Bio data
Name M.I
Age 30 years
Gender male
Siblings 4 sisters and 1 brother
Parents both were alive
Parents education both were uneducated
Occupation Labor
Referral mother
Residence Lahore
Religions Islam
Institute Al shams-hospital
Past psychiatric history of family Nil
Qualification of patient middle
Marital status married
Birth order middle born child
Behavioral observation
He was 30 years old His dress was neat and clean his hair was proper cut .He was not in good condition
he had good health he seemed relaxed his eyes contact was normal and did not show any sign of
restlessness his behavior was too much cooperative during interview his face expressions were proper
according to his speech he seemed wellmanerd person.
Presenting complaints
Aggressiveness
Sever tension
Disappointment
Forgetting
Feel burden and anger
Panic attack
Pain in heart
Irritation
Family history
He belong to labor family he was the residence of Lahore he had 5 siblings in which 4 sisters and 1
brother he was middle born child in his family his father and mother were alive his parents were
illiterate his relationships with siblings was normal because he share his every problems of life discuss
with his siblings his all siblings were married.
Past personal history
He was uneducated his problems start about 3years ago he had admitted in PIMH Lahore but he cannot
recovered he had complaint headache and forgetting specially in travel he reported that he was very
loyal with his first wife but she broke his heart and she discovered after that incident he feel
disappointment he did not happy with his 2nd wife.
History of present illness
He was treated in this institute 6 month ago at that time his all symptoms were much prominent he
came from Lahore after these symptoms his parents wants to his save life they came him in his hospital
he was cooperative he feel that this IQ was normal and can do all his work and easily earn for all family
members. He was much talkative and normal relationship with his friends.
Evaluating technique
HTP
House tree person
RPM
Raven progressive metrics
TAT
Thematic Apperception Test
MAS
Manifest anxiety scale
Depressions inventory scale
Rorchach test
MSE
Mental status examination
Intellectual functioning
Raven progressive metrics test
Total score =22
Personality functioning
He draw a cut house which show that genital inadequacy he not show the any path way which show that
he is not social personality he is defensive personality he draw the fruit on the tree which show the
charming personality.
He draw a split tree which show the split ego functioning he draw the each and every branch on each
side which show the preoccupation he draw the detach branches which show the difficulty reaching out
he draw roots which show the feelings of disconnection from reality emptiness.
He draw a little person which show the feelings of inferiority he draw disturbed head which show the
distorted self images he draw eyes in circle shape which show the ego centricity flight from reality he
draw very thin legs which are showed the dependent personality he draw distorted ear which are show
the sensitive to social approval he draw the open arm which show the defensiveness he draw the small
feet which show the need for security.
Manifest anxiety scale
Total score =27
Beck depression inventory
Total score =11
11-16 which show the mild disturbance
Codes Score Frequency
C3 2
C2 2
C1 5
P3 4
P2 9
P1 12
N 3
0 No score
Case formulation
He was 30 year old he belong to middle class family he was born with normal condition his dress was not
neat and clean his behavior was too much co operative his face expressions was proper according to his
speech his father and mother both were alive his parents were illiterate his problem start 3 years ago he
had admitted in PIMH Lahore but he had not recovered he complain headache and forgetting specially in
travel he was very loyal with his first wife she hurt him and he divorced her after this incident he is not
happy with 2nd wife he coming in Al shams hospital 6 month his all test and symptoms show according to
DSM5 that he is suffering from separation anxiety.
Diagnostic criteria
Separation anxiety
309.21(f93.0)
Recurrent excessive distress when anticipating or experiencing separation from home or from major
attachment figures.
[Link] and excessive worry about losing major attachment figures or about possible harm to them
such as illness injury ,disasters , or death.
[Link] and excessive worry about experiencing an untoward.(e g getting lost being kidnapped
having an accident becoming ill)that causes separation from a major attachment figure.
[Link] reluctance or refusal to go out away from home to school to work ,or elsewhere because of
fear of separation.
[Link] and excessive fear of or reluctance about being alone or without major attachment figures
at home or in other settings.
[Link] reluctance or refusal to sleep away from home or to go to sleep without being near a major
attachment figures.
[Link] nightmares involving the name of separation.
[Link] complaints of physical symptoms(e g headache stomach nausea vomting when separation
from major attachment figures occurs or is anticipated.
B. the fear anxiety or avoidance is persistent ,lasting at least 4 weeks in children and adolescents and
typically 6 months or more in adults.
[Link] disturbance causes clinically significant distress or impairment in social academic occupational or
other important areas of functioning.
[Link] disturbance is not better explained by another mental disorder such as refusing to leave home
because of excessive resistance to change in autism spectrum disorder ;delusions or hallucination
concerning separation in psychotic disorders; refusal to go outside without a trusted companion in
agoraphobia ;worries about health other harm befalling significant others in generalized anxiety
disorder or concern about having an illness in illness anxiety disorder.
Mental status examination
Appearance
His appearance was in normal grooming.
Attitude
His attitude was calm and cooperative.
Motor behavior
He had no unusually movement of psychomotor changes.
Speech
His speech was in normal rate.
Affect
His affect was depressed
Mood
His mood was very happy
Thought process
His thought was disorganized
Thought content
His thought content was passive
Perception
His perception was normal.
Memory
His long term memory was disturb
Insight
His insight was fair.
Treatment plan of anxiety disorder
Target technique Session
behavior
