THE BHOPAL SCHOOL OF SOCIAL SCIENCES

INTERNSHIP REPORT ON
“WORKING EXPERIENCE AT 
BHOPAL MEMORIAL HEALTH AND RESEARCH
CENTRE”
(Practical Part C)

Submitted To, Submitted By,

SIMEEN ALI
Mrs.PrabhleenKaur B.A. HONS
PSYCHOLOGY
II YEAR
           
THE BHOPAL SCHOOL OF SOCIAL SCIENCES

                            Internship report on 

                            Working experience at
“BHOPAL MEMORIAL HOSPITAL & RESEARCH CENTRE”

Submitted by SIMEEN ALI

B.A. PSYCHOLOGY HONS II YEAR
Under the Guidance of MRS. PRABHLEEN KAUR
 ACKNOWLEDGEMENT

My deepest thanks to MR. RUPESH RANJAN for providingthe

opportunity.

I express my thanks to MRS. PRABHLEEN KAUR for extending her

support and guidance. Thanks and appreciation to thehelpful people
and their support.

I would also thank my collage THE BHOPAL SCHOOL OF SOCIAL

SCIENCES and my fellow internswithout whom this would have
been a distant reality.

SIMEEN ALI
 1. INTRODUCTION OF THE INTERNSHIP

 BACKGROUND
We have done our internship in BHOPAL MEMORIAL HEALTH
AND RESEARCH CENTRE (Near best price, karod road). Our
internship was from 1stjune to 30thjune. Timings for our internship
were to 9a.m. to 5p.m. and every Saturday, timing was till 2p.m. and
Sunday was a holiday for us. As we were doing our internship in
psychology we were allowed to go the ward for psychiatric patients to
take their history of mental illness, to observe them and take their
cases to present. In the department their were2 psychiatrist, 2 clinical
psychologist, 2 psychiatrist social workers, 2 junior doctors and other
staff members. Our facilitator was dr. rupeshranjan (clinical
psychologist).
 AIM AND OBJECTIVE

 Competence in applying professional skills in clinical

work, supervision, and outreach activities in accordance
with the profession-wide competencies 

 Articulating your theoretical understanding about

problems in human behaviour and their treatment.

 Respect and appreciation for individual and group

differences.

 Understanding and integration of ethical principles into

practice.

 Your interactions with and impact on professional

colleagues.

 Use of your internal and external resources to deal with the

personal and professional stresses inherent in the provision
of services.

 The developmental transitions of the internship experience

with a balance of support and challenge.

 The transition from student to independently practicing

health services psychologist.
Objective 1: Interns will develop intermediate to advanced
knowledge and skill in the provision of individual therapy.
Competencies Expected:
 To demonstrate clinical intervention and relationship skills

 To demonstrate skills in gathering pertinent and relevant data to

inform clinical decision-making.

 To apply concepts of normal/abnormal behavior to case

formulation and diagnosis in the context of human development
and diversity.

 To integrate scholarly literature into their clinical work.

 To formulate and conceptualize cases based on theoretical

orientation
Objective 2: Interns will develop knowledge and skills in the
provision of group therapy.
Competencies Expected:
 To demonstrate skill in group screening

 To demonstrate intermediate group counselling skills

 To demonstrate knowledge of group theory and practice

 To demonstrate and apply knowledge of evidence-based group

interventions.
Objective 3: Interns will develop proficiency in triage screening and
crisis intervention.
Competencies Expected:
 To gather and document relevant data during telephone or in-
person sessions
 To demonstrate ability to conduct a thorough and effective risk
assessment

 To demonstrate the ability to effectively tolerate clients intense

feelings, attitudes, or wishes

 To demonstrate sensitivity and skill in working with diverse

clients

 To make good judgment regarding case disposition

Objective 4: Interns will develop requisite skills in psychometric
assessment.
Competencies Expected:
 To demonstrate skill in accurately selecting, administering,
scoring, and interpreting self-report and personality assessment
instruments
 To seek consultation regarding selecting, scoring, interpreting,
and report writing
 To demonstrate knowledge of the empirical basis of assessment
measures.
2. ACTIVITIES.

 DESCRIPTION.

The internship was from 1stjune to 3ostjune. We had 8 hours i.e.

from 9 a.m. to 5 p.m. we have to be there in the hospital. For 1st
2 hours i.e. from 9a.m. to 11a.m. we have to go to the ward,
where psychological ill patients were there. We have to take
history of the patient which we have to present as a case history
every Saturday. Then after going to the ward, we have our
lectures which were taken by the psychiatrist, psychologist,
psychiatric social workers. When there was opd day in which
patient would come to thedoctors for their routine check up. We
have to observe those patients and understand what
psychological illness they have. Then we have different types of
lectures from the doctors present in the psychology
department.They taught us the different types of psychological
diseases and how to treat them through clinical psychology.
They have allowed us to take the psychometric testing and apply
it to one of the patient. The test which we have tested was
wechlers adult intelligence performance test.
  AREA.
As we wasdoing the internship in the subject of psychology. The main
criteria is to understand all the approaches, techniques, schools, and
therapies. So our main area was clinical psychology.
Clinical psychology is an integration of science, theory, and clinical
knowledge for the purpose of understanding, preventing, and
relieving psychologically-based distress or dysfunction and to
promote subjective well-being and personal development. Central to
its practice are psychological assessment, clinical formulation,
and psychotherapy, although clinical psychologists also engage in
research, teaching, consultation, forensic testimony, and program
development and administration. In many countries, clinical
psychology is a regulated mental health profession.
The field is generally considered to have begun in 1896 with the
opening of the first psychological clinic at the University of
Pennsylvania by LightnerWitmer. In the first half of the 20th century,
clinical psychology was focused on psychological assessment, with
little attention given to treatment. This changed after the 1940s when
World War II resulted in the need for a large increase in the number
of trained clinicians. Since that time, three main educational models
have developed in the USA—the Ph.D. Clinical Science model
(heavily focused on research), the Ph.D. science-practitioner
model (integrating research and practice), and the Psy.D. practitioner-
scholar model (focusing on clinical practice). In the UK and the
Republic of Ireland, the Clinical Psychology Doctorate falls between
the latter two of these models, whilst in much of mainland Europe, the
training is at the masters level and predominantly psychotherapeutic.
Clinical psychologists are expert in providing psychotherapy, and
generally train within four primary theoretical orientations—
psychodynamic, humanistic, cognitive behavioural therapy (CBT),
and systems or family therapy.

Clinical psychologist

Occupation

Names Clinical psychologist

Description

Competencies assessment and treatment of
psychopathology

Education USA: the Ph.D or Psy.D in Clinical

required Psychology); UK and the Republic of
Ireland: Doctor of Clinical Psychology
(D.Clin.Psych.)

Related jobs  Psychologist

 Psychiatrist

Professional practice
Clinical psychologists engage in a wide range of activities.
Some focus solely on research into the assessment, treatment, or
cause of mental illness and related conditions. Some teach,
whether in a medical school or hospital setting, or in an
academic department (e.g., psychology department) at
an institution of higher education. The majority of clinical
psychologists engage in some form of clinical practice, with
professional services including psychological assessment,
provision of psychotherapy, development and administration of
 clinical programs, and forensics (e.g., providing expert
testimony in a legal proceeding).
In clinical practice, clinical psychologists may work with
individuals, couples, families, or groups in a variety of settings,
including private practices, hospitals, mental health
organizations, schools, businesses, and non-profit agencies.
Clinical psychologists who provide clinical services may also
choose to specialize. Some specializations are codified and
credentialed by regulatory agencies within the country of
practice. In the United States such specializations are
credentialed by the American Board of Professional
Psychology (ABPP).
Training and certification to practice
Clinical psychologists study a generalist program in psychology
plus postgraduate training and/or clinical placement and
supervision. The length of training differs across the world,
ranging from four years plus post-Bachelors supervised
practice to a doctorate of three to six years which combines
clinical placement.In the US, about half of all clinical
psychology graduate students are being trained
in Ph.D. programs—a model that emphasizes research—with
the other half in Psy.D. programs, which has more focus on
practice (similar to professional degrees for medicine and
law). Both models are accredited by the American
Psychological Association and many other English-speaking
psychological societies. A smaller number of schools offer
accredited programs in clinical psychology resulting in
a Masters degree, which usually take two to three years post-
Bachelors.In the U.K., clinical psychologists undertake a Doctor
of Clinical Psychology (D.Clin.Psych.), which is a
practitioner doctorate with both clinical and research
components. This is a three-year full-time salaried program
 sponsored by the National Health Service (NHS) and based in
universities and the NHS. Entry into these programs is highly
competitive and requires at least a three-year undergraduate
degree in psychology plus some form of experience, usually in
either the NHS as an Assistant Psychologist or in academia as a
Research Assistant. It is not unusual for applicants to apply
several times before being accepted onto a training course as
only about one-fifth of applicants are accepted each year These
clinical psychology doctoral degrees are accredited by
the British Psychological Society and the Health Professions
Council (HPC). The HPC is the statutory regulator for
practitioner psychologists in the UK. Those who successfully
complete clinical psychology doctoral degrees are eligible to
apply for registration with the HPC as a clinical psychologist.
The practice of clinical psychology requires a license in the
United States, Canada, the United Kingdom, and many other
countries. Although each of the U.S. states is somewhat
different in terms of requirements and licenses, there are three
common elements:
1. Graduation from an accredited school with the appropriate
degree
2. Completion of supervised clinical experience or internship
3. Passing a written examination and, in some states, an oral
examination
All U.S. state and Canadian province licensing boards are
members of the Association of State and Provincial Psychology
Boards (ASPPB) which created and maintains the Examination
for Professional Practice in Psychology (EPPP). Many states
require other examinations in addition to the EPPP, such as a
jurisprudence (i.e. mental health law) examination and/or an oral
examination. Most states also require a certain number of
continuing education credits per year in order to renew a license,
which can be obtained through various means, such as taking
 audited classes and attending approved workshops. Clinical
psychologists require the Psychologist license to practice,
although licenses can be obtained with a masters-level degree,
such as Marriage and Family Therapist (MFT).

 KEY OBSERVATIONS.

a) They allowed us to go in the ward.

b) In the hospital they have allowed us to have a direct

intervention with their patients.

c) We were not allowed to see the files of the patients.

d) We were allowed to observe their patients who have come

to their normal routine check up.

e) We have lectures with all the doctors.

f) Though we faced some problems regarding the psychiatry

department.

g) Every Saturday we have to give topic presentation and

case presentation.

h) Every Sunday we got a holiday.

i) The staff members of the ward was not so supportive.

