King George's Medical University

Department of Psychiatry

Shah Mina Road, Chowk,

Lucknow,226003
Uttar Pradesh

Internship Report

Consultant at KGMU: Dr. Pooja Mahour

Childpsychologist cum associate professor
Psychologist, Psychiatry Department,
KGMU

VIBHA
Bachelor's in Arts (Honors) Psychology
Lady Shri Ram College,
Delhi University,
New Delhi.
 Head of Department
Dr. Vivek Agarwal MD

Professor & Head

Child and Adolescent Psychiatry

E-mail:

psychiatry@kgmcindia.edu

Consultant
Dr. Pooja Mahour
M.Phil. and PhD in Clinical Psychology
Additional Professor cum Clinical Psychologist (Non-medical

faculty)
Child and Adult Clinical Psychology and Psychotherapy

E-mail:
poojamahour@kgmcindia.edu

(Sign)
 CONTENTS

1. ACKNOWLEDGMENT
2. OBJECTIVES OF THE INTERNSHIP
3. KING GEORGE MEDICAL UNIVERSITY
4. DEPARTMENT OF PSYCHIATRY
5. HEAD OF DEPARTMENT
6. CASE 1
7. CASE 2

8. CASE 3

9. CASE 4

10.CASE 5

11.SUMMARY
 Objectives of the Internship (Observership)

It allows the students to obtain a better understanding of psychological concepts while also

developing questions and topics that are pertinent to their field and to build on and expand their
prior knowledge, theoretical viewpoints, and practical constructs. The goal of the internship
observer ship is to introduce students to the evaluation and diagnosis of professional practice
standards. Students can observe the patients and view the clinical picture of various discases
and working with the expert makes the whole process extremely beneficial.

To accomplish internship goals, I interned for

my My fieldwork enabled me to get
a month.
practical knowledge about the major psychiatric diseases that affect the population, which is
my main area of interest, under the supervision of qualified professionals. This training has
enhanced my knowledge and awareness of the various illnesses, as well as the process to assess
and diagnose them.

Aside from professional qualities, this experience has helped me build personal qualities like

steadiness, persistence, collaboration, and most important patience.

 King George's Medical University
In 1870, the Maharaja of Vijanagaram had the idea of starting a medical college in Lucknow,
which couldn't be possible due to the lack of funds. The visit
of King-Emperor George V, then
Prince of Wales, in 1905
prompted the establishment of a
college to mark the event. His Royal
Highness the Prince of Wales laid the foundation stone in
1906 during his second visit to the
Coronation Durbar as
King-Emperor. The university campus is located off Shahmina Road,
near the bank of the river
Gomti, and is adjacent to the bustling Chowk area. There are
separate
buildings for Medicine, Surgery, Pediatrics, Obstetrics and
Gynecology, Cardiology
Neurology, Psychiatry, Neurosurgery, Plastic Surgery,
Rheumatology, Geriatric Psychiatry,
Surgical Oncology, Breast Medicine,
Pathology, Pharmacology, Anesthesiology,
Ophthalmology, Urology, and Community Medicine. Cardiothoracic surgery is
currently
building chest medicine, microbiology along with
pathology, and biochemistry along with
physiology.

Vision: To be the
Outstanding University of Medical Excellence in the world in education,
research, and patient care.

Mission:

To become one of the world's best providers of high-quality teaching

and excellence in education

Generate outstanding leaders in health sciences

Provide compassionate, patient-centered care of the highest quality
 Case 1:10Observation
Socio-Demographie Details:
o Name: XYZ

o Age: 13 years

o Gender: Male

o Religion: Hindu

o Domicile: Fatehpur

o Education: 2nd Standard

o Occupation: -

Socio-Economic Status: Middle-class

Marital Status: Unmarried
Family type: Nuclear Family
Mother tongue: Hindi

Place: Lucknow
Informants' details:
o Name: Santosh Gupta
o Relation to the client: Father

o Reliability: Moderately reliable

Chief Complaints:
Behavioral issues
Aggressive
Verbally abuses family members and others
Unable to wear slippers/clothes by himself
Unable to recall earlier kept things by him
Takes off clothes in front of known and unknown people

