Case Reports

Department of Psychology Institute of Southern Punjab

Assignment Prepared By Muhammad Akbar Hussan MSc (Psy) Part 2 Roll NO: 7940

Submitted By

Approved By

External Examiner

Internal Examiner

Case NO 1

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: Sarfraz Ahmad 29 years Male Islam Unmarried No 5 (1 brothers, 4 sisters) middle one Primary Laborer Multan

REASON FOR REFERRAL: Client has been forced to come to the doctor. He is an habitual user of medicinal drugs. He has been using these drugs for the last 4-5 years. PRESENTING COMPLAINTS: 1. 2. 3. 4. 5. 6. He has an abnormal behavior. He feels uneasiness. He is mentally tense. He does not feel hungry. He says he is dependent on drugs. I do not wear clean cloths.

Duration: 1 year 6 month

HISTORY OF PRESENT ILLNESS: He started using drugs in early twenties. He smoked at the age of 25 but abandoned it quickly. When he started drug usage for the first time he abandoned it due to change in work place and pressure from the mother.

PAST PSYCHIATRIC HISTORY: Patient does not have a past psychiatric history. His cousin was a drug user during his childhood. FAMILY HISTORY: The patient belongs to a lower class family and living in Mumtazabad . His father is 55 years old, and is blind for the past 20 years.His mother is 45year old woman. She works as a servant in the people home. PERSONAL HISTORY: The subject childhood was a normal childhood. He went to school but left it due to teacher fear of beating the student in class 5.His childhood was spend in the village. Afterward they migrated to the city. Here he worked with a band for some time. It was here that he used drug for the first time as he saw his neighbor using it. There after he became a victim of drug usage. He stopped it when he changed his work place and abstained from drug usage. PRE-MORBID PERSONALITY: He was sociable with good interpersonal relations with his family, relatives and others. He is not a very religious man but a happy go lucky person with no history of mood swings. He spent his leisure time with his friends and was constantly under pressure due to the unmarried status of his sisters. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by forma & informal assessment. 1. Informal Assessment 2. Formal Assessment A: Informal Assessment: I. II. Behavioral observation Mental Status Examination I. Behavioral Observation: The patient was cooperative and he was kept well. II. Mental Status Examination: a) General Appearance: He was cooperative well kept with combed hair and was dressed in neat clothes. b) Speech: His speech was low and he told about his addiction in a clear way.

B.

Formal Assessment: Preliminary Investigation

Following test were administered on individual. i) Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 166. Quantitative Analysis of RISB: Table#1

P1=3 P2=4 P3=6

C1=7 C2=3 C3=5 Table#2 Positive Responses N=5

Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3 Conflict Responses

3 4 6

Total conflict responses of C1 Total conflict responses of C2 Total conflict responses of C3 Table#4 Neutral Responses

7 3 5

Total neutral responses

Table#5 Total score of responses

Response Type Total Item Obtain score

C3=6

C2=5

C1=4

N=3

P1=2

P2=1

P3=0

5 30

3 15

7 28

5 15

6 12

4 4

3 0

Cut off score of RISB is 135, obtained score is 104 which shows that patient is a normal person. DIAGNOSIS: Axis I 304.40 Amphetamine Dependence 305.70 Amphetamine Abuse Axis II Axis III Axis IV Axis V None None Bad company, Economic pressure GAF=55

CASE FORMULATION: The research mentioned above describes the present condition of client. The research indicates that the individual used the drugs to get rid of the emotional stress combined with the social pressure to get his sister married. Talking about the client, he had a peer pressure that was cause of his addiction to multiple drugs. His curiosity about the result the drug usage brings about coupled with his expectation that their usage will relieve his tension. THERAPEUTIC INTERVETION: Relaxation Training Behavior Therapy Supportive Therapy Family Therapy

CONCLUSION: Bad company combined with the economic pressure lead to the person taking refuge in drug usage. The person needs to be encouraged to work hard and to face the pressure and life difficulties. The person simply wants to shy away from his duties. He need to be stressed the importance of his duties and guidance must be provided to him.