They don’t care of the patients much.

j) In the department, one of the doctor which he is a clinical

psychologist have supported a lot. He has guided us very
 well. He teaches us very good and understood us. He
always supported us.

k) They taught us psychotherapy, and different types of

behavioural and cognitive techniques. Different types of
psychiatric illness.
 MAJOR LEARNINGS.
 1ST JUNE – 4RD JUNE.(learned psychology, clinical
psychology).
DAY 1- 1ST JUNE SATURDAY.
PSYCHOLOGY
Psychology is the science of behaviour and mind. Psychology
includes the study of conscious and unconscious phenomena, as well
as feeling and thought. It is an academic discipline of immense scope.
Psychologists seek an understanding of the emergent properties of
brains, and all the variety of phenomena linked to those emergent
properties, joining this way the broader neuroscientific group of
researchers. As a social science it aims to understand individuals and
groups by establishing general principles and researching specific
cases. In this field, a professional practitioner or researcher is called a
psychologist and can be classified as a social, behavioural, or
cognitive scientist. Psychologists attempt to understand the role of
mental functions in individual and social behaviour, while also
exploring the physiological and biological processes that underlie
cognitive functions and behaviours.Psychologists explore behaviour
and mental processes, including perception, cognition, attention,
emotion, intelligence, subjective experiences, motivation, brain
functioning, and personality. This extends to interaction between
people, such as interpersonal relationships, including psychological
resilience, family resilience, and other areas. Psychologists of diverse
orientations also consider the unconscious mind. Psychologists
employ empirical methods to infer causal and correlational
relationships between psychosocial variables. In addition, or in
opposition, to employing empirical and deductive methods, some—
especially clinical and counselling psychologists—at times rely upon
symbolic interpretation and other inductive techniques.

DAY 2- 3RD JUNE MONDAY.

 Major schools of thought

BIOLOGICAL.
False-colour representations of cerebral fiber pathways
affected, per Van Horn et al.Psychologists generally
consider the organism the basis of the mind, and therefore
a vitally related area of study. Psychiatrists and
neuropsychologists work at the interface of mind and
body. Biological psychology, also known as physiological
psychology, or neuropsychology is the study of the
biological substrates of behaviour and mental processes.

BEHAVIOURAL.
Skinner's teaching machine, a mechanical invention to
automate the task of programmed instruction
Psychologists take human behaviour as a main area of
study. Much of the research in this area began with tests
on mammals, based on the idea that humans exhibit
similar fundamental tendencies. Behavioural research ever
aspires to improve the effectiveness of techniques for
behaviour modification. The film of the Little Albert
experiment.Early behavioural researchers studied
stimulus–response pairings, now known as classical
conditioning.

COGNITIVE.
The Stroop effect refers to the fact that naming the colour
of the first set of words is easier and quicker than the
second.
Cognitive psychology studies cognition, the mental
processes underlying mental activity. Perception, attention,
reasoning, thinking, problem solving, memory, learning,
language, and emotion are areas of research. Classical
cognitive psychology is associated with a school of
thought known as cognitivism, whose adherents argue for
an information processing model of mental function,
informed by functionalism and experimental psychology.

SOCIAL
Social psychology studies the nature and causes of social
behaviour.Social psychology is the study of how humans
think about each other and how they relate to each other.

DAY 3- 4TH JUNE TUESDAY.

PSYCHOANALYSIS.

Group photo 1909 in front of Clark University. Front row:

Sigmund Freud, G. Stanley Hall, Carl Jung; back
row: Abraham A. Brill, Ernest Jones, SándorFerenczi.
Psychoanalysis comprises a method of investigating the
mind and interpreting experience; a systematized set of
theories about human behaviour; and a form of
psychotherapy to treat psychological or emotional distress,
especially conflict originating in the unconscious mind and
the unconscious.

EXISTENIAL-HUMANISTIC THEORY.
 Psychologist Abraham Maslow in 1943 posited that
humans have a hierarchy of needs, and it makes sense to
fulfill the basic needs first (food, water etc.) before higher-
order needs can be met. Humanistic psychology developed
in the 1950s as a movement within academic psychology,
in reaction to both behaviourism and psychoanalysis. 

 Themes

Personality.
Theories of personality vary across different psychological
schools and orientations. They carry different assumptions
about such issues as the role of the unconscious and the
importance of childhood experience. According to Freud,
personality is based on the dynamic interactions of the id,
ego, and super-ego.

Motivation.
Psychologists such as William James initially used the
term motivation to refer to intention, in a sense similar to
the concept of will in European philosophy. With the
steady rise of Darwinian and Freudian thinking, instinct
also came to be seen as a primary source of
motivation. According to drive theory, the forces of
instinct combine into a single source of energy which
exerts a constant influence. Psychoanalysis, like biology,
regarded these forces as physical demands made by the
 organism on the nervous system. However, they believed
that these forces, especially the sexual instincts, could
become entangled and transmuted within the psyche.

Development.
Developmental psychologists would engage a child with a
book and then make observations based on how the child
interacts with the object.

 5TH- 7TH JUNE. ( PSYCHOTHERAPY.)

DAY 4- 5TH JUNE WEDNESDAY.
Psychotherapy (psychological therapy or talking therapy)
is the use of psychological methods, particularly when
based on regular personal interaction, to help a person
change behaviour and overcome problems in desired ways.
Psychotherapy aims to improve an individual's well-
being and mental health, to resolve or mitigate
troublesome behaviours, beliefs, compulsions, thoughts, or
emotions, and to improve relationships and social skills.
Certain psychotherapies are considered evidence-based for
treating some diagnosed mental disorders.
Psychotherapy (psychological therapy or talking therapy)
is the use of psychological methods, particularly when
based on regular personal interaction, to help a person
change behaviour and overcome problems in desired ways.
Psychotherapy aims to improve an individual's well-
being and mental health, to resolve or mitigate
troublesome behaviours, beliefs, compulsions, thoughts, or
emotions, and to improve relationships and social skills.
Certain psychotherapies are considered evidence-based for
treating some diagnose. There are over a thousand
different psychotherapy techniques, some being minor
variations, while others are based on very different
conceptions of psychology, ethics (how to live), or
techniques. Most involve one-to-one sessions, between
client and therapist, but some are conducted
with groups,including families.

DAY 5- 6TH JUNE THURSDAY.

The American Psychological Association adopted a

resolution on the effectiveness of psychotherapy in 2012
based on a definition developed by John C. Norcross:
"Psychotherapy is the informed and intentional application
of clinical methods and interpersonal stances derived from
established psychological principles for the purpose of
assisting people to modify their behaviours, cognitions,
emotions, and/or other personal characteristics in
directions that the participants deem desirable".

Problems helped by psychotherapy include difficulties in

coping with daily life; the impact of trauma, medical
illness or loss, like the death of a loved one; and specific
mental disorders, like depression or anxiety. There are
several different types of psychotherapy and some types
may work better with certain problems or issues.
 Psychotherapy may be used in combination with
medication or other therapies.

Therapy Sessions
Therapy may be conducted in an individual, family, couple, or
group setting, and can help both children and adults. Sessions
are typically held once a week for about 30 to 50. Both patient
and therapist need to be actively involved in psychotherapy. The
trust and relationship between a person and his/her therapist is
essential to working together effectively and benefiting from
psychotherapy.Psychotherapy can be short-term (a few
sessions), dealing with immediate issues, or long-term (months
or years), dealing with longstanding and complex issues. The
goals of treatment and arrangements for how often and how long
to meet are planned jointly by the patient and
therapist.Confidentiality is a basic requirement of
psychotherapy. Also, although patients share personal feelings
and thoughts, intimate physical contact with a therapist is never
appropriate, acceptable, or useful.
Psychotherapy and Medication

Psychotherapy is often used in combination with medication to

treat mental health conditions. In some circumstances
medication may be clearly useful and in others psychotherapy
may be the best option. For many people combined medication
and psychotherapy treatment is better than either alone. Healthy
lifestyle improvements, such as good nutrition, regular exercise
and adequate sleep, can be important in supporting recovery and
overall wellness.
Does Psychotherapy Work?
Research shows that most people who receive psychotherapy
experience symptom relief and are better able to function in
their lives. About 75 percent of people who enter psychotherapy
show some benefit from it. Psychotherapy has been shown to
improve emotions and behaviours and to be linked with positive
changes in the brain and body.
DAY 6- 7TH JUNE FRIDAY.
Types of Psychotherapy
1. Interpersonal therapy (IPT) 
It is a short-term form of treatment. It helps patients understand
underlying interpersonal issues that are troublesome, like
unresolved grief, changes in social or work roles, conflicts with
significant others, and problems relating to others. It can help
people learn healthy ways to express emotions and ways to
improve communication and how they relate to others. It is most
often used to treat depression.
2. Dialectical behaviour therapy
 It a specific type of CBT that helps regulate emotions. It is
often used to treat people with chronic suicidal thoughts and
people with borderline personality disorder, eating disorders and
PTSD. It teaches new skills to help people take personal
responsibility to change unhealthy or disruptive behaviour. It
involves both individual and group therapy.
3. Psychodynamic therapy
It is based on the idea that behaviour and mental well-being are
influenced by childhood experiences and inappropriate
repetitive thoughts or feelings that are unconscious (outside of
the person’s awareness). A person works with the therapist to
improve self-awareness and to change old patterns so he/she can
more fully take charge of his/her life.
4. Psychoanalysis
It is a more intensive form of psychodynamic therapy. Sessions
are typically conducted three or more times a week.

5. Cognitive behavioural therapy (CBT)

It helps people identify and change thinking and behaviour
patterns that are harmful or ineffective, replacing them with
more accurate thoughts and functional behaviours. It can help a
person focus on current problems and how to solve them. It
often involves practicing new skills in the “real world.”
CBT can be helpful in treating a variety of disorders, including
depression, anxiety, trauma related disorders, and eating
disorders. For example, CBT can help a person with depression
recognize and change negative thought patterns or behaviours
that are contributing to the depression.
6. Supportive therapy 
It uses guidance and encouragement to help patients develop
their own resources. It helps build self-esteem, reduce anxiety,
strengthen coping mechanisms, and improve social and
 community functioning. Supportive psychotherapy helps
patients deal with issues related to their mental health conditions
which in turn affect the rest of their lives.
7. Additional therapies
It is sometimes used in combination with psychotherapy
include:
o Animal-assisted therapy – working with dogs, horses or other
animals to bring comfort, help with communication and help
cope with trauma
o Creative arts therapy – use of art, dance, drama, music and
poetry therapies
o Play therapy – to help children identify and talk about their
emotions and feelings
8TH JUNE – 20thTH JUNE (Psychiatric History).
DAY 7- 8TH JUNE. SATURDAY
Psychiatric history 
Familiarity with the technique of psychiatric assessment is
important not only for a psychiatrist but also for a medical
practitioner or any mental healthprofessional, since more than
one-third of medicalpatients can present with psychiatric
symptoms.A psychiatric history is the result of a medical
process where a clinician working in the field of mental
health (usually a psychiatrist) systematically records the content
of an interview with a patient.

