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Division of Cognitive Neuroscience and

Psychology, Faculty of Life Sciences, JSS AHER,
Mysuru

INTERNSHIP REPORT
Aashritha Neuro-Psychiatry & De-addiction
centre
07/09/2022- 07/10/2022

To,
Ms. Patteshwari D
Class Co-ordinator
JSS Academy of Higher Education and Research
Mysuru

From,
Raksha R Naik
20L00556
III Year BSc Psychology
JSS Academy of Higher Education and Research
Mysuru
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ACKNOWLEDGEMENT

I take this opportunity to thank those who helped me

during my internship and for that, I would like to
express my sincere gratitude to Dr. Naveen Kumar A,
Director and First contact Rehab specialist who helped
me and motivated me throughout the duration of my
internship.
I would also like to express my gratitude to Ms.
Manjula (Psychologist) who guided me and provided
me with extending various facilities which played an
important role in completing this internship, and, Mr.
Shashank HV (Psychiatrist) who spared his valuable
time and assisted me despite his busy schedule.
I am extremely grateful towards the above mentioned
people for their guidance about psychiatric approach
for mental health in the program.
I also thank all the staff members for their constant
aiding and help during this program.
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CASE REPORTS

Case no: 1
Name– Mr. H. Channegowda
Age and Gender- 55 year-old male
Education- Unlettered
Marital Status- Married
Occupation- Farmer
Socioeconomic Status- Lower class
Informant- Family member

Chief Complaints:
Patient Version-
Patient informs that he was administered with certain tablets
by his wife that ceases the functioning of nerves for a period
of 8 months. He also mentions about shoulder pain. Also
shows suspiciousness about his wife saying she might have
had an extra-marital affair. And recently he has been fearful
of his wife’s behaviour and mentions about her being abusive
towards him. Hence he was hospitalized for a week, and was
suggested to be under observation in Aashritha Neuro-
Psychiarty & De-addiction centre.
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Informant’s version-
Here, the informant is the patient’s wife. She exclaims that her
husband refused to come here for the consultation. Upon
building rapport, wife confines with the fact that the patient
is being diagnosed with alcohol use disorder and that he is
very fearful and always suspicious about her. She also says
that he suspects of her of injecting medications into his body
without his consent. She informs that the patient complains
about hearing of voices and feeling of somebody touching him
all the time. In addition to this, she states that the patient
becomes extremely aggressive and violent after consuming
alcohol.

Diagnosis:
According to the DSM-5, alcohol use disorder is characterized
by symptoms as alcohol craving, recurrent use of alcohol that
interferes with the fulfillment of one’s daily responsibilities,
alcohol-seeking behavior, inability to control one’s drinking,
drinking despite potential hazards (e.g., drinking while
driving), the need for increased amounts of alcohol to achieve
its effects (tolerance), and withdrawal symptoms when one
stops or reduces alcohol intake (e.g., hand tremors, nausea,
agitation, hallucinations). The disorder is distinguished as
mild, moderate, or severe depending on the number of these
symptoms that an individual may have: Mild cases
305.00(F10.10) present with two to three symptoms;
moderate cases 303.90(F10.20) four to five symptoms; and
303.90(F10.20) severe cases ( six or more symptoms.A
comprehensive differential diagnosis of alcohol use disorder
is necessary to distinguish the disorder from other mental
conditions:
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Depression can be exhibited from opioids, alcohol, sedative,

anxiolytic, hypnotic, and cannabis use.
Mania and anxiety can be exhibited from
stimulants (cocaine and amphetamine).
Psychosis can be associated with substances but varies from
individual to individual and with time.