Case NO 2

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: A.M 30 years Male Islam Married No 9(7 brothers, 2sisters) 1st Matric Shopkeeper Hussain Agahi

REASON FRO REFERRAL: Client was suffering from delusion and hallucination because he had occupational problems. According to her wife he talk irrelevant, suspiciousness, displaying aggressive behavior and disturbed sleep. His wife and sister wanted his treatment. PRESENTING COMPLAINTS: 7. 8. 9. 10. 11. 12. My body is always tense. He gets angry. He is afraid at night. He does not sleep at night. People want to kill me. My mother calls me from the grave.

Duration: 6months

HISTORY OF PRESENT ILLNESS: Patients mother died and his aunt and wife realized that he needs psychological treatment but he dont want to be treated because he feel that he is normal and other people create negative image of him. There is a history of auditory delusion and hallucination. As the time passes the problem gradually increased. So his wife and sister wanted his treatment. PAST PSYCHIATRIC HISTORY: Patient have not past psychiatric history. FAMILY HISTORY: The patient belongs to upper middle class family and living in Hussain Agahi. His father was 47 years old, SDO in Wapda. His father remarriage his sister-in-law after his mother death. He didnt accept his stepmother. There are four brothers from first mother and three brothers and two sisters from stepmother. PERSONAL HISTORY: Patients father was SDO in Wapda. His mother dies and stepmother was authoritarian and has aggressive personality. During childhood he was intelligent and proud. He started his schooling at the age of 6years. His school career was good. In school he spend most of his time with selective children. He hated poor children and booted them. In adolescence he indulge in bad company. He had arranged marriage with his cousin. He loves his wife but develop belief that his wife was not sincere with him. Then he started torturing his wife. PRE-MORBID PERSONALITY: In childhood he was proud and aggressive child. His social circle was not vast. He had selective friends. He always remembers his mother and not accepted his stepmother. With the passage of time he started to spend most of his time alone in home. Sometimes he goes to graveyard where his mother was buried. After marriage he start torturing his wife and develop a belief that his wife is not sincere with him and will left him alone with the passage of time. He experienced hallucinations and delusions and this problem of his become severe as the time increases. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by forma & informal assessment. 3. Informal Assessment 4. Formal Assessment

A: Informal Assessment: III. IV. Behavioral observation Mental Status Examination III. Behavioral Observation: Patient dressing was not normal. He was not a confident man. He was unable to maintain eye contact. He was serious and gave answer in whispered speech. His memory was good. IV. Mental Status Examination: c) General Appearance: Patient was wearing quite normal dress. He was not well combed, he was looking lazy, and he changed his sitting style many times. d) Speech: His speech was not clear means his tone was not normal. He gave answer in whispered tone. His vocabulary was not good because he just done Matric. In short he looked as dull man.

B.

Formal Assessment: Preliminary Investigation Following test were administered on individual. ii) Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 166. Quantitative Analysis of RISB: Table#1 P1=2 P2=1 P3=0 C1=4 C2=5 C3=6 Table#2 Positive Responses Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3 Conflict Responses Total conflict responses of C1 Total conflict responses of C2 Total conflict responses of C3 Table#4 Neutral Responses Total neutral responses Table#5 Total score of responses Response C3=6 C2=5 C1=4 N=3 P1=2 P2=1 P3=0 3 9 9 11 2 3 0 N=3

Type Total Item Obtain score 11 66 9 45 9 36 4 12 2 4 3 3 0 0

Cut off score of RISB is 135, obtained score is 166 which shows that patient is a psychiatric patient. DIAGNOSIS: Axis I Axis II Axis III Axis IV Axis V 295.30 Paranoid Schizophrenia None None Problems in supportive group GAF=41 50

CASE FORMULATION: Schizophrenia is largely the creation of society and that as a product of norms and expectations, the disorder can be expected to vary from society to society as norms and expectations vary (Smith, 1982). A more contemporary psychodynamic explanation for schizophrenia is focused on the role of stress, regardless of its source specifically, it is suggested that high levels of stress disrupt cognitive function and that disruptive effects of stress lead to the symptoms of schizophrenia (Browns and Birley, 1968). The individuals with schizophrenia were more likely to have experienced stressful life events (e.g. job loss, geographic move, divorce) than the normal individuals (Holmes, 1997). Although it appears in all socioeconomic groups, schizophrenia is more likely to be found in people of the lower socioeconomic classes. Some researchers believe that the stress of poverty is itself a cause of schizophrenia (Comer, 1995). THERAPEUTIC INTERVETION: Family counseling Relaxation Training Behavior Therapy Drug Therapy

Supportive psychotherapy Social skill training CONCLUSION: Death of mother and Father second marriage, aggressive behavior of his stepmother are the main factors of patient to suffer from Paranoid Schizophrenia.

