Assignment I: Individual (Weightage 50%)

Paper: Understanding Psychological Problems- II- MA Sem II

Instruction:

1. This is an individual assignment.

2. Answer ANY TWO sections (case vignettes).
3. Total weightage for the assignment is 50 %.
4. Similarity index should be less than 25%
5. There are a total of three sections and each section carries 25 marks.
6. Write answers by supporting evidences from contemporary research studies.
7. For provisional diagnosis – mention codes as per DSM-5 for respective conditions.

Sections

1. Section 1, 2 and 3 consist of case vignettes.

Format

1. APA 7th edn. Formatting Style

2. Word Limit – 3000-5000 words (1000-1500 words per answer approx.)
3. Font – Times New Roman
4. Line Spacing 1.5 or 2

Important Dates

1. Opening Date – March 14, 2023 (Tuesday)

2. Submission Date - March 28, 2023 (Tuesday)
3. Closing Date – April 01, 2023 (Saturday)

1
 Section 1
Diana is a 9-year-old girl brought in for her first psychiatric consultation by her parents, who were troubled
by Diana’s behavior during the Thanksgiving holiday. Diana’s mother described Diana’s propensity toward
interrupting others’ conversations, her inability to stay seated at the dinner table for longer than several
minutes at a time, and her frequent, brief, but very noticeable bouts of sullen mood. Both parents reported
that Diana’s “quirks” have been observable throughout her life. They described her as “moody,” “stubborn,”
“turbo-charged,” “impulsive,” and “a bit aggressive with others,” traits which they’ve noticed since she
was an infant. They’ve also been concerned among themselves about Diana’s limited friendships, noting,
“She doesn’t seem to get many invitations for play dates.” They wondered whether Diana’s tendencies
toward bossiness and quick bursts of temper, which they’d long observed at home, were impairing her
ability to form strong ties with peers. Academically, Diana thrived in certain classes, particularly those in
which she was immediately engaged with the material, but she also struggled mightily with certain subjects,
particularly reading and writing. She seemed to grasp new concepts at first before falling off and losing
interest in the task. She was frequently frustrated with herself and openly self-critical. She left materials
scattered around the classroom and frequently forgot necessary papers or books at home. Distractibility also
caused significant problems; teachers frequently commented on the need to seat Diana away from the
windows and at the front of the class in an effort to maintain her focus on the lesson. The teacher also
commented that Diana rarely stayed in her seat for more than a few minutes at a time and made frequent
visits to the bathroom and drinking fountain. At home, she and her sister frequently argued, and Diana at
times was physically aggressive with her sister, though never harmed her in any significant way. Diana was
noted to be quick to anger and quick to cry, and had “bad afternoons” in which she sulked and didn’t
respond to consoling. She was described as somewhat uncoordinated by her parents; sports at school were
always difficult for her. Diana was resistant to meeting with the psychiatrist and was feeling “grouchy”
when the interview began. She expressed frustration over her difficulties at school and acknowledged her
struggles with paying attention and with sitting still; she volunteered feeling that “I’m stupider than the
other kids and I hate it.” She spoke of several friends at school but also acknowledged, “We fight
sometimes” and expressed her hope that she might “get a best friend someday.” During the interview, after
initially sitting in a chair with her arms crossed, she walked around the psychiatrist’s office, examining
objects within reach, and at one point perching perilously on the edge of an end table in an effort to reach
a book, responding only to the psychiatrist’s repeated insistence that she not climb on the furniture

Q1. Give a provisional diagnosis by referring to DSM-5. Justify your answer by highlighting the
clinical features from the case vignette above. 8 marks

Q2. Would you like to explore any additional information- YES/NO? Explain the reasons for the
same. If YES- what kind of questions would you like to ask Diana and her parents? 5 marks

Q3. What would be the differential diagnosis for the case vignette above? Justify the same 6 marks

