A PRACTICUM REPORT SUBMITTED AS PARTIAL FULFILMENT OF

THE REQUIREMENTS
FOR THE M.A CLINICAL PSYCHOLOGY SEMESTER III
EXAMINATION

SUBMITTED TO
DEPARTMENT OF PSYCHOLOGY,
SAVITRIBAI PHULE PUNE UNIVERSITY

BY

AKSHATA WHAVAL

UNDER THE GUIDENCE OF

DR. JUHI DESHMUKH

DEPARTMENT OF PSYCHOLOGY

SAVITRIBAI PHULE PUNE UNIVERSITY

DECEMBER 2024
 DECLARATION

I declare that the following internship work is a genuine record work carried out

under the Guidance of Dr. Juhi deshmukh at Yerawada Regional Mental Hospital,

Yerawada, Pune and Samyak Rehabilitation Center, Baner, Pune

And I also declare that the case reports are not a copy of any previous work and

have not been the basis for the award of any degree, diploma, fellowship, or title

to this or any other institute of higher learning.

I further declare that the articles, books and resources referred to have been duly

acknowledged.

Akshata Whaval,

Pune, 2024
 ACKNOWLEDGEMENT

Initially I’d like to thank Dr. Mhaske, Head Of Department for giving us an

opportunity to intern at such renowned institutes. Mainly I’d like to thank Dr Juhi

Deshmukh for her guidance and support. It was because of the collaborative efforts

of the entire department that I got such an insightful experience. Thank you

everyone, I really appreciate this.

I’d like to thank Mrs. Rohini Bhosale Ma’am, the Social Superintendent (SSS) of

Yerawada Regional Mental Hospital. It was really informative and insightful

experience and her guidance was valuable.

Next I’d like to thank my batch-mates for being such a fun group, I got to learn

loads from you all.

I’d also like to thank my entire family for supporting me through the tough times.

And finally I’d like to thank myself for not giving up when the times were trying.
CASE I

DEMOGRAPHIC DETAILS

Name:SM

Age:19

Sex: M

Marital Status: Unmarried

Education: 12th Standard

Language: Marathi, Hindi, English

Socioeconomic Status: Middle Class Family

Informant: Aunt

CHIEF COMPLAINTS:

Disorganized Speech- The patient is stuttering and is not able to bring his

thoughts in alignment in order to express them making them incoherent.

precipitating event or situation. The laugh or smile differs from when something

actually funny is happening around.

Aggressiveness- Patient had shown aggressive reactions to mild provocation. He

has shown tendency to throw temper tantrums without any reason. He has also

shown signs of being destructive in his ongoing classes.

Assaulting Behavior- Got complaints from female peers to be staring at them

weirdly and tried to “come onto” one of his female classmates, as reported by her.

Self Harm-Attempted Self Harm once. He threatened to jump on the roadside

several times even with mild provocation.

Social Withdrawal- He distanced himself with any people who disagreed or even

said anything criticizing. Patient was not seen making any friends throughout his

secondary education and did not participate in any extra circular activities.

Physical Symptoms- Hypothyroidism

HISTORY OF PRESENT ILLNESS (HOPI)

PRECIPITATING FACTOR: Fight with his mother over failed grades (as

mentioned by his aunt).

COURSE OF ILLNESS: Since 3 years patient has became progressively

unmanageable to anyone he has interacted.

ASSOCIATED DISTURBANCES: Weight Loss, Extreme outbursts of anger and

threats to self-harm.

PAST HISTORY

Patient is a single child of a working single mother. His mother reports him starting

to really “act out” since 3 years.

Patient was a very intelligent but aloof student in his class. His classmates and

even teachers have told that he was quick tempered. He did not like being told

anything more than one time, but was fairly normal till his middle school. After

that there was a significant drop in his participation in extra circular activities.

Teachers reported that he used to even eat his lunch alone somewhere outside the

class. Even then he was normal and manageable.

to her for sometime he screamed very loudly and ran away. He cried a lot after

that. After this incident he started skipping classes. He would disappear for 1 to

1&1/2 hours from on-going classes. He withdrew his interest from studying; he

would not do his homework. After this other abnormal behavior was reported by

his classmates and teachers.

After the precipitating event gradual change in his behavior developed and patient

became extremely irritable. He started skipping school.

TRATMENT HISTORY:

Patient’s aunt consulted a psychiatrist and he was taken to the psychiatrist for the

treatment. His Aunt then contacted the rehabilitation center as well and he was

admitted in the organization.

FAMILY HISTORY

Mother: Healthy (No known Mental or Physical Illness)

Father: Reported to have Schizophrenia by patient’s mother

(Since patient’s mother was not informed before-hand about father’s Illness;

mother filed a divorce after understanding whole history).

GENOGRAM
 44 42

19

PRE-MORBID PERSONALITY

Academically intelligent and extremely studious

Introvert and socially awkward

Attitude towards Others: Slightly agitated towards his peers, little group of friends.

He always followed instructions of teachers. Patient is close to his Aunt.

Attitude towards Self: Shy and introverted. Avoid meeting other people in school

and in neighborhood. Studying or reading books at every chance he got. He did not

like listening to same thing again and again.

