testing. MMPI was done to assess psychopathology. (Also
because these test came as a referral.) TAT was done to see if there are any interpersonal
conflicts and relationship with others
ROR
Name: J.A.A.
Age: 25
MRD NO: 2733396
Sex: M
Date of testing: 4th October 2019
Date of Report: 8th October 2019
CC: Ghabrahat, restlessness, general body aches, feels that people may harm him.
consideration.
In the constellation of worksheet CDI was found to be positive, which is the coping deficient
index.
Controls
Person is highly vulnerable to loss of control and becoming disorganized under stress. They
usually have histories that include numerous events marked by faulty judgement, emotional
disruption or behavioural ineffectiveness. (Step 1, Potential finding 2)
The person has more limited available resources. He is more vulnerable to becoming
disorganized by many of the natural everyday stresses of living in a complex society. They
function most effectively in environments that are well structured and reasonably free of
ambiguity. (Step 2, potential finding 6)
The subject's capacities for control and stress tolerance may be overestimated. (Step 4,
The person is experiencing some distress. (Step 5, potential finding 1)
Person is less socially mature than might be expected. This is the type of individual who is
limited in social skills and is disposed to experience frequent difficulties when interacting
with environment, especially the interpersonal sphere. (Step 1potential finding 1)
The person tends to acknowledge and/or express his or her needs for closeness in ways that
are dissimilar to those of most people. The individual is more conservative than might be
anticipated in close interpersonal situations, especially those involving tactile exchange. (Step
5 finding 2)
The individual is not as interested in others as much as most people. (Step 6 finding 5)
Self-perception
The individual's estimate of personal worth tends to be negative. Such individuals regard
themselves less favourably when compared to others. (Step 3, Potential finding 3)
The person engages in self-inspecting behaviours somewhat routinely. (Step 4 potential

finding 2)
Some unusual body concern or preoccupation is present. If no health problems exist, it

suggests the likelihood of rumination about body and/or self-image and may indicate a
disconcerting sense of vulnerability. (Step 5 finding 2)
Affect
The person is identified as an avoidant ambitent. The avoidant orientation is more pervasive
and, typically, will be invoked in relation to the extent that the person perceives the situation
as being complex or ambiguous. Thus, the frequency of incidents in which emotions are less
well modulated or overly constricted, or in which thinking is less sophisticated, are likely to
be much greater than for the ambitent who does not have an avoidant style. (Step 2: finding
9)
No specific hypothesis can be warranted. (Step 4, finding 1)
No interpretive hypothesis can be formed. (Step 5)
This finding indicates a marked tendency to avoid emotional stimuli. People such as this
usually are quite uncomfortable when dealing with emotion. As a result they often become
much more socially constrained or even isolated. (Step 6, potential finding 4)
Processing
The tendency to economize and avoid complexity does not mean that the processing effort is
inadequate. It simply reflects the cautious or conservative orientation that is consistent with
the avoidant style. (Step 1 potential finding 2)
The person has been very economical in the processing effort. (Step 2 potential finding 2b)
W: M
Scanning efficiency is similar to that of most people. (Step 5 potential finding 1)
Perseverations (PSV)
The mechanistic PSV is coded when the individual reports the same content over and over. It
is the least common form of perseveration.
DQ Distribution
that the style is very dominant in directing the psychological activities of the individual. (step
7: finding 5)
Mediation
The dysfunction is severe and reality testing will be markedly impaired. It can be assumed
that the impairment is global, that is, the dysfunction tends to occur regardless of how
obvious distal cues may be. (Step 1, finding 7)
There is a likelihood of a serious meditational impairment. (Step 3, potential finding 4)
The style has become ineffective and is being maintained by reality distortions. (Step 3A,
Less conventional, more individualistic responses will occur, even in situations that are
simple and/or precisely defined. (Step 4, potential finding 3)
4)
Ideation
It represents an unwanted psychological mixture in which the less efficient ambitent is

markedly influenced by the avoidant style. The orientation to avoid complexity overlays the
inconsistency in conceptual thinking and the end product is much greater inefficiency
because the array of possible conceptualizations is reduced significantly. The avoidant-
ambitent is vulnerable to less sophisticated thinking and more frequent incidents in which
emotions are less well modulated. (step 1: finding 6)
They appear most often in the protocols of individuals who have an avoidant coping style.
(Step 5 potential finding 2)
The client’s capacity to deal effectively with stress is low. He finds it difficult to get any
sleep under tension. He has been having sleep disturbances for the past 10 years. He will not
even express his feelings or even ask for food or water. He is also really aggressive and
impulse control is low. He tried to strangle his wife and often used to throw things at his
mother. The client when asked about family said that the parents live in Saudi when they
actually live in their native village. The client is rather impulsive. He leaves without
informing anyone where he is going and returns after days. He only remembers his mother’s
number and calls on it. He also feels that people may harm him. He constantly suspects
everyone. He is also suspicious about his wife. When he sees two people talking he feels they
are talking about him. These feelings of suspiciousness reflect his delusion of persecutory
thoughts. Through his responses we have come to know that he has been economical about
his processing, ideation was reflected in his protocol. There is likelihood of serious
meditational impairment in the client. He is overly constricted. His personal worth tends to be
negative. He is socially less mature. The reality testing of the client was found to be not
intact.
MMPI
Name: Javed Ansari
Age: 27
Sex: Male
Name of Administrator: Juveria K. & Srishti B
Referral: JJ Hospital, OPD 33
The Minnesota Multiphasic Personality Test 2 (MMPI-2) was administered as it was referred
by the psychiatrists at the hospital. Minnesota Multiphasic Personality Inventory (MMPI) has
been originally developed to quantitatively measure various personality traits and
psychopathology. MMPI deals largely with psychiatric, psychological, neurological or
physical symptoms of different psychological disorders.
Test Behavior Observations:

The client was cooperative while the test was administered. The client read the first 20 items
on his own and ticked the appropriate answer on the response sheet. After that, he requested
the administrator to read the questions for him. The client was listening to each question
carefully and asked doubts if he had any. For some sentences, the administrator had to
explain to the client what the statement actually meant, because the client misunderstood the
statements. During the testing procedure a lot of derailment in the thought process of the
client was found.
Table of Clinical Scale Scores:
Scales Raw Scores T Scores

1. Hypochondriasis (Hs) 13 75
2. Depression (D) 22 59
3. Hysteria (Hy) 28 66
4. Psychopathic Deviate (Pd) 18 57
5. Masculinity Femininity (Mf) 21 40
6. Paranoia (Pa) 11 53
7. Psychasthenia (Pt) 8 53
8. Schizophrenia (Sc) 20 74
9. Hypomania (Ma) 23 69
10. Social Introversion (Si) 28 52
As noted above the elevations have been on the clinical scales of Hypochondriasis and
Schizophrenia.
Code Type:
The scoring of the profile yields a code type of 18/81, i.e. Hypochondriasis (Hy) and
Schizophrenia (Sc) are elevated. The key features of people with this code type is that the
clients often show a variety of vague and medically atypical physical complaints. Periods of
confusion and disorientation are possible, and where these occur there is a possibility of a
psychotic or prepsychotic condition should be considered. They are typically alienated
interpersonally, as others see them as strange in thought and behavior. Some of these persons
appear to be attempting to hold themselves together via somatic pre-occupations-delusions to
try to ward off a break with reality. Home life may be severely disrupted by poor control over
their hostility. They show little response to simple reassurance and in treatment is unlikely to
attain much insight into personality difficulties. Diagnostically, the possibility of an acute
schizophrenic episode must be considered.
Validity Scales:
Scales Raw Score T Scores

L 9 74
F 11 70
K 20 60
As can be seen in the table the raw score for the Lie Scale (L) is 9 with a T score of 74
which indicates that the client has intense needs to present himself in a good light combined
with repression and denial. The client might be introspective, excessively ruminative who has
difficulty making friends. The client might be tense, slow, stereotyped and unoriginal in their
response to problems, naïve, passive, insecure and unaware of their social stimulus value.
Others see this person as aloof and wary.
The F scale indicates the extent to which the person presents himself in a deviant manner.
The T score of the client on this scale is 70 which means that the client might have unusual
or markedly unconventional thinking.
The K scale detects faking good behavior. It measures guardedness or defensiveness in text-
taking attitude. It also provides a measure of ego-strength, reality contact, coping ability, and
the intactness of emotional defenses. The client’s score on this scale is 60 which means that
the client is independent, enterprising, ingenious, resourceful, sociable, reasonable,
enthusiastic. It indicates ego strength, reality contact and adequate functioning of
psychological mechanisms.
The F-K indicates faking good or bad. The F-K index for the client is -9, which suggests that
the client is glossing over and minimizing problems in an attempt to look good.
Harris Lingoes:
The Harris Lingoes subscales were developed grouping together items that seems to reflect
single traits or attitudes contained in the already existing MMPI Scales 2,3,4,6,8 and 9.
Here we will consider the Harris-Lingoes Scales for the scales that are elevated. The elevated
scales for this profile are Hypochondriasis and Schizophrenia. There are no Harris Lingoes
Scales for Hypochondriasis.
Schizophrenia:
Lack of Ego Mastery, Defective Inhibition: (T = 75) Sense of losing control of impulses
and feelings, labile, hyperactive, cannot control or recall certain behaviours.
Emotional Alienation: (T = 69) Depression, fear, possible suicidal wishes.
Lack of Ego Mastery, Conative: (T = 65) Depressed, worried, fantasy withdrawal, life is
too difficult, possible suicidal wishes.
Bizarre Sensory Experiences: (T = 65) Hallucinations, peculiar sensory and motor

experiences, strange thoughts, delusions.
Conclusion:
The validity of the profile is questionable because the L and F Scales are elevated. But with
the code type 18/81 this is expected. The client might have schizophrenia as the F scale is
also elevated. The elevations in the Harris Lingoes Scales of Schizophrenia also suggest that
the client might have Schizophrenia. The highest elevation is in the Lack of Ego mastery,
Defective Inhibition which means that the client loses impulse control and is unable to recall
such events. This is in line with the history where the client’s brother mentioned that he
physically abused his wife, but the client does not remember any such event. The client also
mentioned that when he gets angry, he runs away from the house. There have been instances
where he ran away from the house and disappeared for 2-3 days.
TAT
Name: Javed Ansari

