INTERNSHIP REPORT

METRO MIND, KALAMASSERY

PREETHI B
39
 Introduction

From December 12, 2020 to December 23, 2020, I completed 16 days internship at Metro

Mind, Kalamassery. The internship was an opportunity to improve my skills in test

administration and interpretation, counselling, program evaluation, and to broaden my

experiences by working with professionals from several disciplines.

At metro mind assessment by a team of specialists comprising of psychiatrist, psychologist,

social worker, etc. Following evaluation, a personalised plan of management designed to suit

individual person is crafted which is duly communicated to the person as well as to his

caregivers. Before commencing treatment, all the possible options of management are

conveyed and discussed with them. The internship was supervised by Mr. Sarath Kumar. He

is as a Consultant Psychologist and Psychotherapist, have obtained clinical training in

Psychology, Psychiatry, Behaviour Therapy, CBT, REBT and Therapeutic Counselling. He

also has experience in vivid areas like Neuroscience and Training in Sports

Psychology, Industrial and Organizational Psychology, Neurobiology, Medical Transcription,

Vocational Rehabilitation and Language Training.

During my internship my responsibilities were to plan psychological treatment programmes. I

was asked to review reports and case files to assess the need for psychological services. I was

also given the opportunity to manage difficult cases and come up with a comprehensive

programme of therapy, evaluation and treatment.

 SCHIZOPHRENIA

Schizophrenia is a serious mental disorder in which people interpret reality abnormally.

Schizophrenia may result in some combination of hallucinations, delusions, and extremely

disordered thinking and behaviour that impairs daily functioning and can be disabling. It can

have a profound impact on a person’s life, as well as the lives of those around them. The

symptoms usually emerge when a person is between their late teens and early 30s. They tend

to develop earlier in males than in females. In some cases, a person will start to show unusual

behaviours from childhood, but these only become significant as they get older. In others, the

symptoms may appear suddenly.

SYMPTOMS

Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking,

perception, emotions, language, sense of self and behaviour. Common experiences include:

1. Hallucination: hearing, seeing, or feeling things that are not there.

2. Delusion: fixed false beliefs or suspicions not shared by others in the person’s culture

and that are firmly held even when there is evidence to the contrary.

3. Abnormal behaviour: disorganised behaviour such as wandering aimlessly,

mumbling, or laughing to self, strange appearance, self-neglect or appearing unkempt.

4. Disorganised speech: incoherent or irrelevant speech.

5. Disturbances of emotions: marked apathy or disconnect between reported emotion

and what is observed such as facial expression or body language.

TYPES

1. Paranoid Schizophrenia

Paranoid-type schizophrenia is distinguished by paranoid behaviour, including delusions and

auditory hallucinations. Paranoid behaviour is exhibited by feelings of persecution, of being

watched, or sometimes this behaviour is associated with a famous or noteworthy person a

celebrity or politician, or an entity such as a corporation. People with paranoid-type

schizophrenia may display anger, anxiety, and hostility. The person usually has relatively

normal intellectual functioning and expression of affect.

2. Disorganized Schizophrenia

A person with disorganized-type schizophrenia will exhibit behaviours that are disorganized

or speech that may be bizarre or difficult to understand. They may display inappropriate

emotions or reactions that do not relate to the situation at-hand. Daily activities such as

hygiene, eating, and working may be disrupted or neglected by their disorganized thought

patterns.

3. Catatonic Schizophrenia

Disturbances of movement mark catatonic-type schizophrenia. People with this type of

schizophrenia may vary between extremes: they may remain immobile or may move all over

the place. They may say nothing for hours, or they may repeat everything you say or do.

These behaviours put these people with catatonic-type schizophrenia at high risk because

they are often unable to take care of themselves or complete daily activities.
 4. Undifferentiated Schizophrenia

Undifferentiated-type schizophrenia is a classification used when a person exhibits

behaviours which fit into two or more of the other types of schizophrenia, including

symptoms such as delusions, hallucinations, disorganized speech or behaviour, catatonic

behaviour.

5. Residual Schizophrenia

When a person has a history of at least one episode of schizophrenia, but the currently has no

symptoms (delusions, hallucinations, disorganized speech, or behaviour) they are considered

to have residual-type schizophrenia. The person may be in complete remission or may at

some point resume symptoms.

TREATMENTS

The goal of schizophrenia treatment is to ease the symptoms and to cut the chances of a

relapse or return of symptoms. Treatment for schizophrenia may include:

1. Medications: The primary medications used to treat schizophrenia are called

antipsychotics. These drugs don’t cure schizophrenia but help relieve the most

troubling symptoms, including delusions, hallucinations, and thinking problems.