Mood: Normal, short tempered.

Leisure: reading, watching TV, writing.

MENTAL STATUS EXAMINATION (MSE)

GENERAL APPEARANCE: Well kept, slouched posture

Exhibits inappropriate smiling without context.

BODY LANGUAGE: Staring at different directions, Smiling to self.

RAPPORT: Difficult

MOOD AND AFFECT: Euthymic mood. inappropriate Affect.

SPEECH: Disorganized

COGNITION: Oriented to time, place and person.

Attention- Poor. Easily Distracted

Memory- Intact

Executive Function- Poor

THOUGHT: Process- Thought blocking, Disorganized

Content- Obsessions.

PERCEPTION: Fair

JUDGEMENT: Limited

INSIGHT: Absent

CLINICAL FORMULATION AND DIAGNOSIS:

characteristic of schizophrenia. No predominant feature aligns with other specific

subtypes (e.g., paranoid, catatonic).

The Differential Diagnosis can be Hebephrenic Schizophrenia as the patient’s age

fits the onset for the diagnosis, and many of the symptoms do line-up with the

diagnosis. Ultimately patient cannot be diagnosed with Hebephrenic Schizophrenia

because it is episodic with progressive deficit, but after observing patient for more

than 2 months he seems episodically remittent. (Patient is active and responsive,

the episodes of giggling and smiling to self; though not significantly, but have

decreased and there are no signs of any hallucinations.)

Therefore, the Diagnosis of the patient is Undifferentiated Schizophrenia.

ICD-10 CRITERIA: Undifferentiated Schizophrenia- F20.3

DSM5 Criteria: 295.90

A. Two (or more) of the following, each present for a significant portion of time

during a

1 -month period (or less if successfully treated). At least one of these must be (1),

(2), or (3):
1. Delusions.

2. Hallucinations.

3. Disorganized speech (e.g., frequent derailment or incoherence).

4. Grossly disorganized or catatonic behavior.

5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of

functioning in one or more major areas, such as work, interpersonal relations, or

self-care, is markedly below the level achieved prior to the onset (or when the

onset is in childhood or adolescence, there is failure to achieve expected level of

interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month

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. During these prodromal or residual periods, the

signs of the disturbance may be manifested by only negative symptoms or by two

or more symptoms listed in Criterion A present in an attenuated form (e.g., odd

beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic

features have been ruled out because either 1) no major depressive or manic

episodes have occurred concurrently with the active-phase symptoms, or 2) if

present for a minority of the total duration of the active and residual periods of the

illness.

E. The disturbance is not attributable to the physiological effects of a substance

(e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of

childhood onset, the additional diagnosis of schizophrenia is made only if

prominent delusions or hallucinations, in addition to the other required symptoms

of schizophrenia, are also present for at least 1 month (or less if successfully

treated).

PROGNOSIS: The patient has poor insight; however with stable medication and

consistent therapeutic efforts he can lead a relatively stable life.

PROPOSED TREATMENT PLAN

PSYCHIATRIC:

Medication Management:

Monitoring: Regularly monitor medication adherence, response, and side effects.

Adjust medication dosage or switch (with the consultation of a psychiatrist) to an

alternative agent if necessary to optimize therapeutic outcomes while minimizing

side effects.
PSYCHOTHERAPEUTICAL:

Individual Psychotherapy: Offer individual psychotherapy, such as cognitive

behavioral therapy (CBT) or supportive therapy, to address cognitive distortions,

enhance coping skills, and promote insight into psychotic symptoms.

Family Therapy: Involve family members in therapy to provide education,

support, and communication skills training. Address family dynamics and stressors

that may exacerbate symptoms or impact treatment adherence.

Social Skills Training: Provide social skills training to improve interpersonal

functioning, communication skills, and problem-solving abilities. Help the

individual navigate social situations and relationships more effectively.

Rehabilitation Services:

Vocational Rehabilitation: Assist the individual in assessing vocational

rehabilitation programs and supported employment services to develop job skills,

explore career options, and secure meaningful employment opportunities.

Educational Support: Provide educational support and accommodations to

facilitate academic success, such as tutoring, study skills training, and access to

special education resources.

PLAN OF MANAGEMENT:
Community Integration: Promote community integration and participation in

recreational activities, volunteer opportunities, and social groups to enhance social

support and reduce isolation.

Assertive Community Treatment (ACT): Consider ACT teams for individuals

with complex treatment needs who require intensive, community-based support

and monitoring.

LONG TERM

Lifestyle Modifications:

Healthy Lifestyle: Encourage the individual to maintain a healthy lifestyle with

regular exercise, balanced nutrition, adequate sleep, and avoidance of substance

use or abuse.

Stress Reduction: Teach stress management techniques such as relaxation

exercises, mindfulness meditation, and stress-reducing activities to help the

individual cope with everyday stressors more effectively.

Continuity of Care:

Regular Follow-Up: Schedule regular follow-up appointments with the individual's

healthcare providers to monitor treatment progress, assess symptom severity, and

adjust interventions as needed.

adherence and address barriers to compliance, such as side effects or stigma

associated with psychiatric medications.