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Internship Report
Roll No: 04
Semester: 4TH
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Acknowledgment
I Maria Kousar hereby certify that the work is being presented in the project report
entitled internship report in the partial fulfillment for the award of Master’s degree in Applied
Bahawalpur, Bahawalnagar Campus is an authentic record of my own work carried out under the
Maria Kousar
______________
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Table of Content
Case No. 1
3 8
Schizophrenia
Case No. 2
4
Depressive Disorder
Case No. 3
5
Caffeine Intoxication
6 References
7 Appendix A
8 Appendix B
9 Appendix C
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Fountain House Lahore is a unique institute of its Kind offering mental health services in
Pakistan for the past 40 years. The institution was started as a project of Lahore Mental Health
Association with only 16 members (Patient) in a small Building Half-Way House. Presently,
Fountain House serving to the rehab needs of over 400 (300 males & 100 Females) Individuals
with mental health illnesses from all over Pakistan, as well as Pakistanis Living abroad come
Lahore Mental Health Association (LMHA) was formed in 1962 to mobilize efforts &
resources for the uplift and promotion of mental health in the country. In 1965, Prof. Dr.
Mohammad Rashid Chaudhry (Late) a founder member of the association, worked out a plan for
the establishment of a rehabilitation center for the mentally ill in Lahore. A formal proposal
entitled "Establishment of a Half-Way House and Day-Night Rehabilitation Unit for persons
After approval by the Govt. in 1968, the proposal was sent to the Social and Rehabilitation
Services, Department of Health, Education and Welfare, Govt. of USA for the purpose of
obtaining technical and financial assistance. In 1971 Mr. John H. Beard, Executive Director,
Fountain House, New York as a consultant of Social and Rehabilitation Services, Washington
USA visited the Rehabilitation Unit of Lahore Mental Health Association. The close relationship
that developed as a result of the technical collaboration between the two houses led to the adoption
Crime & Justice is an integration of science, theory and clinical knowledge for the
and to promote subjective well-being and personal development. Central to its practice are
criminological assessment and criminology, although crime & justicealso engage in research,
teaching, consolation, forensic testimony and program development and administration. To many
The field is often considered to have begun in 1986 with the opening of the first crime &
justice at the University of Pennsylvania by Lightner Witner. In the first half of the 20 th century,
crime & justice was focused on criminological assessment, with little attention given to
treatment. This changed after the 1940s when World War II resulted in the need for a large
Crime & justice are now considered experts in providing psychotherapy, psychological
testing, and in diagnosing mental illness. They generally train within four primary theoretical
family therapy. Many continue clinical training in post-doctoral programs in which they might
Throughout the history of criminal justice, evolving forms of punishment, added rights
for offenders and victims, and policing reforms have reflected changing customs, political ideals,
Although modern, scientific criminology is often dated at the 1879 opening of the first
psychological laboratory by Wilhelm Wundt, attempts to create methods for assessing and
treating mental distress existed long before. The earliest recorded approaches were a
combination of religious, magical and medical perspectives, Early examples of such physician
In the early 19th century, on could have his or her head examined, literally, using
phrenology, the study of personality by the shape of the skull. Other popular treatments included
physiognomy—the study of the shape of the face—and mesmerism, Mesmer’s treatment by the
use of magnets. Spiritualism and phineas Quimby’s “mental healing” were also popular. While
the scientific community eventually came to reject all of these methods, academic psychologists
also were not concerned with serious forms of mental illness. That area was already being
addressed by the developing fields of psychiatry and neurology within the asylum movement. It
was not until the end of the 19th century, around the time when signund Freud was first
developing the recent ideal of a “talking cure” in Vienna that the first scientifically clinical
Case No. 1
Introduction
Schizophrenia is a chronic, sever, and disabling brain disorder that has affected people
People with the disorder may hear voices other people don’t hear. They may believe other
people are reading their minds, controlling their thoughts, or plotting to harm them. This can
terrify people with the illness and make them withdrawn or extremely agiated.