Age: 27
Sex: Male
Name of Administrator: Srishti Bhatnagar & Juveria K.
Referral: JJ Hospital, OPD 33
Rationale: TAT is a projective measure which is used to interpret the client’s wishes, desires,
conflicts, fantasies, drives, impulsive behaviour etc. This measure uses cards that depict
psychological situations, through which the client can project their behaviour and thought.
Observations: The client gave very concrete story responses. He did not maintain eye
contact. He took way too much time to respond. Instructions were to be repeated on every
card. His hands were trembling. He would keep staring at the card for a considerable amount
of time.
Unconscious structure:
The needs that were prominent in the client’s protocol came out to be the need of nurturance
and dejection. Other needs were counteraction, aggression (physical) & affiliation. Need for
nurturance was observed in card 5 and 12. In card 5 a woman, with her head down has come
to a man to seek his help. The man listens to the woman’s problem and is going to then help
her and give advice. In card 12 there is a mother and a son. The mother is on the bed trying to
sleep and the son comes and asks if there is anything he can bring for her or anything she
needs. Need for Dejection was seen in cards 1 and 4. In card 1 the boy is sitting with his hand
on his neck. He is feeling sad and is troubled. In card 4 there is a mother and daughter. They
are sitting together. The girl is troubled. She must be in some kind of pain. They are upset
and sad as the girl lost her father. She is remembering him. Need for counteraction was
observed in card 3. A father is explaining to his son that he should not be doing mischief all
the time and should study. The boy will work hard and go on to become a good man. Need
for aggression was depicted in card 7. The man is strangling his wife while she is screaming
for help. He is also scolding her. Aggression in this card is both physical and verbal. The
need for affiliation was portrayed on card 10. The man and woman are in love.
Conception of the environment and perception of significant others:
The presses of the client’s environment came out to be that of loss, succorance, acquisition
and rejection. Press of loss was depicted in cards 1, 2 &4. In card 1 the boy is being sad about
something that has been lost. Something bad has also with him that makes him sadder. In
card 2 the people bear a loss in their crops. In card 4 the girl loses her father. Press of
succorance was seen in card 5 and 7. In card 5 the woman has come to the man seeking help
for her problems. In card 7 the woman is crying for help when she is being strangled. Press
for acquisition was seen in card 3 and 10. In card 3 the son studies to become a good man and
to earn through social means. In card 10 the woman accuses the man of trying to steal or take
something from her. Press of rejection was seen in card 12 as the mother rejects the son, tells
him to go away and not disturb her.
Integration of ego:
Reality testing: The client’s sense of reality didn’t seem intact. His level of organizing the
information was observed to be low.
Judgement: The client had less than moderate understanding of how to handle relationships
interpersonally. The client’s judgement as depicted by the stories was seen to be low.
The regulation of control of drives: it was observed that the client had almost no control over
his drive for aggression.
Object relation: The client displayed low relationship stability. He barely talks to his family.
He recently hit his wife. He sits and waits for people to give him food as he won’t even ask
for food.
Thought process: The client’s story was not rich. He could barely create proper stories. He
took time to respond and was not able to comprehend at one go.
Nature of anxieties: the client displayed the anxiety of loss and deprivation.
Defence mechanisms: Various maladaptive defence mechanisms were used by the client like
denial and repression.
The overall maturity: The overall maturity of the client was low.
Intelligence: The client’s intelligence was moderately low.

Summary of the findings:
The responses given by the client were not rich in content. He barely could make proper
stories. He would just give answer to all the aspects of the story required rather than creating
a story. Instructions were required to be given on every card. Even then he didn’t answer
promptly and would just stare at the cards. The client’s anxiety consists of deprivation. He
reported saying that he wants to be indulged in work. He just wants to keep working and not
sit idle. Reality testing was low. The client suffers from delusions of reference and
persecution.
CASE CONCEPTUALISATION:
The client is married and has three kids. He is very aggressive. He has been physically
aggressive with his wife as well as with his mother. He throws things and also gets verbally
aggressive. His brother reported that once in a month he gets a “jhatka” in which he throws
things, verbally abuses. He also reported that the client just wanders off without telling
anyone. He travelled from Mumbai to his village without informing his relative he was
staying here with. He had no money, so upon reaching the bus stand in his village he walked
60 kms to his place. He only remembers his mother’s number and called her. That’s when his
brother came to pick him up. The client is suspicious of his wife having an affair and hence
was aggressive towards her. Whenever two people are talking he feels they are talking about
him. The client also displays flat affect and apathy. The client does not interact much with
people around him. He wouldn’t even ask for food, he eats when his family gives him food.
The client has delusions and negative symptoms of schizophrenia. He is very suspicious of
people around him. He suspects of his wife having an affair.
The client’s stressors are that he doesn’t have enough work to do right now. He says he
cannot sit idle. He just wants to be doing something or anything. He also doesn’t like when
people tell him what to do and how to do his work. He hate when people interfere with his
work. He has no work currently and is not feeling good about it. He just wants to be occupied
with work rather than sitting with no work
In TAT it was found that the client’s story was not at all rich in content. He gave concrete
responses. He was unable to make proper stories. In ROR, the client’s reality testing came out
to be severely impaired. In MMPI the client got an elevation on Schizophrenia. All these
assessments portray that the client has serious meditational impairment. His impulse control
is low. He suspects everyone around him. These symptoms point to schizophrenia. These
findings of the assessment are supported by the case record of the client.
Differential Diagnosis
Major depressive or bipolar disorder with psychotic or catatonic features:
If hallucinations and delusions occur exclusively during a major depressive or manic episode
then a diagnosis of schizophrenia will not be given.
Schizoaffective Disorder:
If a major depressive or manic episode occur concurrently with active phase symptoms and
mood symptoms be present for a majority of the total duration, then diagnosis of
schizoaffective will be given.
Schizophreniform and Brief Psychotic disorder:
The duration for these disorders is shorter than mentioned in Criterion C of Schizophrenia.
Delusional Disorder:
This can be distinguished by the absence of other symptoms found in Schizophrenia.
Schizotypal Personality Disorder:
It may be distinguished by the sub-threshold of symptoms that are associated with persistent
personality features.
OCD and body dysmorphic disorder:
These are distinguished by their prominent obsessions, compulsions, preoccupations with

body appearance or odour, hoarding or body focused repetitive behaviours.
PTSD:
This is characteristic of symptom features relating to reliving and re-enacting to the event are
required to make the diagnosis.
Diagnostic features
(According to DSM V coding note; 295.90) [According to ICD 10; (F20.9)] Schizophrenia
No single symptom is pathognomonic of the disorder but a constellation of symptoms must
be present. At least two criterion A symptoms should be present for a considerable amount of
time for at least 1 month, one of these should be Criterion A1, A2 or A3. The client had
Delusions (A1) and Negative symptoms (A5) [flat affect and apathy]. It involves impairment
at least in one major area of life as per Criterion B (disturbed interpersonal relationships and
occupational setting). Some signs of the disturbance must persist at least for 6 months to fulfil
Criterion C (4 years).
Specifier: First episode, currently in acute episode.
Course &Prognosis
The client’s symptoms began 4 years back. The course has been one of exacerbations. There
has been no remission found till date. The symptoms do subside for a few days but not
completely to fulfil it as remission. The client displays negative symptoms. This could mean
bad prognosis. However, he is married. He has his parents and siblings who seem to support
him.
Treatment Implications:
Pharmacotherapy: Antipsychotics diminish psychotic symptom expression and reduces

relapse rate, if taken the whole course.
Hospitalisation: Hospitalisation is done for stabilization of medications. Another reason to

hospitalize patients is that they could be aggressive or be having self-harming behaviours so
it’s also done for the patient’s safety.
CASE HISTORY 3
Name of the Hospital: Sion Hospital
OPD NO: 31
Name: S.M.F.
Age: 20 years old
Sex: Male
Native place: Mumbai