Case NO 3

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: Noman Umar 21 years Male Islam Unmarried No 2(1 brothers, 1 sisters) 2nd number class 2 Laborer Multan

REASON FOR REFERRAL: Client has been forced to come to the doctor. He is an habitual user of narcotic drugs. He has been using these drugs for the last 3 years. PRESENTING COMPLAINTS: 13. 14. 15. 16. 17. 18. He has an abnormal behavior. He feels uneasiness. He is mentally tense. He does not feel hungry. He says he is dependent on drugs. I do not wear clean cloths.

Duration: 1 year 6 month

HISTORY OF PRESENT ILLNESS: He started using drugs in late teens. He has been brought here by his parents. He has evil dreams. His friendship with a drug addict made him a drug addict. His parents used to fulfill his every wish. His friend is a drug user. According to the patient he loves Mahmooda a girl. His marriage was arranged with him but was later broken due to family feud. His aim in his life is to marry Mahmooda. He says people have done taweez on his family. His condition is due to effect of those taweezs. His father was murdered and he want to take revenge. He does not know who killed his father. PAST PSYCHIATRIC HISTORY: Patient does not have a past psychiatric history. FAMILY HISTORY: The patient belongs to a lower class family and living in @@@ . His father is dead and is blind for the past 20 years. His mother is 35year old woman. She is a house wife. PERSONAL HISTORY: The subject childhood was a normal childhood. He went to school but left it due to economic reasons. His childhood was spend in the village. Afterward they migrated to the city. Here he worked with a band for some time. It was here that he used drug for the first time as he saw his neighbor using it. There after he became a victim of drug usage. He stopped it when he changed his work place and abstained from drug usage. PRE-MORBID PERSONALITY: He was sociable with good interpersonal relations with his family, relatives and others. He is not a very religious man but a happy go lucky person with no history of mood swings. He spent his leisure time with his friends.. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by forma & informal assessment. 5. Informal Assessment 6. Formal Assessment A: Informal Assessment: V. VI. Behavioral observation Mental Status Examination V. Behavioral Observation: The patient was cooperative and he was kept well.

VI.

Mental Status Examination: e) General Appearance: He was cooperative well kept with combed hair and was dressed in neat clothes. f) Speech: His speech was low and he told about his addiction in a clear way.

B.

Formal Assessment: Preliminary Investigation Following test were administered on individual. iii) Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 166. Quantitative Analysis of RISB: Table#1

P1=3 P2=4 P3=6

C1=7 C2=3 C3=5 Table#2 Positive Responses N=5

Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3 Conflict Responses

3 4 6

Total conflict responses of C1

Total conflict responses of C2 Total conflict responses of C3 Table#4 Neutral Responses

3 5

Total neutral responses

Table#5 Total score of responses

Response Type Total Item Obtain score

C3=6

C2=5

C1=4

N=3

P1=2

P2=1

P3=0

5 30

3 15

7 28

5 15

6 12

4 4

3 0

Cut off score of RISB is 135, obtained score is 104 which shows that patient is a normal person. DIAGNOSIS: Axis I 304.40 Amphetamine Dependence 305.70 Amphetamine Abuse Axis II Axis III Axis IV Axis V None None Bad company, Economic pressure GAF=55

CASE FORMULATION: The research mentioned above describes the present condition of client. The research indicates that the individual used the drugs to get rid of the emotional stress combined with the social pressure to get his sister married. Talking about the client, he had a peer pressure that was cause of his addiction to

multiple drugs. His curiosity about the result the drug usage brings about coupled with his expectation that their usage will relieve his tension. THERAPEUTIC INTERVETION: Relaxation Training Behavior Therapy Supportive Therapy Family Therapy CONCLUSION: Bad company combined with the economic pressure lead to the person taking refuge in drug usage. The person needs to be encouraged to work hard and to face the pressure and life difficulties. The person simply wants to shy away from his duties. He need to be stressed the importance of his duties and guidance must be provided to him.

