1

INTERNSHIP REPORT
Submitted in partial fulfillment of the requirement for the award of
MASTERS IN CLINICAL PSYCHOLOGY

SUBMITTED BY

Ms. CHINMAYI C S

23CMSPC014

Under the guidance of

Dr. Bhabhuti Kashyap

ASSISTANT PROFESSOR

CMR UNIVERSITY

Bengaluru

2023-2025

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DECLARATION

I, Ms. Chinmayi C S, bearing registration no. 23CMSPC014 hereby declare that the Internship
Report submitted is an original work undertaken by myself for the award of the degree of Master
of Science in Psychology (Clinical) under the supervision/guidance of Assistant Professor Dr.
Bhabhuti Kashyap, Department of Psychology. This supervised Internship report has not been
submitted for the award of any other degree or diploma to any other university.

Date: Name and Signature of the candidate:

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CERTIFICATE

This is to certify that Ms. Chinmayi C S Bearing Register Number 23CMSPC014 pursuing the
course MSc. Psychology - Clinical has completed the requirements for the Supervised Internship
Program. Here are the details of the internship that the student completed:

Place of Internship: Prerana Hospital, Mysuru

Total Duration of Internship: 30 days
Internship Period: From 8th July 2024 to 6th August 2024
Place: Mysuru, Karnataka

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ACKNOWLEDGEMENT

I would like to take this opportunity to thank those without whom this internship would have
never been possible. I am thus grateful to them all and thank them sincerely. I humbly and with
all the love extend my heartfelt thanks to Dr. Abhijit, Director & Consultant Neuropsychiatrist,
Dr. H.S Venkatesh, Chief Advisor & Consultant Neuropsychiatrist, Mr. Gautham, Clinical
psychologist, Ms. Anitha Shetty, Clinical psychologist, Neha Dechamma, Clinical psychologist
and Mrs. Keerthi Menon, Clinical psychologist for granting me this privilege to visit the institute
and also for helping me in every concern of academics and learning. I am much indebted and
thanks from bottom of my heart to act as onsite supervisors by giving me supervision, directions,
and confidence and thus helped me in sharpening a better understanding and appreciation of the
subject of clinical psychology. I would thank all the supporting staff of Prerana Hospital for
extending the required supports. I express my regards to all of them. I would like to thank the
director of school of liberal arts for encouraging us and giving such a great chance to do
internships. Special thanks to all my family, friends, as well as myself for always standing
behind me in this process where I will do my best.

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TABLE OF CONTENTS

SI. No CONTENT PAGE NO

1 Introduction 6-7

2 Case Reports 8-36

3 Assessments 37-52

4 Experiential Learning 53-54

5 References 55-57

6 Annexure 58-66
a. Certificate
b. Reflective
c. Plagiarism Report

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Chapter I: Introduction

INTRODUCTION TO INTERNSHIP

The form of on-job training for most jobs is an internship, which very much resembles the
apprenticeship of old. Students of college and university take this up during spare time for either
their undergraduate or master's degrees to supplement that formal education. An internship is any
closely monitored work or service experience for which the student has specific intentional
learning goals and reflects actively on what he or she is learning during the experience. Details
of the characteristics of an internship adapted from materials published by the National Society
for Experiential Education (NSEE),

• Duration: from a month to two years, but an experience lasts usually between three to six
months.
• One-time experience, generally.
• Part-time or full-time, maybe.
• Paid or non-paid, may be.
• Internships are part of an educational program and highly monitored and evaluated for
academic credit, or internships can be part of a learning plan that someone creates on
their own.
• A critical element that distinguishes an internship from a short-term job or volunteer
work is that an intentional "learning agenda" is built into the experience.
• Most internships share the same learning activities. These include the learning objectives,
observation, reflection, evaluation, and assessment.

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Organization Profile

Prerana Hospital is one of the reputed Hospital in Mysore, was launched in the year 2013 as a
high-tech facility that provides complete and high-end Psychiatry care. Prerana Hospital has
been committed since its inception to building cutting-edge service in Psychiatry, Neuro-Care,
De-addiction, and Fertility and making it accessible and affordable. It is the first ever institution
in Mysore which specifically focused on Psychiatry, Neuro-Care, and De-addiction. It has
effortlessly brought together a wide range of skilled professionals under one roof. Members of
the team include psychiatrists, clinical psychologists, family therapists, child guidance
counsellors, fertility specialists, and sexual medicine experts.

The Psychiatry Department at Prerana Hospital Mysore is an all-inclusive network of mental

health, addiction, and psychiatric services woven seamlessly into the fabric of Prerana's holistic
healthcare system. Our care levels are focused on adult, adolescent, and pediatric patients and
include the following:

• Emergency Care: Quick response and support during critical situations

• Inpatient Services: Comprehensive and dedicated care through a supportive environment.

• Partial Hospitalization: Easy transition from inpatient to outpatient care.

• Outpatient Services: Continuity of care solutions.

• Prerana Hospital makes an effort to bring together all the dynamic aspects of clinical
care, scientific advancement, and education to deliver the best in mental health care for
every patient.

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Chapter II: Case Reports

CASE REPORT – I

Name: JD

Age: 32yrs

Sex: Female

Occupation: Software Engineer

Education level: Bachelor of Engineering

Marital Status: Single

Informants: Mother

Case History

Presenting Illness:

• Persistent feelings of anxiety for the past six months.

• Reports feeling overwhelmed by constant worry about work, personal relationships, and
future.
• Has difficulty relaxing and experiences physical symptoms such as muscle tension, frequent
headaches, and sleep disturbances

History of presenting Illness:

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• Duration: 6 Months

• Precipitating factors: JD has always been a "worrier," but over the years, this tendency
has intensified. She constantly ruminates on "what if" scenarios, such as losing her job,
falling ill, or disappointing her family. The cumulative stress from years of unaddressed
worry has likely contributed to her current state of chronic anxiety.

Medical history

• No chronic medical conditions.

• Occasionally experiences headaches and digestive issues (likely stress-related).
• No history of substance abuse.

Psychiatric history

• No formal psychiatric diagnoses before this episode.

• Some history of occasional stress and anxiety but no history of panic attacks.

Family history

JD

• The mother is diagnosed with General Anxiety Disorder as well.

Aetiology

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• Predisposing factors: Family history of General Anxiety Disorder, patient’s

mother.

• Precipitating factors: JD has always been a "worrier," but over the years, this
tendency has intensified. She constantly ruminates on "what if" scenarios, such
as losing her job, falling ill, or disappointing her family. The cumulative stress
from years of unaddressed worry has likely contributed to her current state of
chronic anxiety.

• Perpetuating Factors: The patient tends to expect the worst outcomes in various
situations, such as believing she will fail at work or never find a fulfilling
relationship.

Mental Status Examination

General appearance and behavior:

• Consciousness: Alert
• Dressing/Appearance: Neat
• Tics/Mannerisms/Catatonic signs: Fidgeting
• Rapport: Cooperative

Psycho-motor activity: Normal & Balanced

Speech:

• Spontaneous: Hesitant
• Relevant/Irrelevant: Tangential
• Tone/Tempo/Volume: Monotone
• Coherent/Incoherent: Disjointed
• Reaction Time: Delayed

Thought:

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• Form – Disjointed
• Stream – Racing
• Possession – Intrusive
• Content - Catastrophic

Mood:

• Subjective – Anxious
• Objective – Restlessness
• Congruence - Consistent

Perception: Distorted

Judgment: Anxious

Insight: Distress

Assessments:

1. Depression, Anxiety & Stress Scale (DASS) - Interpretations were Severe

Anxiety, Moderate Stress and Mild Depression.

Diagnosis (DSM-5):

1. 300.02 (F41.1) – Generalized Anxiety Disorder

Case Summary

JD is a 32year old, female. The chief complaints she came with an increased nervousness,
anxiety and panic attacks. She informed me that she has been experiencing nervousness everyday
due to work pressure in the past 6 months. She reported difficulty managing her stress,

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experiencing an overwhelming sense of dread and worry on most days. JD felt unable to cope
with the demands of her job and was unable to find relief from her anxiety despite previous
attempts to manage it independently. After experiencing a worsening of her anxiety symptoms,
which interfered with her ability to function at work and in her personal life, her primary care
physician referred her for psychiatric evaluation after she presented with significant distress
during a routine check-up.