2. Coordinated specialty care (CSC): This is a team approach toward treating

schizophrenia when the first symptoms appear. It combines medicine and therapy with

social services, employment, and educational interventions. The family is involved as

much as possible. Early treatment is key to helping patients lead a normal life.
3. Psychosocial therapy: While medication may help relieve symptoms of schizophrenia,

various psychosocial treatments can help with the behavioural, psychological, social, and

occupational problems that go with the illness. Through therapy patients also can learn to

manage their symptoms, identify early warning signs of relapse, and come up with a

relapse prevention plan. Psychosocial therapies include:

a. Rehabilitation: focuses on social skills and job training to help people with

schizophrenia function in the community and live as independently as possible

b. Cognitive remediation: involves learning techniques to make up for problems

with information processing. It often uses drills, coaching, and computer-based

exercises to strengthen mental skills that involve attention, memory, planning, and

organization.

c. Individual psychotherapy: It can help the person better understand their illness,

and learn coping and problem-solving skills

d. Family therapy, which can help families deal with a loved one who has

schizophrenia, enabling them to better help their loved one

e. Group therapy/support groups, which can provide continuing mutual support

4. Hospitalization: Many people with schizophrenia may be treated as outpatients. But

hospitalization may be the best option for some people.

5. Electroconvulsive therapy (ECT): In this procedure, electrodes are attached to the

person's scalp. While they’re asleep under general anaesthesia, doctors send a small

electric shock to the brain. A course of ECT therapy usually involves 2-3 treatments per

week for several weeks.

 CASE STUDY 1

Name: V

Chief Complaints

1. Extreme Aggressive behaviour

2. Suspicious of everyone

3. Instability of jobs

4. Insomnia

5. Delusions

6. Loss of hygiene

7. Paranoid feelings or feelings of persecution

8. Lack of self-care

Diagnosis

Schizophrenia

V is a 45-year-old male, not married. V was referred to a psychologist by his family member. He

has been treated in 3 hospitals before visiting Metro Mind. His symptoms started about 12 years

ago. There was a psychotic gradation. The psychiatrist has been treating him for about 5-6 years.

V was accompanied by his mother for the first meeting with the clinical psychologist. Her mother

stated that he had stopped taking his medicines and was getting more and more aggressive. He

has a job in the IT company. He considers himself a failure. V also has hatred towards his father.
His mother informed us that he heard sounds from the telephone even though no one was

speaking. It also seemed as if he saw something and tried to commit suicide. V disclosed during

his therapy that he hasn’t been sleeping properly for months. V family history has cases of

psychic illness. His grandfather showed symptoms of Schizophrenia which was not diagnosed.

His paternal uncle and 2nd paternal cousin died of suicide. His maternal aunt also showed

symptoms of Schizophrenia. His father has bipolar disorder.

Treatments given to V are stated below:

1) Medications: V was administered with Anti-psychotic drugs.

2) Assertive community treatment: Support teams were created which included psychiatrists,

nurses, trainers, and psychologists met regularly to help reduce the need for hospitalization or a

decline in their mental status.

3) Family psycho-education: V’s family members were given family counselling. It was given

to decreases the relapse rate of psychotic episodes and improves the person's outcomes. 

4) Cognitive behavioural therapy: CBT was given to V to help him "test" the reality of their

thoughts to identify hallucinations or "voices" and ignore them. 

5) Self-care: Self-care focused on diet, exercise and maintaining a daily routine.

The treatments given to V helped him a lot of ways. He was able to get proper sleep and could

maintain a daily routine. He started taking an interest in the games organized by the clinic for the

patients. He also developed insight for his illness. The tension between him and his family also

reduced. He also feels confident of going back to a job.

 CASE STUDY 2

Name: A

Chief Complaints

1. Difficulty expressing emotions

2. Disorganized speech or behaviour

3. Delusions

4. Loss of appetite

5. Difficulty focusing or paying attention

6. Memory loss

Diagnosis

Schizophrenia

A is a 20-year-old male; not married. A was referred to the psychologist by his family member. A

was brought to the clinic by his mother and brother. He was very disoriented and wouldn’t make

eye contact. He kept making gestures and wouldn’t respond to anyone. His mother stated that he

saw something and got scared. Since then, he has not been talking. After 2-3 days of his

admission, he still couldn’t recognize people and kept having delusions. His family is highly

religious and took him to a religious place when he started showing symptoms of schizophrenia.

