Internship Report

Summer Internship

Rachana Muralidhar (2137443)

Department of Psychology, Christ (deemed to be) University

18 June, 2022
 Case 1

Name: Mrs. SS

Education: Bcom

Age: 44 years

Sex: Female

Occupation: Teacher

Marital Status: Married

Presenting Complaints

The patient has her heart racing and feels anxious at times. She is constantly thinking

about her past and future. She experiences low mood and there is no energy left for her to engage

in daily activities.

History of Presenting Complaint

For about 8 years, she has been in a low mood. She quit her job to focus on the family,

she has no interest in work anymore and does not feel confident to go back to teaching.She has

been having repeated negative thoughts and suicidal ideations. She feels worthless and hopeless

about herself and carries guilt of not being a good enough mother.

Precipitating factors- marital discord and infidelity from the partner.

Personal History

The patient has had an episode of mild depression as an adolescent and took treatment for

the same.No history of medical illness.No history of substance use

Family History
 The patient has been married for about 20 years. She has two daughters who are in their

adolescence. Her relationship with her daughters is close and warm.The patient is close with her

children and receives support from them.

There is marital discord along with infidelity issues with her partner.

Marital History

She has a frictious relationship with her husband. Her husband is illegally married to

another woman and is having an extramarital relationship. The family does not receive any kind

of financial support from the husband.

Vocational History

She worked as a teacher before she quit 8 years ago to focus on her family. She got back

to teaching a few months ago but found it overwhelming.

Premorbid Personality

Mood has been low. Her appetite has increased and she faces sleep disturbances. She has

not been engaging in any of her hobbies.

Mental Status Examination

She was dressed well and appeared well groped. Her mood was low and she was crying.

Her speech was slow and she showed psychomotor retardation.

Diagnosis- Dysthymia with depressive episode

Interventions

The patient was prescribed antidepressant medication

Name: Mrs.S

Education: Electrical engineer

Age: 32 years

Sex: Female

Occupation: Currently unemployed

Marital Status: Married

Presenting complaint

Mrs S is a 32 year old female who is currently unemployed. She was brought in for

consultation by her family. The patient has anger issues and experiences mood swings frequently.

“I’m an angry child and I know it, I try to deal with it by avoiding situations”.

“I feel lonely and lost”.

History of Presenting Illness

The patient has always had anger issues from the time she can remember. A week before

the admission she performed a ritual where she acted possessed. It scared her partner and family

after which they brought her to consult a psychiatrist.

Precipitating factors:quitting job, stress in the family

Personal History

Family History

The patient has had a traumatic childhood with history of sexual and physical abuse. She

was physically and emotionally abused by her father who did not provide for the family and

expected her to earn a living. She has been in a toxic relationship for 7-8 years and has been a
victim of infidelity and manipulation. She feels that she is the sole member who takes

responsibility for looking after her parents and both of her sisters are uncaring.

Marital History

She has been married for a year now and reports her relationship with her husband to be

stable and loving. She does not share a warm relationship with her in-laws who are said to be

manipulating her husband against her.

Occupational History

She has changed jobs 5-6 times in the past 1 year. She quit her previous job as she felt

they were not doing right by the employees. She is intelligent and performed well in academics

as a child.

Religious Beliefs

She practices hinduism and is a staunch believer in faith. She has strong religious beliefs

and is said to have several transpersonal experiences.

Premorbid Personality

The mood seems to be labile. She feels that she has a lot of potential but not enough

support from others. She views others as hostile and is suspicious of others intentions.

Mental Status Examination

She appeared to be well groomed and neat. She was cooperative and answered the

questions comfortably. She had an elevated mood and grandiose ideas. She had strong thoughts

that she is all alone and nobody actually cares about her.Her speech appeared to be rapid and

showed circumstantiality.

Diagnosis- Bipolar Disorder

Intervention
The patient was admitted to the inpatient ward for treatment. She was given lithium for mania

and suggested to take therapy.

Name: Ms.A

Education: Bcom graduate

Age: 22 years

Sex: Female

Occupation: Analyst

Marital Status: Unmarried

Informant is the patient’s mother who complained that she is very sensitive and aloof.

Presenting Complaint

She feels disinterested in doing activities and feels lonely most of the times. She

experiences mood swings and is easily irritated by others.