Treatment Plan:
The goals in treating alcohol use disorder include targeting
symptoms, preventing relapse, and increasing adaptive
functioning so that the patient can be integrated back into the
community. Since patients rarely return to their baseline level
of adaptive functioning, both non-pharmacological and
pharmacological treatments must be used to increase long-
term outcomes.
Pharmacotherapies such as sedatives, mood stabilizers can be
used as a mainstream treatments for alcohol use disorder.
Psychotherapeutic approaches may be divided into three
categories: individual, group, and cognitive behavioral.
Psychotherapy is a constantly evolving therapeutic area.
Emerging psychotherapies include meta-cognitive training,
narrative therapies, and mindfulness therapy. Non-
pharmacological treatments should be used as an addition to
medications, not as a substitute for them.
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Case no: 2
Name- Mrs. Mahalakshmi
Age and Gender- 48 year-old female
Education- 10th standard
Marital Status- Married
Occupation- Homemaker
Socioeconomic Status- Upper middle class
Informant- Family member

Chief Complaints:
Patient’s version-
The patient has reported of suffering from excessive
headaches, body pain and stress for the past two years. She
also informs about her inability to carry out the daily
household chores. Due to her headache, she says that she has
the ability see her daughter who passed away 5 years back.
The patient also agreed that she can detect smells that aren’t
really present in her surrounding.

Informant’s version-
Here, the informant is the patient’s husband. He says that the
patient complains about headaches and body pains despite
taking treatments for it. He informs that the patient exhibits a
bizarre behaviour wherein she talks alone continuously and
gets aggressive for no reason.
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Diagnosis:
According to the DSM-5, a diagnosis of schizophrenia is made
if a person has two or more core symptoms, one of which
must be hallucinations, delusions, or disorganized speech for
at least one month. Other core symptoms include gross
disorganization, grandiosity, persecutory delusions and
diminished emotional expression. For patients that presents
with these symptoms, the first thing to consider is substance
use. Check if they had prior urine drug screens in their
medical records, physical signs of substance use (e.g. poor
dentition, track marks) and history of motor vehicle accidents.

Other considerations include psychosis due to another

medical condition (e.g. Wilson’s disease), personality disorder
(long history of passive suicidal intent dating back to
adolescence for borderline personality disorder, odd beliefs
associated with Cluster A personality disorders, etc.), mania
(e.g. rapid talking, grandiosity, decreased need for sleep) or
severe depression (long progressive history with eventual
psychosis). With schizophrenia being a diagnosis of exclusion,
it is important to consider all possible diagnoses.

Treatment Plan:
Non-Pharmacological therapy-
The goals in treating schizophrenia include targeting
symptoms, preventing relapse, and increasing adaptive
functioning so that the patient can be integrated back into the
community. Since patients rarely return to their baseline level
of adaptive functioning, both non-pharmacological and
pharmacological treatments must be used to optimize long-
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term outcomes. Pharmacotherapy is the mainstay of

schizophrenia management, but residual symptoms may
persist. For that reason, non-pharmacological treatments,
such psychotherapy, are also important. Emerging
psychotherapies include meta-cognitive training, narrative
therapies, and mindfulness therapy. Non-pharmacological
treatments should be used as an addition to medications, not
as a substitute for them.
Pharmacological therapy-
In most schizophrenia patients, it is difficult to implement
effective rehabilitation programs without anti-psychotic
agents. Prompt initiation of drug treatment is vital, especially
within five years after the first acute episode, as this is when
most illness-related changes in the brain occur. Predictors of a
poor prognosis include the illicit use of amphetamines and
other central nervous system stimulants, as well as alcohol
and drug abuse. Alcohol, caffeine, and nicotine also have the
potential to cause drug interactions.
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Case no 3:
Name– Supreeth
Age and Gender- 32 year-old male
Education- M.Tech
Marital status- Divorcee
Socioeconomic Status- Upper middle class
Informant- Self, Family member

Chief Complaints:
Informant’s Version-
The patient’s father exclaims that the patient is his eldest son.
He says that the patient was initially living a cordial life at
home. Later, he reports that the patient started using
cannabis, alcohol and cigarettes everyday for four years. When
his mother was against his behaviour, the patient got into a
brawl with his mother. The father mentions that the patient
was previously admitted at this very hospital for his addiction
problems. The patient also has intense anger issues and often
found in fights with his mother.