In the first session, JD appeared visibly anxious, often fidgeting with her hands and unable to
maintain prolonged eye contact. She was cooperative and engaged in the assessment but had
difficulty articulating her thoughts without veering into topics of worry or concern. Her speech
was at times pressured, and her mood appeared anxious and slightly depressed. The patient JD
spoke about her overwhelming fears about her job performance, relationships, and future,
reflecting her chronic pattern of excessive worry. There were no signs of psychosis, delusions, or
hallucinations, and she demonstrated fair insight into her condition. JD's judgment was intact in
terms of managing her daily responsibilities, but her decision-making was compromised due to
anxiety-driven emotional reactions.

JD's anxiety disorder appears to be primarily triggered by work-related stress, and ongoing
family pressures. She has a history of perfectionistic tendencies and a family history of anxiety
disorders, which have likely contributed to her vulnerability. These stressors, compounded by
her tendency to ruminate over potential negative outcomes, have led to a chronic state of anxiety.
JD reports that her symptoms started gradually but have intensified over the past six months,
after an increase in job responsibilities.

The issue was initially identified through JD’s presentation of excessive worry, restlessness, and
physical symptoms such as muscle tension and sleep disturbances. During the first session, JD
spoke about her heightened sense of dread and a constant fear that something bad would happen,
whether related to her job or personal life. This excessive worry, along with difficulty controlling
her thoughts, led to a diagnosis of generalized anxiety disorder. Her focus on worst-case
scenarios, coupled with her inability to relax, was key in recognizing the nature of her anxiety.

JD’s anxiety disorder is the result of a complex interaction between her genetic predisposition,
personality traits, and recent life stressors. Her perfectionistic tendencies, fear of failure, and
tendency to overestimate the likelihood of negative outcomes have contributed to her chronic
anxiety. Additionally, the significant stress related to her work and personal life has exacerbated
her symptoms. JD’s insight into her condition is fair, though she struggles with applying coping
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strategies to manage her anxiety. It is crucial for her treatment to focus on cognitive-behavioral
therapy (CBT) to address her cognitive distortions and worry patterns, as well as medication
management to help alleviate her physical symptoms.

The treatment plan for the patient JD includes a combination of therapy and pharmacological
interventions. Cognitive-behavioral therapy (CBT) will be employed to help her identify and
challenge her cognitive distortions, particularly catastrophizing and perfectionistic thinking.
Relaxation techniques, such as mindfulness and breathing exercises, will also be introduced to
reduce physical tension. A selective serotonin reuptake inhibitor (SSRI) such as sertraline may
be prescribed to help manage her anxiety symptoms. Additionally, JD will be encouraged to
adopt healthier lifestyle practices, including regular physical activity and improved sleep
hygiene, as part of her comprehensive treatment plan.

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CASE REPORT – II

Name: LS
Age: 45 yrs
Sex: Male
Occupation: Hotel Manager
Education Level: BBA
Marital Status: Married
Informants: Wife

Case History

Presenting Illness:

• Consumption of alcohol for 13-15years.

• Increased consumption of alcohol for 4 years.

History of presenting Illness:

• Duration: 13-15 years

• Precipitating factors: The patient took his first alcohol in 2009. He was at work, away
from home. He thought alcohol would eliminate the tiredness of his work, and it has
grown into a habit for him now.

Medical history

• Nil

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Psychiatric history

● Nil

Family history

LS

• No family history of psychiatric illness.

Aetiology

• Predisposing factors: Work environment, where almost every colleague drinks.

• Precipitating factors: The patient consumed his first alcohol in the year 2009 while he was
away from home for work. He started it, thinking alcohol would take away his work’s
tiredness, but has grown to be a habit now.

• Perpetuating factors: Triggering family environment, to avoid thinking of it he consumes

alcohol.

Mental Status Examination

General appearance and behavior:

• Consciousness - Oriented by time, place, and person

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• Dressing/Appearance - Well dressed

• Tics/ Mannerisms/Catatonic signs - Absent
• Rapport - Well-Established

Psycho-motor activity: Normal

Speech:

• Spontaneous - No
• Relevant/Irrelevant
• Tone/Tempo/Volume - Low
• Coherent/Incoherent
• Reaction time: Normal

Thought:

• Form - Normal
• Stream - Normal
• Possession – NIL
• Content - Depressive cognitions.

Mood:

• Subjective – Normal
• Objective - Depressed
• Congruence - Congruent

Perception: NIL

Judgment: Intact

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Insight: Grade III (good insight)

Assessments:

1. The Alcohol Use Disorder Identification Test (AUDIT) - High risk of

Addiction identified.

Diagnosis (DSM-5):

1. 303.90 (F10.20) Severe Alcohol Use Disorder.

Case Summary

LS, a 45-year-old male, presented with increased alcohol consumption over the past few years,
accompanied by chronic fatigue. Two weeks before seeking help, LS fainted during a cultural
event at his workplace, which left him feeling deeply embarrassed. He reported that he had
refrained from drinking alcohol for 24 hours before the event and attributed his fainting to
exhaustion. However, LS felt that his colleagues now had more reason to view him as
"irresponsible" due to his drinking habits, heightening his feelings of guilt and shame.

LS comes from a family of five, including an elder sister and a younger brother. He has a closer
bond with his sister, while his relationship with his brother is strained. LS believes his drinking
habit has directly impacted his younger brother’s prospects for marriage, as several families
expressed interest but later withdrew, citing LS’s alcohol consumption as a concern. This notion
has intensified his guilt, which he describes as “unbearable at times.” LS’s wife expressed
concerns about her husband’s impulsivity and quick temper. During the first session of
Motivational Enhancement Therapy (MET), LS admitted that his anger and impulsive decisions
had caused distress within his family. He acknowledged moments of regret, specifically
mentioning arguments with his wife and missed opportunities at work.

The Alcohol Use Disorder Identification Test (AUDIT) was administered, indicating a high risk
of addiction.

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LS prefers to drink alone rather than socializing with coworkers after work. After work, he
isolates himself in his rented apartment, where he drinks heavily while watching movies or
listening to music. Over the past month, LS reported unintentional weight loss of 5 kilograms,
attributing it to a decreased appetite and disrupted eating habits linked to his alcohol
consumption.

LS’s alcohol dependence has eroded his self-esteem and led to strained relationships with family
and colleagues. He is deeply concerned about being judged by his family and peers, which
perpetuates his feelings of isolation. Despite acknowledging the negative impact of his drinking,
LS reports that he finds it hard to stop due to the emotional relief it provides after a long day at
work.

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CASE REPORT – III

Name: RK

Age: 32yrs

Sex: Female

Occupation: Software Engineer

Education Level: Bachelor of Engineering

Marital Status: Married

Informants: Husband

Case History

Presenting Illness

• Intrusive thoughts of contamination (e.g., fear of germs and dirt).

• Compulsive handwashing, averaging 40–50 times per day.
• Avoidance of public places like markets, public transport, and restaurants.

History of Presenting Illness

• Duration: Symptoms persisted for 2 years, with gradual worsening.

• Precipitating Factors: Mrs. RK's symptoms began during the COVID-19 pandemic,
where heightened focus on hygiene and fear of infection became widespread societal
norms. This served as a trigger for obsessive thoughts about contamination.

Medical history

• No significant physical illnesses or surgeries.

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Psychiatric History:

• No previous psychiatric diagnoses or treatments.

Family History

RK

• Mother had a history of anxiety; no known OCD in the family.

Aetiology

• Predisposing Factors: Mrs. RK's mother had a history of anxiety, which may have
predisposed her to developing similar mental health issues, including OCD. A genetic
vulnerability to anxiety disorders can increase the likelihood of developing OCD.