Case NO 4

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: M.W. 54 years Male Islam Married 10(6 Sons, 4 Daughters) 7 2nd number Uneducated Farmer DG Khan

REASON FOR REFERRAL: The client was brought by his son on account of talkativeness. Quarrelsome/aggressive behavior and disturbed sleep. He was admitted to psychiatric unit for evaluation.

PRESENTING COMPLAINTS: 19. 20. 21. 22. 23. 24. He talks a lot. Some time he talks the whole day. His anger is severe. He does not sleep. He does not eat. . He says strange things about religion.

Duration: 10 Months.

HISTORY OF PRESENT ILLNESS: The patient was well some one week back when he develops disturbed behavior he started excessive smoking and over religiously, his talk increase in amount and volume. Later on his sleep disturbed and oral intake decreased. He also developed aggressive behavior towards his family members and neighbors. With the passage of time he develop ideas. The participating factor for these symptoms is that he has loss in business 2 months back. PAST PSYCHIATRIC HISTORY: Patient has no past psychiatric history. FAMILY HISTORY: His father Bashir Ahmed died 2 years back at the age of 65years. The relation of patient with his father was satisfactory. His mother Sharifan Bibi died 25 years back at the age of 50 years. Relation with her was good. He has three brothers and 4 sisters. His relation with them is satisfactory. PERSONAL HISTORY: He had a pleasant childhood. He is uneducated because of financial problems. His parents refused to send him to school. PRE-MORBID PERSONALITY: He was sensitive extrovert and responsible. Before his illness he had no significant leisure activities. He was not a religious person but had a good moral character. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by formal & informal assessment. 7. Informal Assessment 8. Formal Assessment A: Informal Assessment: VII. Behavioral observation VIII. Mental Status Examination VII. Behavioral Observation: The patient was cooperative and he was kept well. VIII. Mental Status Examination: a) General Appearance: He was cooperative well kept with combed hair and was dressed in neat hospital blue uniform. He appeared excited, talkative and wanted to talk in length.

B.

Formal Assessment: Preliminary Investigation Following test were administered on individual.

iv)

Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 171. Quantitative Analysis of RISB: Table#1

P1=2 P2=1 P3=0

C1=4 C2=5 C3=6 Table#2 Positive Responses N=3

Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3 Conflict Responses

3 1 0

Total conflict responses of C1 Total conflict responses of C2 Total conflict responses of C3 Table#4

10 11 10

Neutral Responses

Total neutral responses

Table#5 Total score of responses

Response Type Total Item Obtain score

C3=6

C2=5

C1=4

N=3

P1=2

P2=1

P3=0

10 60

11 55

10 40

3 9

3 6

1 1

0 0

Cut off score of RISB is 171, obtained score is 166 which shows that patient is a psychiatric person. DIAGNOSIS: Axis I Axis II Axis III Axis IV Axis V 296.4 Manic Episode V 71.09 no diagnosis None Financial loss GAF=55 current

CASE FORMULATION: Some studies have produced data that support the connection between stress and the organ of manic episode (Ellicott, 1998 G Dwin and Samsonm, 1990). All people who had a high level of stress in their lives and those who lacked social support from close confiding relationships are more likely to develop a Bipolar Affective Disorder (Comer, 1995( Researches conducted in US suggest that Bipolar Disorders are equally common in socioeconomic & ethnic group (APA, 2000, Weissman et.al.1999)

THERAPEUTIC INTERVETION: Behavior Therapy Relaxation Training Family Therapy Social skill training CONCLUSION: Financial loss of 12 lacs may be the cause of illness.

Case NO 5

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: Ahmad Raza 43 years Male Islam Married No 6 (3 brothers, 3 sisters) 4th Undermatric Land Lord Multan

REASON FOR REFERRAL: Client has been forced to come to the doctor. He is an habitual user of drugs. He has been using these drugs for the last 6 years. PRESENTING COMPLAINTS: 25. 26. 27. 28. 29. 30. He has an abnormal behavior. He feels uneasiness. He is mentally tense. He does not feel hungry. He says he is dependent on drugs. I do not wear clean cloths.