INTERVIEW TECHNIQUE
In no other branch of Medicine is the history takinginterview as
important as in Psychiatry. All physiciansneed to communicate with
their patients and a skilful interview can clearly help in obtaining
better information, making a more accurate diagnosis, establishinga
better rapport with patients, and working towardsbetter adherence
with management plan.A psychiatric interview is usually different
from the routine medical interview in several ways
A few important points regarding the interviewtechnique are
mentioned below. These serve aspointers towards a technique which
clearly has tobe mastered over a period of time with
repeatedexaminations.A consistent scheme should be used each time
forrecording the interview, although the interview neednot (and
should not) follow a fixed and rigid method.The interview technique
should have flexibility,varying according to appropriate clinical
circumstances.Whenever possible, the patient should be seen first.

DAY 8 – 10TH JUNE MONDAY

Table 2.1: Psychiatric vs Medical Interview 
A psychiatric interview can be different from a medical interview in
several ways, some of which can include:
1. Presence of disturbances in thinking, behaviour and
emotions can interfere with meaningful
communication
2. Collateral information from significant others can
be really important.

3. Important to obtain detailed information of

personal history and pre-morbid personality.
 4. Need for more astute observation of patient’s
behaviour

5. Difficulty in establishing rapport may be

encountered more often

6. Patients may lack insight into their illness and

may have poor judgement

7. Usually more important to elicit information

regarding stressors and social situation. During the
interview session(s), the patient should be put at ease
and an empathic relationship should be established. 

In psychiatric assessment, history taking interview and mental status

examination need not always be conducted separately (though they
must be recorded individually). During assessment, the interviewer
should observe any abnormalities in verbal and non- verbal
communication and make note of them. 
IDENTIFICATION DATA 
It is best to start the interview by obtaining some identification data
which may include Name (including aliases and pet names), Age,
Sex, Marital status, Education, Occupation, Income, Residential and
Office Address(es), Religion, and Socioeconomic background, as
appropriate according to the setting. It is useful to record the source of
referral of the patient. In medicolegal cases, in addition, two
identification marks should also be recorded. 
Background
In the field of medicine a patient history is an account of the
significant events in the patient's life that have a relevance to the issue
being addressed. The clinician taking the history guides the process in
an attempt to achieve a succinct summary of these relevant details.
Much of the history is obtained by asking questions. Some of these
questions are quite specific, such as, "How old are you?" and others
are more open, such as, "How have you been feeling lately?"
Although the structure of the interview may appear disjointed, the end
result is usually under a set of headings which have a worldwide
similarity.
Patient identification
The basic details of who the patient is are collected. This includes
their age, sex, educational status, religion, occupation, relationship
status, address and contact details. This serves several purposes.
Firstly, it is necessary information for administrative purposes and for
this reason some of this is often taken by clerks. Secondly, the
questions are largely non-threatening and provide a gentle
introduction into the meeting of patient and clinician. Thirdly, it
provides a format for individual introduction suitable to the culture.
Thus the clinician may start by introducing themselves and then move
on to these questions. This initial structure can provide a sense of
familiarity for the patient who is stressed about what is happening.

INFORMANTS 
Since sometimes the history provided by the patient may be
incomplete, due to factors such as absent in- sight or
uncooperativeness, it is important to take the history from patient’s
relatives or friends who act as informants and sources of collateral
information. It is important to take the patient’s consent before taking
this collateral history unless the patient does not have capacity to
consent. 
The informants’ identification data should be recorded along with
their relationship to the patient, whether they stay with the patient or
not, and the duration of stay together. 
Finally, a comment should be made regarding the reliability of the
information provided. The reliability of the information provided by
the informants should be assessed on the following parameters:
1. Relationship with patient,
2. Intellectual and observational ability
3. Familiarity with the patient and length of stay with the patient, and
4. Degree of concern regarding the patient. 
. 

DAY 9 – 11TH JUNE TUESDAY .

PRESENTING (CHIEF) COMPLAINTS 
The presenting complaints and/or reasons for consultation should be
recorded. Both the patient’s and the informant’s version should be
recorded, if relevant. If the patient has no complaints (due to absent
insight) this fact should also be noted. 
It is important to use patient’s own words and to note the duration of
each presenting complaint. Some of the additional points which
should be noted include:
1. Onset of present illness/symptom.
2. Duration of present illness/symptom.
3. Course of symptoms/illness.
4. Predisposing factors.
5. Precipitating factors (include life stressors).
6. Perpetuating and/or relieving factors.

The clinician next tries to clarify what are the main problems that
have brought the patient to be there. Some of this may have already
been achieved in the previous section. The patient may have more
than one problem and these may be related, such as posttraumatic
stress disorder and alcohol abuse or seemingly unrelated, such
as panic disorder and premature ejaculation. The patient is unlikely to
present a diagnosis and is more likely to describe the nature of their
problems in common language.

HISTORY OF PRESENT ILLNESS 

When the patient was last well or asymptomatic should be clearly
noted. This provides useful information about the onset as well as
duration of illness. Establishing the time of onset is really important
as it provides clarity about the duration of illness and symptoms. The
symptoms of the illness, from the earliest time at which a change was
noticed (the onset) until the present time, should be narrated
chronologically, in a coherent manner. 
The presenting (chief) complaints should be expanded. In particular,
any disturbances in physiological functions such as sleep, appetite and
sexual functioning should be enquired. One should always enquire
about the presence of suicidal ideation, ideas of self-harm and ideas of
harm to others with details about any possible intent and/or plans. 
It is also essential to consider and record any important negative
history (such as history of alcohol/ drug use in new onset psychosis). 
The clinician then attempts to obtain a clear description of these
problems. When did they start? How did they start, suddenly, slowly
or in fits and starts? Have they fluctuated over time? What does the
patient describe as the essential features of the complaints? Having
developed a hypothesis of what may be the diagnosis, the clinician
next looks at symptoms that might confirm this hypothesis or lead
them to consider another possibility. Much of the mental process for
the clinician is involved in this process of hypothesis testing to arrive
at a diagnostic formulation that will form the basis of a management
plan. The severity of each complaint is assessed and this may include
probing questions on sensitive issues such as suicidal thoughts or
sexual difficulties.

PAST PSYCHIATRIC AND MEDICAL HISTORY 

Any history of any past psychiatric illness should be obtained. Any
past history of having received any psychotropic medication, alcohol
and drug abuse or dependence, and psychiatric hospitalisation should
be enquired. 
A past history of any serious medical or neurological illness, surgical
procedure, accident or hospitalisation should be obtained. The nature
of treatment received, and allergies, if any, should be ascertained. A
past history of relevant aetiological causes such as head injury,
convulsions, unconsciousness, diabetes mellitus, hypertension,
coronary artery disease, acute intermittent porphyria, syphilis and
HIV positivity (or AIDS) should be explored.

Past history
This is divided into the psychiatric past history, which looks at any
previous episodes of the presenting complaint as well as any other
past or ongoing psychiatric problems. The past substance (drug)
history included data about patterns of use (mode of administration,
age of onset, frequency, amount, last use, medical or psychological
complications, history of attempting to quit) for alcohol, tobacco, and
illicit drugs. The medical past history documents significant illnesses,
both past and current, and significant medical events such as head
injury, seizures, major surgeries, and major illnesses. A
separate sexual history gathers data about sexual orientation and
sexual activity. Finally a history of abuse, including physical,
emotional, and sexual abuse is obtained from the patient and collateral
sources (family members or close family friends) as trauma might not
be directly remembered by the patient.
DAY 10- 12TH JUNE WEDNESDAY.

TREATMENT HISTORY 
Any treatment received in present and/or previous episode(s) should
be asked along with history of treatment adherence, response to
treatment received, any adverse effects experienced or any drug
allergies which should be promin.
Mental illness affects many individuals in the United States.
According to the National Alliance on Mental Illness, approximately
one in five American adults experience mental illness each year.
That’s 43.8 million people, or more than 18 percent of the population.
Children are affected as well, with about 13 percent of those ages 8 to
15 experiencing a severe mental disorder at some point during their
lives.With data like this, it’s no surprise that attitudes toward mental
health have changed for the better in recent years. Though stigma still
exists, CNN reports that 90 percent of Americans value mental and
physical health equally, according to a 2015 survey by the American
Foundation for Suicide Prevention (AFSP), the National Action
Alliance for Suicide Prevention and the Anxiety and Depression
Association of America. “People see connection between mental
health and overall well-being, our ability to function at work and at
home and how we view the world around us,” Dr. Christine Moutier
of AFSP told CNN. This change comes as mental health approaches
continue to focus on community-oriented, holistic care.This hasn’t
always been the case, however. Mental health treatment has
undergone extensive change over the years, with some strategies
being ineffective and even dangerous: “Many of the treatments
enacted on mentally ill patients throughout history have been
‘pathological sciences’ or ‘sensational scientific discoveries that later
turned out to be nothing more than wishful thinking or subjective
effects” .
DAY 11 – 13TH JUNE THURSDAY.
FAMILY HISTORY 
The family history usually includes the ‘family of origin’ (i.e. the
patient’s parents, siblings, grandparents, uncles, etc.). The ‘family of
procreation’ (i.e. the patient’s spouse, children and grandchildren) is
conventionally recorded under the heading of personal history. 
Family history is usually recorded under the following headings.
1. Family structure: Drawing of a ‘family tree’ (pedigree chart) can
help in recording all the relevant information in very little space
which is easily readable
2. Family history of similar or other psychiatric illnesses, major
medical illnesses, alcohol or drug dependence and suicide (and
suicidal attempts) should be recorded.
 3. Current social situation: Home circumstances, per capita income,
socioeconomic status, leader of the family (nominal as well as
functional) and current attitudes of family members towards the
patient’s illness should be noted.
Many psychiatric disorders have a genetic component and the
biological family history is thus relevant. Clinical experience also
suggests that a response to treatment may have a genetic component
as well. Thus a patient who presents with clinical depression whose
mother also suffered from the same disorder and responded well
to fluoxetine would indicate that this drug would be more likely to
help in the patient's disorder.
Apart from the genetic factors, research has shown that illnesses in
the parents such as depression and alcohol abuse are associated with a
higher rate of some conditions in the children growing up in that
environment. Similar effects are seen with the death of a parent from
a protracted illness.
DAY 12 – 14TH JUNE FRIDAY.