• Precipitating Factors: Mrs. RK's symptoms began during the COVID-19 pandemic,
where heightened focus on hygiene and fear of infection became widespread societal
norms. This served as a trigger for obsessive thoughts about contamination.

• Perpetuating Factors: Mrs. RK’s compulsions (e.g., excessive handwashing) temporarily

reduce her anxiety, which reinforces the behavior. The belief that compulsions prevent
harm or contamination creates a cycle of reinforcement.

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Mental Status Examination

General Appearance and Behavior:

• Consciousness: Alert
• Dressing/Appearance: Neat
• Tics/Mannerisms/Catatonic signs: None
• Rapport: Cooperative

Psycho-motor activity: Agitated

Speech:

• Spontaneous – Yes
• Relevant/Irrelevant - Relevant
• Tone/Tempo/Volume - Anxious/Pressured/Normal
• Coherent/Incoherent - Coherent
• Reaction time: Normal

Thought:

• Form – Logical
• Stream - Ruminative
• Possession – Intrusive
• Content – Contamination

Mood:

• Subjective - Anxious
• Objective - Restless

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• Congruence - Yes

Perception: NIL

Judgment: Impaired

Insight: Partial

Assessments

Hamilton Anxiety Rating Scale (HAM-A) - scores 34, which can be interpreted as severe
anxiety.

Diagnosis (ICD-10)

• F42 - Obsessive-compulsive disorder

• F41.1 - Generalized Anxiety Disorder (GAD)
• F43.22 - Adjustment disorder with Mixed Anxiety and Depressed Mood
• F32.0 - Major Depressive Disorder, Single Episode (Mild)

Case Summary

RK is a 32-year-old, female, diagnosed with severe anxiety (obsessive compulsive disorder),

with a score of 34. She was brought into hospital by her husband. The chief complaints included
intrusive thoughts of contamination (e.g., fear of germs and dirt), compulsive handwashing,
averaging 40–50 times per day, avoidance of public places like markets, public transport, and
restaurants.

RK’s husband says that, Mrs. RK’s anxiety and compulsive behaviors have significantly
impacted their relationship. He reports that her excessive cleaning rituals, particularly around
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hygiene and contamination, have become a daily struggle. While he recognizes her distress, he
feels frustrated by her inability to control the compulsions and the emotional distance this has
created between them. He also mentions that Mrs. RK's fears regarding contamination often lead
to her avoiding public spaces or social gatherings, which further isolates her from family and
friends. He has tried to offer emotional support but feels helpless, especially when her obsessions
take over her daily routine. Although he is supportive, he is concerned about the worsening
impact of her behavior on both their lives.

Mrs. RK’s anxiety heightens and a tendency to engage in compulsive behaviors as a way to cope.
For example, when she faces situations where she perceives contamination risks—such as in
public places or even at home—she becomes overwhelmed with fear, leading her to perform
repetitive cleaning rituals. When she is unable to perform these rituals, she experiences increased
physical symptoms like restlessness, dizziness, and shortness of breath. Mrs. RK often seeks
reassurance from her husband or family members, yet still feels persistently anxious,
demonstrating difficulty in tolerating uncertainty. Her inability to control these impulses leads to
frustration and a sense of helplessness when things don’t go as planned.

Mrs. RK’s OCD symptoms emerged during the COVID-19 pandemic, a time when societal fears
around hygiene and contamination were heightened. She was already predisposed to anxiety due
to her perfectionistic tendencies and family background, where cleanliness and responsibility
were emphasized. The isolation during the pandemic, combined with increased family
responsibilities and work-related stress, acted as a precipitating factor, amplifying her fears of
contamination. Her obsessive thoughts, particularly about germs and illness, became more
pronounced during this period, and she engaged in compulsive cleaning rituals to alleviate the
anxiety caused by these intrusive thoughts. Over time, these behaviors interfered with her daily
life, work, and relationships, leading to significant distress and functional impairment.

Based on the assessment and symptomatology, Mrs. RK’s primary diagnosis is obsessive-
compulsive disorder (OCD). Her symptoms include intrusive, distressing thoughts about
contamination, paired with compulsive cleaning rituals aimed at reducing the anxiety caused by
these obsessions. In addition, Mrs. RK experiences Generalized Anxiety Disorder (GAD) due to
her pervasive worries about various life aspects, including family responsibilities and health
concerns. She also displays mild depressive symptoms, possibly indicating Major Depressive
Disorder, Single Episode (Mild). The onset of her symptoms during the pandemic, compounded
by stressors in her family and work life, suggests the possibility of adjustment disorder with
Mixed Anxiety and Depressed Mood.

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The treatment plan for Mrs. RK includes a combination of Cognitive Behavioral Therapy (CBT),
specifically Exposure and Response Prevention (ERP), and pharmacotherapy. CBT with ERP
will help her confront her fears regarding contamination in a controlled manner, gradually
reducing the need for compulsive rituals. The therapy will also address her cognitive distortions,
such as overestimating the threat of contamination, and help her develop healthier coping
mechanisms. Additionally, Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine
or sertraline, may be prescribed to help regulate anxiety and obsessive thoughts.
Psychoeducation and support for Mrs. RK’s family, particularly her husband, will also be
important to foster understanding and reduce accommodation behaviors that may reinforce her
compulsions. Regular follow-ups will be necessary to monitor progress and adjust the treatment
plan as needed.

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CASE REPORT – IV

Name: KD
Age: 28yrs
Sex: Male
Occupation: Software Developer
Education Level: Bachelor’s Degree in Computer Science
Marital Status: Single
Informants: Patient, Mother

Case History

Presenting Illness:

• Reports feeling unusually energetic, with an inability to sleep for extended periods.
• Expresses inflated self-esteem, believing they have special talents or abilities.
• Talks rapidly and has difficulty staying focused, jumping from one topic to another.

History of Presenting Illness:

• Duration: Over the past 3 years, with increasing severity over the last 6 months.
• Precipitating Factors: The onset and exacerbation of KD’s symptoms were triggered by
increased work stress, lack of sleep, and unresolved personal conflicts. A recent breakup
further intensified his depressive episodes. Additionally, family history of mood disorders
may have contributed to the onset and severity of his condition.

Medical History

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• The patient has a history of Type 1 Diabetes Mellitus (T1DM) diagnosed at age 10. He
has been on insulin therapy and has had occasional episodes of hyperglycemia and
hypoglycemia but has not experienced significant complications from diabetes.

Psychiatric History

• No psychiatric history

Family History

KD

• KD’s maternal uncle has been diagnosed with bipolar disorder and is currently
undergoing long-term treatment with medications.

Aetiology

• Predisposing Factors: A strong family history is a significant predisposing factor. Bipolar

disorder has a genetic component, and the risk increases if a close relative is affected.

• Precipitating Factors: Major life changes such as a relationship breakup, job loss, or
significant personal loss can act as stressors that trigger manic or depressive episodes.

• Perpetuating Factors: Negative thought patterns and maladaptive coping mechanisms

may perpetuate depressive or manic states.

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Mental Status Examination

General appearance and behavior:

• Consciousness - Alert
• Dressing/Appearance - Overdressed
• Tics/ Mannerisms/Catatonic signs - Fidgety
• Rapport - Enthusiastic

Psychomotor activity: Agitation

Speech:

• Spontaneous - Yes
• Relevant/Irrelevant - Irrelevant
• Tone/Tempo/Volume - Pressured
• Coherent/Incoherent - Coherent
• Reaction time – Rapid

Thought:

• Form - Disorganized
• Stream - Rapid
• Possession - Flight
• Content - Grandiose

Mood:

• Subjective - Euphoric
• Objective - Elevated

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• Congruence - Incongruent

Perception: Auditory Hallucinations

Judgment: Impaired

Insight: Limited

Assessments

• Young Mania Rating Scale (YMRS) - The patient KD scores 30, which can be
interpreted as Severe Mania.

Diagnosis (ICD-10)

• F31.2 - Bipolar 1 Disorder, Current Episode Manic, Severe, with Psychotic Features.