Current place: Mumbra
Occupation: Student
Informant: Client and the mother
Reliability: Moderate
C.C.: “IQ testing k liye aaya hun” the client experiences severe anxiety. He’s always scared
of death. He feels scared that he might die.
O.D.P.:
The client saw a video on Youtube where he saw an angel in black clothes come to take a
man back with him. This disturbed the client. The client then lost his two close friends. His
fear of death became more pronounced. The video keeps coming in his mind and scaring him.
He has consulted 2-3 doctors. He first went to Prime hospital in 2017. He was on medication
for 6 months. He was feeling fine. He then left medicine because he wanted to show his
mother that he was fine without it. He was then taken to Kalwa hospital in 2018. Then in
2018 end he went to Machis wala. The medicines he was given was too strong. He only kept
sleeping. He also used to have chakkar. He then finally came to Sion hospital. The client had
remission. However, he left his medication in between. Also, during the same time he heard
of two deaths of young people (one was a youtuber and the other was his neighbour, early
20’s). His symptoms came back. His symptoms include anxiety. He fears death. He doesn’t
like being alone because he feels that something might happen to him and there would be no
one around to take care. He gets aggressive to the point where he breaks things. He then feels
satisfaction after breaking things. After he gets calm he feels guilty and apologises. He feels
safe only at home. He rarely goes out. Even while coming to the hospital by a train he feared
that a terrorist might have planted a bomb and he might die.
The client was taken to Prime hospital in 2017. He was admitted there for 7 days. In 2018 he
was taken to Kalwa hospital. He was admitted there for 15 days. He then went to Machis
wala in the end of 2018. His medicines were however, strong. So he then came to Sion
Hospital.
Family History:
The client lives in Mumbra with his mother and his younger sister. His mother is a doctor and
his father is an engineer. He has a younger sister who studies in the eighth grade. The client’s
mother and father both have done two marriages. His father didn’t live with them and had a
secret marriage. When the client’s father came to live with the client’s family, the mother got
to know about her husband’s second marriage. They divorced in 2014. To get back at her
husband the client’s mother also married another man. The client’s mother sent her kids to
their grandparent’s place thinking that would make them realise to bring back their daughter-
in-law. The client doesn’t have good relationship with his grandparents and his uncle. The
reason being his uncle is very aggressive and once or twice have hit the client real badly. The
grandparents didn’t say anything to the client’s uncle. The client’s uncle is going under a
psychiatric treatment because of his anger issues. The client and his sister then went on to
live with their mother and her new husband. There the client and his little sister witnessed the
new husband hitting their mother. They say him strangling her. When his sister started crying
the husband left their mother’s neck. The client’s sister started keeping unwell all the time.
So she sent her to her father’s place in Mumbai and saw a change in her health. She then also
sent the client to Mumbai. The kids told their father about what happened. Seeing the
condition of their kids the client’s mother and father decided to remarry in 2017 end, however
the husband didn’t leave his second wife but promised the client’s mother to take care of her
and the kids. However after they got married the client’s father barely came through his
promise. Client’s cousin was also undergoing some psychiatric treatment. The client reported
“who ghar se bhaag jaata tha. Kahin bhi chala jaata tha.”
Past Medical History:
The client had acquired malaria and typhoid when he was a kid. He also suffered from
Dengue in 2014.
The client had lots of friends in school. He used to have fun in school. He studied in Mumbai
till 9th class. He did his 10th from Surat as he went to live on with his mother and her new
husband. He then came back to Mumbai and did his 11th and 12th from here itself. He is
currently doing his FYBMS from M.S. College, Mumra.
He tried working as a receptionist in Prime Hospital for 10 days. He started on 1st October.
But he was removed and told to get a psychological evaluation done first. He is looking to do
a job in Pizza Hut.
Sexual History:
The client started masturbating at the age of 16 years. He masturbates while watching porn.
His semen was white but after sometime it came out to be yellow. When he was in Surat he
used to masturbate 5 times a day. Now he does it 1-2 times in a month. He has had no sexual
intercourse.
Social support:
The client has good social support from his mother, father and sister. He is closest to his
mother. He also loves being with his sister and playing with her. He has a few close friends.
Stressors/Habits & Hobbies:
The client has various stressors. One stressor the client has is of pre-mature death. Another
stressor for the client is his health which could lead to his death. Another stressor is his
family environment. The client loves to go to the gym. The client also loves cricket.
Appearance: The client was neat and well-dressed.
Behaviour: Cooperative throughout the testing. He was willing to talk. He was open.
Motor Activity: no disturbance observed as such in motor activity. He maintained eye

contact.
Speech:
a. Fluency: Appropriate
b. Amount: Good
c. Rate: normal. Not too fast and not too slow.
d. Tone: Anxious
e. Volume: Appropriate
Mood:
“Achha nahi feel ho raha

Affect:
Quality: Not feeling good.
Quantity: moderate
Range: normal
Thought content:
Anxiety related to death, illness, youtube video.
Thought process:
No thought process was observed.
No perceptual disturbances were observed.
Cognition:
Alert: 
Orientation: 
Concentration:
Memory;
LTM: 
STM: 
Calculations: 
Fund of knowledge: 
Abstract reasoning: 
Insight:
The client had insight.