Patient’s version-
The patient argues that, the reason he got admitted here was
because, he heard voices in his ears. He says that his relatives
talk to him in his ears all the time and provoke him to
respond to them; if he fails to do so, the voices threaten him
to harm himself and his family.
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Diagnosis:
The patient is showing substance-induced psychosis, that is
listed under psychoactive substance-induced psychotic
disorder with delusions (F19.150). Substance-induced
psychosis is a form of psychosis brought on by alcohol or
other drug use. It can also occur when a person is
withdrawing from alcohol or other drugs.The criteria to be
diagnosed for the above mentioned disorder is, the patient
must have delusions or hallucinations or both, and the
symptoms must persist for a substantial period of time (e.g. -
about 1 month) after the cessation of acute withdrawal or
severe intoxication. Here, the patient is seen using substances
like cannabis, alcohol for about four years and has shown
withdrawal symptoms for a brief period. Hence, he was asked
to get admitted at the hospital for further treatments.

Treatment Plan:
The answer to substance-induced psychosis is an effective
treatment. There are plenty of options for drug and alcohol
addiction treatment. Medically supervised detox can easily
prevent the more severe symptom of psychosis through the
use of common medications. Once the initial detoxification is
completed, psychosis should not be an issue. However,
relapse and the subsequent necessity for another detox can
increase the chances that psychosis will appear as a symptom
during withdrawal.
After several weeks of that, continuing to attend support
group meetings or group therapy significantly reduces the
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chance of relapse. Mood stabilizers like lithiumcan prevent the

intense manic states that can lead to psychosis.

Case No 4:
Name– Ratnavathi Shedthi
Age and Gender- 67 year-old female
Education- 12th standard
Marital Status- Widow
Occupation- Homemaker
Socioeconomic Status- Middle class
Informant- Family member

Chief Complaints:
Informant’s version-
The patient was brought to the hospital by her daughter. She
found that the patient had progressive declination in
remembering certain information, regular motor activities and
ability to learn new tasks after the death of her husband. The
informant also mentioned that the patient had sleeplessness
and could remember the events in detail before the passing
away of her husband. She also exhibited aggressive behaviour
and was restless and agitated most of the time. The patient
also used foul language while being diagnosed.

Patient’s version-
The patient had poor insight and judgement about her
condition. While trying to build a rapport and during
interrogating her, she was found talking irrelevant and was
speaking excessively.
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Diagnosis:
After adequate assessments including laboratory tests,
imaging tests and neurocognitive tests of the patient, it is
seen that she is being diagnosed with dementia, which is
categorized as neurocognitive disorder. The NCD category
encompasses the group of disorders that the primary clinical
deficit is in cognitive function, which is acquired rather than
developmental. Impairment may occur in attention, planning,
inhibition, learning, memory, language, visual perception,
spatial skills, social skills or other cognitive functions.

Treatment Plan:
Medicines may slow down dementia, but they don't cure it.
Some medications can help manage dementia symptoms:
Cholinesterase inhibitors like donepezil are used to treat
Alzheimer disease.
NMDA receptor antagonists like memantine are used for
severe Alzheimer disease and vascular dementia. Medicines to
control blood pressure and cholesterol can prevent additional
damage to the brain due to vascular dementia.
Palliative care is a kind of care for people who have a serious
illness. It's different from care to cure the illness. Its goal is to
improve a person's quality of life.
The patient will need routine follow-up visits every 3 to 6
months. The doctor will monitor medicines and the person's
level of functioning.
At some point, the family may have to think about placing the
patient in a care facility that has a dementia unit.
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Case No: 5
Name- Shivamurthy
Age and Gender- 32 year-old male
Education- M.Com
Marital Status- Unmarried
Occupation- Day-laborer
Socioeconomic Status- Lower Middle Class
Informant- Father

Chief Complaints:
Informant’s version-
The patient was brought here by his brother. The brother said
that the patient spent most of his time filling water in small
glasses. And he also mentioned that the patient takes almost
three hours to bathe. The patient was also seen washing
hands more than required for no reason. He also exhibited
aggressive behaviour, hopelessness and was preoccupied with
cleaning and organizing things that are already arranged in an
orderly manner. According to the patient’s brother, the
patient presented the above mentioned behaviors for about
three months.