Case Summary:

The patient, KD, is a young male who has been diagnosed with Bipolar I Disorder and has
struggled with Type 1 Diabetes since the age of 10. KD’s symptoms of Bipolar Disorder are
currently manifesting as a severe manic episode, characterized by elevated mood, grandiosity,
decreased need for sleep, increased energy, and pressured speech, along with possible psychotic
features such as delusions. These manic symptoms severely impair his daily functioning, making
it difficult for him to maintain relationships or perform daily tasks. His condition is further
complicated by the chronic management of his diabetes, which requires careful monitoring and
medication adherence to prevent complications.

The patient’s mother, reports that KD has experienced mood swings for several years, though his
condition has become more pronounced in recent months. She describes KD as someone who

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was generally well-behaved during his childhood but has recently become more impulsive,
irritable, and hyperactive. She also notes that his diabetes management has been challenging, as
his fluctuating moods sometimes interfere with his ability to adhere to his insulin regimen.

KD's problems seem to have developed gradually, with early signs of mood instability appearing
in his teenage years. He was diagnosed with Type 1 Diabetes at the age of 10, which introduced
a lifelong challenge of managing his physical health. Around the same time, his mood swings
began to intensify, which were initially attributed to the stress of managing a chronic illness. As
he entered adulthood, however, his symptoms became more pronounced, including periods of
euphoria and hyperactivity followed by depression and irritability. The family history of bipolar
disorder in his maternal uncle raised concerns about the genetic predisposition to the condition.
The interplay between his diabetes management and his bipolar symptoms seems to exacerbate
his overall health condition, with episodes of mania and depression affecting his ability to
manage his diabetes effectively.

The patient was assessed using the Young Mania Rating Scale (YMRS), which revealed a total
score of 30, indicating severe mania. Key symptoms included pressured speech, flight of ideas,
grandiosity, increased energy, and decreased need for sleep. The patient also reported feeling
euphoric and had difficulty focusing on tasks, a hallmark of manic episodes. The presence of
psychotic features, such as grandiose delusions, was noted, aligning with the severity of the
current manic episode. The YMRS score confirmed that KD is in the midst of a severe manic
episode with significant functional impairment, requiring urgent intervention.

The treatment plan for KD focuses on both managing his bipolar disorder and addressing the
challenges of his diabetes. Pharmacologically, the plan includes the use of mood stabilizers (such
as lithium or valproate) to stabilize his mood and antipsychotic medications (such as olanzapine)
to address the psychotic features. Given the severity of his symptoms, inpatient care may be
necessary for close monitoring and to ensure safety. Additionally, regular psychotherapy (e.g.,
Cognitive Behavioral Therapy) will be introduced to help KD manage stress, increase insight
into his condition, and improve adherence to his diabetes regimen. The patient will also require
ongoing support from his family and medical team to ensure proper diabetes management, with
regular check-ups to monitor both his blood sugar levels and the effects of his psychiatric
medications. Coordination between his psychiatric team and diabetes care team is critical to
ensure holistic care.

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CASE REPORT - V

Name: AB
Age: 29yrs
Sex: Male
Occupation: Sales Representative
Education Level: Bachelor’s Degree in Commerce
Marital Status: Single
Informants: Mother, Elder Sister

Case History

Presenting Illness:

• The patient reported hearing voices (auditory hallucinations) that others could not hear
for the past 2 years.
• Exhibited persistent delusions of persecution, believing neighbors were conspiring to
harm him.
• Demonstrated significant social withdrawal, neglecting work and relationships for the
past year.

History of Presenting illness

• Duration: 2 years
• Precipitating Factors: Symptoms began insidiously 2 years ago, with the patient
initially experiencing mild distrust of others. Over the next 6 months, auditory
hallucinations became more frequent and distressing. Family noticed a decline in
personal hygiene, reduced communication, and erratic behavior, such as shouting at
seemingly no one.

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Medical History

• No Medical History

Psychiatric history

• No Psychiatric History

Family History

AB

• No Family history of schizophrenia

• No history of substance use or other major psychiatric illnesses in the immediate family.

Aetiology

• Predisposing Factors: Early exposure to chronic stress during childhood due to financial
instability in the family.

• Precipitating Factors: Intense work-related stress he experienced as a sales representative,

which coincided with the initial onset of his symptoms.

• Perpetuating Factors: lack of social support and isolation, as he has progressively

withdrawn from friends and colleagues, exacerbating his condition and delaying effective
intervention.

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Mental Status Examination

General appearance and behavior:

• Consciousness - Alert
• Dressing/Appearance - Disorganized (Disheveled)
• Tics/ Mannerisms/Catatonic signs - Absent
• Rapport - Guarded (Hesitant)

Psychomotor Activity: Retarded

Speech:

• Spontaneous - Reduced
• Relevant/Irrelevant - Relevant
• Tone/Tempo/Volume - Low volume, slowed tempo
• Coherent/Incoherent - Coherent
• Reaction time - Delayed

Thought:

• Form: Tangential
• Stream: Slow
• Possession: Delusional
• Content: Paranoid

Mood:

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• Subjective: Fine
• Objective: Flat
• Congruence: Incongruent

Perception: Auditory Hallucinations

Judgment: Impaired

Insight: Poor

Assessments:

• Brief Psychiatric Rating Scale (BPRS) - The patient scores 57 indicating the severity of
the symptoms.
• The patient's prominent symptoms include auditory hallucinations, delusions of
persecution, and significant emotional withdrawal, which are consistent with severe
schizophrenia.
• The moderate to severe ratings in categories such as Suspiciousness, Hallucinatory
Behavior, and Cognitive Impairment reflect the ongoing severity of the patient's
condition.

Diagnosis:

• DSM-5: 295.90 (F20.9) - Schizophrenia

• ICD-10: F20.9 - Schizophrenia, unspecified

Case Summary

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Mr. A.B. is a 29-year-old male, employed as a sales representative, with a bachelor's degree in
commerce. He is single and lives with his mother, who is the primary caregiver. The patient has
no significant past psychiatric history and had been leading a relatively stable life until the onset
of his symptoms. Over the past year, his behavior has changed drastically, marked by social
withdrawal, neglect of personal hygiene, and a decline in work performance. The patient was
referred for psychiatric assessment after concerns about his mental health became more apparent
to his family and colleagues.

The primary concerns reported by the patient were auditory hallucinations, wherein he heard
voices that others could not perceive. He also expressed paranoid delusions, particularly a belief
that his neighbors were conspiring against him. These symptoms significantly impacted his
ability to maintain normal social interactions and work responsibilities. Furthermore, the
patient’s mood has become increasingly flat, and he has withdrawn from his social circles. His
family reported that he had become increasingly irritable and suspicious over time.

The onset of the patient's symptoms was gradual, beginning about two years ago. Initially, the
patient experienced mild mistrust towards others, which was not immediately concerning.
However, over the course of six months, the patient’s thoughts became more disorganized, and
his auditory hallucinations intensified. During this period, he began withdrawing from his social
and professional obligations. His family noticed that he was becoming more isolated, neglecting
his hygiene, and displaying erratic behavior, such as talking to himself and expressing irrational
fears about his neighbors. Despite these signs, the patient continued to function at work, though
his performance gradually deteriorated.

The Brief Psychiatric Rating Scale (BPRS) was administered to assess the severity of the
patient's symptoms. The total score indicated moderate severity of psychiatric symptoms, with
higher ratings for suspiciousness, hallucinations, and social withdrawal. Positive symptoms such
as delusions and hallucinations were prominent, while negative symptoms included emotional
blunting and social isolation. The patient’s score for anxiety and depression was also elevated,
reflecting his internal distress. This assessment was crucial in determining the severity of the
patient’s schizophrenia and guided the formulation of the treatment plan.

The treatment plan for Mr. A.B. focused on both pharmacological and psychosocial
interventions. The patient was started on an atypical antipsychotic (Risperidone 4 mg daily) to
address his delusions and hallucinations. The goal of the medication was to reduce the intensity

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of positive symptoms and improve the patient's overall functioning. In addition to medication,
the patient was referred for psychosocial interventions, including cognitive-behavioral therapy
(CBT) to address his delusional thoughts and social skills training to help him engage more
effectively with others. Family psychoeducation was also provided to his mother to improve
understanding of the condition and enhance caregiving strategies. Weekly follow-up visits were
scheduled to monitor medication adherence and adjust the treatment plan as necessary.