PERSONAL AND SOCIAL HISTORY 

In a younger patient, it is often possible to give more attention to

details regarding earlier personal history. In older patients, it is
sometimes harder to get a detailed account of the early childhood
history. Parents and older siblings, if alive, can often provide much
additional information regarding the past personal history. Not all
questions need to be asked from all patients and personal history
(much like rest of the history taking) should be individualised for each
patient.

PERINATAL HISTORY.
Difficulties in pregnancy (particularly in the first three months of
gestation) such as any febrile illness, medications, drugs and/or
alcohol use; abdominal trauma, any physical or psychiatric illness
should be asked. Other relevant questions may include whether the
patient was a wanted or unwanted child, date of birth, whether
delivery was normal, any instrumentation needed, where born
(hospital or home), any perinatal complications (cyanosis,
convulsions, jaundice), APGAR score (if available), birth cry
(immediate or delayed), any birth defects, and any prematurity. 
DAY 13 – 15TH JUNE SATURDAY.

CHILDHOOD HISTORY

Whether the patient was brought up by mother or someone else,

breastfeeding, weaning and any history suggestive of maternal
deprivation should be asked. The age of passing each important
develop mental milestone should be noted. The age and ease of toilet
training should be asked. 
The occurrence of neurotic traits should be noted. These include
stuttering, stammering, tics, enuresis, encopresis, night terrors, thumb
sucking, nail biting, head banging, body rocking, morbid fears or
phobias, somnambulism, temper tantrums, and food fads. 

EDUCATIONAL HISTORY,
The age of beginning and finishing formal education, academic
achievements and relationships with peers and teachers, should be
asked. 
Any school phobia, non-attendance, truancy, any learning difficulties
and reasons for termination of studies (if occurs prematurely) should
be noted. 
DAY 14 – 17TH MONDAY.

PLAY HISTORY
The questions to be asked include, what games were played at what
stage, with whom and where. Relationships with peers, particularly
the opposite sex, should be recorded. The evaluation of play history is
obviously more important in the younger patients. 

PUBERTY
The age at menarche, and reaction to menarche (in females), the age
at appearance of secondary sexual characteristics (in both females and
males), nocturnal emissions (in males), masturbation and any anxiety
related to changes in puberty should be asked. 

MENSTRUAL AND OBSETRIC HISTORY

The regularity and duration of menses, the length of each cycle, any
abnormalities, the last menstrual period, the number of children born,
and termination of pregnancy (if any) should be asked for. 

OCCUPATIONAL HISTORY
The age at starting work; jobs held in chronological order; reasons for
changes; job satisfactions; ambitions; relationships with authorities,
peers and subordinates; present income; and whether the job is
appropriate to the educational and family background, should be
asked. 
DAY 15 – 18TH JUNE TUESDAY.
Sexual and Marital History 
Sexual information, how acquired and of what kind; masturbation
(fantasy and activity); sex play, if any; adolescent sexual activity;
premarital and extramarital sexual relationships, if any; sexual
practices (normal and abnormal); and any gender identity disorder, are
the areas to be enquired about. 
The duration of marriage(s) and/or relationship(s); time known the
partner before marriage; marriage arranged by parents with or without
consent, or by self-choice with or without parental consent; number of
marriages, divorces or separations; role in interpersonal and sexual
relations; contraceptive measures used; sexual satisfaction; mode and
frequency of sexual intercourse; and psychosexual dysfunction (if
any) should be asked. 
Dialogue with patient
I am going to ask you a few questions about your sexual health and
sexual practices. I understand that these questions are very personal,
but they are important for your overall health.
Just so you know, I ask these questions to all of my adult patients,
regardless of age, gender, or marital status. These questions are as
important as the questions about other areas of your physical and
mental health. Like the rest of our visits, this information is kept in
strict confidence. Do you have any questions before we get started?
The five “P”s stand for: • Partners • Practices • Protection from STDs
• Past history of STDs • Prevention of pregnancy These are the areas
that you should openly discuss with your patients. You probably will
need to ask additional questions that are appropriate to each patient’s
special situation or circumstances.
Premorbid Personality (PMP) 
It is important to elicit details regarding the personality of the
individual (temperament, if the age is less than 16 years). Instead of
using labels such as schizoid or histrionic, it is more useful to describe
the personality in some detail. 
The following subheadings are often used for the description of
premorbid personality. 
1. Interpersonal relationship: Interpersonal relationships with family
members, friends, and work colleagues; introverted/extroverted; ease
of making and maintaining social relationships.
2. Use of leisure time: Hobbies; interests; intellectual activities;
critical faculty; energetic/ sedentary.
3. Predominant mood: Optimistic/pessimistic; stable/prone to
anxiety; cheerful/despondent; reaction to stressful life events.
4. Attitude to self and others: Self-confidence level; self-criticism;
self-consciousness; self- centred/thoughtful of others; self-appraisal of
abilities, achievements and failures.
5. Attitude to work and responsibility: Decision making; acceptance
of responsibility; flexibility; perseverance; foresight.
6. Religious beliefs and moral attitudes: Religious beliefs; tolerance
of others’ standards and beliefs; conscience; altruism.
7. Fantasy life: Sexual and nonsexual fantasies; daydreaming-
frequency and content; recurrent or favourite daydreams; dreams.
8. Habits: Food fads; alcohol; tobacco; drugs; sleep. 
One of the most reliable methods of assessment of premorbid
personality is interviewing an informant familiar with the patient prior
to the onset of illness. 
DAY 16 – 20TH JUNE THURSDAY.

ALCOHOL AND SUBSTANCE HISTORY 

Although alcohol and drug history is often elicited as a part of
personal history, it is often customary to record it separately. Alcohol
and drugs can often contribute to causation of several psychiatric
symptoms and are often present co-morbidly alongside many
psychiatric diagnoses. 
If the information has not already been obtained, the clinician then
documents the social circumstances of the patient looking at factors
such as finances, housing, relationships, drug and alcohol use, and
problems with the law or other authorities. This is also a time to
document racial or cultural issues that are relevant to the presenting
complaint.

PHYSICAL EXAMINATION 
A detailed general physical examination (GPE) and systemic
examination is a must in every patient. Physical disease, which is
aetiologically important (for causing psychiatric symptomatology), or
accidentally co-existent, or secondarily caused by the psychiatric
condition or treatment, is often present and can be detected by a good
physical examination. 
Review of Systems

A psychiatric review of systems  may include screening questions

directed at identifying or exploring co-morbid psychiatric illnesses or
issues (e.g., SIGECAPS mnemonic or PHQ-9 for
depression, Generalized Anxiety Disorder 7 for anxiety, DIGFAST
mnemonic for mania, or specific questioning around psychoses or
other psychiatric complaints. A full review of systems should attempt
to identify and list all of the relevant STRESSORS that may be
impacting a patient's function and overall health.

Summary

Having collected this information the clinician usually then considers

any other factors that might be relevant to the particular patient and
enquires about them. Although the gathering of the information may
follow the flow of the patient's thoughts rather than those of the
clinician, it is not uncommon for the clinician to record the
psychiatric history under headings, such as those above, to make it
easier for others who will later read it.
Subsequent history taking on reviews concentrates on changes in the
levels of symptoms and responses to treatment, including
possible side-effects.
  21TH JUNE – 25TH JUNE (Mental status examination)
DAY 17 – 21TH JUNE FRIDAY.
MENTAL STATE EXAMINATION.
The mental status examination or mental state examination (MSE)
is an important part of the clinical assessment process
in neurological and psychiatric practice. It is a structured way of
observing and describing a patient's psychological functioning at a
given point in time, under the domains of appearance, attitude,
behaviour, mood, and affect, speech, thought process, thought
content, perception, cognition, insight, and judgment. There are some
minor variations in the subdivision of the MSE and the sequence and
names of MSE domains.
The purpose of the MSE is to obtain a comprehensive cross-sectional
description of the patient's mental state, which, when combined with
the biographical and historical information of the psychiatric history,
allows the clinician to make an accurate diagnosis and formulation,
which are required for coherent treatment planning.
The data are collected through a combination of direct and indirect
means: unstructured observation while obtaining the biographical and
social information, focused questions about current symptoms, and
formalised psychological tests.
The MSE is not to be confused with the Mini–Mental State
Examination (MMSE), which is a brief neuropsychological screening
test for dementia.
Theoretical foundations
The MSE derives from an approach to psychiatry known as
descriptive psychopathologyor descriptive phenomenology, which
developed from the work of the philosopher and psychiatrist Karl
Jaspers.
Mental Status Examination 
1. General Appearance and Behaviour 
i. General Appearance
ii. Attitude towards Examiner
iii. Comprehension
iv. Gait and Posture
v. Motor Activity
vi. Social Manner
vii. Rapport
2. Speech 
i. Rate and Quantity ii. Volume and Tone iii. Flow and Rhythm
3. Mood and Affect
4. Thought 
i. Stream and Form ii. Content
5. Perception
6. Cognition (Higher Mental Functions) 
i. Consciousness ii. Orientationiii.Attention iv. Concentration v.
Memory vi. Intelligence vii. Abstract thinking
7. Insight
8. Judgement 
Understandably, general appearance and behaviour needs to be given
more emphasis in the examination of an uncooperative patient. 
DAY 18 – 22TH JUNE SATURDAY.
General Appearance and Behaviour 
A rich deal of information can be elicited from examination of the
general appearance and behaviour. While examining, it is important to
remember patient’s sociocultural background and personality.
 The important points to be noted are: Physique and body habitus
(build) and physical appearance (approximate height, weight, and
appearance), Looks comfortable/uncomfortable, Physical health,
Grooming, Hygiene, Self-care, Dressing (adequate, appropriate, any
peculiarities),Facies(non-verbal expression of mood),
Effeminate/masculine .
Abnormalities of behaviour, also called abnormalities of
activity, include observations of specific abnormal movements, as
well as more general observations of the patient's level of activity and
arousal, and observations of the patient's eye contact and gait.
Abnormal movements, for
example choreiform, athetoid or choreoathetoid movements may
indicate a neurological disorder. A tremor or dystonia may indicate a
neurological condition or the side effects of antipsychotic medication.
The patient may have tics (involuntary but quasi-purposeful
movements or vocalizations) which may be a symptom of Tourette's
syndrome. There are a range of abnormalities of movement which are
typical of catatonia, such as echopraxia, catalepsy, waxy
flexibility and paratonia (or gegenhalten). Stereotypies (repetitive
purposeless movements such as rocking or head banging) or
mannerisms (repetitive quasi-purposeful abnormal movements such
as a gesture or abnormal gait) may be a feature of chronic
schizophrenia or autism.
Attitude towards examiner
Cooperation/guardedness/evasiveness/hostility/combativeness/haughti
ness, Attentiveness, Appears interested/disinterested/apathetic, Any
ingratiating behaviour, Perplexity 
Comprehension 
Intact/impaired (partially/fully) 
Gait and posture 
Normal or abnormal (way of sitting, standing, walk- ing, lying) 
Motor activity 
Increased/decreased, Excitement/stupor, Abnormal involuntary
movements (AIMs) such as tics, tremors, akathisia, Restlessness/ill at
ease, Catatonic signs (mannerisms, stereotypies, posturing, waxy
flexibility, negativism, ambitendency, automatic obedience, stupor,
echopraxia, psychological pillow, forced grasping), Conversion and
dissociative signs (pseudo seizures, possession states), Social
withdrawal, Autism, Compulsive acts, rituals or habits (for example,
nail biting).
Social manner and non-verbal beviour.
Increased, decreased, or inappropriate behaviour Eye contact (gaze
aversion, staring vacantly, staring at the examiner, hesitant eye
contact, or normal eye contact). 
Rapport 
Whether a working and empathic relationship can be established with
the patient, should be mentioned. Attitude, also known as rapport or
cooperation, refers to the patient's approach to the interview process
and the quality of information obtained during the assessment
Hallucinatory Behaviour 
Smiling or crying without reason, Muttering or talking to self (non-
social speech). Odd gesturing in response to auditory or visual
hallucinations.

