BIO DATA:

Name MI

Age 30 years

Sex Female

Marital status Single

Qualification Matric

Occupation No

Siblings 8 brothers 4 sisters

Client birth order 4th

Reason for referral:

Client was referral for the purpose of assessment and psychological management.

Presenting Complaints :

‫ کہنیوں کے جوڑ سـخت ہوگیے ہیں‬،‫ـ انگلیوں‬،‫میرے گھٹنوں‬

‫میں اسی وجہ کوي کام نہیںـ کر پاتی‬

‫مجھ سے گھر کے کام نہیں ہوتے کیونکہ مجھسے اٹھا بیٹھا بھی نہیں جاتا‬

‫بار بار کھانسی اور چھینکیں آتی ہیں جسکی وجہ سے میں کوي کام نہیں کر پاتی‬

As reported by family:

‫ہر وقت تاش کھیلےگی مگر کام نہیں کریگی‬

‫کام چور ہوگي ہے‬

History of present illness:

Her illness started due to domestic disturbed environment where she all the time remain in stress.
Client’s illness started before the six years. Client’s family showed aggressive behavior and
ignore her. Client’s father showed aggressive behavior. Client’s brother was also aggressive. The
client’s illness duration is six years and due to her illness her social relation were also affected.
Client birth was normal and she was born like a normal child .Her early development was also
normal and there were no neurotic traits in her. She was a poor student in child but she was a
healthy child. She started school at the age of six. She do not likes to go school and her relation
towards school was not good. She was not interested in studies. Client’s hobby were to play and
watch tv. Her performance in school was not good. Her relationship with her siblings was not
good they use to quarrel with each other .Her father died at the age of 57 at that time client’s age
was 25 years. Her father was a watchman in school and his income was 4000 rupees per month
her mother was alive and her relation with her mother was not good because she did not perform
her responsibilities .Client’s home atmosphere was not good because of financial problems.
Siblings have no understanding they quarreled on minor problems.

History of past Psychiatry:

The client’s cousin was also a psychotic patient; her brother was also admitted in fountain house
who suffered from aggressive attacks he was getting psychological treatment there.

Family History:

She used to live in a joint family system where there were too many family members. Her father
died at the age of 57 at that time client age was 25 years. Her father was a watchman in school
and his income was 4000 rupees per month her mother was alive and her relation with her
mother was not good because she did not take her responsibilities. She did not have good relation
with her siblings. Client’s home atmosphere was not good because of financial problems.
Siblings have no understandings they quarreled on miner problems.

Personal History:

Client birth was normal and she was born like a normal child. Her early developmental life was
normal and there were no neurotic traits in her. Her health was good and she was a healthy child
in her childhood.

 Birth : normal
 Milestone of development:
 Early childhood: She was not average student.

Educational History:

She started going to school at the age of six. She was a poor student in the school. She don’t likes
to go to school and her relation towards school was not good. Client’s hobbies were to play and
watch T.V her performance in school was not good she was usually fail in monthly tests and
annual exams in the school.

Occupational History:
She was not a good student in her childhood. She did not work and also did not perform home
chores due to her illness.

Premorbid Personality:

She was not very social and friendly. Friendly but at times became irritated. Her socially life was
disturbed. She had no interpersonal relationships with other. She was not a good student and her
academic years. She had not interested in religious.

Psychological Assessment:

Informal Assessment:

Interview:

Detailed interview was taken from the client to better able to understand the problem of the
client.

Mental Status Examination:

Appearance and behavior: She was not wearing neat and clean clothes. Her hair were not
properly combed she was maintaining eye contact.

Speech:

Form: She was not talkative but had low voice tone.

Content: She told that her father use to beat her.

Mood:

Objective: She said she was not happy

Subjective: She was looking sad

Thought:

Form: Different types of thought come in her mind

Content: She said she wants to kill her. Irrational thoughts come to her mind

Disorder of Perception:

Delusions: not reported

Hallucinations: not reported

Digit span: Her digital memory was not good.

Short term memory: not intact

Long term memory: not intact

General knowledge: Her general knowledge was not good and was unable to tell the name of
president and prime minister of Pakistan.

Intelligence: poor

Abstract thinking: Her abstract thinking was good she was able to understand between an apple
and a ball

Insight:

Her insight was not good. She was not fully aware about the problem she was having.

Formal Assessment:

Formal assessment was done by using:

 R.I.S.B
 BAI
 MMSE

Rotter Incomplete Sentence Blank:

R.I.S.B is a semi projective test the points drawn from the test are as follows.