History of Presenting Complaint

She has been experiencing low mood for the past 1.5 years and shows no interest in work

or her activities that used to interest her. For that period of time she has experienced anger

outbursts in which she shouts, throws things and hurts herself by biting into her skin.

Personal History

No history of psychiatric illness. No history of medical illness. She had previously visited

a counselor due to work stress.

Menstrual cycles are regular. Started menstruating when she was 13 years old. Presently

not sexually active.

Family History
 The patient lives with her parents and her older brother. She shares a close relationship

with her mother. She feels that her family is overinvolved in her life and pampers her a lot. They

do not have high expectations of her and walk on eggshells around her, which upsets her.

Premorbid Personality

The patient has low self esteem and is sensitive to criticism. She has a lot of self doubt

and lacks confidence in taking up initiatives. She shows impulse dysregulation and has no

hobbies or interests. She is wary of her future and holds high standards of expectations from

herself.

Diagnosis- Dysthymia with impulsive traits

Intervention

The patient was recommended psychotherapeutic intervention along with antidepressant

medications.
 Case 4

Name: Mr. S

Age: 43.

Gender: Male

Education: Diploma

Occupation: Electrician

Marital Status: Married

Informant: Wife

Presenting Complaint

For 1 month, during intoxication, displays physical aggression, and anger outbursts and is

hypersensitive to sound. During withdrawal, he has tremors, irritability and headaches. Has been

drinking during work, hence he is unable to concentrate on work due to intoxication. Also, has

been neglecting family responsibilities and future goals.

Associated Disturbance. Reduced appetite and sleep disturbance. Lack of sleep without

alcohol. Liver damage.

Precipitating Factors. Work-related stress for 2-3 months. Increased tolerance to alcohol and

managing its withdrawal.

Personal History

Birth and physical development during childhood were normal. No behavioral issues

during childhood. No medical history present.

Family History
 The patient has two children. His father used to drink regularly and died due to kidney

failure. There was no history of psychiatric illnesses in the family.

Substance Use History

He has been using multiple substances for the past 20 years (Alcohol, Bedhi , tobacco).

Uses 2 packs of Bedhi (50), and 4-5 packs of oral tobacco, every day. For the past one month, 3

quarters of alcohol every day.

Premorbid Personality

He is sensitive to stress, hence drinks to cope with it. Indifferent, reserved and low

sociability for the past 20 years.

Attitude towards family- Has a good relationship with children and wife. But has been

neglecting his responsibilities. Exhibits physical aggression towards children while he is

intoxicated.

Attitude towards self- Has low self-confidence and struggles to cope with stress.

Mental Status Exam

General Appearance- Not groomed. Not maintaining eye contact. Was drowsy, and had

bloodshot eyes and slight tremors in his hand. Psychomotor activity- showed some retardation

Speech/ Thought- Occasional incoherent and slurred speech. The tone and speed are slow.

Movement- Slowed movements

Mood-Low mood

Cognitive Functions

Perception--Good perception

Orientation - Is well oriented

Attention-Unable to focus occasionally

Insight- Grade 2

Judgment- Good

Diagnosis. Substance Use Disorder ( Alcohol Dependent Syndrome)

Interventions

Medications to reduce craving and motivational enhancement therapy.

Name: Mr. M P

Education: SSLC

Age: 28 years

Sex: Male

Occupation: fieldworker

Marital Status: Unmarried

The informant was Kumar and was the relative of the patient.

Presenting Complaint

The patient presented with auditory hallucinations where he felt like someone was talking

into my ears at all times. He said to experience this even while he is asleep.

History of Presenting Illness

The first episode occurred 3 months ago in March. The patient had a psychotic episode

which he can’t remember. He was said to have abandoned his lorry and roamed around in the

streets complaining of hearing voices of the devil. The recent episode of auditory hallucination

began 10 days ago after cessation of alcohol. The patient was said to be under the influence of a

game that gave him instructions that are magical.

These symptoms onset 3 months ago (1 episode) after which the patient presented these

symptoms reappeared a week ago. The patient has not been able to function properly due to the

voice. There were two failed attempts of suicide.

Personal History

No medical or psychiatric history.