People with schizophrenia may not make sense when they talk. They may sit for hours
without moving or talking. Sometimes people with schizophrenia seem perfectly fine until
Definition:
as a result of unusual perception, odd thoughts, disturbed emotions, and motor abnormalities.
Symptoms of Schizophrenia:
Positive Symptoms
Hallucination
Delusions
Negative Symptoms
The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative
Positive Symptoms:
Positive symptoms are psychotic behaviors not seen in healthy people. People with positive
symptoms often “lose the touch” with reality. These symptoms can come and go. Sometimes
they are severe and at other times hardly noticeable, depending onwhether the individual is
Hallucination:
Hallucinations are things a person sees, hears, smells,, or feels that no one else can see, hear,
smell, or feel, “Voices” are the most common type of hallucination in schizophrenia. Many
people with the disorder hear voices. The voices may talk to the person about his or her behavior,
other the person to do things, or warn the person of danger. Sometimes the voices talk to each
other. People with schizophrenia may hear voices for a long time before family and friends
Other types of hallucinations include seeing people or objects that are not there, smelling odors
that no one else detects and feeling things like invisible fingers touching their bodies when no
one is near.
Delusions:
Delusion are false belief that are not part of the person’s culture and do not change. The person
believes delusions even after other people prove that the beliefs are not true or logical. People
with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can
control their behavior with magnetic waves. They may also believe that people on television are
directing special messages to them, or that radio stations are broadcasting their thoughts aloud to
others. Sometimes they believe they are someone else, such as a famous historical figure. They
may have paranoid delusions and believe that others are trying to harm them, such as by
cheating, harassing, poisoning, spying on or plotting against them or the people they care about.
Negative Symptoms
Negative symptoms are associated with disruptions to normal emotions and behaviors. These
symptoms are harder to recognize as part of the disorder and can be mistaken for depression or
“Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous
voice).
People with negative symptoms need help with everyday tasks. They often neglect basic personal
hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are
A. Characteristic symptoms: Two (or more) of the following each precent for a significant
Delusions
Note: Only one criterion A symptoms is required if delusions are bizarre or hallucinations consit
of voice keeping up a running commentary on the person in behavior or thoughts, or two or more
B. Social/occupational dysfunction:
For a significant portion of the onset of the disturbance, one or more major areas of
functioning such as work interpersonal, interpersonal relation or self-care are markedly below
the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to
period must include at least 1 month of symptoms (or less if successfully treated) that meet
criterion a (i.e. active-phase symptoms) and may include periods of prodromal or residual
symptoms.
disorder with Episode, Manic Episode, or Mixed Episode have occurred concurrently with
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the active phase symptoms their total duration has been brief relative to the duration of the
The disturbance is not due to the direct criminological effects of a substance (e.g. a drug of abuse
only if prominent delusions of hallucinations are also present for at least a month (or less if
Summary:
The client was A.B and her age was 35 year old. She was suffering from schizophrenia
from last 10 months. The cause of the disorder that she was being beaten by her school
teachers due to low grades it made her introverted and she felt inferior in front of others and
later on in her married life she had bad relationship with her spouse and got divorced.
Through informal assessment it was observed that her general appearance was inappropriate
and she was suffering with auditory hallucination and persecutory delusion. Her behavior
was distorted. For the formal assessment HTP tests was applied on the client. The
interpretation indicated that the client had problems in the maintaining good relationship with
the spouse and other family members. The client had difficulty in the adjustment of the
environment; Relaxation techniques and cognitive behavior therapy were applied on the
client.
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Identification:
Name: A.B
Age: 35 Years
Education: Middle
Gender: Female
No. of Sibling: 03
Source of Referral:
Date of Referral:
12-04-2015
1. Irritability
2. Loss of appetite
3. Insomnia
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4. Auditory hallucination
5. Paranoia.
Presenting Complaints:
Duration Client
Duration Informants
The client was suffering from schizophrenia from last 10 months. She was introverted
and sensitive because she was below average student and she was being beaten by her school.
