Internship Report

SUMMER INTERNSHIP REPORT 1
Summer Internship Report
A Report submitted in Partial fulfilment of the Requirement for the completion of the Master of
Science in Clinical Psychology
Aastha Arora
2239306
M.Sc Clinical Psychology
Department of Psychology
CHRIST (Deemed to be University)
Yeshwanthpur Campus
July 12, 2023

Index
Letter of Completion…………………………………..……………………………………….3
Log Sheet…………………………………………..……………..……………………………4
Intern Evaluation………………………………………………………………………………6
Report……………………………….…………………………………………..……………..8
Letter of Completion
Log Sheet
Intern Evaluation
About the Institution
Tulasi Healthcare
Tulasi Psychiatric Hospital and Rehabilitation Centre, Delhi-NCR was co-founded by Dr.
Gorav Gupta and Dr. Ruchika Gupta in 1998. Having led major psychiatric wards such as ones in
Sir Ganga Ram Hospital, Apollo Hospital, Batra Hospital etc, the psychiatrist duo started this
institution with one psychologist and two psychiatrists looking after about ten patients. Now,
they have opened four branches across Delhi-NCR. Practical experience-based internships are
offered in all four branches.
The facility where I interned was a 100-bedded hospital in Gurugram, Haryana with IPD
and OPD services for psychiatric and psychological disorders. Primarily, the in-patients at the
facility were observed and engaged with during the course of the internship. The treatment for
such patients was a combination of psychiatric medication, psychosocial rehabilitation and
caregiver psycho-education with the help of group and individual sessions. Currently, the facility
comprises of a team of seven psychiatrists and 26 clinical, counselling and rehabilitation
psychologists and psychiatric social workers who cater to the alleviating the psycho-social
distress of patients hailing from different genders, ages, socio-cultural groups as well as varying
manifestations of psychological difficulties such as psychotic symptoms as in schizophrenia,
personality disorders majorly coming in for medico-legal referrals, mood disorders, addictive
behaviour and more. Male and female patients resided on separate floors in single, double or
triple occupancy rooms but socialised during group sessions throughout the day. Personalised
models of holistic care were developed for the patients and their family members who were seen
as important stakeholders in the process.

Supervision from Team at Tulasi Healthcare
Supervision at the internship was provided to the interns through direct and indirect
supervisors via a team of skilled psychologists and psychiatrists. During the rounds, Dr. Gorav
Gupta made attempts to engage the interns with tasks and insights by quizzing us on our
observations and reflections. Interns also attended classes he took for his patients, where he
involved us to add to what he discussed.
I was directly reporting to Dr. Abhishek Tiwari, who has been working with Tulasi as a
psychologist for over a decade. Abhishek sir was instrumental in orienting us to the system and
made sure he checked in with us on our reflective observations. These discussion sessions were
majorly one on one where he put forth questions and shared his own experiences of working in
the field. Having completed his PhD in psycho-social rehabilitation in Schizophrenia, his
experience with a wide range of therapies was also aligned with areas that I wished to learn
about. Readings and resources were also recommended.
Lastly, I shadowed Ms. Tanvi Arneja, a clinical psychologist and closely observed the
cases that she was in charge of. She supervised my conversations with her patients and assigned
assessments or activities I could do with them on an individual basis.
Tasks and Duties Assigned
Structure, Schedule and Routine at the Internship
Majorly, the internship provided me with opportunities for observation of the in-patient
ward at the institution. During the day, the patients were engaged in group and individual
sessions to give a sense of structure to their days. The patients were divided in two groups - one
with psychotic symptoms due to schizophrenia, bipolar disorder or substance use and the other
brought in for alcohol or substance de-addiction. Their schedule for weekdays consisted of group
and individual therapy sessions as explained in Table 1.
Table 1: Patients’ Routine
Time Psychosis Addiction Intern Tasks