Rationale for tests:
ROR was done for reality testing. MMPI was done to screen out potential psychopathology.
TAT was done as his history consisted of disturbed interpersonal relationships.
ROR
Name: S.M.F
Age: 20
Sex: M
Test Administrator: Miss Srishti and Miss Dimple.
Date of testing: 18th/11/2019
Date of Report: 25/11/2019
CC: “IQ testing karane aaya hun.”
consideration.
Processing
Those with avoidant styles have a tendency to economize and avoid complexity. This does
not mean that the processing effort is inadequate. It simply reflects the cautious or
conservative orientation that is consistent with the avoidant style. (Step 1 potential finding 2)
More effort has been invested in processing than might be expected. (Step 2 potential finding
2a)
W: M
The subject scans hastily and haphazardly, and often may neglect critical bits or cues that
exist in a stimulus field. (Step 5 potential finding 2)
The person has significant difficulty shifting attention. (Step 6, potential finding 1)
The quality of processing usually is adequate. However, at times, the processing activity
falters to a less adequate or less mature level. (Step 7, potential finding 2)
DQ Distribution
that the style is very dominant in directing the psychological activities of the individual. (Step
7: finding 5)
Mediation
A significant mediational impairment is observed. The dysfunction is serious and reality

testing will be markedly affected. The impairment is global, that is, the dysfunction tends to
occur regardless of how obvious distal cues may be. (Step 1, finding 7)
The hypothesis generated in the above step should be reconsidered to indicate that the
effectiveness of the mediational activity is impeded at times by the interference of strong
affects (types of No Form answers have occurred). (Step 2, finding)
There may be some pervasive tendencies to mediational dysfunction. (Step 3, potential

finding 3)
The style has become ineffective and is being maintained by reality distortions. (Step 3A,
The acceptable responses are likely to occur when the cues for those responses are obvious.
The probability of less conventional responses occurring in situations that are simple and/or
precisely defined is minimal even if some problems in processing have been noted. (Step 4,

4)
Ideation
Avoidant extratensive individuals are inclined to use and be influenced by feelings. They
depend a great deal on feedback. They apply trial and error behaviour when faced with a
problem. The dominance of the avoidant style, however, increases the probability that they
will not fully differentiate emotional experiences, and their feelings often become overly
influential on their thinking. When they become lackadaisical about modulating their
feelings, this negligence easily gives rise to impulsive like thinking. This often results in
flawed or simplistic logic, which can easily lead to decisions and/or behaviours that are less
effective or even inappropriate for the situation. (Step 1: finding 4)
The person is more prone than most to intellectualize feelings. This suggests that the
individual may adopt or accept a distorted form of conceptual thinking that serves to deny the
true impact of a situation. (Step 7, finding 1)
Controls
The person has a more sturdy tolerance for stress than do most, and is far less likely to
experience problems in control, regardless of the value for the CDI. (Step 1, Potential finding
3)
It provides information about internal stimulus demands. However this finding can be
misleading and requires further evaluation. (Step 2, potential finding 2)
The subject's capacity for control and stress tolerance may be over-estimated. (Step 4,
Affect
An avoidant-extratensive style exists. It is reasonable to assume that, ordinarily, the person is

more prone to use and be influenced by emotion than others, and generally prefers to test out
postulates and assumptions through trial-and error behaviours. However, the presence of the
avoidant style increases the likelihood that complex emotional experiences will not be
differentiated very thoroughly. In those situations, when the person intermingle feelings with
thinking during decision making, the feelings may be afforded either much more or much less
inf1uence than appropriate for the situation. In either circumstance, the resulting behaviour
may be less effective. (Step 2: finding 5)
No specific hypothesis can be warranted. (Step 4, finding 1)
No interpretive hypothesis can be formed. (Step 5, potential finding)
There is a marked tendency to avoid emotional stimuli. Such people are quite uncomfortable
while dealing with emotions. (Step 6, potential finding 4)
The person is inclined to deal with feelings on an intellectual level more often than most
people. Although this process reduces or neutralizes the impact of the emotions, it also
represents a form of denial that tends to distort the true meaning as well as the impact of a
situation. (Step 7, potential finding 1)
There is a significant laxness in modulating emotion. It is an unusual finding among adults

and frequently they are regarded by others as being impulsive or, at the very least, overly
emotional and/or less mature (Step 9, finding 10)
Self-perception
The individual is no more or less self-involved than most others. (Step 3, Potential finding 4)
Some body concern may be present. This finding should not necessarily be considered as a
significant issue concerning the psychological organization. (Step 5, finding 1)
It is reasonable to presume that the self-image of the person is based more on experience than
imagination. Social interactions have probably contributed to the formulation of the self-
image. (Step 7a, finding 1)
It is reasonable to assume that the individual is as interested in others as much as most

people, and probably conceptualizes them in a way that is reality based (Step 6, potential
finding 1
The individual generally engages in forms of interpersonal behaviours that are likely to be
adaptive for the situation. (Step 7, finding 1)
The person usually anticipates positive interactions among people and is interested in
participating in them. The specific patterns of interaction ordinarily will be defined by other
features of the person, especially coping styles and self-image. (Step 8, potential finding 3)
Situational Stress
The impact of the situational stress is probably rather modest. (Step 5, finding 1)
The client’s processing level is adequate but at times can go to an immature level or
sometimes may use too much effort than required. The person is neglectful while he is
modulati
SCALES RAW SCORE T score ng or
regulating his emotions. The client has some body concerns related to self. This finding is
supported by his mother’s information stating that he likes to be well groomed and is always
cautious about his health and body, for which reason he loves to go to the gym. The reality
testing may be markedly impaired. However, the client and his mother haven’t reported any
such information that might make us want to believe that the reality testing might be
impaired. Also, according to Kohfler (FLR) the client’s reality testing was found to be intact.
MMPI
Name: S.M.F.
Age: 20 years
Sex: Male
Date of testing: 18.11.2019
Date of report: 25.11.2019
Test Administrator: Miss Srishti Bhatnagar
MMPI was initially created to measure various personality traits. It deals with psychiatric,
neurological, psychological or physical symptoms of various psychological disorders.
MMPI REPORT TABLE