More global behavioural abnormalities may be noted, such as an

increase in arousal and movement (described as psychomotor
agitation or hyperactivity) which might reflect mania or delirium. An
inability to sit still might represent akathisia, a side effect of
antipsychotic medication. Similarly, a global decrease in arousal and
movement (described as psychomotor retardation, akinesia or stupor)
might indicate depression or a medical condition such as Parkinson's
disease, dementia or delirium. The examiner would also comment on
eye movements (repeatedly glancing to one side can suggest that the
patient is experiencing hallucinations), and the quality of eye contact
(which can provide clues to the patient's emotional state). Lack of eye
contact may suggest depression or autism.
DAY 19 – 24TH JUNE MONDAY.
Speech 
The patient's speech is assessed by observing the patient's
spontaneous speech, and also by using structured tests of specific
language functions. This heading is concerned with the production of
speech rather than the content of speech, which is addressed under
thought process and thought content (see below). When observing the
patient's spontaneous speech, the interviewer will note and comment
on paralinguistic features such as the loudness,
rhythm, prosody, intonation, pitch, phonation, articulation, quantity,
rate, spontaneity and latency of speech. A structured assessment of
speech includes an assessment of expressive language by asking the
patient to name objects, repeat short sentences, or produce as many
words as possible from a certain category in a set time. Simple
language tests form part of the mini-mental state examination. In
practice, the structured assessment of receptive and expressive
language is often reported under Cognition
Speech can be examined under the following headings: 
Rate and quantity of speech 
Whether speech is present or absent (mutism), If present, whether it is
spontaneous, whether productivity is increased or decreased, Rate is
rapid or slow (its appropriateness), Pressure of speech or poverty of
speech. 
Volume and tone of speech 
Increased/decreased (its appropriateness), Low/high/normal pitch 
Flow and rhythm of speech 
Smooth/hesitant, Blocking (sudden), Dysprosody,
Stuttering/Stammering/Cluttering, Any accent, Circumstantiality,
Tangentiality, Verbigeration, Stereotypies (verbal), Flight of ideas,
Clang associations. 
Mood and Affect 
Mood is the pervasive feeling tone which is sustained (lasts for some
length of time) and colours the total experience of the person. Affect,
on the other hand, is the outward objective expression of the
immediate, cross-sectional experience of emotion at a given time. The
assessment of mood includes testing the quality of mood, which is
assessed subjectively (‘how do you feel’) and objectively (by
examination). The other components are stability of mood (over a
period of time), reactivity of mood (variation in mood with stimuli),
and persistence of mood (length of time the mood lasts). 
The affect is similarly described under quality of affect, range of
affect (of emotional changes displayed overtime), depth or intensity
of affect (normal, in- creased or blunted) and appropriateness of affect
(in relation to thought and surrounding environment). 
Mood is described as general warmth, euphoria, elation, exaltation
and/or ecstasy (seen in severe mania) in mania; anxious and restless in
anxiety and depression; sad, irritable, angry and/or des paired in
depression; and shallow, blunted, indifferent, restricted, inappropriate
and/or labile in schizophrenia. Anhedoniamay occur in both
schizophrenia and depression.
The distinction between mood and affect in the MSE is subject to
some disagreement. For example, Trzepacz and Baker (1993) describe
affect as "the external and dynamic manifestations of a person's
internal emotional state" and mood as "a person's predominant
internal state at any one time", whereas Sims (1995) refers to affect as
"differentiated specific feelings" and mood as "a more prolonged state
or disposition". This article will use the Trzepacz and Baker (1993)
definitions, with mood regarded as a current subjective state as
described by the patient, and affect as the examiner's inferences of the
quality of the patient's emotional state based on objective observation.
Mood is described using the patient's own words, and can also be
described in summary terms such as
neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. A
lexithymic individuals may be unable to describe their subjective
mood state. An individual who is unable to experience any pleasure
may be suffering from anhedonia.
Vincent van Gogh's 1889 Self Portrait suggests the artist's mood and
affect in the time leading up to his suicide.

Affect is described by labelling the apparent emotion conveyed by the

person's nonverbal behaviour (anxious, sad etc.), and also by using the
parameters of appropriateness, intensity, range, reactivity and
mobility. Affect may be described as appropriate or inappropriate to
the current situation, and as congruent or incongruent with their
thought content. For example, someone who shows a bland affect
when describing a very distressing experience would be described as
showing incongruent affect, which might suggest schizophrenia. The
intensity of the affect may be described as normal, blunted
affect, exaggerated, flat, heightened or overly dramatic. A flat
or blunted affect is associated with schizophrenia, depression or post-
traumatic stress disorder; heightened affect might suggest mania, and
an overly dramatic or exaggerated affect might suggest
certain personality disorders. Mobility refers to the extent to which
affect changes during the interview: the affect may be described as
fixed, mobile, immobile, constricted/restricted or labile. The person
may show a full range of affect, in other words a wide range of
emotional expression during the assessment, or may be described as
having restricted affect. The affect may also be described as reactive,
in other words changing flexibly and appropriately with the flow of
conversation, or as unreactive. A bland lack of concern for one's
disability may be described as showing la belle indifférence, a feature
of conversion disorder, which is historically termed "hysteria" in older
texts.

Thought 
Normal thinking is a goal directed flow of ideas, symbols and
associations initiated by a problem or a task, characterised by rational
connections between successive ideas or thoughts, and leading
towards a reality oriented conclusion. Therefore, thought process that
is not goal-directed, or not logical, or does not lead to a realistic
solution to the problem at hand, is not considered normal. 
Traditionally, in the clinical examination, thought is assessed (by the
content of speech) under the four headings of stream, form, content
and possession of thought. However, since there is widespread
disagreement regarding this subdivision, ‘thought’ is discussed here
under the following two headings of ‘stream and form’, and
‘content’. 

Stream and form of thought 

For obvious reasons, the ‘stream of thought’ overlaps with
examination of ‘speech’. Spontaneity, productivity, flight of ideas,
prolixity, poverty of content of speech, and thought block should be
mentioned here. The ‘continuity’ of thought is assessed; Whether the
thought processes are relevant to the questions asked; Any loosening
of associations, tangetiality, circumstantiality, illogical thinking,
perseveration, or verbigeration is noted. 
Content of thought 
Any preoccupations; Obsessions (recurrent, irrational, intrusive, ego-
dystonic, ego-alien ideas); 
Psychiatric History and Examination
Contents of phobias (irrational fears); Delusions (false, unshakable
beliefs) or Over-valued ideas; Explore for delusions/ideas of
persecution, reference, grandeur, love, jealousy (infidelity), guilt,
nihilism, poverty, somatic (hypochondriacal) symptoms, hope- less
ness, helpless ness, worthlessness, and suicidal ideation. Delusions of
control, thought insertion, thought withdrawal, and thought broad
casting are Schneiderian first rank symptoms (SFRS). The presence of
neologisms should be recorded here. Delusions should be reported as
primary (coming from no particular source), secondary (sourced from
another delusion or hallucinations), tertiary (sourced from a secondary
delusion), or a delusional system (a network of associated
delusions).Delusional symptoms can be reported as on a continuum
from: full symptoms (with no insight), partial symptoms (where they
may start questioning these delusions), nil symptoms (where
symptoms are resolved), or after complete treatment there are still
delusional symptoms or ideas that could develop into delusions you
can characterize this as residual symptoms.