Prayer and newspaper Prayer and newspaper Facilitate and help with
10:00 to 10:45
reading reading doubts
Cognitive Remediation Observe or take class
10:45 to 11:30 Psycho-education
Therapy when assigned
Observe or take class
12:00 to 12:45 Psycho-education Psycho-education
when assigned
Observe sharing and
14:00 to 15:00 Recreation sessions Sharing sessions
facilitate recreation
Observe and discuss
15:00 to 16:00 Individual sessions Individual sessions
with supervisor
16:00 to 18:00 Indoor and outdoor sport Indoor and outdoor sport N. A.
Weekly Progress
My first week at the internship was focused around observation of the system at the
facility, understanding symptoms and context of their illness and observing the approach to
clients’ treatment including engagement in group sessions. This was also when we were engaged
with room rounds and assigned cases to follow. The second week was when close follow-up on
the assigned cases was done to be able to observe and work with them. This was also when we
were assigned our respective topics for CRT and Psycho-education classes for patients with
psychosis to be taken under supervision of psychologists. During the third week, we were
encouraged to work closely with our assigned cases with one on one activities for rapport
building, cognitive engagement and supportive sessions. This was also when I undertook some
intake interviews. The focus of the fourth week was on understanding and administering
assessments and therapeutic resources widely used in clinical settings. Assessments such as
MCMI, PGI-BBD etc were explained with opportunities to further learn them by hands-on
administration. In the final week, I took part in discharge planning and procedures to prevent
relapse with psycho-education and reflection.
Re ections and Learnings
I completed a period of 218 hours at Tulasi Healthcare over 5 weeks. This was a very
enriching and rewarding experience for me. Working in a private setting exposed me to the
intricacies of access to mental healthcare in treatment and the role that socio-economic privilege
plays in defining the approach and availability to treatment. Within a very specific social strata of
patients, it was evident that certain kind of socio-cultural and environmental factors were more
commonly seen than others. For instance, a lot of young individuals who came in with concerns
of substance use were exposed to electronic music which became a trigger for use. A lot of them
who were into music production, DJ-ing and similar professions explained that a large part of
their professions revolved around the use of such substances. Such linkages and explanations
were interesting to observe and understand.
Being part of an in-patient setting was a completely new experience for me. This was the
first time I got to look so closely at manifestations of some severe mental health concerns in
people of various ages and genders. There was a major shift in my perspective of therapist roles
and boundaries, which seemed to be a lot more informal and undefined in this very new setting I
was exposed to. On discussing this with my supervisor, I was informed that this is needed to be
able to support these patients while they’re institutionalised away from the comfort of their
homes and families.

fl
Additionally, I got exposed to the holistic approach to treatment of various disorders. The
use of psychiatric medication was important in management of such cases due to their severity.
The wide variety of methods that I observed at use had their own pros and cons and
complemented each other in terms of strengths and weaknesses. The treatment of substance use
disorders, for instance, makes use of literature such as books by Alcoholics Anonymous and
Narcotics Anonymous that highlight the powerlessness perspective in addictions based on
relatable accounts of people who have been in recovery. However, this needs to be adopted with
an adequate balance of responsibility to make the right choices even in the face of powerlessness.
Locus of control, therefore, plays an important role in treatment and balancing of blame and
responsibility in such illnesses
This internship opened multiple avenues for me in terms of exploring my interest areas as
far as therapeutic interventions are concerned. I was extremely drawn to understanding how
dynamics of group therapy work. Observing and taking sessions in groups was intimidating but
enriching. Third wave therapies such as MET, DBT and art therapy have always been of great
interest to me and to be able to see them in practice was a great push in understanding my
orientation. Scale administration, even as it looks structured and defined in theory, can present its
own challenges in practical application, which require a great deal of practice to overcome.
In how I observed practitioners deal with their patients, I understood that simple
techniques of mutual agreement in goal setting, postponement and persuasion come handy in
response to their requests. Use of metaphors, dividing interventions into short forms and steps,
making use of personal examples and simplified language for reflective psycho-education based
on Indian social contexts was a crucial learning. While emphasis was laid on aiming for
independent living and enhancing quality of life post discharge, it was also reiterated throughout
treatment that patients must accept and prepare for possible relapses as part of effective
treatment.
Case 1: Mr. A
Socio Demographic Details
The index patient identifies as “Mr. A” (name changed). He is a 28 year-old, unmarried
Hindu male, belonging to MSES and urban background, currently residing in Delhi NCR,
educated upto undergraduate in international relations from United Kingdom and is currently
unemployed. He lives in a nuclear family with his mother, while his father and elder brother stay
in Bhopal. He was brought for psychiatric admission on 23rd April ’23.
Informant Details
The primary informant was the patient’s mother, 58 years old and works as joint
secretary. She knows the patient since birth and currently lives with him. Information was
reliable and adequate based on her continuous close relationship with the client.
Chief Presenting Complaints
Total duration of illness is reported to be 6 to 7 years. The onset of illness (in 2016) was
insidious and course of illness has been fluctuating but manageable According to the informant
and the patient, he was brought in with complaints of:
- “He has stopped bathing and brushing for a week now.”