1 Hs Hypochondriasis 21 85
2D Depression 31 76
3 Hy Hysteria 28 66
4 Pd Psychopathic deviate 29.2 77
5 Mf-M Masculinity- 36 70
Femininity
6 Pa Paranoia 24 101
7 Pt Psychasthenia 40 92
8 Sc Schizophrenia 53 102
9 Ma Hypomania 23.6 64
0 Si Social Introversion 34 60
Scale 6: Paranoia:
High scores indicate suspiciousness, resentfulness and aggressive. The will feel mistreated
and typically misinterpret the motives of others. It would be difficult discussing emotional
problems with them. They might have underlying feelings of anger. They would also be
likely to defend themselves from anxiety through intellectualisation.
Scale 7: Psychasthenia
Elevations on this scale suggest people who are apprehensive, worrying, perfectionistic, tense
and superstitious. They might appear as indecisive apprehensive, rigid and experience self-
doubt.
Scale 8: Schizophrenia
A high score suggests persons who have unusual and unconventional beliefs and may
experience difficulties concentrating and focusing their attention. They may have
philosophical, religious, or abstract interests, and care little about concrete matters. Others
might describe them as shy, aloof, and reserved. They might have aggressive, resentful,
and/or hostile feelings yet cannot express their feelings. They might feel incompetent,
inadequate and be plagued by a wide variety of self-doubts. At their best they might be
peaceable, generous, sentimental, sharp witted, interesting, creative, and imaginative.
Scale 1: Hypochondriasis
High scores on this scale mean stubborn, pessimistic, narcissist and ego-centric. Others might
perceive them as dull, unenthusiastic, ineffective and unambitious. They will use their
symptom related complaints to manipulate others. Their complaints are often vague and
diffuse and will often shift to various locations on their bodies. They often overuse the
medical system and their histories might reveal numerous visits to a wide variety of
practitioners. They refuse to believe assurances that their difficulties have no organic basis.
CONCLUSION:
The common traits found were of aggression, apprehension, resentfulness & self-doubts.
These traits were found in some way or the other in the scales that showed elevation. The
client’s protocol’s scores that show high scores on scales 6, 7 and 8 were seen to incorporate
these traits.
CODE TYPE:
The code type found to be was 68/86
The scoring of the clinical scale gives us the coding type of 68/86. In such a type the person
is suspicious and distrustful. They seem to be extremely distant from others. They can be
described as shy, resentful, and anxious. They can be uncooperative and apathetic. They have
poor judgement and experience difficulty concentrating. However in Harris Lingoes
subscales of scale 6 he got an elevation on persecutory ideas (perceives world as dangerous),
and poignancy (feels lonely, tense, hypersensitive). On scale 8 he got elevation on social
alienation (feels unloved, mistreated) & emotional alienation (fear). These sub scales
elevation are supported by the case history.
Elevated Harris lingoes subscales:
Pa1: 94, Pa2: 89, Sc1: 92 & Sc2 98
Validity scales
Scales Raw score T score

F 19 95
L 08 70
K 18 56
The F scale in MMPI testing represents the extent to which the client is trying to answer in a
deviant way. High scores indicate an invalid profile. This might have been caused by clerical
errors in scoring, random responding, false claims by the client regarding symptoms. In the
current protocol the score is high but not exceptionally high to deem the profile invalid.
The L score represents the lie score. It depicts the client’s need to present oneself in an
unrealistically positive light. In the current protocol the score is above average. It is elevated.
The client is trying to show himself in a favourable manner.
The K score is the correction score. It is similar to L score but has a subtlety to it. The client’s
score is average which indicates he was not being defensive and guarding.
Clinical Presentation
Scale 5 scores is average which suggests that the client has traditional macho interests. His
likings are similar to most men. Scale 0 scores are also average.
Conclusion:
The client got a type of 68/86. The client also got an elevation on the scale 7 i.e.
psychasthenia. High score means greater levels of self-doubt and are rigid and indecisive.
They have trouble concentrating. Harris Lingoes subscales score are supported by the case
history. The client lives in immense fear of death. He feels he can die anytime. He perceives
the world as dangerous (while coming to the hospital he was scared because he was feeling
that a terrorist might blow up his train and he will die). He reported saying that “sirf ghar pe
safe feel hota hai”. He feels lonely when his parents go out or when his sister is watching tv.
TAT
Name: S.M.F.
Age: 20 years old
Sex: M
Test administrator: Miss Srishti and Miss Dimple
Date of Administration: 20th November 2019
Date of report: 25th November 2019
Rationale: TAT is a projective measure which is used to interpret the client’s wishes, desires,
conflicts, fantasies, drives, impulsive behaviour etc. This measure uses cards that depict
psychological situations, through which the client can project their behaviour and thought.
Observations: The client was very open and cooperative while the test and hence was
willing to do it. The client’s mood was stable throughout the administration of the cards. The
client maintained eye contact while responding.
Unconscious structure:
The needs that were prominent in the client’s protocol came out to be the need for affiliation,
need for aggression, need for acquisition, need for dejection. Need for Affiliation
(emotional) nAff has been prominent in cards 10, 11, 13 and the blank card. In card 10 the
husband loves his wife. He keeps thinking about her even when the wife’s friend is making
advances toward him. In card 11 the woman is wishing for her husband to return to her who
has left her for another woman. In card 13 the same woman from card 11 is sitting at the
window waiting for her ex-husband. In the blank card the mother loves her children. It’s in
this card only that the mother provides nurturance to her children after the husband has left
them. Need for aggression has been seen in cards 4, 7 & 10. In card 4 the aggression is of the
physical kind. The mother is going to strangle her daughter because she wanted a son. She
kills her daughter. In card 7 the son is strangling her mother out of rage. The mother just told
her son that she is going to marry another man. This enraged the son and he is strangling her
to her death. In card 10 the husband is in an argument with the wife’s friend. There is verbal
aggression. The friend is making advances on the husband while the wife has gone out. This
does not sit right with the husband. Need for acquisition has been depicted on cards 5 and the
blank card. In card 5 the need for acquisition is asocial. The son steals money because they
are in need. In the blank card the need for acquisition is social as the mother works to provide
for her children after the husband leaves them. Internal state of dejection was seen in various
cards such as 1, 3,6 & 9. In card 1 the boy is feeling sad as he is not able to come up with
anything to play the sitar. He is not able to play. However this is the card that also has need
for achievement as finally the hero overcomes his hurdle and plays the sitar. In card 3 the son
is sad and upset because his dad killed his mother and he’s thinking about her. In card 6 the
husband is upset as his wife has an affair and is leaving him for someone else. In card 9 the
husband is having an affair with another woman. The wife finds out and is upset.
Conception of the environment and perception of significant others:
The presses of the client’s environment came out to be that of aggression, lack, affiliation,
and nurturance. The cards showing aggression in the client’s environment are 2 3, & 5. In
card 2 the woman’s husband wants to kill her while the others look and have fun watching it.
In card 3 the boy’s father has killed the mother because he had enough of her. In card 5 the
aggression is of the verbal kind where the mother is angry with the son because she got to
know that he was stealing money. Lack was depicted in card 4 where the mother felt a lack of
having a son. Affiliation was seen across various cards such as 5, 7, 12 and the blank card.
The son has the mother who loves him a lot and forgives him. In card 7 the mother loves her
son and wishes to marry another man so as to be able to support herself and her son
economically. In card 12bthe wife’s friend loves the husband. In the blank card the woman’s
children love her and take care of her when they grow up. In this card nurturance was also
depicted as the woman has her son who takes care of her needs and loves her very much.
Loss was depicted in cards 9, 11 and 13. In card 9 the husband leaves the wife for another
woman. Similar thing happens in card 11 and 13 and the blank card. The husband leaves the
wife for another woman. Destruction was showed in cards 6, 9, 11, 13 and the blank card. In
all these cards the hero’s heart was broken.
Relevant dimension of personality:
He is a little low on self-confidence. He is a worrier and is restless. He is also aggressive (a