A’s family history indicated that his paternal uncle had schizophrenia.
Treatments given to A are stated below:

1) Medications: A was administered with Anti-psychotic drugs.

2) Assertive community treatment: Support teams were created which included psychiatrists,

nurses, trainers, and psychologists met regularly to help reduce the need for hospitalization or a

decline in their mental status.

3) Self-care: Self-care focused on diet, exercise and maintaining a daily routine.

4) Group therapy: A was given the opportunity to mingle with others and play games with

them.

5) Social skills training: Focus was given on improving communication and social interactions

and improving the ability to participate in daily activities.

The treatments given to A helped in a variety of ways. The medications given to him helped him

finally get out of his trance. He got his appetite back and could maintain a daily routine. A was

also able to form a close attachment to another patient. He was able to communicate properly

with others. He still had problems with his memory.

 CASE STUDY 3

Name: R

Chief Complaints

1. Difficulty expressing emotions

2. Disorganized speech or behaviour

3. Loss of appetite

4. Difficulty focusing or paying attention

5. Memory loss

6. Lack of Self Care

Diagnosis

Schizophrenia

R is a 35-year-old male, not married. R was referred to the psychologist by a psychiatrist. He

was treated in a hospital setting for 21 days. He was brought to the clinic by his mother and

brother. He looked very disoriented and shabby. His family stated that when he gets angry, he

starts breaking things. He also has insomnia, and is not able to express himself. During the

therapy sessions his brother revealed that he once jumped into the river because someone

called him from behind. He was brought up in a protective environment, his mother knew of

illness but still wouldn’t take him to a hospital for 1 year. R also has hatred towards his

father. During his graduation he had a relationship with a girl. When they broke up it affected
him deeply. He was largely an introverted person and wouldn’t socialize. R’s family history

indicated that his maternal aunt committed suicide and his maternal uncle had a psychotic

disorder.

Treatments given to R are stated below:

1) Medications: A was administered with Anti-psychotic drugs.

2) Assertive community treatment: Support teams were created which included

psychiatrists, nurses, trainers, and psychologists met regularly to help reduce the need for

hospitalization or a decline in their mental status.

3) Self-care: Self-care focused on diet, exercise and maintaining a daily routine.

4) Group therapy: A was given the opportunity to mingle with others and play games with

them.

5) Social skills training: Focus was given on improving communication and social

interactions and improving the ability to participate in daily activities.

6) Psychosocial therapy: Psychosocial rehab focused on social and vocational training. R

was taught skills he needs for interacting with others, living in the community, and getting

and keeping a job.

7) Cognitive behaviour therapy: In CBT, the psychologist helped him change potentially

harmful or destructive beliefs and behaviours.

The treatments helped R in a lot of ways. He was able to eat properly and maintain a daily

routine. He was also able to mingle with others. His communication skills improved. He feels

confident on getting a job. He does not have delusions anymore.

CASE STUDY 4

Name: M

Chief Complaints

1. Disorganized speech or behaviour

2. Delusions

3. Loss of appetite

4. Difficulty focusing or paying attention

5. Delirium

6. Gastrointestinal problems

Diagnosis

Schizophrenia

M is 70-year-old male, not married. He was referred to the psychologist by a family member. He

was brought to the clinic by his wife and daughter. He seemed very disoriented. His family stated

that he was too “dangerous” to be outside a hospital setting. He has had episodes of violent

outbursts where he would hurt those around him. He hurt his family members and would shout

that they were trying to kill him. He would shout out to his mother who has already passed away.

M also has delusions of someone hitting his children. He has had a stroke in the month of July
2020 which resulted in Stroke Psychosis. It affected his occipital lobe deeply. His medical

records indicated that he has diabetes and is heavily dependent on insulin. M outbursts increases

when his family members are not nearby. He always likes to keep his daughter and son nearby.

Treatments given to M are stated below:

1) Medications: M was administered with Anti-psychotic drugs.

2) Assertive community treatment: Support teams were created which included psychiatrists,

nurses, trainers, and psychologists met regularly to help reduce the need for hospitalization or a

decline in their mental status.

3) Self-care: Self-care focused on diet.

4) Social skills training: Focus was given on improving the ability to participate in daily

activities.

5) Cognitive behaviour therapy: In CBT, the psychologist helped him change potentially

harmful or destructive beliefs and behaviours.

The treatments helped M. He was able eat properly and could sleep better. At the end of 1 week

he was referred to another psychiatrist.