- “He hasn’t slept well in the last week either.”
- “I only eat once a day like saadhus.”
- “He spends most of his time in his room, and keeps the lights off - doesn’t talk to anyone all
day.”
- “He has been preoccupied with suspicious thoughts about extended family to the point that he
refused to eat the food his aunt cooked when we visited them last week. Thoughts about
money that has been lent within family are also becoming suspicious.”
- “He got verbally aggressive while driving 2-3 days back, and ran away when I asked to
handover the keys.”
- “He often leaves home at night without informing - we cannot find them anywhere.”
- “I had gone to a priest when I left home that night.”
History of Presenting Illness
Total duration of difficulties is reported to be 6 to 7 years. The onset of illness (in 2016)
was insidious and course of illness has been fluctuating but manageable with medication and
psychotherapy. The current episode was precipitated by discontinuation of medication.
About 6 months ago, the patient stopped taking prescribed medication because he felt a
strange cluttering of thoughts due to it. Subsequently, he started spending a lot of time driving
around aimlessly. The informant also observed that his wandering behaviours - both driving-
related and otherwise - increased in the next few weeks. She also observed self-muttering and
aggression (verbal and physical). He reports that he started getting flashes and voices from
incidents from his past that made his aggressive. He started going to a lot of priests and chanting
mantras. He attributed his difficulties to astrological reasons, and started engaging with ideas of
black magic. He started spending a lot of time with his thoughts, just by himself in his room,
mostly with lights off. Sleep has been disturbed over these months and appetite has been
considerably reduced due to his belief that he wants to live like a sadhu and hence doesn’t need
food.
In the past week, his symptoms escalated when he stopped sleeping properly, and did not
brush and bathe at all. He got paranoid and suspicious of his family members and refused to eat
the food cooked by his aunt at their home when they visited them in Dehradun. He was visiting a
lot of pandits during this time. High aggression and restlessness were seen in incidents such as
when he was driving with his mother and got aggressive. When he was asked to give the keys, he
stopped the car and ran away. Due to this unmanageability, he was brought in for psychiatric
admission.
Negative History
The patient has not undergone any serious illness or head injury, and does not use any
substances.
Past History
The patient was diagnosed with Schizophrenia in 2016 and has been on medication for
the same since then. No other medical condition or illness was reported. He was admitted for
psychiatric rehabilitation for 2 months in Feb-March 2022.
Family History
Figure 1: Genogram
The patient is the elder son and has a younger brother (27). His mother is a joint secretary
and currently lives with him. His father is a politician and lives in Bhopal with his brother who is
also helping their father manage the family business of farming-related supplies.
He has a close relationship with his mother and is apparently overly dependent on her.
However, he doesn’t have a very cordial relationship with his father and brother due to their
work commitments as well as his aggressive outbursts during the course of his illness. There is
no history of mental illness or substance use reported.
Personal History
The informant, his mother, gave birth to him through normal delivery. She reports that
there were no complications or illnesses before or after birth. All major developmental
milestones were achieved.