Perception 
Perception is the process of being aware of a sensory experience and
being able to recognize it by comparing it with previous experiences. 
Perception is assessed under the following headings: 
Hallucinations 
The presence of hallucinations should be noted. A hallucination is a
perception experienced in the absence of an external stimulus. The
hallucinations can be in the auditory, visual, olfactory, gustatory or
tactile domains. 
Auditory hallucinations are commonest types of hallucinations in
non-organic psychiatric disorders. It is really important to clarify
whether they are elementary (only sounds are heard) or complex
(voices heard). 
The hallucination is experienced much like a true perception and it
seems to come from an external objective space (for example, from
outside the ears in the case of an auditory hallucination). If the
hallucination does not either appear to be a true perception or comes
from a subjective internal space (for example, inside the person’s own
head in the case of auditory hallucination), then it is called as a
pseudohallucintion. 
It should be further enquired what was heard, how many voices were
heard, in which part of the day, male or female voices, how
interpreted and whether these are second person or third person
hallucinations 
(i.e. whether the voices were addressing the patient or were discussing
him in third person); also enquire about command (imperative)
hallucinations (which give commands to the person). 
Enquire whether the hallucinations occurred during wakefulness, or
were they hypnagogic (occurring while going to sleep) and/or
hypnopompic (occurring while getting up from sleep) hallucinations. 
Illusions and misinterpretations 
Whether visual, auditory, or in other sensory fields; whether occur in
clear consciousness or not; whether any steps taken to check the
reality of distorted perceptions. 
Depersonalisation/derealisation 
Depersonalisation and derealisation are abnormalities in the
perception of a person’s reality and are often described as ‘as-if’
phenomena. 
Somatic passivity phenomenon 
Somatic passivity is the presence of strange sensations described by
the patient as being imposed on the body by ‘some external agency’,
with the patient being a passive recipient. It is one of the Schneider’s
first rank symptoms. 
Others 
Autoscopy, abnormal vestibular sensations, sense of presence should
be noted here. 
Preoccupations
Preoccupations are thoughts which are not fixed, false or intrusive,
but have an undue prominence in the person's mind. Clinically
significant preoccupations would include thoughts of suicide,
homicidal thoughts, suspicious or fearful beliefs associated with
certain personality disorders, depressive beliefs (for example that one
is unloved or a failure), or the cognitive distortions of anxiety and
depression.
DAY 20 – 25TH JUNE TUESDAY.
Perceptions
A perception in this context is any sensory experience, and the three
broad types of perceptual disturbance
are hallucinations, pseudohallucinations and illusions. A hallucination
is defined as a sensory perception in the absence of any external
stimulus, and is experienced in external or objective space (i.e.
experienced by the subject as real). An illusion is defined as a false
sensory perception in the presence of an external stimulus, in other
words a distortion of a sensory experience, and may be recognized as
such by the subject. A pseudohallucination is experienced in internal
or subjective space (for example as "voices in my head") and is
regarded as akin to fantasy. Other sensory abnormalities include a
distortion of the patient's sense of time, for example déjà vu, or a
distortion of the sense of self (depersonalization) or sense of reality
(derealization).
Hallucinations can occur in any of the five senses,
although auditory and visual hallucinations are encountered more
frequently than tactile (touch), olfactory (smell) or gustatory (taste)
hallucinations. Auditory hallucinations are typical of psychoses: third-
person hallucinations (i.e. voices talking about the patient) and
hearing one's thoughts spoken aloud (gedankenlautwerden or écho de
la pensée) are among the Schneiderian first rank symptoms indicative
of schizophrenia, whereas second-person hallucinations (voices
talking to the patient) threatening or insulting or telling them to
commit suicide, may be a feature of psychotic depression or
schizophrenia. Visual hallucinations are generally suggestive of
organic conditions such as epilepsy, drug intoxication or drug
withdrawal.

Cognition
This section of the MSE covers the patient's level
of alertness, orientation, attention, memory, visuospatial
functioning, language functions and executive functions. Unlike other
sections of the MSE, use is made of structured tests in addition to
unstructured observation. Alertness is a global observation of level of
consciousness i.e. awareness of, and responsiveness to the
environment, and this might be described as alert, clouded, drowsy, or
stuporous. Orientation is assessed by asking the patient where he or
she is (for example what building, town and state) and what time it is
(time, day, date).
Attention and concentration are assessed by several tests,
commonly serial sevens test subtracting 7 from 100 and subtracting 7
from the difference 5 times. Alternatively: spelling a five-letter word
backwards, saying the months or days of the week in reverse order,
serial threes (subtract three from twenty five times), and by
testing digit span. Memory is assessed in terms of immediate
registration (repeating a set of words), short-term memory (recalling
the set of words after an interval, or recalling a short paragraph), and
long-term memory (recollection of well known historical or
geographical facts). Visuospatial functioning can be assessed by the
ability to copy a diagram, draw a clock face, or draw a map of the
consulting room. Language is assessed through the ability to name
objects, repeat phrases, and by observing the individual's spontaneous
speech and response to instructions. Executive functioning can be
screened for by asking the "similarities" questions ("what do x and y
have in common?") and by means of a verbal fluency task (e.g. "list
as many words as you can start with the letter F, in one minute"). The
mini-mental state examination is a simple structured cognitive
assessment which is in widespread use as a component of the MSE.
Mild impairment of attention and concentration may occur in
any mental illness where people are anxious and distractible
(including psychotic states), but more extensive cognitive
abnormalities are likely to indicate a gross disturbance
of brain functioning such as delirium, dementia or intoxication.
Specific language abnormalities may be associated with pathology
in Wernicke's area or Broca's area of the brain. In Korsakoff's
syndrome there is dramatic memory impairment with relative
preservation of other cognitive functions. Visuospatial or
constructional abnormalities here may be associated with parietal
lobe pathology, and abnormalities in executive functioning tests may
indicate frontal lobe pathology. This kind of brief cognitive testing is
regarded as a screening process only, and any abnormalities are more
carefully assessed using formal neuropsychological testing.
The MSE may include a brief neuropsychiatric examination in some
situations. Frontal lobe pathology is suggested if the person cannot
repetitively execute a motor sequence (e.g. "paper-scissors-stone").
The posterior columns are assessed by the person's ability to feel the
vibrations of a tuning fork on the wrists and ankles. The parietal lobe
can be assessed by the person's ability to identify objects by touch
alone and with eyes closed. A cerebellar disorder may be present if
the person cannot stand with arms extended, feet touching and eyes
closed without swaying (Romberg's sign); if there is a tremor when
the person reaches for an object; or if he or she is unable to touch a
fixed point, close the eyes and touch the same point again. Pathology
in the basal ganglia may be indicated by rigidity and resistance to
movement of the limbs, and by the presence of characteristic
involuntary movements. A lesion in the posterior fossa can be
detected by asking the patient to roll his or her eyes upwards
(Parinaud's syndrome).

Insight.
The person's understanding of his or her mental illness is evaluated by
exploring his or her explanatory account of the problem, and
understanding of the treatment options. In this context, insight can be
said to have three components: recognition that one has a mental
illness, compliance with treatment, and the ability to re-label unusual
mental events (such as delusions and hallucinations) as pathological.
As insight is on a continuum, the clinician should not describe it as
simply present or absent, but should report the patient's explanatory
account descriptively.
Impaired insight is characteristic of psychosis and dementia, and is an
important consideration in treatment planning and in assessing the
capacity to consent to treatment.
Judgement.
Judgment refers to the patient's capacity to make sound, reasoned and
responsible decisions. One should frame judgement to the functions
or domains that are normal vs impaired. (I.e. poor judgement is
isolated to petty theft, able to function in relationships, work,
academics.)
Traditionally, the MSE included the use of standard hypothetical
questions such as "what would you do if you found a stamped,
addressed envelope lying in the street? however contemporary
practice is to inquire about how the patient has responded or would
respond to real-life challenges and contingencies. Assessment would
take into account the individual's executive system capacity in terms
of impulsiveness, social cognition, self-awareness and planning
ability.Impaired judgment is not specific to any diagnosis but may be
a prominent feature of disorders affecting the frontal lobe of the brain.
If a person's judgment is impaired due to mental illness, there might
be implications for the person's safety or the safety of others.
 26TH JUNE – 28TH JUNE( TREATMENT AND
DIAGNOSTIC FORMULATION.
DAY 21 – 26TH JUNE WEDNESDAY.
INVESTIGATIONS
After a detailed history and examination, investigations
(laboratory tests, diagnostic standardised interviews, family
interviews, and/or psychological tests) are carried out based
on the diagnostic and aetiological possibilities.
FORMULATION
After a comprehensive psychiatric assessment, a diagnostic
formulation summarises the detailed possibilities.
Clinical Rating of Insight
Insight is rated on a 6-point scale from one to six.
1. Complete denial of illness.
2. Slight awareness of being sick and needing help, but
denying it at the same time.
3. Awareness of being sick, but it is attributed to external or
physical factors.
4. Awareness of being sick, due to something unknown in
self.
5. Intellectual Insight: Awareness of being ill and that the
symptoms/failures in social adjustment are due to own
particular irrational feelings/thoughts; yet does not apply this
knowledge to the current/future experiences.

Some Investigations in Psychiatry

I. Biological Investigations Medical Screen Some of the
following tests may be useful in screening for the medical
disorders causing the psychiatric symptoms. Some examples
of indications are stated in front of the tests (these examples
are not intended to be comprehensive). Haemoglobin:
Routine screen. Total and differential leucocyte counts:
Routine screen, Treatment with antipsychotics (e.g.
clozapine), lithium, carbamazepine. Mean Corpuscular
Volume (MCV): Alcohol dependence (increased). Urinalysis:
Routine screen; Drug screening. Peripheral smear: Anaemia.
Renal function tests: Treatment with lithium. Liver function
tests: Treatment with carbamazepine, valproate,
benzodiazepines. Alcohol dependence. Serum electrolytes:
Dehydration, SIADH, Treatment with carbamazepine,
antipsychotics, lithium. Blood glucose: Routine screen
(age>35 years), treatment with antipsychotics Thyroid
function tests: Refractory depression, rapid cycling mood
disorder. Treatment with lithium, carbamazepine.
Electrocardiogram (ECG): Age>35 years, Treatment with
lithium, antidepressants, ECT, antipsychotics. HIV testing:
Intravenous drug users, suggestive sexual history, AIDS
dementia. VDRL: Suggestive sexual history. Chest X-ray:
Age>35 years, Treatment with ECT. Skull X-ray: History of
head Injury. Serum CK: Neuroleptic malignant syndrome
(markedly increased levels).
Toxicology Screen Useful when substance use is suspected;
for example, alcohol, cocaine, opiates, cannabis,
phencyclidine, benzodiazepines, barbiturates; remember
thatcertain medications can cause false positive results (for
example, quetiapine for methadone).
Drug Levels Drug levels are indicated to test for therapeutic
blood levels, for toxic blood levels, and for testing drug
compliance. Examples are lithium (0.6-1.0 meq/L),
carbamazepine (4-12 mg/ml), valproate (50-100 mg/ ml),
haloperidol (8-18 ng/ml), tricyclic antidepressants
(nortriptyline 50-150 ng/ml; imipramine 200-250 ng/ ml),
benzodiazepines, barbiturates and clozapine (350- 500 μg/L).
Electrophysiological Tests EEG (Electroencephalogram):
Seizures, dementia, pseudoseizures vs. seizures, episodic
abnormal behaviour. BEAM (Brain electrical activity
mapping): Provides topographic imaging of EEG data.
Video-Telemetry EEG: Pseudoseizures vs. seizures. Evoked
potentials (e.g. p300): Research tool. Polysomnography/Sleep
studies: Sleep disorders, seizures (occurring in sleep). The
various compo nents in sleep studies include EEG, ECG,
EOG, EMG, airflow measurement, penile tumescence,
oxygen saturation, body temperature, GSR (Galvanic skin
response), and body movement. Holter ECG: Panic disorder.
Brain Imaging Tests (Cranial) Computed Tomography (CT)
Scan: Dementia, delirium, seizures, first episode psychosis.
Magnetic Resonance Imaging (MRI) Scan: Dementia. Higher
resolution than CT scan. Positron Emission Tomography
(PET) Scan: Research tool for study of brain function and
physiology. Single Photon Emission Computed Tomography
(SPECT) Scan: Research tool. Magnetic Resonance (MR)
Angiography: Research tool Magnetic Resonance
Spectroscopy (MRS): Research tool