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Teachers because of low grades his made her introverted. Later on the relationship of the
client with her husband was not good, they fought with each other and she got divorced. The
Family History:
Her father name was A.A and he was businessman. He died couple of years ago. When
he died he was 65 years old. He had an extroverted personality. He wasn’t suffering from any
psychiatry problem when he died. Her mother was 63 years old. She also had an extroverted
personality. She had two brothers and one sister. And her relationship with her parents and
siblings was satisfactory. There was no criminological issue reported in the family.
Personal History:
Her birth and early developmental stages were normal. She had not any criminological
problem before suffering from schizophrenia. She was being beaten in the school due to low
grades as she had a problem in recalling her school lesson. Her relationship with her spouse was
Premorbid Personality:
She was introverted and had lack of interest in social activities. Her father’s behavior
towards her was good. She had good relationship with her siblings.
Her pulse rate (72/m) and temperature (98 C) and BP (120/70) was normal.
ASSESSMENT:
Criminological Assessment
Formal
Informal
Informal Assessment:
Behavioral Observation:
The client’s height was 5 feet and 4 inches and shw was overweighed according to her
height. She was wearing shalwer & kameez. Her hair was organized. She wasn’t in stable mood
at that time and was able to maintain eye contact. Her speech was comprehensive and tone was
Her speech was comprehensive. Her mood was unstable. Her speech was not normal at
present time. She had no suicidal ideation. She wasn’t aware of time, place and person present
around her at the moment. She reacted to the stress according to the situation. Her remote and
recent past memories were not good. Her arithmetic reasoning was poor.
Formal assessment:
HTTP:
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The client draw person with no ears, displacement of ears show suspicious tendencies.
The client draw dummy figure which indicated withdrawal in interpersonal relation. The client
draw thin and flat legs which indicated insecure and dependency. The client draw no arms and
legs it showed withdrawal from reality or difficulty in interpersonal relationship and also the lack
of confidence.
The client draw no doors which indicated the insecurity. The client did emphasis on the
Etiology:
Diagnosis:
According to above mentioned problem the client presents complaints and behaviors that are
Recovery/Prognosis
Favorable Points
Will power
Unfavorable Points
No family support
Poor insight
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Management Plans
Short-term goal
Psychoeducation
Diversion Technique
Relaxation therapy
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Case No. 2
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Depressive Disorder
Introduction:
A low sad state marked by significant levels of sadness, lack of energy, low self-worth,
guilt, or related symptom. The word depressed is a common everyday word. People might say
“I’m depressed” when infect they mean “I’m up because I’ve had a row, or failed an exam, or
lost my job”, etc. these ups and downs of life are common and normal. Most people recover quite
quickly. With true depression, you have a low mood an other symptoms each day for at least two
weeks. Symptoms can also become severe enough to interfere with normal day-to-day activities.
A severe pattern of depression that is disabling and is not caused by suc factors as drugs
Symptoms
1. Depressed mood
4. Insomnia or hypersomnia
6. Suicidal ideation
7. Feeling of worthlessness
8. Psychonomotor agitation
9. Diminished ability
A five (or more) of the following symptoms have been present during the same 2-weeks period
and represent a change from previous functioning; at least one of the symptoms is either (1)
Note: do not include symptoms that are clearly attributable to another medical condition.
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Depressed mood most of the day, nearly every day, as indicated by either subjective report
(e.g., feels sad empty, hopeless) or observation made by others (e.g., appears tearful). (Note:
Markedly diminished interest or pleasure in all, or almost, activities most of the day nearly
Significant weight loss when not dieting or weight gain (e.g., a change of more than
delusional) nearly every (not merely self-reproach or guilt about being sick).
Recurrent thought of death (not just fear of dying), recurrent suicidal ideation with-
out a specific plan, or a suicide attempt or a specific plan for committing suicide.
medical condition.
Note: Responses to a significant loss (e.g., Bereavement unless six persist for two months or
show marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation,
D. The occurrence of the major depressive episode is not better explained by schizoaffective
psychotic disorder.