During his school years, the patient performed well in academics. He mentions being
interested in subjects such as Geography and EVS during these years. After completing his
schooling, he went to the United Kingdom to pursue further studies in International Relations.
He came back after completing the course, did a few other short courses in subjects such as
maths and has been unemployed since then.
He is currently single and has never been in a relationship. No sexual history was
reported. Finally, no use of alcohol or substances was reported.
Premorbid Personality
He was introverted and shy as a child and throughout adolescence. He has had close
relationships with his mother, brother and driver who taught him how to drive. He was cheerful
overall and would rarely get aggressive with them, up until he was in class 11. He would often
feel stressed in dealing with criticism. His hobbies included sports such as swimming, walking,
cycling and football which used to give him peace and pleasure. Travelling and driving were also
pleasurable activities but were controlled, purposeful and planned. He feels more drained and
tired to engage in work of any kind than he used to before.
Mental Status Examination
General Appearance and Behaviour
The patient looked own age, was shabbily groomed and unkempt with inadequate
cleanliness. He was fully alert and conscious, but uncooperative and hence rapport was poor and
difficult to establish. He was unable to sustain and maintain eye contact.

Psychomotor Activity
His psychomotor activity was increased, and restlessness could be observed during the
course of the session. He would wipe his mouth and beard repeatedly, due to increased salivation
and sweating. Upright posture was maintained, with occasional shifts back and forth. Gesturing
was also normal.
Speech
The patient spoke only when spoken to. His speech was coherent but relevance of content
was sometimes off target, with no apparent difficulties in utterance. Reaction time was normal
but pauses could be observed. Both speed, prosody and manner were normal and pressure was
absent. Tone had normal variation but volume was reduced.
Thought
Form and stream of thought could be observed to be adequate and normal. Abnormal
phenomena related to possession of thought such as obsession, compulsion or alienation were not
mentioned or observed. He was able to analyse his own control over thoughts even when
thoughts were “influenced” by others. He denies suicidal and homicidal ideas. However, thought
content consists of delusions of reference and persecution along with somatic preoccupation.
Perseveration with wanting to achieve driving targets was observed. The flow of his thoughts, as
assessed from her speech is mostly coherent, and sometimes logical.
Mood and Affect

When asked about his mood, he said, “theek hai,” implying that it was okay. He reiterated
some sources of restlessness, and also added the things (like being w mother and driving) that
were the only source of positive emotions and happiness for him. Diurnal variations were present
as mood would worsen at night when he felt more aggressive and irritable. Anxious affect was
observed and with range and reactivity reduced. Expression was blunted but communicable
overall.
Perception
The patient experiences auditory hallucinations but the content of the same is unclear,
except for one reported incident. A guard told him that he was mad long time ago, and he
mentions that he keeps hearing his voice over and over. He also vaguely describes these “voices”
as “cluttering of thoughts” in his head.
Cognition
Attention was normally aroused and concentration was established as well as sustained
upto appropriate levels. He was well oriented to time and place, and knew who the interviewer
and informant were. Immediate and recent memory assessed in visual and verbal tasks and
remote memory of illness and personal incidents were intact, as assessed through questions
asked. He was aware and informed as far as general knowledge was concerned. He was found to
demonstrate average intellectual capacity in tasks of comprehension, vocabulary, arithmetic and
abstract thinking. However, level of personal, social and overall judgment was impaired. Despite
being diagnosed in the past, he had no insight about his unmanageable difficulties.
Management Plan
The patient, 28 year-old Hindu male, graduate was brought in for psychiatric admission
with complaints of wandering, aggressive behaviour, suspiciousness, over-religiosity and
inadequate self-care. Upon further probing, disturbed relationships with family members and
pre-occupying beliefs and activities where reported. Disturbances in sleep, appetite, affect and
cognition are apparent from examination. The patient is uncooperative and lacks insight.
Multi-Axial Diagnosis
Axis 1: Provisional: F 20 - Schizophrenia
Differential: Formal Thought Disorder
Axis 2: TDI: 6 years, Current: 6 months
Personal: 4
Occupational: 4
Family: 3
Social: 3
Axis 3: Psychosocial Factors: lack of employment, disturbed familial relations, social
withdrawal and lack of support.
Short Term Goals
Unmanageability needs to be dealt with on the level of symptoms. Delusions need to be
identified using exploration and assessment, with simultaneous supportive sessions for emotional
management. This will be followed by psycho-education for insight generation.