Neuroendocrine Tests Dexamethasone Suppression Test

(DST): Research tool in depression (response to
antidepressants or ECT). If plasma cortisol is >5 mg/100 ml
following administration of dexamethasone (1 mg, given at
11 PM the night before and plasma cortisol taken at 4 PM and
11 PM the next day), it indicates non-suppression. TRH
Stimulation Test: Lithium-induced hypothyroidism,
refractory depression. If the serum TSH is >35 mIU/ml
 (following 500 mg of TRH given IV), the test is positive.
Serum Prolactin Levels: Seizures vs. pseudo seizures,
galactorrhoea with antipsychotics. Serum 17-
hydroxycorticosteroid: Organic mood (depression) disorder.
Serum Melatonin Levels: Seasonal mood disorders.
Biochemical Tests 5-HIAA: Research tool (depression,
suicidal and/or aggressive behaviour). MHPG: Research tool
(depression). Platelet MAO: Research tool (depression).
Catecholamine levels: Organic anxiety disorder (e.g.
pheochromocytoma).
Genetic Tests Cytogenetic work-up is useful in some cases of
mental retardation. Sexual Disorder Investigations Papaverine
test: Male erectile disorder (intracavernosal injection of
papaverine is sometimes used to differentiate organic from
non-organic male erectile disorder). Nocturnal penile
tumescence: Male erectile disorder.
Serum testosterone: Sexual desire disorders, Male erectile
disorder. Penile Doppler: Male erectile disorder.
Miscellaneous Tests Lactate provocation test: Panic disorders
(In about 70% of patients with panic disorders, sodium lactate
infusion can provoke a panic attack). Drug assisted interview
(Amytal interview): Useful in catatonia, unexplained mutism,
and dissociative stupor. Discussed in Chapter 18. CSF
examination: Meningitis.

DAY 22 – 27TH JUNE THURSDAY.

II. Psychological Investigations Objective Tests These are
pen-and-paper objective tests, which are employed to test the
various aspects of personality and intelligence in a person.
Objective personality tests: Some examples of objective
personality tests are MMPI (Minnesota multiple personality
inventory) and 16-PF (16 personality factors). Intelligence
tests: Some commonly used tests of intelligence are WAIS
(Wechsler adult intelligence scale), Stanford Binet test and
Bhatia’s battery of intelligence tests. Projective Tests In
projective tests, ambiguous stimuli are used which are not
clear to the person immediately. Some commonly positive
(and important negative) information regarding the patient
under the focus of care, before listing differential diagnosis,
prognostic factors, and a management plan.
The diagnostic formulation focuses on aetiological factors
based on the bio psychosocial model (Table 2.5; Fig. 2.3).
Similarly, it is useful to devise the management plan based on
the bio psychosocial model (Table 2.6). It is possible to use
specific formulations based on treatment options; for
example, a cognitive formulation for CBT and a
psychodynamic formulation for psychodynamic
psychotherapy.
Thus, psychiatric assessment is an initial step towards
diagnosis and management of psychiatric disorders.
Some used projective tests of personality are Rorschach
inkblot test, TAT (Thematic apperception test), DAPT
(Draw-a- person test), and sentence completion test (SCT).
Neuropsychological Tests Some of the commonly used
neuropsychological tests are Wisconsin card sorting test,
Wechsler memory scale, PGI memory scale, BG test (Bender
Gestalt test), BVRT (Benton visual retention test), Luria-
Nabraskaneuro psychological test battery, Halstead-
Reitanneuropsychological test battery, and PGI battery of
brain dysfunction. Rating Scales Several rating scales are
used in psychiatry to quantify the psychopathology observed.
Some of the commonly used scales are BPRS (Brief
psychiatric rating scale), SANS (Scale for assessment of
negative symptoms), SAPS (Scale for assessment of positive
symptoms), HARS (Hamilton’s anxiety rating scale), HDRS
(Hamilton’s depression rating scale), and Y-BOCS (Yale-
Brown obsessive-compulsive scale). Diagnostic Standardized
Interviews The use of these instruments makes the diagnostic
assessment more standardized. These include PSE (Present
state examination), SCAN (Schedules for clinical assessment
in neuropsychiatry), SCID (Structured clinical interview for
DSM-IV), and IPDE (International personality disorder
examination).
 Diagnostic Formulation
Biological Psychological Social
Predisposing
Precipitating Perpetuating
Protective
 Management Plan
Biological Psychological Social
Short-term
Medium-term Long-term.

28THJUNE – 29TH JUNE( CASE PRESENTATION AND

TOPIC PRESENTATION).
DAY 24 – 28TH JUNE FRIDAY.
 CASE PRESENTATION.
• Sociodemographic details 
Mr. X, a 29 year old hindu married male, formally educated
up to 10th class, tailor by profession (currently not working for
past 6 months) lives with his family, (wife and a daughter) in
rohini, belongs to lower socio-economic strata, resident of
Bhopal. 
• Informant 
1. Patient himself, 
2. Wife 
3. Medical records 
• Reliability of the information 
The wife lives with pt. for past 11 years, is aware of his
minor or major life issues, his illness, is the only care giver,
medical records could be corroborated with the history given
by the family members and a working diagnosis could be
reached and a suitable management plan could be formulated.
Thus the information is reliable and adequate. 
• Chief Complaints/ Presenting Complaints 
1. Pt’s version; 
➢ “man udasrehta he, 
➢kuchkarneka man nahikarta, 
➢zindgikiumeede toot chuki he, 
➢lagta he mar jau.” 
2. Informant’s Version; 
➢ Low and sad mood and excessive guilt feelings 
➢ Decreased interest and lack of pleasure 
➢ Pessimistic thoughts and attitude 
➢ Remains on his own self. 
➢ Lack of energy 
➢ Suicidal thoughts 
➢ Decreased sleep 
➢ Decreased appetite 
• The total duration of illness is 11 months, currently
symptoms exaggerated from 9 months, onset is insidious,
course being continues and deteriorating. 
Critical life events/ contributory stressors; 
1. Father’s death, 1 year ago, to whom the pt. was deeply
attached, 
2. Death of his own 2 years old son 10 months back due to
pneumonia, 

• History of present illness 

As reported, index pt. was apparently maintaining well 11
months earlier. 1 year back the pt. lost his father due to a fatal
undiagnosed disease, he was very deeply attached to his
father and his death was very traumatizing for him. Also he
started holding himself responsible for his father’s death as
he thought that he isn’t a good son, he could not get his father
treated properly for his ailments due to his poverty. These
thoughts kept growing in his mind and made him sad. He had
not got over these guilt feelings and the next month he lost
his 2 year old son due to pneumonia, this made the pt. even
more upset and further fostered the thoughts of inadequacy
and insufficiency in him. Since then the pt. had started
remaining significantly sad, he used to cry at times, telling his
wife that neither he is a good son nor a responsible father. He
used to feel bad about his own being, his deprived situations,
his inability to overcome these situations, and for passively
losing his loved ones. Whenever he interacted with his family
members or relatives or friends he only talked about these
issues and cried hard, it was difficult to console him. He used
to think of these issues every time, and would cry and
complain to God for his misfortune when alone. He felt full
of guilt and deserted inside. 
Pt. could not find anything interesting, not even those things
which used to be his fav. He was not able to attend anything
due to his persistently sad and occupied mind state. He felt
unable to distract himself even when he tried hard. Earlier pt.
had great interest in and liking for his profession, and he used
to experience pleasure while working, but all this changed.
Now, the work seemed bothersome to him, and he did not
feel like working. Even if he tried, he failed to concentrate on
it. He had lost the habit of having good family time in the
evening when he used to sit with his family, interact, play and
tell stories to his kids. Initially when he tried doing the same
he was reminded of the earlier times spent with his father and
son which made him feel even worse and he started crying
and was forced to withdraw from the situation. Later, he
completely lost interest in these activities, as he rather found
them irritating, and started to avoid them completely, and did
not revive them even after repeated coaxing by his wife,
daughter and other significant and concerned people. 
Pt. had started viewing the world as a threatening,
unpredictable, dangerous place, where nothing and no one
was safe and anything could happen at any moment and take
away everything and everybody from anyone. He viewed life
as a punishment worse than a death sentence. He could not
see any ray of hope anywhere. He described the future as the
dark tunnel full of venomous creatures, intolerable and
avoidable hurt and pains. He said that being born as a human
is the best way of getting punished. 
Gradually the pt. started remaining in his own self. He would
not prefer to interact with anyone, including his family, close
friends and relatives. He used to lie on his bed all the time,
most of the times not responding to his daughter and wife. If
someone visited their house and tried talking to him, he
simply left the place without responding. If in case he
responded, it was in the form of nods, shakes or
monosyllables, and at the max one sentence. He avoided
social contacts, didn’t go out of the house, didn’t even go to
his workplace though he was the only bread winner of the
family. Later he disliked people coming to his house and
would instruct the wife to tell people not to visit their house. 
Pt. even reported his wishes to die. He mentioned that he
actually wishes and prays every moment for something to
happen to him so that he dies. He thought he was good for
nothing, was rather a burden on the family and he should die.
Three days back he even revealed to his wife that he was
planning to kill himself and that he will die soon and so she
should take care of herself and their daughter. Even after
repeated enquiries by the wife he did not tell the details of his
plans, and thus the lethality and intentionality could not be
judged. 
Pt’s sleep is significantly disturbed. Initially he had problems
falling asleep later he developed other sleep difficulties like;
many breaks approx 5-6 times during the sleep, had problems
falling asleep again, and did not have deep sleep. Currently
he keeps twisting and turning in the bed, cries, smokes beedi
at night and doesn’t sleep at all. 
Pt’s appetite has gone down markedly. Initially he used to
accept the request of the family members and accepted 1-2
chapatis during each meal a day which deteriorated to 1-2
chapati a day and currently the pt. is not eating at all for past
10 days and is only having tea with 1-2 pieces of biscuits in a
day. When asked for the reason or forced to eat he gets
irritated and reports that he is not hungry and others should
not disturb him, also he simply leaves that place to avoid
further argument. 
The predominant mood of the pt. for all this while was
excessively low and sad accompanied by crying spells. 
o General medical condition such as B.P., Sugar, thyroid
etc. are absent in the pt. 
Biological functioning- sleep and appetite- significantly
decreased. 
Bowel- constipation 
Bladder- normal 
Libido- markedly decreased as the pt. has not had any
physical contact with his wife for past 10 months. Even when
the wife approaches him he avoids the situation and when
asked for the reason he says he doesn’t feel like. 
Typical day; pt. spends his entire day by lying on his bed, not
doing and interacting with anyone, not eating and sleeping
properly and smoking beedi. He does nothing productive,
doesn’t involve in any activity at all, doesn’t work, doesn’t
help in house hold tasks, doesn’t take care of himself, doesn’t
follow any routine and is not concerned with the hygiene. 
Functioning; pt’s personal, social, occupational, emotional
and spiritual life is markedly influenced in a negative way
and there is significant personal, socio-occupational decline
the pt’s functioning. 
o Negative history 