The score obtained by the client provide the clear cut picture of her personality she has got 18
score on conflicting score. Her positive responses are 17 whereas neutral responses are 10. It
clearly shows that client has problem in adjustment, which is shown by the conflict responses.

It is assumed that client is very much attached with her family and has strong desire to get
married and settle down in future. Social and sexual attitude are revealed but client seemed to
know that an individual can never live alone i.e. without society and family and she want to do
whatever she feel like. In general responses she gave positive responses she was ambiguous and
neutral in these responses. She also gave some responses which show her weak character and
have very weak hope for future prospect.

Mini mental Status examination:

cognitive impairment and to follow the course of cognitive changes in an individual over time.

Thus making it an effective way to document an individual response to treatment.

Beck Anxiety Inventory:

The beck anxious inventory measures the severity of anxiety in patient.

Quantitative analysis:

In beck anxiety inventory her rating 24 which indicates high level of anxiety .Because she fears

of losing control her.

Diagnosis:

According to symptoms, the patient lie in the category of conversion disorder and code is 300.11

(F44.4)

Prognosis : The prognosis seems to be favorable or promising because the client appeared to be

motivated and cooperative. He also wanted to be perfect and wanted to lead a normal life like

other human beings.

Management Plan:

1. Rapport building

2. Supportive therapy

3.16PMR

4. Insight therapy

5. Distraction thought

6. Family counseling

7. Psycho education

Rapport buildings:
It is the relation of trust between therapist and a patient a feeling of sympathy understanding

(fingers 2009).

Supportive therapy:

Supportive therapy was given to her in order to ensure her problem, through active listening,

unconditional positive regard and empathy. She responded positively and ultimately. Opened to

show progress.

16PMR:

Deep breathing should be taught to the patient with the rationale to induce relaxation by

regulating breathing process and to reduce physiological arousal.

He should be asked to follow these steps:

 Sit or lie comfortably, with lose garments.

 Put one hand on chest and one on stomach.

 Slowly inhale through nose.

 As you inhale feel your stomach expand with your hand.

 Slowly exhale through pursed lips.

 Give yourself statements in your mind that your mind and body is relaxing.

 He should be asked to continue doing it for 15 minutes twice a day, or whenever he felt

disturbed.

Insight therapy:

Client was give education on the disorder, and tried to develop insight in him so he can develop
his cognition in order to improve his illness.

Distractions thought:
Distractions as bad things, as annoying things that get in the way of us getting ahead. Some
typical examples of distractions are when we need to revise for exams, do homework, or do
household chores; there is always something more appealing nagging at our thoughts to do that,
whatever it may be, instead. A distraction can lead to procrastination, which is something
perceived as negative

Family Counseling:

In the present case, family counseling should be regarded to improve

communication, reducing conflicts between them. The client’s brother should be psycho

educated about the client’s illness and he should be asked try to decrease the conflicts and

improve home atmosphere.

Psychoeducation:

The patient should be motivated to improve his condition however he was unaware of his illness
that he had been suffering from. He and his family should be provided relevant information
about illness. They should be educated about the nature, predisposing, precipitating and
perpetuating factors of illness. The patient’s wife should be explained the symptoms of
schizophrenia, stressful factors that predispose some people to the illness and importance of
taking antipsychotic medication. He should be told that this disorder has biological as well as
psychological basis and good compliance to medication as well as to psychological intervention
could help to improve his symptoms

Sessions Report:

Total 12 sessions were conducted

Initial Sessions report:

In the first 4 sessions, rapport was built (the relation of trust between therapist and client).

Supportive therapy was given to him in order to ensure his problems through the active listening.

She responded positively and ultimately opened up to show progress.

History was taken in semi structured way to gather information about the nature of the problem.

Its causes, presenting complaints and other factors were also identified. These sessions were
based on hope restoration in the client. The client was psycho educated about the nature of her

problem so that he would understand his own symptoms of hypochondriasis by giving more

information about the somatic and cognitive responses which contribute to the maintenance of

the problem. The main purpose of these sessions was catharsis of the client regarding her

feelings related to family and studies.

Middle Sessions Report:

In the middle phase of session the main focus was catharsis of the client and hope restoration.

Assessment of client’s problem was also done during these sessions. For the purpose of

assessment both formal and informal test was administered in order to have better understanding

of the client’s problem. As the client in very low mood so he was taught deep breathing to

enhance its effect this was useful.

Final Sessions Report:

In this phase, supportive therapy, family counseling are given. Copying statement used to her

irrational beliefs in four levels disputes. Copying statements were used to enhance internal

control and to decrease the intensity of sad mood.