This multi-faceted approach aimed to stabilize the patient’s symptoms, improve his social
functioning, and prevent relapse. The prognosis was cautiously optimistic, with the expectation
of partial improvement in symptoms over time with consistent treatment.

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Chapter III: Assessments

ASSESSMENTS

1. Depression, Anxiety, Stress Scale – DASS

The psychological scale measuring the states of depression, anxiety, and stress, also known as
DASS- Depression, Anxiety, Stress Scales was developed for the first time by Lovibond and
Lovibond in 1995. Increasingly being utilized as a measurement in clinical cases, this serves both
as an aid for the screening and evaluation tool in analyzing the depth of emotion that marks the
conditions of depression, anxiety, and stress. There are two kinds by which it is administered
namely the 42-item DASS-42 as well as a shorter version-DASS-21, which counts 21. The score
describes the extent by which each item applied during the past week scored on a scale of four
options of the Likert scale, for all questions, the measure ranges from 0 or "did not apply to me at
all to 3 of "applied to me very much, or most of the time.". The DASS is a measure that attempts
to define specific but shared aspects of emotional distress, helping in treatment planning and
monitoring.

It is the only non-classifying tool that measures emotional symptoms. Instead of classifying
people, it measures the intensity of emotional symptoms, thus giving a subtle insight into the
depth of psychological distress. More so, the instrument is versatile. It can be used in multiple
populations and environments, such as workplaces, learning institutions, and health facilities. It's
simple nature and accessibility explain why it is used by most practitioners in the field of mental
health.

Validity

• Construct Validity: The DASS has demonstrated excellent construct validity since factor
analyses are repeatedly supportive of its three-factor structure, that is, depression,
anxiety, and stress.

• Concurrent Validity: The scores of DASS have been found to be very highly correlated
with other well-established measures of emotional distress like BDI and STAI.

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• Discriminant Validity: DASS can differentiate between the constructs of depression,

anxiety, and stress, therefore it establishes a fact that is measuring the aforementioned
interrelated yet different emotional conditions.

• Cross Cultural Validity: DASS is validated across different cultures and languages with
its use on various populations

Reliability

• Internal Consistency: DASS has been found to possess very good internal consistency
with the Cronbach's alpha values largely above 0.90 on each subscale.

• Test-Retest Reliability: The scale boasts of good test-retest reliability, where the scores
are said to be constant in the long run; well, in case of no strong changes in the emotional
states.

• Inter-Rater Reliability: Self-report; however, evidence of good inter-rater reliability

between DASS scores and ratings by clinicians.

• Reliability Across Versions: There's a similar reliability between DASS-42 and DASS-
21; thus, the shorter version could be appropriate as a replacement in time-crunch
situations

Scoring

The sum score of the subscale of the items on the DASS scores is derived from summing items.
For example, DASS-42 scores are made with 14 items per subscale of depression, anxiety, and
stress, and in the DASS-21, it comprises 7 items per subscale. Thus, the raw score of the DASS-
21 must be doubled so as to equal the score in the DASS-42.
According to predetermined cut-offs, the symptom of distress is graded as normal, mild,
moderate, severe, or extremely severe. For example, in DASS-21:
Depression:

• Normal: 0-9
• Mild: 10-13
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• Moderate:14-20
• Severe: 21-27
• Extremely Severe: 28+
Anxiety:

• Normal: 0-7
• Mild: 8-9
• Moderate: 10-14
• Severe: 15-19
• Extremely Severe: 20+

Stress:

• Normal: 0-14
• Mild:15-18
• Moderate:19-25
• Severe: 26-33
• Extremely Severe: 34+

Interpretation
JD is a 32-year-old, female. The chief complaints she came in with were Persistent feelings of
anxiety for the past six months, Reports feeling overwhelmed by constant worry about work,
personal relationships, and future, has difficulty relaxing and experiences physical symptoms
such as muscle tension, frequent headaches, and sleep disturbances. The Depression, Anxiety
and Stress Scale (DASS-42) was administered where she scores 25 for Anxiety, which falls
within the "severe" range, 12 for Depression, placing him in the "mild" range, 18 for stress,
indicating "mild" stress, suggesting that JD is experiencing heightened levels of stress, though
not as severe as his anxiety.

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2. ALCOHOL USE DISORDER IDENTIFICATION TEST - AUDIT

The AUDIT, or Alcohol Use Disorders Identification Test, has been utilized to identify
individuals with risk for alcohol-related problems. Created by the World Health Organization in
1989, it consists of 10 questions that focus on alcohol consumption, drinking behaviors, and
consequences of alcohol use. The test has been relevant in this regard because of its primary
goals of enabling early detection and intervention, thus greatly reducing the risk of progressing
to severe alcohol use disorders. The test is versatile in that it can be applied in various settings,
such as primary care, community health, and research.

The strengths of AUDIT are that it delves into the patterns of alcohol use in-depth. Both the
quantity and the pace of consumption and the potential damage are considered to ensure a fair
evaluation of risky drinking is made. Because of its simplicity, ease of administration, and
evidence-based basis, healthcare providers commonly rely on AUDIT for simplicity and ease of
administration, yet its effectiveness in diverse populations and cultural contexts.

Validity

• Criterion Validity: AUDIT had a fair association with criteria for clinical diagnoses of
alcohol use disorders, as that of the DSM-5; it was valid enough in predicting the
clinical diagnoses.

• Cross-Cultural Validity: Such research also reveals that AUDIT is indeed effective in
identifying the abuse of alcohol among cultures and age groups; for the items of
AUDIT are designed to be valid as well as applicable across all places.

• Simultaneous Validity: Scores of the AUDIT measure showed a gigantic correlation

with other known screening measures, like the CAGE questionnaire and MAST. This
further increases the validity of this measure.

• Predictive Validity: It predicts future alcohol problems such as dependence and health
problems. Hence, it increases its applicability in preventive care.

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Reliability

• Internal Consistency: AUDIT has very good internal consistency values from
Cronbach's alpha values mostly above 0.80, meaning the questions of AUDIT
measure reliably one construct.

• Test-Retest Reliability: Studies on the same individuals who are tested and tested
again on later dates following administration of AUDIT have also resulted in
consistent values, which therefore establish the stability of this instrument.

• Inter-Rater Reliability: When different practitioners are rating the result of AUDIT,
then it is very reliable hence uniform results.

• Cross-Population Reliability: When the tool used is in another population set. For
instance, the age range, sex, socio-economic status amongst others.

Scoring

The AUDIT scores are based on responses to its 10 questions, which are rated from 0 to
4. The total score ranges from 0 to 40 and is interpreted as follows:

• 0-7: Low risk for alcohol-related problems; brief education might be enough

• 8-15: Moderate risk; it indicates hazardous drinking, and a brief intervention will be
needed.

• 16-19: High risk; it represents harmful drinking, and professional advice may be
necessary.

• 20–40: Likely alcohol dependence; proper evaluation, and possibly treatment, will be
necessary.

The AUDIT is a known and reliable instrument that can give a comprehensive assessment of
alcohol use behaviors and problems related to alcohol. Its 10-item structure, which balances
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brevity with complexity, is appropriate for application in diverse settings. Scoring allows easier
differentiation between levels of risk for alcohol-related problems, thus allowing the right type of
intervention and referral.

Interpretation
LS is a 45-year-old, male. The chief complaints he came in with were increased consumption of
alcohol. The Alcohol Use Disorder Identification Test (AUDIT) was administered where
moderate risk of Addiction was identified with a score of 18.