History of Substance Use.

been smoking regularly for 4-5 years.

Family History

The patient is unmarried and has an older sister who is married with two children. He lives with

his parents in his native.

Vocational History

He has been working in transport service since the age of 16 and is presently a lorry driver.

Mental Status Examination

He appeared to be well groomed. The posture was slouched and he seemed dull. His sleep is

distributed due to psychotic symptoms, mood is labile. His speech was slurred but it was relevant

and coherent. He was oriented and showed a Grade 3 insight.

Diagnosis: Substance induced psychosis with dissociative amnesia

Intervention

The patient was prescribed antipsychotic medications along with aversive therapy
 Reflective Essay

I did my summer internship in Spandana Nursing Home, Rajajinagar. It is a Psychiatric

hospital having 50 Beds in the inpatient block, 8 bedded ICU with 4 ventilators, Fully fledged

Operation Theatre and Outpatient services. They have specialist services for patients with

personality disorders, Bi-polar disorder, Alcohol/Drug dependency, Anger management,

Anorexia nervosa, Anxiety & panic attacks and mental health issues. The vision of the hospital is

to improve each individual patient's quality of life through intensive, highly flexible

rehabilitation and care programmes delivered in safe, supportive environments.

I worked for 5 hours everyday from 11 am to 4 pm for a period of one month. The

intern’s day to day responsibilities included to see follow-up patients, observe intake interviews

of new patients, take case history of inpatient admissions and case discussions. In my one month

at Spandana we saw cases of patients with personality disorder, mood disorder, psychosis,

substance use disorders, dissociative identity disorder, anxiety disorders and obsessive

compulsive disorder.

The difference that I observed in the presentation of a disorder between a theoretical

understanding of it and its actual presentation is stark. Interning in a clinical setting helped me

understand that there is no one correct manner in which a disorder manifests. There are various

different ways that an illness could look like and it is important for one to work around the core

symptoms.

Working in a practical setting also helped me understand and remember the theoretical

content of psychopathology better. My existing knowledge was just limited to knowing the

symptoms and the criteria one should meet to be given a diagnosis. Having a practical exposure

to patients with various disorders helped me better understand the underlying basis of the
theoretical concepts and the biology of the disorder. It allowed me to connect my theoretical

knowledge to real world applications.

Interning in Spandana also gave me the confidence to continue in this line of work. With

the opportunities and the freedom given to me by the supervisors, I was able to learn and make

mistakes with responsibility. By the end of the internship I was confident to come up with a

tentative diagnosis for a patient and interact with a patient by myself. This gave me reassurance

about my efficacy in working in a clinical setting in the future in professional capacities.

The most helpful aspect of this internship was having case discussions and study sessions

with the junior psychiatrists. Having discussed cases after observing a patient’s screening or after

case history taking was an enriching experience that opened up a whole new perspective of how

we view a disorder. It also made me realize the importance of asking the right kind of questions

to arrive at a diagnosis. Additionally having study sessions with the psychiatrist, where we would

go through various assessment scales and different topics of disorders from the ICD.

The highlight of my internship was observing the administration of Electroconvulsive

Therapy (ECT). Watching the whole procedure from the patient being sedated to the shock being

administered, tracking the progress of the patients after each session, was exciting.I also got to

observe the EEG administration and understand the clinical purposes behind this investigative

procedure.

Some of the challenges that I faced during the internship was the language barrier. Most

of the patients only spoke Kannada making it difficult making it hard for me to converse with

them independently. My skills in kannada are limited to understanding conversations and basic

spoken language, but do not extend to having fluent conversations. This restricted my capacity to

talk to patients on my own during case history taking and I had to always depend on other interns
to help me out in this matter. Another disadvantage that I had was information being lost in

translation between languages.

Another challenge I faced was in framing the questions in the best way possible during

probing. Considering the literacy and awareness of the patient population, asking questions in

layman terms or in the most simplest way possible becomes crucial. I found it difficult to cite

examples for different symptom presentations in order to convey the point across to the patient in

simplest terms.

The internship experience has expanded me both on a personal and professional level.It

has made me realize my privileges and the huge gap between the educated and the

underprivileged division in our society. Professionally, I move forward with a practical

experience that has given me a better and more holistic understanding of psychopathology.