Behavioural issues of social isolation and poor self care can be managed with the help of
scheduling of activities involving group interaction, as in classes and records of hygiene-related
tasks need to be maintained using trackers.
Relationships at home - specifically with brother and father, need to be worked on by
understanding reasons for discord and encouraging conversation and effort from the patient’s
side. Relation with mother also requires exploration and independence.
Finally, the patient wishes to work on his occupational goals and career prospects. Hence,
it will be helpful to understand his capacity and interest areas.
Long Term Goals
Since this episode was precipitated by discontinued medication, it would be important to
achieve compliance to treatment and medication through psycho-education. The end goal would
be to build on personal resources for relapse prevention. Finally, the treatment would also work
on occupational rehabilitation by planning out prospects and options available to the client.
Case 2: Mr. S
The patient, Mr. S, is a 47 year-old Hindu male, graduate businessman. He is married and
father of two sons, lives in a joint urban family and was brought in for psychiatric admission by
wife in May '2023 with complaints of excessive alcohol consumption, aggressive behaviour,
irritability and sleep disturbances.
He started consuming alcohol about 15 years ago. The problems of alcohol use have been
exacerbated in the last one year. After his last discharge, he was only able to abstain for less than
a week and started consuming at social events and then everyday. He would gulp it down too
quick and even start early and continue drinking till he passed out. He did not consume it for two
months while living with relatives at Chandigarh, but resumed with it on his way back. About 6
months ago, he stopped taking his medications or going for follow ups for diagnosed health
conditions and also sustained a fall very recently. It was reported that about three months ago,
when his in-laws were charged with a CBI case, was a stressful time for him. This was when his
consumption increased in terms of the amount. He also started having withdrawal symptoms so
he would sometimes consume early in the morning. When it wasn’t readily available, he would
ask his guard or driver to get it for him.
Upon further probing, it was reported that he has co-morbid conditions of
hypothyroidism, diabetes, dialysis, TB and pancreatitis, and has been diagnosed with chronic
liver damage (CLD) very recently. There is no history of alcohol, substance or psychiatric
difficulties within the family. His relationship with wife is disturbed with reported verbal and
physical abuse as well as sexual involvement outside of marriage. He is also detached from his
children since they’ve moved away for studies.
He was born with normal delivery and all developmental milestones were reported to be
normally achieved. He completed school and engineering at BITS Pilani. Having lived away
from home from a very young age, he feels deeply attached to friends, probably even more than
his family. Not being able to socialise with them freely has been a reason for marital discord. He
owns a construction business and was married at the age of 23, which was also when his father
passed away suddenly. He was premorbidly social, friendly and grandiose. Lastly, alcohol use
has been happening since 15 years, with continuous use reported for the last ten years.
Disturbances in sleep, appetite and affect were apparent from examination. Appearance,
speech, thought and cognition were seen to be normal but restlessness was increased. The patient
was cooperative and had about grade III insight.
Management Plan
Axis 1: Provisional: F 10.2 - Alcohol Dependence Syndrome
Differential: Alcohol Use Unspecified
Axis 2: TDI: 15 years, Current: 1 year
Personal: 4
Occupational: 2
Family: 3
Social: 2
Axis 3: Psychosocial Factors: Marital Discord, Familial Maladjustment, Nature of Occupation.
Treatment Goals
Unmanageability needs to be dealt with on the level of substance use. Pharmacological
and psychotherapeutic interventions can go hand in hand for the same. Motivational
Enhancement Therapy (MET) will be important to elicit and strengthen protective factors.
Trigger identification and coping strategies will be crucial.
Since the patient presents signs of impulsivity and short-temper, it will be important to
work on his aggressive behaviours with anger management strategies. Working on his familial
relationships, especially with his wife, will also be required to help him understand the nature of
his triggers and break the bidirectional relation between discord and alcohol consumption. Since
he continues to be in denial about any significant impacts on his work or health, insight
generation would be crucial on those fronts. Finally, since this is a case of multiple admission,
relapse prevention will be a crucial target.
Case 3: Ms. I
The patient, Ms. I, is a 24 year-old unmarried Hindu female who lives with her parents,
siblings and grandmother in a USES urban household. She is a final year medical student
currently residing and studying in Delhi NCR and was brought it for re-admission in May ’23 to
manage her suicidal attempt and chief complaints of socio-emotional disregulation as described.
Total duration of difficulties is reported to be 6 to 7 years. The onset of illness (in 2016)
was insidious and course of illness has been fluctuating but manageable with medication and
psychotherapy. The current episode was precipitated by disturbances with partner and family.
The patient was manageable since last discharge in Jan ’22. A few months later, she
