Internship Presentation

Institute of Mental Health

Chennai
Presented By
Keerthika K
22MPLB26
Table Of Contents

01 About the Organization

04 Case Presentation

02 Cases observed

05 Learning outcomes
Assessments: administered
03 & Observed
Institute of mental health
The Government Mental Hospital, Chennai, called as the
Institute of Mental Health (IMH), is one of the oldest
and largest in our country, and in South Asia, providing
psychiatric care for the mentally ill in Tamil Nadu. Its past
extends beyond the year 1871 when this hospital was built
at the present site and the inmates were also from the
neighbouring areas of Andhra Pradesh, Karnataka, and
Odisha in the days before the state's reorganization on a
linguistic basis in 1956.
Vision
In line with National Mental Health policy, the
vision of Tamil Nadu Mental Health Care Policy
is to promote mental health, prevent mental
illness, enable recovery from mental illness,
promote de-stigmatization and desegregation
and ensure socio-economic inclusion of person
affected by mental illness by providing
accessible, affordable and quality health and
social care to all persons through their lifespan,
within a rights-based framework, as envisaged
in the Mental Health Act, 2017.
Wards and departments

The hospital has a capacity for 1500 in-patients, in 21

wards including ones for the de- addiction, ward for
mentally ill prisoners, intensive psychiatric care ward,
and geriatric ward. The patients admitted here mostly
suffer from severe mental illness like schizophrenia,
bipolar disorder, alcohol and drug dependence,
traumatic brain injury and more.
Criminal ward
In 1954, before States Reorganization on linguistic
lines, there were about 170 criminal patients.
This part of the hospital was considered almost an part
of the Central Prison, even though manned by the
hospital staff. The patients did not have the privileges
of their civilian wards. It occupied almost a tenth of the
hospital area, with a number of airy blocks, single
rooms, and cultivable lands to grow good quality
vegetables and fruits that were supplied to the hospital
kitchen. A number of sports such as football, ring
tennis, and kabaddi and indoor games such as carrom
and chess were encouraged.
Cases observed

● Government Aided cases-

Psychosis and addiction
● Schizophrenia spectrum disorders-
Schizoaffective disorder, paranoid schizophrenia
● Mood Disorders- Bipolar 1
● Neurocognitive Disorder
● Addiction Cases- Alcohol addiction
● Child and adolescent cases- Psychosis (Nephrotic
Syndrome), Autism
 Assessments: administered and
observed

● Bhatia Battery Of Intelligence

● Binet Kamat Test of Intelligence
● Millon Clinical Multiaxial Inventory
● Rorschach Inkblot Test
● Thematic Apperception Test
● Malin’s Intelligence Scale for Indian Children
Case Presentation

60 y/o with Neurocognitive Disorder

Socio-demographic details
Name Mrs.S

Sex Female

Age 60

Place Tiruvannamalai

Education Uneducated

Language Tamil

Date 05-06-2023

Information Husband and Daughter

Chief complaints:

● Memory loss
● Personality Changes ( more aggressive, using
abusive language and physical abuse)
● Wandering at night
● Inability to do daily activities such as bathing,
brushing and eating
● Falling
● Unsteady walking
● Sleeplessness
● Not speaking
● Poor hand eye coordination
Onset Insidious
Course Progressive

History Of presenting According to the informant, the patient's

illness behavior underwent a significant change in
May, characterized by the use of abusive
language, irritability, and instances of physical
aggression, such as throwing chairs at family
members or hitting them during meals. The
patient also experienced disturbances in sleep
patterns and exhibited episodes of wandering
during the night.
History Of Furthermore, by the end of May, the patient's
presenting illness cont. motor abilities were affected, as she began
experiencing difficulties while walking,
leading to frequent falls. Additionally, there
were observed issues with drinking, as the
patient inadvertently placed the bottle mouth
near her nose instead of her mouth when
attempting to drink.

The informant further noted that the patient's

ability to carry out daily activities became
compromised, and her speech became
incomprehensible and jumbled, making it
challenging for others to understand her
communication.
Family History The patient originates from Tiruvannamalai,
hailing from a Tamil-speaking family of lower-
middle-class background. She has three elder
brothers and two younger sisters, with a
particularly strong bond with her second elder
brother.

In 1985, the patient entered into an arranged

marriage, and it was reported that she had a
harmonious marital life. She is a mother to a
daughter and a son, with the daughter being the
elder of the two.
Family History cont. Subsequently, her son opted for a love marriage and
relocated to Erode to establish his residence there.
On the other hand, her daughter experienced a
divorce in 2020, and custody of her children was
awarded to her former husband. Following the
divorce, the daughter encountered a skin disorder,
leading to a two-month period of convalescence at
home before eventually relocating to Chennai.

Please note that the information provided above is

based on the available data and should be treated
with confidentiality and sensitivity.
Genogram
Past Medical History The patient experienced a traumatic accident
at the age of 10, resulting in a head injury.
Following the incident, she began
experiencing epileptic seizures, which
persisted until the age of 30, after which
they ceased. Subsequently, at the onset of
the year 2020, she exhibited mild
indications of dementia. The informant
claimed that the patient started developing
symptoms gradually after their daughter
divorced and her grandchildren were taken
away by the father. She was taken to a
hospital in Tiruvannamalai, where she was
diagnosed with dementia.
Treatment History The patient had been under medication for
seizures until the age of 30. Subsequently,
since 2020, she has been on medication for
dementia; however, she has not pursued
therapy alongside the medication.

Premorbid The patient primarily engaged with family

Personality members, , she liked spending time with
grandchildren. Patient was calm and soft
spoken and carried out all household work
regularly.
Mental status examination

General Appearance and Behaviour The patient’s husband helped with grooming

Psychomotor Activities Decreased

Speech The general tone was low & spoke incoherently.

Thought Form, stream and content were all not intact

Mood and Affect Mood fluctuations were present

Perception Not intact

Cognitive Function:
• Attention and Concentration: Not sustained
• Orientation: Disoriented
• Memory: Impaired

Insight- Grade 1
Symptoms

Mental decline
Inability to speak or
Memory Loss understand language

Disorientation Unsteady walking

Personality Changes wandering

Inability to recognise
Hallucinations
common things
 Treatment and diagnosis

Diagnosis Dementia

Treatment that can be given • Memory tests can be done

• Occupational Therapy
• Memory aids
Learning outcomes
● I learnt how to administer assessments and how important it is to establish
rapport for better cooperation from patients.
● I learnt how to interact with patients and attenders from different backgrounds
● I learnt about caregiver burnout and the difficulties faced by the family
members of patients.
● I learnt how to expect the unexpected- with respect to diagnosis and
treatment of patients.
● I learnt how the criminal ward works.
● I learnt about rehabilitation process
● I learnt how an Government organization works.
● I learnt that textbooks can only help with what to diagnose but only through
experience I can know how to diagnose
Thank you