CASE HISTORY

Areeba Babar
 Identifying Data:

Date:

Name:

Age:

Marital Status: (Married/Unmarried)

Gender: (Male/Female) Education:

Occupation:

No of Siblings:

Birth Order:

Informant (client/guardian):

Presenting Complaints (verbatim):

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------

History of present illness:

When did this problem happen the first time? (Masla pehli dafa kb hua?)
------------------------------------------------------------------------------------------------------------

Cause or predisposing factor behind the problem? (Waja kya bani?)

-----------------------------------------------------------------------------------------------------------
Symptoms and duration of symptoms (Alaamatain)
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------

What did you started to think about yourself? (Apne bare mai kya sochna shuru kr
dya?)

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------

How did this entire thing happen? (Kis trhan shuru hua?)

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------

How did you manage this? (Kya krte thy jab aise khyaal atay thy?)
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

How did your parents respond to you? (Ghar walon ka kya rad e amal tha?)
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

When things become problematic? (Kb cheezon ne tang krna shuru kiya?)
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
----------------------------------------------------------

When and why symptoms appeared again? Did any stressful event happen? How
did you respond towards your symptoms? (Alaamaton k zeer e asar kese behave
krte thy?) ONLY IF RELAPSE!
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
Did you take any medicines? (taken/left) (Dr k kehne pr li thin ya chori thin?)
------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------

How well are you sleeping?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------

How well are you eating?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------

Do you have any digestive issues? (How much water have you been drinking)

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------

Do you have any respiratory issues?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
-------

Have you been facing hallucinations? (kab se khyalaat aa rhy hain?) Did you share
them with anyone? (kisi ko btaya hai kbhi?)

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------

You can share with me/Such things are normal in any kind of illness (Bemari ki
surat mai aise khyalaat aa skte hain)

------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------
 FAMILY BACKGROUND HISTORY:

FATHER’S Name:

Age:

Education:

Occupation:

Temperament

-----------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------

Any forensic history (kia apkai abu ka kabhi koi kanoni masla howa hai?)

-----------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------

Relation with client

-----------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------
----------------------------------------------------

Psychological illness: Reported/Not reported

------------------------------------------------------------------------------------------------------------

MOTHER’s Name:

Age:

Education:

Occupation:

Temperament:
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------

Any forensic history ( kia apki ami ka kabhi koi kanoni masla howa hai?)
 -----------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------

Relation with client

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
----------------------------

RELATION OF PARENTS with each other:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Psychological illness: Reported/Not reported

------------------------------------------------------------------------------------------------------------

RELATIONSHIP WITH SIBLINGS:

Age:

Education:

Occupation:

Temperament:
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------

Any forensic history

------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------

Relation with client:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
----------------------------

RELATION OF PARENTS with said sibling:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Age:

Education:

Occupation:

Temperament:
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------

Any forensic history

------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------

Relation with client:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
----------------------------

RELATION OF PARENTS with said sibling:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Age:

Education:

Occupation:
Temperament:
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------

Any forensic history

------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------

Relation with client:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
----------------------------

RELATION OF PARENTS with said sibling:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

ENVIRONMENT AT HOME:

Family system: Joint family/Nuclear family Socioeconomic

status:

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

What do you think was your home environment like?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

What type of conversations happened at home mostly?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

Who makes the primary decisions at home?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

Does the decision maker take your opinion in consideration?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

What role do you think you played in the family?

------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------

HISTORY OF PSYCHIATRIC ILLNESS IN THE EXTENDED FAMILY:

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

PERSONAL HISTORY:

How old were your parents when they had you?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
Delivery: Normal/C-Section

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Developmental Milestones ( kia apnai time pai chalna aur bolna shuru kar dia tha)
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Any trait presentsince childhood: (kia apki koi esi adat hai jo bachpan sai ab tak ho)
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Any head injury?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Trauma history? (abuse/ death/ bad experience)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Social nature: Social/Not social-

------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------

EDUCATIONAL HISTORY:

Age of school going and client’s reaction to it?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

School: Government/Private

School changed: Yes/No (If yes: how many classes in previous school?)
 -----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you like going to this school?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Do you have any achievements from school days?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you take part in any extracurricular activities?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Type of student: (Average, Above Average, Below Average)

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you make any friends at school and what was your relationship with them like?
------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Did you like your teachers?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Which College/University did you attend?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

OCCUPATIONAL HISTORY:

What was your first job?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Did you like it?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

How was your relationship with colleagues?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

What was your role in the company?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Did you like your boss?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Were you satisfied with your job?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Any other jobs?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Why did you take it?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

SEXUAL HISTORY:

Age of maturation:
What was your reaction to pubertal changes?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Adjustment issue during pubertal changes and who helped you with it (Balugat ki
tabdeeliyon k dauran koi msla hua?)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Do you have an interest in the opposite gender? (Mukhalif jins ki taraf ruhjaan hua
kbhi?)

------------------------------------------------------------------------------------------------------------
----------------

Any type of homosexual interest? (Hm jinsi taluqaat kbhi qaem rkhe hain?)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Who do you identify as?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Pornography (Fahash films dekhi hain?)

------------------------------------------------------------------------------------------------------------
------------------------------------------------------

Do you masturbate or did you? How often? How long? How do you feel about it?
(Khud lazatti)

-----------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------

Who told you about sex/ sexual practices? How long have you known it for?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
How many romantic/sexual partners have you had? How long were you with them?
How did you feel about them?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Can you tell me about your sexual partners? Age/gender/traits

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

PREMORBID PERSONALITY (prior to illness):

Were you social before your diagnosis?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Did you trust your friends/family?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Decision making power (was dependent on others or was headstrong in making

decision)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

What was your temperament before you were diagnosed?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

What was your view about your failures/successes?

 -----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you take care of your health? Were you ever worried for your health?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

What were your thoughts about your future?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

What were your thoughts about death? Were you worried about dying?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Were you mainly happy or sad?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you experience mood swings? (Elevated mood to depressed mood)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Were you optimistic or pessimistic?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

Were you able to express your mood?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

What was your reaction to stress?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

What were you religious?

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

What was your attitude towards religious practices? (Excessive inclination towards
religious practices)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------

What were your hobbies and how did you implement them in your life?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Were you a daydreamer?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

Did you fantasize about things at night to avoid other thoughts/ fear?

-----------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------

What was your reaction towards a stressor? (coping/ not coping)

------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------