Milestones: Significantly delayed

o Birth cry- Not present

o Sit-2 years
o Walk-7 years
o Talk 10 years

Current functioning:
o Toilet Signals- Not present
 anNot presen
Aath Aesisted

Rutton Not present

Tie No resert

Drrse- Not presen

Eat-Partial

Count-Not present
Colour Present

Shame- Not present

Danger-Present
Academic:

Read- Partial
o Write- Cannot

Moncy:
o Concept- Present
o Recognize- Not present
o Calculate- Not present
History of Present Illness:

P a s t Psychiatric History: None

Substance use, abuse, and addiction: None

.Past Medical History:

o Encephalitis after 1-2 days of birth which persisted for 2-3 days.
o Paralysis after I month of birth lead to the present permanent paralysis in one

hand.
Epileptic seizures after 5 months of birth.

o Squint Eyed.
Family History: The patient is a 13-year-old male who has a 17-year-old sister. The

patient lives in a nuclear family with a 45-year-old mother and a 50-year-old father. There
was no history of mental retardation or any mental illnesses in the family as reported by

the informants.
Development and social history
The child was born after 11 months gestation period. The delivery was normal.

Tests Conducted and Results: VSMS, GDT, SFBT

1heVineland Social Maturity Scale (VSMS) is a psychometric assessment instrument
designed to help in the assessiment of social competence. The Vineland Social Maturity Scales

VSMS). published by Edgar Doll in 1935, measures social maturity or social competence in
individuals from birth to adulthood. Doll classified eight categories of items on the VSMS

(Doll, 1935): self-help general, self-help dressing, self-help eating, communication, self-
direction, socialization, locomotion, and occupation.

The Gesell Developmental Schedules (GDT) are a set of developmental metrics which outline
the ages & stages of development in young children developed by Dr. Amold Gesell and
colleagues. The Gessell Drawing Test is one of the most frequently used screening measures
of intelligence for clinical populations, such as children with mental handicaps, hearing
impairments, and other developmental disabilities in our country. It is easy to use, expeditious,

and effective screening device for regular use in clinical populations.

Seguin Form Board Test (SFBT) is one of the popular tests of intelligence for children in the
Indian subcontinent. It is a much sought-after test due to its simplicity, ease of administration
and takes less than 10 minutes to arrive at an IQ score. Further, it elicits interest in children, is
easy to score and can be administered to even shy, speech impaired, autistic spectrum and/or

attention deficit and hyperactive children. Seguin Form Board is said to measure visuospatial
perception, organization and discrimination; psychomotor dexterity, coordination and
development; as well as motor and cognitive speed (Cattel, 1953; David and Virginia, 1972;

Venkatesan, 2014). SFB is said to measure'g' factor of intelligence, but only till the age of 8-
10 years, after which it is said to become a test of manual dexterity instead of intelligence.

1Q Assessment report:

The assessment was done using SFBT, GDT, and VSMS. The scores on VSMS showed
MA/SA =3 years 8 months with 1Q/SQ="25-30" which is indicative ofa "Severe" level of
intellectual and socio-adaptive functioning.

Disability is 90%.
 CASE 3:Obsessive Compulsive Disorder (0CD)
Socio-Demographic Details:
Name: MNO

Age: 36 years

Gender: Male

Religion: Muslim
Domicile: Lucknow

Education: Till 12th standard

Occupation: - Unemployed

Socio-Economic Status: Lower middle class

Marital Status: Married
Family type: Joint Family
Mother tongue: Hindi
Place: Lucknow
Informants' details: -

o Name: -

o Relation to the client: -

o Reliability:
Chief Complaints:
o Aggressive behavior. Indulges in physical fights with family members. He frequently

beats his wife and mother and feels guilty about it. However, ends up repeating the
same behavior.
o Unable to handle social situations by himself. Takes either mother or wife along to

deal with non-familiar people.

o Demanding inappropriate sexual favors from the wife.

o Attempted suicide twice.

oInappropriate sexual comments were passed about mother and wife.