started experiencing mood fluctuations due to disturbances in her relationship with partner. She
was in therapy during this time which reportedly helped her manage her thoughts. However, the
disturbances with her partner soon started affecting her academics. Recognising these impacts,
she made several attempts to distance herself from him, but would eventually give in and go
back to him whenever she felt lonely.
In May ’23, she suffered from diarrhoea and was hospitalised for a week. The medication
for the same is reported to have induced panic attack and irritable mood. Currently, after her
discharge, when her vacation was going on, she also felt that she was thinking too negatively
with all the free time that she had. She was further isolated socially and adversely affected when
her boyfriend seemed to care little about her recent illness. Her constant need for validation and
approval along with low mood and disinterest in previously enjoyable activities such as skincare
was further
She reports feeling lonely despite having some friends in college, and has also rejected
relationships in the past in the fear of abandonment. These feelings have increased in the last one
week due to inconsistencies with her partner. Her feelings of hopelessness and helplessness were
also heightened during this time. These factors exposed her to increased suicide risk, given her
history of attempts.
She expressed that she felt her life was meaningless and tried to die by strangulation. The
knots were loose and came off. The next day, harsh comments from her sister, when she told her
to die, triggered her to break a cup and use the broken piece to try to cut her neck. Her brother
stopped her in the attempt and disturbance in home atmosphere led them to go for psychiatric
admission to manage the incident.
She has been in therapy for the last seven years and in in-patient care twice before - when
attempts of suicide were unmanageable. No medical history has been reported otherwise. In
terms of psychiatric conditions within family, her mother has been diagnosed with Major
Depressive Disorder, her brother has been diagnosed with Bipolar Affective Disorder and her
sister is reported to show early signs of psychosis. She is easily triggered by comments made by
her family and has disturbed relations with them due to her own condition and theirs. She is
overly attached and dependent on her father and seeks his presence beyond age appropriate level.
She was born through normal delivery with no difficulties in developmental milestones
reported. She was social, outgoing and friendly before she started facing social difficulties due to
her illness. Currently, she is a final year MBBS student and reports having examination anxiety.
She is also emotionally and sexually involved in a strained relationship that she seems to not be
able to let go of. Emotional patterns of fear of abandonment and perceived loneliness can be
observed. There is no history of substance use.
On conduction of MSE, anxious affect and increased psychomotor activity were present.
Social judgment was impaired but personal judgment was adequate. No abnormalities in thought,
cognition and speech were found. Appearance and behaviours including rapport and eye contact
were established. Insight of grade IV could be inferred due to prior experience with
psychotherapy.
Management Plan
Ms. I, who was brought in for crisis management, was worked with on acute care basis.
Axis 1: Provisional: F 60.3 - Borderline Personality Disorder
Differential: Major Depressive Disorder, Bipolar Disorder
Axis 2: TDI: 7 years, Current: 1 week
Personal: 2
Occupational: 2
Family: 4
Social: 3
Axis 3: Psychosocial Factors: Disturbed environment at home, mental illnesses within family,
lack of stable relationships with family and partner.
Treatment Goals
Developing tolerance for distress would be crucial for extinction of suicidal attempts.
Acceptance of her social situations and working on thoughts and behaviours related to the nature
of her relationships would be required. Coping strategies need to implement beyond her current
level of understanding were she knows all of them but fails to apply them when needed. Finally,
psycho-education of mindfulness-based practices can help her in managing situations that she
considers stressful. Grounding will be helpful in dealing with social and academic stressors.
Working on her relationships with her family members and her sense of self can be taken
up for long-term if she expresses concerns and willingness to work on these areas.
Conclusion
This internship experience was a rewarding glimpse into the practice of mental health in
our country. Everyday was a lesson on the dos and don’ts of this field. It was an opportunity for
self-reflection, where I learnt about my own strengths and weaknesses in dealing with the
challenges of mental health practice. While we as future therapists cannot take on ourselves the
ginormous task of healing the entire world, we can understand our purpose in making minute
changes everyday, case by case, session by session. It will be exciting to see where this journey
takes us in being able to do that. I look forward to exploring this field further and let it bring out
the best in me. I hope to be able to create an impact in the lives of people who I find through this
profession and make positive change in how they lead their lives ahead. I also hope that the path
forward equips me with the knowledge and skills to be able to accomplish what this field offers
in its truest meaning and essence. It will be worthwhile to find my inclinations and integrate
them as a practitioner in future.