Duration: 6year

HISTORY OF PRESENT ILLNESS: He started using drugs in thirties. He smoked at the age of 25 but abandoned it quickly. When he started drug usage for the first time he abandoned it due to change in work place and pressure from the mother. PAST PSYCHIATRIC HISTORY: Patient does not have a past psychiatric history. FAMILY HISTORY: The patient belongs to a Higher class family and living in Muzfrabad . His father is 70 years . His mother is 65 year old woman . she is a housewife. PERSONAL HISTORY: The subject childhood was a normal childhood. He went to school but left it due to teacher fear of beating the student in class 1. His childhood was spend in the village. Afterward they migrated to the city. Here he worked with a band for some time. It was here that he used drug for the first time as he saw his neighbor using it. There after he became a victim of drug usage. PRE-MORBID PERSONALITY: He was sociable with good interpersonal relations with his family, relatives and others. He is not a very religious man but a happy go lucky person with no history of mood swings. He spent his leisure time with his friends and was constantly under pressure. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by forma & informal assessment. 9. Informal Assessment 10. Formal Assessment A: Informal Assessment: IX. X. Behavioral observation Mental Status Examination IX. Behavioral Observation: The patient was cooperative and he was kept well. X. Mental Status Examination: g) General Appearance: He was cooperative well kept with combed hair and was dressed in neat clothes. h) Speech: His speech was low and he told about his addiction in a clear way.

B.

Formal Assessment: Preliminary Investigation Following test were administered on individual. v) Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 166. Quantitative Analysis of RISB: Table#1

P1=7 P2=6 P3=6

C1=5 C2=5 C3=5 Table#2 Positive Responses N=5

Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3 Conflict Responses

7 6 6

Total conflict responses of C1 Total conflict responses of C2 Total conflict responses of C3 Table#4 Neutral Responses

5 5 5

Total neutral responses

Table#5 Total score of responses

Response Type Total Item Obtain score

C3=6

C2=5

C1=4

N=3

P1=2

P2=1

P3=0

5 30

5 25

5 20

5 15

7 14

6 6

6 0

Cut off score of RISB is 135, obtained score is 110 which shows that patient is a normal person. DIAGNOSIS: Axis I 304.40 Amphetamine Dependence 305.70 Amphetamine Abuse Axis II Axis III Axis IV Axis V None None Bad company, Friend s company GAF=55

CASE FORMULATION: The research mentioned above describes the present condition of client. The research indicates that the individual used the drugs to get rid of the emotional stress combined with the friend pressure. Talking about the client, he had a peer pressure that was cause of his addiction to multiple drugs. His curiosity about the result the drug usage brings about coupled with his expectation that their usage will relieve his tension.

THERAPEUTIC INTERVETION: Relaxation Training Behavior Therapy Supportive Therapy Family Therapy CONCLUSION: Bad company combined with the peer pressure lead to the person taking refuge in drug usage. The person needs to be encouraged to work hard and to face the pressure and life difficulties. The person simply wants to shy away from his duties. He need to be stressed the importance of his duties and guidance must be provided to him.

Case NO 6

BIO DATA: Name: Age: Gender: Religion Marital Status: No of kids: No of Siblings: Birth Order: Education: Occupation: Residence: K.B. 32 years female Islam Married 2 sons, 2 daughters 7 5th number Uneducated Laborer Multan

REASON FOR REFERRAL: Client illness and sadness started due to family conflicts and health problem of her son 10 month back as a result patient developed the symptom of fear. She was extremely afraid from darkness and her husband wanted her to be treated. PRESENTING COMPLAINTS: 31. 32. 33. 34. 35. I feel fear. I am feeling irritated. I have pain in my head. I Have fear of darkness. I do not feel hungry.