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3. HAMILTON ANXIETY RATING SCALE – HAM A

The Hamilton Anxiety Rating Scale (HAM-A) is one of the most widely used clinician-
administered tools for assessing the severity of anxiety symptoms in individuals. Developed in
1959 by Max Hamilton, the HAM-A consists of 14 items that evaluate both psychological and
physical symptoms of anxiety. The scale allows clinicians to rate the severity of anxiety based on
the patient's responses to a series of questions. It is commonly used in both clinical and research
settings to assess anxiety disorders, track treatment progress, and evaluate the effectiveness of
therapeutic interventions. The items in the scale cover a range of symptoms, including tension,
fear, insomnia, somatic complaints, and autonomic disturbances. The scale is typically
administered during a structured interview by a trained clinician and takes around 15–20 minutes
to complete.

The HAM-A has been a crucial tool in the field of psychiatry for nearly six decades. Its ability to
measure a broad spectrum of anxiety-related symptoms makes it particularly useful in assessing
various anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety
disorder. The scale's comprehensive nature allows for a thorough understanding of the severity
of anxiety and the areas in which the individual might need the most support. Furthermore, the
HAM-A’s ease of use and reliability in assessing anxiety severity have contributed to its
continued relevance in both clinical practice and research.

Validity

• Construct Validity: The HAM-A demonstrates strong construct validity, meaning it

accurately measures the concept of anxiety. Studies have shown that the scale correlates
highly with other established measures of anxiety, such as the Beck Anxiety Inventory
and the State-Trait Anxiety Inventory, validating its ability to assess anxiety symptoms
effectively.

• Criterion Validity: The scale has strong criterion validity, as it effectively differentiates
between individuals with and without anxiety disorders. Research has shown that HAM-
A scores are significantly higher in patients diagnosed with anxiety disorders compared
to those without, supporting its accuracy in screening for anxiety-related conditions.

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• Concurrent Validity: The HAM-A has demonstrated good concurrent validity when
compared to other clinical assessments for anxiety. It has been found to correlate well
with other well-established scales, such as the Clinical Global Impression (CGI) scale for
anxiety, which enhances its credibility as an effective diagnostic tool.

• Predictive Validity: The HAM-A has predictive validity in assessing outcomes related to
anxiety. Research has indicated that the scale can predict treatment outcomes, including
the effectiveness of pharmacological and psychotherapeutic interventions, making it
valuable in clinical settings for monitoring patient progress.

Reliability

• Inter-Rater Reliability: The HAM-A shows excellent inter-rater reliability, meaning

that different clinicians administering the same assessment will achieve similar results.
This is crucial in ensuring that the scale's results are consistent and not influenced by
individual differences among clinicians. Studies have reported high correlation
coefficients between different raters, suggesting that the scale is objective and reliable.

• Test-Retest Reliability: The test-retest reliability of the HAM-A is also strong, meaning
that scores remain stable over time when there is no change in the individual's anxiety
symptoms. This characteristic is important for tracking the progress of anxiety over time,
as it ensures that the scale provides consistent results in follow-up assessments.

• Internal Consistency: The internal consistency of the HAM-A is demonstrated by a high

Cronbach’s alpha, indicating that the scale’s items are measuring the same underlying
concept of anxiety. This high consistency further supports the scale’s reliability in
assessing anxiety symptoms across different individuals.

• Sensitivity to Change: The HAM-A is sensitive to changes in anxiety levels, making it a

reliable tool for assessing treatment outcomes. Clinicians can use the scale to track the
effectiveness of interventions, as significant changes in HAM-A scores are often
reflective of real changes in anxiety symptoms.

Scoring

The HAM-A consists of 14 items, each rated on a 5-point scale ranging from 0 (not present) to 4
(severe). The total score is obtained by summing the ratings for each of the 14 items, with a
maximum possible score of 56. The scoring categories are as follows:

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• 0–17: Mild anxiety

• 18–24: Moderate anxiety
• 25–30: Severe anxiety

It is important to note that the HAM-A is a clinician-administered tool, and its accuracy depends
on the clinician’s assessment skills and experience. Regular evaluation and adaptation of the tool
based on individual patient needs are recommended to maximize its utility in clinical settings.

Interpretation
RK is a 32-year-old, female. The chief complaints were Intrusive thoughts of contamination
(e.g., fear of germs and dirt), compulsive handwashing, averaging 40–50 times per day,
avoidance of public places like markets, public transport, and restaurants. The Hamilton Anxiety
Rating Scale was administered where she scores 34, which can be interpreted as severe anxiety.

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4. YOUNG MANIA RATING SCALE (YMRS)

The Young Mania Rating Scale (YMRS) is a clinician-administered screening tool designed to
assess the severity of manic episodes in individuals diagnosed with bipolar disorder. The scale
was developed by Dr. Robert Young and is widely utilized in both clinical and research settings
to quantify the intensity and range of manic symptoms. The YMRS evaluates multiple domains
of mood, behavior, and thought processes, including elevated mood, motor activity, speech,
thought content, and disruptive behavior. This tool is essential for distinguishing manic episodes
from other psychiatric conditions and helps to monitor the progression or remission of mania in
patients over time.

The YMRS consists of 11 items, each rated on a scale of 0 to 4, with higher scores indicating
more severe symptoms. It is typically administered by trained clinicians, and while the tool
provides a valuable measure of symptom severity, it requires clinical judgment for accurate
interpretation. The scale is generally used in conjunction with other diagnostic assessments to
form a comprehensive understanding of a patient's condition. Its widespread use in both research
and clinical practice helps ensure the appropriate treatment and management of mania in bipolar
disorder.

Validity

• Content Validity: The YMRS is considered to have strong content validity, as it covers a
comprehensive range of symptoms associated with mania, including mood swings,
agitation, speech patterns, and psychotic behaviors. The items within the scale were
chosen based on their relevance to the clinical manifestation of mania, ensuring that the
tool captures the full spectrum of manic symptoms.

• Construct Validity: Construct validity refers to the extent to which the YMRS measures
the underlying construct of mania. Studies have demonstrated that the YMRS effectively
discriminates between individuals with manic, depressive, and mixed states, supporting
its ability to measure mania specifically rather than other mood disorders or psychiatric
conditions.
• Criterion-Related Validity: Criterion-related validity refers to how well the YMRS
correlates with other established measures of mania. Research has shown that the YMRS
correlates strongly with other scales, such as the Clinical Global Impression for Mania
(CGI-M), further supporting its validity as an accurate measure of manic symptoms.

• Predictive Validity: The predictive validity of the YMRS has been demonstrated
through studies showing its capacity to predict the course and response to treatment in
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patients with bipolar disorder. Higher YMRS scores at baseline are associated with more
severe manic episodes, while changes in YMRS scores over time reflect treatment effects
and symptom remission.

Reliability

• Inter-Rater Reliability: Studies consistently show high inter-rater reliability for the
YMRS, meaning that different clinicians administering the scale tend to achieve similar
ratings for the same patient. This is critical for ensuring consistency in diagnosis and
treatment planning across different healthcare providers.

• Test-Retest Reliability: The YMRS demonstrates excellent test-retest reliability,

indicating that scores remain stable over time in the absence of treatment or symptom
change. This is particularly important for monitoring patients over extended periods.

• Internal Consistency: The internal consistency of the YMRS, often measured using
Cronbach's alpha, is generally high, indicating that the individual items on the scale are
reliably measuring the same construct—mania. This strengthens the overall validity of
the tool in assessing manic symptoms.

• Sensitivity to Change: The YMRS is sensitive to changes in symptom severity, which

makes it an effective tool for tracking the progression of manic episodes and assessing
the efficacy of treatment interventions over time.

Scoring

The YMRS consists of 11 items, each with a score range of 0 to 4, depending on the severity of
the symptom. The total score is obtained by summing the individual item scores, with the
possible range of total scores being from 0 to 44. The scoring is categorized as follows:

• 0-7: No symptoms or minimal symptoms of mania.

• 8-15: Mild mania; the individual may demonstrate mild symptoms that do not
significantly impair functioning.

• 16-24: Moderate mania; the individual exhibits more noticeable symptoms, which may
interfere with daily activities.

• 25-35: Severe mania; the individual presents with significant symptoms that disrupt daily
functioning.

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• 36-44: Extreme mania; the individual is severely impaired, and urgent intervention may
be necessary.