o Excessive masturbation (twice a day).
o Inappropriate sexual arousal when exposed to external stimuli.

o Obsessive behavior regarding cleanliness, contamination, and washing hands.

o Inappropriate affect- The patient did not feel any grief or sorrow when his father
passed away a few years ago.
 Clinician's Observation: Fidgety, anxious, stammering, and tongue movement.
Past Psychiatric History: None
Substance use, abuse, and addiction: Use of weed and whitener for substance abuse
when the patient was in 8th standard. Smoking, alcohol, and weed are currently used

substances.
Past Medical History: None
'Family History: The patient is married and has a 1-year-old son from his second
marriage. The patient lives in a joint family with his wife, son, and mother.
Development and social history
Tests Conducted and Results: SSCT, TAT, IPDE, RIBT, SCID-5, and Y-BOCS.

Sentence completion tests are a class of semi-structured projective techniques. The Sacks
Sentence Completion Test (SSCT) is a 60-item test that asks respondents to complete ó0

questions with the first thing that comes to mind across four areas: Family, Sex,
Interpersonal, Relationships and Self concept. They provide respondents with beginnings of
sentences, referred to as "stems", and respondents then complete the sentences in ways that

are meaningful to them. The responses are believed to provide indications of attitudes,
beliefs, motivations, or other mental states.
The Thematic Apperception Test, or TAT, is a type of projective test that involves
describing ambiguous scenes. Popularly known as the "picture interpretation technique," it
was developed by American psychologists Henry A. Murray and Christina D. Morgan at

Harvard University in the 1930s. The subject is asked to tell as dramatic a story as they can

for each picture presented, including:

what has led up to the event shown

what is happening at the moment

what the characters are feeling and thinking

what the outcome of the story was.

The International personality disorder examination or IPDE is a user-friendly and

clinically meaningful tool for clinicians to assess personality disorders. The test has a total of

59 questions and will take around 15-20 minutes to complete. The International Personality

Disorder Examination (IPDE) is a semistructured clinical interview originaly designed to

assess the personality disorders (PDs) in the ICD-10 and DSM-I1-R classification systems,

with DSM-IV.
and subsequently modified for compatibility
 he Rorschach Inkblot Test (RIBT) employs a series of ten bilaterally symmetrical inkblot
cards, of which some are black or gray, and others could contain applications of color. The

est 1aker is asked to provide their perceptions or perspectives on the presented ambiguous
inkblot images. This test was designed to look for patterns of thought disorder in

schizophrenia and has evolved to include other areas, like personality, emotional disorders,
ana intelligence. The Rorschach has been standardized using the Exner system andis

effective in measuring depression, psychosis, and anxiety.

The Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) is a

Semi-structured diagnostic interview for clinicians and researchers to assess the 10 DSM-5

Personality Disorders across Clusters A, B, and C as well as Other Specified Personality

Disorder. Designed to build rapport, the SCID-5-PD can be used to make personality disorder
diagnoses, either categorically (present or absent) or dimensionally. The SCID-5-PD includes

interview and the handy self-report sereening questionnaire for patients or subjects, the

Structured Clinical Interview for DSM-5 Sereening Personality Questionnaire (SCID-5-

SPQ)
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a 10-item scale designed to

measure the severity and type of symptoms in people with obsessive-compulsive disorder
(OCD) over the past seven days. The symptoms assessed are obsessions and compulsions.
This scale is useful in tracking OCD symptoms at intake and during/after treatment.

Impression:
1. SCID-5: The patient met 7 out of 9 criteria for "Borderline Personality Disorder
2. IPDE: The patient met the criteria for "Emotionally unstable Personality Disorder"
3. Y-BOCS: The patient scored 35 on Y-BOCS which indicates "Sever level (compulsive
sexual behavior and contamination, cleaning, washing compulsion.)
4. RIBT: The patient's various scores are-

Productivity= 15 (within range)

Reaction Time= 7 seconds(decreased)
Organizational capacity is poor(1:2:0)
Social conformity is present (P=6)
Reality Contact= 75% (Average)
Affect Ratio= 0.7 (High)

Lambda=0.3 (Low)
 3 fire responses and 3 Bl responses were indicative of uncontrolled affective

reactions.
Activities engaged by human figures were fights, and feelings of hostility against
the world.
T A T : The stories were structured and organized, and they related to the personal life of

the patient (mother-son conflict, mental illness, sexual needs, and isolation).