drive he is unable to control). He apologises and feels guilty after he has been aggressive. He
is determined to have a better future.
Integration of ego:
Reality testing: The client’s sense of reality seemed intact, there was accuracy in perceiving
cards and he articulated his own personal needs on the cards. His level of organizing the
information was observed to be moderate.
Judgement: The client had less than moderate understanding of how to handle relationships
interpersonally. The client’s judgement as depicted by the stories was seen to be a little low
than average.
Sense of self-esteem: It was observed that the client had nearing to moderate self-esteem and
sense of self throughout the cards. The client was seen to be little hopeful for the future (in
few cards).
The regulation of control of drives: it was observed that the client had almost no control over
his drive for aggression. He had an average control of the sex drive.
Object relation: The client displayed moderate relationship stability. He wishes to receive
affection and love from others. He had a girlfriend whom he loved but she cheated on him.
He wishes for his parents to love each other and stay together, however that is not the case.
His father lives with his second wife. The client’s family environment is a disturbed one. The
client feels lonely.
Thought process: among the responses of all the cards, the responses given were based
mostly on the client’s family environment. The blank card story was based on the client’s life
with a future that the client wants to achieve.
Nature of anxieties: the client displayed the anxiety of lack and loss of love, fear, betrayal,
deserted and being lonely.
Defence mechanisms: Various maladaptive defence mechanisms were used by the client like
acting-out and rationalisation, an adaptive defence mechanism was also used, self-
observation.
The overall maturity: The overall maturity of the client was moderate to high.
Intelligence: The client’s intelligence was moderate.
Summary of the findings:
The client’s stories reflected his own story. Most of the stories that were created are based on
his family environment and problems and issues he faced. In most of the stories the husband
leaves the wife or abandons her for another female. The client’s father had a secret marriage
that the wife found out about after a year or two. And they got separated. There is a hint of
aggression in most of the stories. The client acts impulsively on these. There are instances
reported by him as well as his mother of the client indulging in aggression. The findings of
TAT are supported by the case history provided by both, the client himself as well as his
mother.
The client has a disturbing family environment. His parents divorced, married other people
then remarried and still the relationship between them is not that good. The client has lost two
really close friends. One died of heart attack, other died of blood cancer. After the incident
and watching the yourube video of the angel he wouldn’t be able to sleep. He would get up at
3;20 and would feel that now the clock will start reversing and the angel will come to take
him. he was only able to sleep after 3:30am. The client has a younger sister. He doesn’t like
being alone, and likes to play with her sister, if she’s not watching television. The client has
anxiety related to death, acquiring an illness and his body. He is also really aggressive which
could be a learnt response. He saw his chacha being aggressive and accepted that after
watching him he too has become aggressive. He had also seen his mother’s second husband
strangle her. This has made him aggressive and he shows aggression when his mother doesn’t
listen to him. He says he is unable to control his anger.
The client has numerous stressors. His parents have a disturbed marriage. His father didn’t
live with them. He had a secret marriage. When the father came home his mother found out
about the second marriage. She filed for a divorce. After getting divorced she sent her kids to
their father’s parent’s place in the hope that maybe looking at the children they’ll take her
back. But the relationship between the kids and their grandparents and uncle is not at all
good. The mother then called the kids to Surat to live with the new husband. There they saw
him get aggressive with their mother. They told their father and they decided to remarry.
Even after remarriage their relationship isn’t great. The client’s girlfriend also cheated on him
which was another stressor in his life. He heard about two people who died young. One was a
youtuber and another was his neighbour. All these are the stressors in the client’s life
currently.
In TAT most of the stories had elements of his life and family environment. His anxiety
consists of loss and being alone, which he did confirm by saying that he doesn’t like when his
mother goes out. He doesn’t feel nice until she comes back. In his TAT a lot of cards had
aggression themes. In his ROR report there was found to be laxness in modulating emotions.
In MMPI Schizphrenia, Paranoia (perceiving the world as dangerous, fear) and psycasthenia
(anxiety) were elevated.
Differential Diagnosis
Social Anxiety Disorder:
They have anticipatory anxiety that is focused on upcoming social situations in which they
must perform or be evaluated by others.
OCD:
In OCD the inappropriate ideas take the form of intrusive, unwanted thoughts, urges or
image. In GAD the worry is about forthcoming problems.
PTSD & Adjustment disorder:
GAD is not diagnosed if symptoms are better explained by these.
Depressive, Bi-polar and psychotic disorders:
GAD should not be diagnosed separately if it occurs exclusively during this period.
Diagnostic features
(According to DSMV coding note; 300.02) [According to ICD 10 Coding note; (F41.1)]
Generalised Anxiety Disorder
Criterion A is being met (4 years). Criterion B is being met (he finds it difficult to control
worrying). Criterion C 4 symptoms are required to meet the criteria. C1 (restlessness),
C2(being easily fatigued), C3 (difficulty in concentrating) & C4 (irritability). Criteria D is
also being met (interpersonal relationships and occupation, as he wanted to work as a
receptionist in Prime hospital but was removed after 10 days). Criterion E & F are also being
fulfilled.
Course and Prognosis
The problem for the client developed 4 years back. Since then it has intensified. But there
was a remission period where the client was perfectly fine for 6 months. But then there was a
relapse as he stopped taking his medicine and didn’t finish his course and some negative life
event also happened. The anxiety is again present now. The client however has good support
from his mother so the prognosis seems to be good.
Treatment Implications
Treatment includes both, pharmacotherapy and psychotherapy.
Pharmacotherapy:
Benzodiazepines can be prescribed. These are the drugs of choice for generalised anxiety.
Anti-depressants as well as sedatives could be prescribed for the client’s treatment.
Psychotherapy:
In psychotherapy the choice of treatment would be CBT, supportive and insight oriented
therapy. This would help the client to identify and re-structure their negative thoughts that
elicit anxiety.
CLINICAL EXPERIENCE
Sr. Age/ Informant CC Test Interpretation DSMV/ ICD DD