Summary:
The client was R.R and her age was 25 years. She was suffering from depression from
last 4 months. Her mother died last year and she was being abused by her father. Through
informal assessment it was observed that her general appearance was not appropriate and show
flatted expression. In formal assessment BDI –II was applied, According to this test score was 45
which indicated serve depression level. Cognitive behavioral therapy and relaxation technique
were applied.
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Identification:
Name: R.R
Age: 25 Years
Gender: Female
No. of Sibling: 04
Source of Referral:
Date of Referral:
12-02-2015
4. Irritability
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5. Hopeless
Presenting Complaints:
Duration Client
Duration Informants
The client was suffered from depression from last 4 months. She was depended on her
mother and she was sensitive. Her mother died last year and she was being abused by her father.
Family History:
Her father name was R.S and he was 57 years old. Her mother was 50 years old when she
died. She had three brothers and one sister. Her relationship with siblings was normal but she
was a neglected child and her relationship with father was not satisfactory. Family atmosphere
was not normal as the client’s father was a strict person so he usually scolds his child.
Personal History:
Her birth and early developmental stages were normal. There was no criminological
problem reported before suffering from Depression. But she was suffering from migraine. She
Premorbid Personality:
She was introverted and bad lack of interest in social activities. She was dependent child
who depends on her mother. Her father behavior with her was not satisfactory. She tool little
Her pulse rate (82/m) and her temperature was (100 F) and BP was (120/80) normal.
ASSESSMENT:
Informal
Formal
Informal Assessment:
Behavioral Observation:
The client was 25 years old with normal height of 5 feet 2 inches and having below
average weight according to her height. Shw was wearing shalver & kameez with dupatta.
Her hair were very short and her nails were also cut properly. She was in low sad mood at
the time and was able to maintain eye contact. Her speech was comprehensive and tone
was low. She was well aware of time, place and person around her at that time.
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Her speech was not comprehensive. Her tone was low at present time. She had suicidal
ideation. She was well aware of ther ailment and the place where she was admitted. Her remote
Formal assessment
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Qualitative Analysis:
Category Range
Conclusion:
The test administered on the client wad BDL. The client’s total score of depression was 45 it
Etiology:
3) She didn’t get help when was being abused by her father.
Diagnosis Assessment:
According to above mentioned problem the client presents with complaints and behaviors
that are consistent with DSM -5 diagnosis of Major Depressive Disorder, 296.23 (F32.2).
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Recovery/Prognosis:
Favorable Points:
Will Power
Good insight
Unfavorable Points:
No Family support
Management plan:
Psycho education
Activity scheduling
Diversion technique
Family therapy
Relaxation therapy.
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Case No. 3
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Introduction:
Drug addiction, also called substance use disorder, is a dependence on a legal or illegal
drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also
considered drugs. When you’re addicted, you’re not able to control your drug use and you may
continue using the drug despite the harm it causes. Drug addiction can cause an intense craving
for the drug. You may want to quit, but most people find they can’t do it on their own. Drug
addiction can cause serious, long-term consequences, including problems with physical and
mental health, relationships, employment, and the law. You may need help from your doctor,
family, friends, support groups or an organized treatment program to overcome you drug
addiction and stay drug-free. The DSM-V recognizes substance related disorder resulting from
the use of ten separate classes of drugs: alcohol, caffeine, cannabis, hallucinogens (phencyclidine
and other stimulants), tobacco, and other or unknown substances . therefore, while some major
substances can also form the basis of a substance related or addictive disorder (Comer, 2015).
The DSM 5 explains that activation of the brains’ reward system is central to problems
arising from drug use – the rewarding feeling that people experience as a result of taking drugs
may be so profound that they neglect other normal activities in favor of taking the drug. While
the pharmacological mechanisms for each c lass of drug are different, the activation of the
reward system is similar across substances in producing feelings of pleasure or euphoria, which
Definition of Caffeine:
The world’s most widely used stimulant, most often consumed in coffee. Most of this
caffeine is taken in the form of coffee; the rest is consumed in tea; cola; so called energy drinks
Caffeine intoxication:
Recent consumption of caffeine typically a high dose will in excess of 250 mg (Comer,
2015).