Q3. What are the functional consequences of Diana’s provisional diagnoses? 6 marks

2
 Section 2
Question

Mr. Swot was a 45-year-old postal service employee who was evaluated at a clinic specializing in the
treatment of depression. He claimed to have felt constantly depressed since the first grade, without a period
of normal mood for more than a few days at a time. His depression was accompanied by lethargy, little or
no interest or pleasure in anything, trouble in concentrating, and feelings of inadequacy, pessimism, and
resentfulness. His only periods of normal mood occurred when he was home alone, listening to music or
watching TV. On further questioning, Mr. Swot revealed that he could never remember feeling comfortable
socially. Even before kindergarten, if he was asked to speak in front of a group of family friends, his mind
would go blank. He felt overwhelming anxiety at children’s social functions, such as birthday parties, which
he either avoided or attended in total silence. He could answer questions in class only if he wrote down the
answers in advance; even then, he frequently mumbled and could not get the answer out. He met new
children with his eyes lowered, fearing their scrutiny, expecting to feel humiliated and embarrassed. He
was convinced that everyone around him thought he was “dumb or a jerk.” During the past several years,
he had tried several therapies to help him get over his shyness and depression. Mr. Swot had never
experienced sudden anxiety or a panic attack in social situations or at other times. Rather, his anxiety built
gradually to a constant level in anticipation of social situations. He had never experienced any psychotic
symptoms.

Q1. Give a provisional diagnosis by referring to DSM-5. Justify your answer by highlighting the
clinical features from the case vignette above. 8 marks

Q2. Would you like to rule out additional differential diagnosis - YES/NO? Justify why. 5 marks

Q3. What questions would you like to ask Mr.Swot to confirm/dismiss the diagnosis and why?

4 marks

Q3. List down at least four questions to explore protective factors mentioned in the case above?

8 marks

3
 Section 3
Mr. Graham, a 36-year-old man, is admitted to a psychiatric unit after having been brought to the emergency
department by police. As he was walking past a hotel in the central part of the city, he saw a man and
woman standing on the sidewalk about to take a photograph of a building across the street. Thinking that
they were going to take his picture, he grabbed the camera, smashed it on the ground, and pulled out all the
film. He explained his actions by saying the photograph would be used to control him and that it is illegal
to take another person’s photograph. Mr. Graham has a history of multiple hospitalizations dating back to
age 14. During the hospitalizations, his symptoms have been well-controlled with a variety of typical and
atypical antipsychotic medications. Once discharged he begins drinking four to five beers a day, neglects
getting prescriptions refilled, and stops medication when his supply runs out. He made two prior suicide
attempts, both by hanging, in which he suffered no serious medical sequelae. He reports numerous
blackouts from drinking, but he has never had seizures or DTs. He does not use illicit drugs. Mr. Graham
dropped out of high school in the 11th grade. He worked a number of short-term, unskilled jobs before
going on public assistance at age 21. He lives alone, is estranged from his family, and has no friends. On
examination, Mr. Graham is lying motionless. He makes good eye contact and says, “I’m trying not to
move.” He fears that if he moves he may die. He currently hears voices saying, “Be good,” “Get the dog,”
and “He’s the one.” He also sees shapes, which he describes as colored letters dancing in front of his eyes.
He talks about being monitored by hidden cameras and microphones everywhere he goes in the city. He is
alert and oriented. He can recall three out of three objects after 5 minutes. Concentration is impaired.

Q1. Give a provisional diagnosis by referring to DSM 5. What information in the clinical history
supports the diagnosis? What additional information would help to confirm it?

2+ 8 marks

Q2. Based on Mr. Graham’s narrative, provide a summary for mental state examination. 5 marks

Q3. Describe the positive (protective) and negative (risk) factors that would influence Mr.Graham’s
longer-term prognosis?

4 marks

Q4. What differential diagnosis would you like to consider for Mr.Graham and why? 6 marks