A score greater than 20 typically indicates clinically significant mania, which warrants closer
monitoring and possible treatment adjustments. Changes in the total score over time can help
clinicians assess treatment response and make necessary adjustments.

Interpretation

KD is a 28-year-old, male. The Chief Complaints were Reports feeling unusually energetic, with
an inability to sleep for extended periods, expresses inflated self-esteem, believing they have
special talents or abilities, talks rapidly and has difficulty staying focused, jumping from one
topic to another. The Young Mania Rating Scale was administered and the patient KD scores 30,
which can be interpreted as “Severe” mania.

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5. Brief Psychiatric Rating Scale – BPRS

The Brief Psychiatric Rating Scale (BPRS) is a widely used tool in the psychiatric field for
assessing the severity of symptoms in individuals with various psychiatric disorders. The BPRS
was originally developed in the 1960s and has since been refined. The 24-item version is
commonly used due to its efficient nature and comprehensive assessment of psychiatric
symptoms. It evaluates a broad range of psychological domains, including positive and negative
symptoms, anxiety, depression, and hostility. Each item is rated on a 7-point scale, from 1 (not
present) to 7 (extremely severe). This scale is instrumental in both clinical settings and research,
providing a systematic and reliable means of gauging symptom severity, tracking changes over
time, and evaluating treatment responses.

The BPRS-24 includes symptoms such as hallucinations, delusions, agitation, and emotional
withdrawal, making it a versatile screening tool for conditions like schizophrenia, mood
disorders, and anxiety disorders. The scale is designed to provide a snapshot of a patient's
psychiatric condition and to guide treatment decisions. It is particularly useful in assessing the
effectiveness of psychiatric treatments and medications, as it can be administered frequently to
monitor any progress or deterioration in mental health symptoms. The tool is used by clinicians,
researchers, and healthcare providers across diverse settings, and it is valued for its
straightforward application and ability to capture complex psychological symptoms in a brief
timeframe.

Validity

• Content Validity: The BPRS-24 has undergone extensive development to ensure that it
covers a broad spectrum of psychiatric symptoms. The inclusion of items assessing both
positive and negative symptoms allows for a comprehensive evaluation of mental health
conditions, particularly in disorders like schizophrenia. Expert consensus in its
development process reinforces its content validity, ensuring that the scale accurately
reflects the clinical presentation of psychiatric disorders.

• Construct Validity: The BPRS-24 demonstrates strong construct validity by aligning

well with other established psychiatric assessments. Studies have shown that the scale
correlates significantly with other diagnostic measures of mental health, such as the
Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating

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Scale. This suggests that the BPRS-24 is a valid tool for assessing the underlying
constructs of psychiatric disorders, like psychosis and mood disturbances.

• Criterion-related Validity: The BPRS-24 is also supported by strong criterion-related

validity. Research indicates that the scores on the BPRS correlate with clinical outcomes,
such as response to treatment and psychiatric hospitalizations. This validity is particularly
crucial for clinicians seeking to predict the course of a patient's psychiatric condition and
determine the appropriate level of care.

• Predictive Validity: Studies have demonstrated that the BPRS-24 can predict future
psychiatric outcomes, such as the likelihood of relapse or the need for hospitalization.
This predictive power is valuable in guiding treatment decisions and resource allocation,
as it allows clinicians to make informed predictions about the patient’s future mental
health trajectory.

Reliability

• Internal Consistency: The BPRS-24 has been shown to have excellent internal
consistency, with high Cronbach’s alpha scores, indicating that the items within the scale
are measuring the same underlying construct. This internal consistency ensures that the
scale reliably captures the severity of psychiatric symptoms across different domains.

• Inter-Rater Reliability: The scale has demonstrated strong inter-rater reliability, which
means that different clinicians administering the BPRS-24 tend to arrive at similar
conclusions about a patient’s symptoms. This is particularly important for ensuring that
the scale can be used reliably across different clinical settings and by different healthcare
professionals.

• Test-Retest Reliability: Research has supported the test-retest reliability of the BPRS-
24, indicating that it produces consistent results over time when administered to the same
individuals under similar conditions. This consistency is crucial for tracking changes in
psychiatric symptoms over the course of treatment.

• Reproducibility: The reproducibility of the BPRS-24 is strong, as studies have shown

that the tool can be reliably administered across a range of clinical populations. Whether
used in inpatient or outpatient settings, the BPRS-24’s reproducibility ensures that it is a
dependable measure of psychiatric symptoms in diverse patient groups.

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Scoring

The Brief Psychiatric Rating Scale (BPRS-24) is scored based on the assessment of 24
psychiatric symptoms. Each symptom is rated on a 7-point Likert scale, with ratings from 1 to 7
corresponding to the severity of the symptom. The scoring system is as follows:

• 1 = Not Present: The symptom is not observed or reported.

• 2 = Very Slightly Present: The symptom is present, but it is barely noticeable.
• 3 = Mild: The symptom is noticeable but not severely disruptive.
• 4 = Moderate: The symptom is clearly present and moderately disruptive, but not
excessively distressing.
• 5 = Marked: The symptom is quite evident and significantly disruptive, causing
noticeable distress.
• 6 = Severe: The symptom is very severe and greatly impacts the individual’s functioning
or well-being.
• 7 = Extremely Severe: The symptom is overwhelming and causes extreme distress or
dysfunction.

Total Score Calculation:

To calculate the total score, the clinician adds the individual ratings for each of the 24 items. The
total score can range from 24 (if all symptoms are rated as "Not Present") to 168 (if all
symptoms are rated as "Extremely Severe"). Higher total scores indicate more severe
psychiatric symptoms.

Interpretation of Scores:

• Lower Scores (24-48): These scores typically suggest a less severe presentation of
psychiatric symptoms. The patient may have mild symptoms or be in the early stages of
treatment.
• Moderate Scores (49-96): Scores in this range often indicate moderate symptom
severity, and the individual may require ongoing monitoring and treatment adjustments.

• Higher Scores (97-168): These scores indicate severe psychiatric symptoms. The
individual may be experiencing significant impairment in daily functioning, requiring
intensive treatment and possibly hospitalization.

Clinical Use of Scoring:

The BPRS-24 is often used to track changes in a patient's psychiatric condition over time. For
example, clinicians may administer the BPRS-24 at regular intervals to assess treatment
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progress, detect symptom changes, or evaluate the effectiveness of medications or therapies.

Monitoring the total score and subscale scores can help clinicians make informed decisions about
treatment plans and interventions.

It’s important to note that while the BPRS-24 is a valuable tool for assessing symptom severity,
clinical judgment is essential in interpreting scores, considering the patient's history, and taking
into account other diagnostic factors.

Interpretation:

• The patient scores 100 indicating the severity of the symptoms.

• The patient's prominent symptoms include auditory hallucinations, delusions of
persecution, and significant emotional withdrawal, which are consistent with severe
schizophrenia.
• The moderate to severe ratings in categories such as Suspiciousness, Hallucinatory
Behavior, and Cognitive Impairment reflect the ongoing severity of the patient's
condition.

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Chapter IV: Experiential Learning

EXPERIENTIAL LEARNING

As an intern psychologist, it brought to the table the experience of learning within a multi-
specialty hospital. Hence, making it a multi-dimensional experience transcending the learning of
academics for practical application and thereby substantially enriching the experience. An
experience of learning by direct correlation to the theoretical knowledge that can reflect actual
life scenarios of clinical practice developed more concepts within psychology related to how
these pertain to forms of medical arrangement. This is a context that has led me through and been
involved in the diagnosis, assessment, and treatment of a string of mental illnesses by the medial
context. The exposure has been so intense, indispensable in gaining competencies in diagnosing
different kinds of mental illnesses, understanding patient backgrounds, and putting their
treatment practices into action.

In the multi-specialty hospital environment, inter-disciplinary collaboration takes place where

the intern psychologists work along with other health professionals like psychiatry, neuro-care
and de-addiction. This is an integrated approach that gives one a glimpse of how psychological
disorders intersect with other medical conditions, which in turn makes the learning process more
fulfilling.