No. sex done Diagnostic
impression
JJ HOSPITAL IPD & OPD
1 H. 32. Brother Business loss, gf ROR, TAT, Reality testing Substance Conduct, non-
M. ki shaadi. BDI, BSS abuse [303.90 pathological
(F10.20) use, sedative
use disorder
2. N.M.S. - Specific LD MISIC IQ= 83.90 BORDERLINE -
14 F NIMHANS
3. B. 15. Mother IQ BKT - - -
M
4. S.S.B. Father IQ SFB - - -
F
5. P. 16. Mother Maatha dard - - - No
M karta tha assessment
was done so
can’t give a
diagnosis,
hence had to
abandon the
case
6. A. - - Maata pita le k - - - Tried doing
M. aaye ROR but didn’t
give response
after card 2.
Hence
couldn’t make
a diagnosis.
7. A. – Daughter Dimaag kaam - - - No
M. and wife nahi karta. Nass assessment to
dheela ho gaya warrant a
hai. diagnosis.
8. S.M.A. Father Bukhaar rehta h, CAT - - He did not
13. M and bolta nahi, paani acomplete
mother nhi pee raha CAT and no
khaana nahi kha other
raha. assessment
was done to
warrant a
diagnosis.
SION HOSPITAL OPD
9. H.S. 9 Brother IQ BKT 80 Borderline -

M. and
father

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CASE JOURNAL

Submitted at: U.D.A.P., University of Mumbai

Submitted by: Srishti Bhatnagar

MA Part II Sem III

SR. NO. CONTENT

Marital status: Married

Educational Qualification: 8th standard

Employment status: unemployed

Place of residence: Govandi

In/out patient: in patient

Informant: mother and father

Past Medical History:

Past Psychiatric History:

Sion Hospital: three years back (talks to himself)

J.J. Hospital: two years back

Stressors, habits and hobbies:

Dreams: didn’t report any.

Suicide risk: no suicide risk was found.

a. Fluency: could speak hindi fluently

He was feeling good about not taking drugs.

Quality: Irritated (while doing ROR)

Tangentiality was observed.

No perceptual disturbances were observed.

Concentration: Hesitant to read numbers backwards. He was feeling sleepy.

Calculations: He didn’t answer.

Abstract reasoning was not found to be fine.

The client did not have insight.

Date of testing: 30.9.2019

Date of report: 2.9.2019

Test Administrator: Miss Srishti & Miss Juveria

MMPI REPORT TABLE

SCALES RAW SCORE T score

Two code types have been found:

This type is often diagnosed with schizophrenia.

Scales Raw score T score

TAT Report (S.S)

Name: Mr. S.S

Name of Administrator: Srishti B & Juveria K

Date of Administration: 30.09.2019

Date of Report: 02.10.2019

Test Behaviour Observations:

Unconscious structure and needs:

Conception of the world and significant persons:

Defence mechanisms: the defence mechanism used was isolation.

Intelligence: The client’s intelligence was moderate.

Test Administrator: Miss Srishti and Miss Juveria.

Test Administrator: Miss Srishti and Miss Juveria.

CC: “Neend nahi aati. Bhookh nahi lagti.”

Scanning efficiency is similar to that of most people. (Step 5 potential finding 1)

There is a moderate level of mediational dysfunction. It indicates ignored or distorted

The effectiveness of the mediational activity is impeded at times by the interference of

No firm conclusions can be drawn. (Step 5, potential finding 1)

The thinking is peculiar or disturbed. (Step 10, potential finding 4)

Interpersonal perception and behaviour

SUMMARY OF THE FINDINGS:

Major depressive or bipolar disorder with psychotic or catatonic features:

Schizophreniform and Brief Psychotic disorder:

This can be distinguished by the absence of other symptoms found in Schizophrenia.