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SUMMER INTERNSHIP REPORT 1

Summer Internship Report

Science in Clinical Psychology

M.Sc Clinical Psychology

CHRIST (Deemed to be University)

July 12, 2023

About the Institution

offered in all four branches.

such patients was a combination of psychiatric medication, psychosocial rehabilitation and

comprises of a team of seven psychiatrists and 26 clinical, counselling and rehabilitation

manifestations of psychological difficulties such as psychotic symptoms as in schizophrenia,

as important stakeholders in the process.

Supervision from Team at Tulasi Healthcare

involved us to add to what he discussed.

about. Readings and resources were also recommended.

assessments or activities I could do with them on an individual basis.

Tasks and Duties Assigned

Structure, Schedule and Routine at the Internship

and individual therapy sessions as explained in Table 1.

Table 1: Patients’ Routine

Time Psychosis Addiction Intern Tasks

relapse with psycho-education and reflection.

Re ections and Learnings

were interesting to observe and understand.

homes and families.

Narcotics Anonymous that highlight the powerlessness perspective in addictions based on

responsibility in such illnesses

Socio Demographic Details

The index patient identifies as “Mr. A” (name changed). He is a 28 year-old, unmarried

in Bhopal. He was brought for psychiatric admission on 23rd April ’23.

Chief Presenting Complaints

and the patient, he was brought in with complaints of:

- “He has stopped bathing and brushing for a week now.”

- “He hasn’t slept well in the last week either.”

- “I only eat once a day like saadhus.”

handover the keys.”

- “I had gone to a priest when I left home that night.”

History of Presenting Illness

psychotherapy. The current episode was precipitated by discontinuation of medication.

psychiatric rehabilitation for 2 months in Feb-March 2022.

no history of mental illness or substance use reported.

milestones were achieved.

maths and has been unemployed since then.

reported. Finally, no use of alcohol or substances was reported.

tired to engage in work of any kind than he used to before.

Mental Status Examination

General Appearance and Behaviour

difficult to establish. He was unable to sustain and maintain eye contact.

was also normal.

absent. Tone had normal variation but volume was reduced.

assessed from her speech is mostly coherent, and sometimes logical.

Mood and Affect

as “cluttering of thoughts” in his head.

demonstrate average intellectual capacity in tasks of comprehension, vocabulary, arithmetic and

with complaints of wandering, aggressive behaviour, suspiciousness, over-religiosity and

Axis 1: Provisional: F 20 - Schizophrenia

Differential: Formal Thought Disorder

Axis 2: TDI: 6 years, Current: 6 months

Axis 3: Psychosocial Factors: lack of employment, disturbed familial relations, social

withdrawal and lack of support.