In all respects, the internship has truly been a wonderful learning and developing new skills with
additional capabilities to fight newer challenges and professional growth. On the whole, it has
been a highly satisfying experience that positioned and prepared me for later opportunities in my
field of interest.

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Chapter V: Summary

SUMMARY

This internship provides a place to learn the practical experience of the activity to be
carried out, which includes conducting psychological assessments, holding sessions of
intervention and therapies, documentation of cases for reference, and understanding
considerations in ethics and professionalism. Continuous supervision and evaluation
ensure constant guidance and feedback during the internship. This was to give my
skills some practical value and theoretical awareness of the role that psychology plays
in multi-specialty care. Knowledge acquired after internship: Some knowledge was
imparted as considered at the point of completion for an internship. I’m indeed greatful
for this exposure.

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Chapter VI: References

REFERENCES

1. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states:
Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression
and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343.

2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998).
Psychometric properties of the 42-item Depression Anxiety Stress Scales: The DASS.
Psychological Assessment, 10(2), 176-181.

3. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression
Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-
clinical sample. Psychological Assessment, 17(3), 232-240.

4. Daza, P., Novy, D. M., Stanley, M. A., & Averill, P. M. (2002). The Depression
Anxiety Stress Scales (DASS): Psychometric properties and factor structure in a large
community sample. Journal of Clinical Psychology, 58(3), 374-384.

5. Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS):
Normative data and latent structure in a large community sample. British Journal of
Clinical Psychology, 42(2), 111-131.

6. Tran, T. D., Tran, T. P., & Tran, M. T. (2020). The role of the Depression Anxiety
Stress Scales (DASS-42) in screening mental health problems among university students:
A study in Vietnam. Psychiatry Research, 284, 112800.

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(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO
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9. Reinert, D. F., & Allen, J. P. (2007). The Alcohol Use Disorders Identification Test: An
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Chapter VII: Annexure

ANNEXURE

1. Internship Certificate

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2. Reflective Journal

WEEK-1
08/07/2024
• Orientation to the psychiatry department, meeting the supervisor, and understanding the
internship objectives.
• Overview of hospital protocols, patient confidentiality, and ethical guidelines.

09/07/2024
• Introduction to psychiatric assessment techniques.
• Observing patient history-taking and mental status examination (MSE).

10/07/2024
• Shadowing a psychiatrist during outpatient consultations.
• Learning diagnostic criteria (DSM-5/ICD-11) for common psychiatric disorders

11/07/2024
• Case discussions on mood disorders: Depression and bipolar disorder.
• Overview of pharmacological treatments: Antidepressants and mood stabilizers.

12/07/2024
• Introduction to anxiety disorders and their management.
• Observing relaxation techniques and mindfulness sessions.

Key Learnings for Week 1:

• Basics of psychiatric assessment and common disorders.

• Importance of ethical considerations and patient confidentiality.

Challenges Faced in Week 1:

• Understanding complex patient histories in limited time.

• Adapting to the hospital’s workflow.

WEEK-2
13/07/2024

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• Focus on psychotic disorders: Schizophrenia and delusional disorders.

• Understanding antipsychotic medications and their side effects.

14/07/2024

• Observing inpatient care and multidisciplinary team meetings.

• Participating in discussions about treatment plans for psychotic disorders.

15/07/2024

• Introduction to child psychiatry: ADHD and Autism Spectrum Disorder.

• Observing behavioral assessments and therapy sessions.

16/07/2024

• Exposure to geriatric psychiatry: Dementia and late-life depression.

• Discussion on managing psychiatric disorders in elderly patients.

17/07/2024

• Observing group therapy sessions for mood and anxiety disorders.

• Learning about cognitive-behavioral therapy (CBT) techniques.

Key Learnings for Week 2:

• Deeper understanding of psychotic, child, and geriatric psychiatry.

• Hands-on exposure to therapy techniques and patient interactions.

Challenges Faced in Week 2:

• Communicating effectively with patients of varying age groups.

• Grasping diverse therapeutic approaches in a short time.

WEEK-3

18/07/2024

• Introduction to substance use disorders and their management.

• Observing detoxification protocols and withdrawal management.

19/07/2024

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• Learning about motivational interviewing techniques.

• Participating in individual counseling sessions for addiction patients.

20/07/2024
• Case discussions on dual diagnosis (e.g., addiction with mood disorders).
• Exposure to pharmacological treatments for addiction (e.g., naltrexone, methadone).

21/07/2024

• Observing ECT (Electroconvulsive Therapy) for treatment-resistant depression.

• Understanding the preparation and aftercare for ECT patients.

22/07/2024

• Exposure to psychosomatic disorders and their management.

• Observing interdisciplinary discussions involving psychiatrists and general physicians.

Key Learnings for Week 3:

• Insights into addiction psychiatry and dual diagnosis cases.
• Understanding advanced treatment modalities like ECT.

Challenges Faced in Week 3:

• Managing emotional responses to severe addiction cases.
• Understanding complex psychosomatic interactions.

WEEK-4

23/07/2024

• Reviewing cases from Weeks 1-3 and discussing with the supervisor.
• Preparing for case presentations.

24/07/2024

• Presenting selected cases to the team.

• Receiving feedback and discussing alternative approaches.

25/07/2024

• Observed a psychiatry case.

• Understanding legal and ethical issues in psychiatry.

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26/07/2024

• Participating in a hospital-based mental health awareness program.

• Observing the role of community psychiatry.

27/07/2024

• Final feedback session with the supervisor.

• Reflecting on key learnings and preparing the internship report.

Key Learnings for Week 4:

• Consolidation of knowledge and skills acquired during the internship.

• Improved presentation and communication skills.

Challenges Faced in Week 4:

• Balancing case preparation with ongoing learning activities.

• Analyzing complex forensic and community psychiatry cases.

WEEK-5

28/07/2024

• Orientation to the neurology department, meeting supervisors, and understanding the

internship objectives.
• Overview of hospital protocols, patient confidentiality, and ethical guidelines.

29/07/2024

• Introduction to neurological assessment techniques.

• Observing patient history-taking and basic neurological examinations (e.g., cranial nerve
exams).

30/07/2024

• Learning diagnostic criteria for common neurological disorders (stroke, epilepsy, etc.).
• Shadowing neurologists during outpatient consultations.

31/07/2024

• Observing neuroimaging procedures (MRI, CT scans).

• Discussing the interpretation of imaging results with the team.
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01/08/2024

• Case discussions on stroke and transient ischemic attacks (TIAs).

• Understanding acute management and rehabilitation strategies for stroke patients.

Key Learnings for Week 5:

• Basics of neurological assessment and diagnostic imaging.

• Understanding the interdisciplinary approach in neuro-care.

Challenges Faced in Week 5:

• Grasping complex neurological terminologies and concepts.

• Adapting to the fast-paced environment of neuro-care.

WEEK-6

02/08/2024

• Learning about epilepsy: Types, diagnosis, and treatment options.

• Observing EEG procedures and understanding their clinical relevance.

03/08/2024

• Exposure to neurodegenerative diseases such as Parkinson’s and Alzheimer’s.

• Participating in patient counseling sessions for long-term care planning.

04/08/2024

• Observing inpatient care for neurological conditions.

• Understanding the role of physiotherapy and occupational therapy in neurorehabilitation.

05/08/2024

• Case discussions on neuropathic pain and its management.

• Introduction to pharmacological treatments for chronic pain.

06/08/2024
• Attending multidisciplinary meetings to discuss complex cases.
• Reviewing patient progress and treatment adjustments.

Key Learnings for Week 6:

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• In-depth understanding of epilepsy and neurodegenerative disorders.

• Importance of multidisciplinary collaboration in managing neurological conditions.

Challenges Faced in Week 6:

• Communicating effectively with patients and families about chronic conditions.
• Understanding the nuances of neurorehabilitation.

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3. PLAGIARISM REPORT

The internship report was broken down into 10 sections and subjected to a plagiarism check; the
results are averaged out below.

Word Count – 10,996

Unique – 100%

Plagiarized – 0%

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