Patient’s version-
The patient complained that his hands get contaminated
every time he is in contact with objects, and for that matter,
being outside of his home. He also mentions about how his
preoccupation with cleaning and organizing his surrounding
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is a compulsion to him. In addition to this, he also informs

about how he cannot stop himself from thinking about
cleaning and bathing seven times in a day.

Diagnosis:
The patient is diagnosed with obsessive-compulsive disorder
300.3(F42) since the conditions are causing clinically
significant distress in his occupational and inter-personal life.
OCD is characterized by the presence of obsessions and/or
compulsions. Obsessions are recurrent and persistent
thoughts, urges, or images that are experienced as intrusive
and unwanted, whereas compulsions are repetitive behaviors
or mental acts that an individual feels driven to perform in
response to an obsession or according to rules that must be
applied rigidly.
The frequency and severity of obsessions and compulsions
vary across individuals with OCD (e.g., some have mild to
moderate symptoms, spending 1-3 hours per day obsessing or
doing compulsions, whereas others have nearly constant
intrusive thoughts or compulsions that can be incapacitating).

Treatment Plan:
The psychotherapy of choice for the treatment of OCD is
exposure and response prevention (ERP), which is a form of
CBT. In ERP therapy, the patient is placed in situations where
the is gradually exposed to their obsessions and asked not to
perform the compulsions that usually ease his anxiety and
distress. This is done at the patient’s pace; the therapist
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should never force the patient to do anything that he do not

want to do.
Cognitive-behavioral therapy is a treatment for OCD that uses
two scientifically based techniques to change a person’s
behavior and thoughts: exposure and response prevention
(ERP) and cognitive therapy. CBT is conducted by a cognitive-
behavioral therapist who has special training in treating OCD.
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EXPERIENCE
Before I set out on my internship, my two main learning goals
were to get more insight into the field of clinical psychology
and to gain confidence in my work abilities.While not as hands
on as I anticipated, my internship was a wonderful learning
experience and I really valued the time I spent in the hospital. I
definitely saw what working in a clinical psychology field
entails and how it is different from any other working
environment. There is a strict level of confidentiality, especially
when dealing with child clinical psychology.
I feel that I also achieved my second learning goal of gaining a
sense of independence and higher responsibility. I tried to be as
professional as possible in all of my interactions and attempted
to figure things out on my own before asking for clarification.
This program has given noteworthy experience that has
thought me a lot of things that I think has molded my insight
and has enhanced my skills along with the advanced practical
exposure that really helped me to understand the professional
approach.
Overall the experience has been a beneficial and very realistic
and viable that has given a lot of applied knowledge about the
psychological disorders, their interventions and diagnosis.
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FEEDBACK
I think that an internship is extremely valuable to a student. It
is a small taste of the real world. It helped reinforce my
knowledge of responsibility, focus, drive and ambition. Open
communication was one of the strongest and most apparent
skills that I learned during my internship.
When I first started interning, I was intimidated and nervous to
ask too many questions because I didn’t want to admit that I
didn’t understand or that I needed extra help with something.
Luckily I got over that fear quickly because asking questions is
the only way to learn what you are really supposed to be doing.
I never realized how important experience is in the working
world. Obviously in the college bubble we are warned of many
things, but until we actually face them, they are just that,
warnings.

I would like to thank the psychiatrist, Mr. Shashank and the

psychologist, Ms. Manjula for emphasizing the importance of
psychologists in today’s world.

~Thank you~