Needs: Nurturance, sex, infidelity

Presses: Infidelity, aggression, dejection
Emotions projected in the stories are aggression, sadness, and dissatisfaction.
 CASE 4: Depression, 10, and potential MLC
Socio-Demographic Details:
o Name: UVW

Age: 45 years
o Gender: Male

o Religion: Hindu

o Domicile: Lucknow

o Education: Masters in Arts

o Occupation: Political Leader

Socio-Economic Status: Middle class

Marital Status: Married
Family type: Nuclear
Mother tongue: Hindi
Place: Lucknow
Informants' details: -

o Name: -

o Relation to the client:-

o Reliability: -

Chief Complaints:
The mood remains low regularly.
Sleeplessness- sleeps only for 1-2 hours.
Loss of interest in activities that he enjoyed doing earlier.
Irritability- Often broken things like cups and glasses at home.
Suicidal thoughts.
History of Present Illness: The patient had started feeling low and lost interest after his
daughter was kidnapped, allegedly raped, and put in an orphanage by the perpetrators. His

conditions started deteriorating after the commissioner of police also informed him about
his inability to help in this case. The situation got worse when her daughter changed her
statement in court (allegedly brainwashed/forced) against the parents.
Premorbid Personality: The patient was interested in public service and politics. Had an
active social life.

He took great interest in poetry, article writing, reading, et cetera.

No other pathological behavior was present.
Only had verbal feuds with people who disagreed.
 None
Past Psychiatric History:
None
Substance use, abuse, and addiction:

Past Medical History: None

the patient.
the family as reported by
illnesses in
Family History: No history of mental
Later, his career as
a

was born in a rural area.

The patient
Development and social history: a stranded
Lucknow. Whilst in
his job, to save
cadre and then leader drew him to
a
party whom he had his
first
he had to marry the w o m a n from
mother and her little daughter,
daughter.
biological child apart from the previous non-biological
SCID.
(SPM), and
16 PF,SSCT, RIBT, TAT, 1Q
Tests Conducted and Results:
factors. The
based on these 16 personality
16 PF: Cattell developed an assessment
frequently used
Questionnaire and is still
test is known as the 16PF Personality
in business for
career counseling,
marital counseling, and
today, especially in in
The test is composed of forced-choice questions
employee testing and selection. Personality
one of three
different alternatives.
which the respondent must choose somewhere
score falls
traits are then represented by a range
and the individual's
extremes.
on the continuum between highest and lowest
25h-50h Percentile,
assessed using SPM which indicates
.1Q Assessment report: 1Q was

Il1, "Average" level of intellectual functioning.

Grade
that the patient is-
2. 16 PF: Results on 16 PF indicate

High on- Extraversion and Anxiety

Low on-Control and Adjustment.
Rorschach are as follows-
3. RIBT: Results on
"low" level of productivity.
of responses [R=11] is low indicating
a
The total number

Response time is within range [Rt=21.25 seconds].

F+% is within range [F+ % 80%].
Affective ratio is within range [Aff R= 0.57]
which is indicative of low social conformity.
Popular responses are low [P-3; TOL=1]
which are indicative of significant guilt feelings.
High shading responses lg-2]
indicative of the tendency to withdraw.
A lack of human responses is

4. SSCT: Results on significant conflicts in

SSCT show
Attitude towards father

Self-concept (guilt feelings)

Atitude towards future
 structured, and organized.
5. TAT: stories on TAT were original, well
able to identify with the hero adequately.
The patient was

loved one", getting rejected by a loved one

Major themes: "losing a

nNurturance
Significant needs: nAffiliation,
Intellectualization
Defense mechanisms: Suppression and
and nAffiliation Vs. n Loss.
Significant conflicts: nAffiliation Vs. nRejection

IMPRESSION:

Intellectual functioning.
The patient was average level of
He has depressive features.
nAffiliation Vs. n Loss.
nAfiliation Vs. nRejection and
He has significant conflicts seen as-

He has significant conflicts in Attitude towards father and self-concept.