No history suggestive of thoughts being inserted, withdrawn

from the mind 
No history suggestive of thoughts being influenced or
controlled. 
No history suggestive of thoughts being read or known to
others without telling 
No history suggestive of one’s thoughts being heard aloud 
No history suggestive of perception in full consciousness,
without stimuli in the external objective space, out of
volitional control in any sense modality. 
No history suggestive of firm, falls, bizarre, socio-culturally
unacceptable and insignificant beliefs. 
No history suggestive of elated, exalted, expansive mood,
inflated, self- esteem, grandiose ideas regarding one’s
identity, possession or special mission,over familiarity, over
talkativeness, over religiosity, over demanding nature,
extravagant attitude, increased psychomotor activity,
increased distractibility. 
No history suggestive of generalized anxiety, intrusive, and
repetitive, distressing thoughts or behaviours which are not in
one’s control. 
No history suggestive of intrusive, distressing, repetitive
thoughts, images, nightmares, flashbacks and apprehensions
regarding traumatic life events which are not in one’s
control. 
No history suggestive of fear of closed places, heights, social
situations, going away from home, non harming objects. 
No history suggestive of head injury, seizures and animal
bite. 
• Treatment history 
Pt was first brought to the psychiatry OPD of XYZ hospital
on 1.2.19, and was given the following treatment; 
1. Strict observation. 
2. Pt. to be accompanied by the family every time  
3. No sharp objects to be left around him 
4. Psychological interventions 
For 3 weeks with the advice of bringing the pt. in the
emergency if any worsening of the condition was noted. 
Second visit on 22nd may 14 pt. was seen, no fresh
complaints, and no significant improvement was noted and
thus the treatment was revised.
For 3 weeks 
 This is the third visit of the pt. to the hospital, slight
improvement was reported by the family in his sleep and
crying behaviour but rest still remained the same.

DAY 25 – 29TH JUNE SATURDAY.

TOPIC PRESENTATION.
INTELLIGENCE.
Intelligence has been defined in many ways: the capacity
for logic, understanding, self-awareness, learning,
emotional knowledge, reasoning, planning, creativity,
critical thinking, and problem solving. More generally, it
can be described as the ability to perceive or infer
 information, and to retain it as knowledge to be applied
towards adaptive behaviours within an environment or
context.

Intelligence is most often studied in humans but has also

been observed in both non-human animals and in plants.
Intelligence in machines is called artificial intelligence,
which is commonly implemented in computer systems
using programs and, sometimes, appropriate hardware.

Judgment, otherwise called "good sense", "practical

Alfred
sense", "initiative", the faculty of adapting one's self to
Binet
circumstances ... auto-critique.

The aggregate or global capacity of the individual to act

David
purposefully, to think rationally, and to deal effectively
Wechsler
with his environment

Theories of Intelligence
Different researchers have proposed a variety of theories to explain
the nature of intelligence. Here are some of the major theories of
intelligence that have emerged during the last 100 years:
Charles Spearman: General Intelligence
British psychologist Charles Spearman (1863–1945) described a
concept he referred to as general intelligence or the g factor. After
using a technique known as factor analysis to examine some mental
aptitude tests, Spearman concluded that scores on these tests were
remarkably similar. People who performed well on one cognitive test
tended to perform well on other tests, while those who scored badly
on one test tended to score badly on others. He concluded that
intelligence is a general cognitive ability that can be measured and
numerically expressed
Robert Sternberg: Triarchic Theory of Intelligence
Psychologist Robert Sternberg defined intelligence as "mental activity
directed toward purposive adaptation to, selection, and shaping of
real-world environments relevant to one's life." While he agreed with
Gardner that intelligence is much broader than a single, general
ability, he instead suggested that some of Gardner's types of
intelligence are better viewed as individual talents. Sternberg
proposed what he referred to as "successful intelligence," which
involves three different factors:
 Analytical intelligence: Your problem-solving abilities.
 Creative intelligence: Your capacity to deal with new situations
using past experiences and current skills.
 Practical intelligence: Your ability to adapt to a changing
environment
Intelligence tests may be classified under three categories:
1. Individual Tests:
These tests are administered to one individual at a time. These cover
age group from 2 years to 18 years.
These are:
(a) The Binet- Simon Tests,
(b) Revised Tests by Terman,
(c) Mental Scholastic Tests of Burt, and
(d) Wechsler Test.

2. Group Tests:
Group tests are administered to a group of people Group tests had
their birth in America – when the intelligence of the recruits who
joined the army in the First World War was to be calculated.
These are:
(a) The Army Alpha and Beta Test,
(b) Terman’s Group Tests, and
(c) Otis Self- Administrative Tests.
Among the group tests there are two types:
(i) Verbal, and
(ii) Non-Verbal.

Verbal tests are those which require the use of language to answer the
test items.
3. Performance:

These tests are administered to the illiterate persons. These tests

generally involve the construction of certain patterns or solving
problems in terms of concrete material.
Some of the famous tests are:
(a) Koh’s Block Design Test,
(b) The Cube Construction Tests, and
(c) The Pass along Tests.

In the ‘Omnibus’ test or ‘Richardson’s ‘Simplex Text’, the different

sections are not timed separately, but there is a time limit for the
whole test.

Army Beta test is the most widely known group performance test.
In general, group tests have the following characteristics:
(i) Most of the group-tests have been standardised, and these are
commonly used in educational institutions in the western countries.
The directions and manuals for examiners have been worked out, so
that even a layman can administer these.
(ii) Most of the test items in group verbal tests are linguistic in
character. Some of the test items include problems requiring
reasoning about numbers, or geometrical forms.
(iii) Some group verbal tests have been used in measuring scholastic
aptitude also.

3. OUTCOME / CONCLUSION.
The outcome of this internship was good. We have learned a lot from
this. We had a great opportunity and we had used it wisely. Although
care of the mentally ill has been shifted to community services, we
lack hard data on the social and clinical outcome of community care
at the nation-wide level. Mental illness can be treated with the proper
treatment and if the person is willing to be mentally and physically
healthy.
Mental disease can cure by many ways and ways are described above.
This was very helpful to us because this will help us in the
future.Since the mid-twentieth century, psychiatry has undergone
revolutionary changes in how psychiatrists diagnose patients, how
they treat them, and how they evaluate whether a treatment works.
These changes have brought with them major advances, especially in
the neurosciences. But this history also suggests that psychiatry has
lost something as it has narrowed its focus mainly to the brain and
psychotropic drugs. Though psychiatrists are now trained to expertly
manipulate a patient's drug regimen, they have become increasingly
less able to situate a patient's suffering within a psychological and
social context, and the doctor-patient interaction is often reduced to a
querying and reporting of diagnostically sanctioned symptoms.
Psychiatry, long charged with caring for those suffering from largely
chronic conditions, has become focused on the diagnosis and cure of
disease. This focus may someday bear therapeutic fruit, but until true
cures are actually forthcoming it is important that the role of care not
be lost. Like many of the shifts that psychiatry has undergone, these
concerns are not unique to psychiatry, but are part of larger changes
within medicine and the culture in which it is situated.

4. APPLICABILITY.

The use of methods and findings of scientific psychology to

solve practical problems of human and animal behaviour and
experience. A more precise definition is impossible because the
activities of applied psychology range from laboratory
experimentation through field studies to direct services for
troubled persons.
The same intellectual streams whose confluence produced
psychology as an independent discipline toward the end of the
19th century led to the later development of applied psychology.
In 1883 the publication of Inquiries into Human Faculty and Its
Development by Francis Galton foreshadowed the measurement
of individual psychological differences. In 1896 at
the University of Pennsylvania, LightnerWitmer established the
world’s first psychological clinic and in so doing originated the
field of clinical psychology. Intelligence testing began with the
work of French psychologists Alfred Binet and Théodore Simon
in the Paris schools in the early 1900s. Group testing, legal
problems, industrial efficiency, motivation, and delinquency
were among other early areas of application. At the Carnegie
Institute of Technology, a division of applied psychology was
established as a teaching and research department in 1915.
The Journal of Applied Psychology appeared in 1917, along
with Applied Psychology, the first textbook in the field,
coauthored by Harry L. Hollingworth and Albert T.
Poffenberger.Early emphases in applied psychology included
vocational testing, teaching methods, evaluation of attitudes and
morale, performance under
stress, propaganda and psychological warfare, rehabilitation
and counselling.
 Educational psychologists began directing their efforts toward
the early identification and discovery of talented persons. Their
research complemented the work of counselling psychologists,
who sought to help persons clarify and attain their educational,
vocational, and personal goals. Concern for the optimum
utilization of human resources contributed to the development
of industrial-organizational psychology. The development of
aviation and space exploration fostered rapid growth in the field
 of engineering psychology.In response to society’s concern for
treatment of the mentally ill and for development of preventive
measures against mental illness, clinical psychology has shown
tremendous growth within the broader field of psychology.
Psychologists have studied the application and effects
of automation, and in developing countries they have helped
with the problems of rapid industrialization and human
resources planning.Regardless of applied psychologists’
professional focus, their job description is likely to overlap with
those of other areas. The applied psychologist may or may not
teach or engage in original research. In addition to drawing on
experimental findings gleaned from psychological research, the
applied psychologist uses information from many disciplines.
The scope of the field is continually broadening as new types of
problems arise. Other branches of applied psychology include
consumer, school, and community psychology. Prevention and
treatment of emotional problems have received a great deal of
attention, as have medically related areas such
as sports psychology and the psychology of chronic
illness.Psychometrics, or the measurement and evaluation of
psychological variables such as personality, aptitude, or
performance, is an integral part of applied psychology fields.
For example, the clinical psychologist may be interested in
measuring the traits of aggressiveness or obsessiveness; the
industrial psychologist, work effectiveness under certain
conditions of lighting or office design.

ALONE I CAN ‘SAY’ BUT, TOGETHER WE CAN SAY ‘TALK’

ALONE I CAN ‘ENJOY’ BUT, TOGETHER WE CAN
‘CELEBRATE’
ALONE I CAN ‘SMILE’ BUT, TOGETHER WE CAN ‘LAUGH’
THAT’S THE BEAUTY OF HUMAN RELATIONS.
STAY CONNECTED

THANK YOU