A. Recent consumption of caffeine (typically a high dose well in excess of 250 mg).
B. Five (or more) of the following signs or symptoms developing during, or shortly after
caffeine use:
1. Restlssness.
2. Nervousness.
3. Excitement.
4. Insomnia.
5. Flushed face.
6. Diuresis.
7. Gastrointestinal disturbance.
8. Muscle twitching
D. The signs or symptoms are not attributable to another medical condition and are not better
explained by another mental disorder, including intoxication with another substance (Aerican
Summary:
Client’s name was U.J and he was 28 years old. He was suffering from caffeine
intoxication from last 6 years. The cause of his disorder was the inherited tolerance for caffeine.
Through informal assessment it was observed that his behavior was aggressive. For the formal
assessment DAST-20 test was applied on the client. The total score was 12 which indicated that
client suffered from substantial level of caffeine intoxication. The client had problem in
Identification:
Name: U.J
Age: 28 Years
Gender: Male
No. of Sibling: 04
Education: Masters
Source of Referral:
Informal:
Date of Referral:
11-03-2017
1. Restlessness
2. Gastrointestinal disturbance
3. Caffeine craving
4. Insomnia
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5. Nervousness
Presenting Complaints:
Duration Client
Duration Informants
The client was suffering from caffeine intoxication and problem started last 6 years ago.
The client had inherited tolerance for caffeine. The intoxication increased because of the
influence of the peers. He was dependent on caffeine, he intake more caffeine in stressful
situation.
.
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Family History:
The client’s father was 58 years old when he died and he was educated person. His father
was a religious person and he also had caffeine intoxication. Client’s father had an extroverted
personality. Client father’s temperament toward him was good. Client relationship with his father
was good. Client’s mother was 48 years old when she died. She was a school teacher. The
relationship of the client with his mother was satisfactory. Client had two sisters and one brother.
The relationship of the client with his siblings was quite good.
Personal History:
His birth was normal. His early development stages were also normal. He was educated
person. His physical health was not normal. Due to peer pressure, he tool caffeine regularly. His
schooling was moderate. Hi was single. His social relationship were normal but sometimes he
showed too much aggressive behavior with his friends or family whin he didn’t get caffeine.
Premorbid Personality:
His B.P was (120/80) and temperature was (98) and his pulse rate was (82/s) which was normal.
ASSESSMENT:
41
Criminological Assessment
1. Formal
2. Informal
Informal Assessment:
Behavioral Observation:
The client was a young man. He was wearing pant shirt. His hair were short and his nails
were also cut properly. He was in stable mood. He gave all the answers in detail and answers
were related to the question. He was sitting in appropriate posture. He was nervous in the
His speech was comprehensive. His mood was stable. Rather he gave all the answers in
detail. His speech was quite normal at present time. He was well aware of time, place and person
present around him at that moment. His remote and recent past memory were good. He knew his
ailment and the place where he was currently admitted. His arithmetic reasoning was also good.
Formal assessment:
DSM criteria)
Total Score: 12
Conclusion:
The test administered on the client was DAST-20. The client’s total score was 12, it
Etiology:
Diagnosis:
According to above mentioned problem the client presents with complaints and behaviors that
Recovery/Prognosis
Favorable Points
Social support
43
Family support
Unfavorable Points
Will power
Poor insight
Management Plans
Short-term goal
Psycho Education
Activity Scheduling
Copping Statement
o CBT
References:
1. Compas, R.M, Bruce, P.S., & Gotilb, M.F. (2013). Introduction of crime & justice. In
6. Neale, J.M. (2012). Schizophrenia. In Abnormal Psychology (12 ed., pp. 253-258).
7. Neale, J.M. (2012) Major Depressive disorder. In Abnormal Psychology (12 ed., pp.134-
8. Neale, J.M. (2012). Substance use Disorder. In Abnormal Psychology (12 ed., pp. 282-