16 PF.
He has low control and adjustment and high anxiety as on
 SUMMARY

professionai
learning exper
onal leaming experience that offers
An
internship
is a

field study
of study
ield of or career interest. An
meaningful, practical work
to a
student's
internship gives a
student the
related
nloration and development, and
exploration
to learn new
ortunity
for
career
skills.

the o ortunity to observe various cases of IQ

interm, I got assessment, Autism, Specific
Learning
As an
disability, Neuropsychiatry, Obsessive Compulsive Disorder, Depression, and
hich
Personality disorders wh provided me ith
great knowledge of the
symptoms, phases.
differential
diagnosis,
and co-morbidities
and co-morbidities of vario
various disorders. I was
equipped with the basic
that a
clinicianchould adhere to while taking a case
history, rapport formation, and the
conduct

whole process of conducting a mental status examination. During the period, I gained insights
acsing
factors
pressing fact that cause a mental illness and the
into the
various
repercussions of it on the
heir
their caretakers.
caretake I am now a little confident in
atient as well as
understanding the clinical
encess of administering various
tests, especially IQ tests. I
have greater
cammand over rapport formation and de-briefing the patient. This opportunity helped me value
the guantitative tests which was not the case earlier. I now know the importance of takin

with cases of personality disorders

interviews while dealing

various tests that I was acquainted with during the month are SFBT, MCMI, SSCT. TAT
The v

pIRT NIMHANS Neuropsychological Bartery, DSI, CPM, SPM, MISIC, IPDE, VAIS. L
r oin. PD. and Y-BOCS. Apart from the psychological factors, my knowledge base for
he hinlogiçal causes of mental 1nesses was widened and I am familiar with the role of
disordets and diseases like hypothyroidism, Fragile X Syndrome, Huntington's disease, and
acromegaly, Parkinson's Disease, DSH, NSSI, CVA, et cetera.

lt intrigued me how the various precipitating and perpetuating factors like socio-economic
stressors, family stressors, pre-natal and post-natal environment,
geography, and literacy had
effects on mental disabilities, especially on 1Q. I also learned about the ethical
concerns and
clinicians' judgments while dealing with sensitive profiles like medico-legal cases. The
case

point that kept on arresting my attention was the stereotypical role of women as mothers
and
sisters and the amount of dedication, and hard work in
given painstakingly doing the basic
 activities of cleaning and looking after the patients' necessities is done by the mother

other household demands and

for the family needs. Their
addition to caring role
by herself in repeatedly ignored and nd
structure and is
mental health
is crucial in the

addition to having
enricned my Knowledge of psychologv. snarl questions
The internship,
in aons
the
tools like that of 1Al,
the role
of social capital, and f
about the
and thoughts or SOCial hierarchy and the hiph
at the lower rungs
coes
of
to the citizens
mental healthcare State-of-arfairs of mental health and ilnae
the over-all
institutes and olls al
special training dedication that is required to become a

work and the

me the hard
internship showed snoulders which come from the ability to lahel
label
our
that rest on
psychologist, the
responsibilities
the mature approach of maintaining.
ning our
rested in us and taking
individuals which is the power Another learning was
biases continuously.
our own
restrict and challenge
mental balance and is to psycho-educate the
patients
ofa clinical psychologist
crucial role
that the extremely for the patient
and their care providers
understanding
adopt an empathetic
caregivers and
hard work.
appreciating
their patience and
nstiling and

internship experience
team for making my
and faculty
I grateful to the working staff the technical
am in understanding
However, Istill
have a long way to go
worthwhile and enriching. Internship experience
to be
Clinical Psychology
Overall, 1 found the
aspects of Psychology. learmed here in my pursuit of
valuable skills I
able to use the
sure I will
be
positive, and I'm
future.
clinical psychologist in the