Duration: 10 months

HISTORY OF PRESENT ILLNESS: Her illness started about 10 months back. She has 2 daughters and 2 sons. Her both sons are mentally retarded. Both daughters are normal. Her in-laws didn t like to see her; even they didn t allow the children to play with patient s daughters. This attitude made her depressed. There are financial problems also. She became sad. She was afraid of darkness, she had dreadful dreams. She cannot sleep. PAST PSYCHIATRIC HISTORY: Patient does not have a past psychiatric history. FAMILY HISTORY: Her father is a nice person. He loves her a lot. He is above 60 years. He is hafiz-e Quran. He is teaching in a madarsah. Her mother died at the age of 50 years. She was a house wife. Her relation with patient was good. Patient has 3 sisters and 4 brothers. Her brother is farmer by occupation. One was working in a factory. Last one is still unemployed. Her siblings are very good and cooperative with her. She has good feeling for all of them. There is no psychological & mental illness in her family. PERSONAL HISTORY: She is an uneducated woman. She was not very active in her childhood. She spent most of her time with her siblings at home. She was very cool and calm person. PRE-MORBID PERSONALITY: Patient s husband is very good with her and cared for her but sometimes conflict from her in-laws and financial problems depressed her a lot. She remains tense most of the time for her two mentally retarded sons, as society is not accepting them. PSYCHOLOGICAL ASSESSMENTS: Psychological assessment of the client has been done by forma & informal assessment. 11. Informal Assessment 12. Formal Assessment A: Informal Assessment: XI. XII. Behavioral observation Mental Status Examination XI. Behavioral Observation: Her dress was neat and clean but simple. She was looking depressed and confused. She was nice and cooperative. She was so depressed that she started weeping during session.

XII.

Mental Status Examination: i) General Appearance: She was cooperative well kept with combed hair and was dressed in neat clothes.She was sad and depressed. j) Speech: His speech was slow and after sometime started weeping.

B.

Formal Assessment: Preliminary Investigation Following test were administered on individual. vi) Rotter Incomplete Sentence Blank

ROTTER INCOMPLETE SENTENCE BLANK: Rotter incomplete Sentence Blank was applied on a client and his obtained score is 166. Quantitative Analysis of RISB: Table#1

P1=6 P2=6 P3=7

C1=5 C2=5 C3=5 Table#2 Positive Responses N=5

Total positive responses of P1 Total positive responses of P2 Total positive responses of P3 Table#3

6 6 7

Conflict Responses

Total conflict responses of C1 Total conflict responses of C2 Total conflict responses of C3 Table#4 Neutral Responses

5 5 5

Total neutral responses

Table#5 Total score of responses

Response Type Total Item Obtain score

C3=6

C2=5

C1=4

N=3

P1=2

P2=1

P3=0

5 30

5 25

5 20

5 15

7 14

6 5

6 0

Cut off score of RISB is 135, obtained score is 110 which shows that patient is a normal person. DIAGNOSIS: Axis I Axis II Axis III Axis IV Axis V 300.29 Specific Phobia No diagnosis None Health problem of her son GAF=55 current

CASE FORMULATION: Among the most frequently type of specific phobia are agoraphobia (fear of height),claustrophobia (fear of closed spaces), phobia of body injury and animal phobia especially for dogs, snake, mice and insect. The most common are the animal phobia. The lesser of person s income and education, the greater the risk of both specific and social phobia. THERAPEUTIC INTERVETION: Cognitive Therapy These procedures are used when the therapist determines that the maintenance of the phobia may have a significant cognitive component. Procedures may include those in which the child is taught skills for contingency management, modeling management, and self-control. Applied tension and relaxation may be introduced, as well as improvement of specific skill deficits. No significant differences in outcome have been reported comparing individual cognitive behavioral therapy with group cognitive behavioral therapy, with improvements noted in both types of therapeutic settings Behavior Therapy 1) Systematic Desensitization

The patient is repeatedly exposed to the feared stimulus until the anxiety response it elicits is habituated. One-session treatment, as long as 3 hours, combining exposure therapy in a fear hierarchy with participant modeling, cognitive components, and reinforcement is a promising form of treatment in patients with specific phobias (SPs).5 Especially in children, a gradual exposure program is developed, in which the least-feared stimulus in a fear hierarchy is presented first, followed sequentially over time (in a graduated manner) by the more feared stimuli in the hierarchy. Fear hierarchies are created by the behavior therapist in collaboration with the child and parents. Exposure to the feared stimulus may be conducted in real-life or imaginary contexts, in which the child is requested to visualize the feared object or situation. The longer the child is exposed to the aversive stimulus, the greater the likelihood that habituation occurs and anxiety decrease 2) Relaxation Training

CONCLUSION: Son s mental retardation cause specific phobia.

Appendix