DEPARTMENT OF PSYCHOLOGY
UNIVERSITY OF DELHI
NORTH CAMPUS

FIELD REPORT
(2011 – 2012)

MEGHA AGGARWAL
MA PSYCHOLOGY, II-SEM
Under the supervision of Prof. Ashum Gupta
Submitted in Fulfillment of partial requirement of Masters Degree in
Psychology
 CERTIFICATE

This is to certify that Megha Aggarwal has successfully completed the prescribed period of field training
for Partial fulfillment of Masters of Arts Degree in Psychology under the supervision of Prof. Ashum
Gupta (Professor, Department of Psychology) at Delhi Psychiatry Centre, New Delhi. The report
submitted is original & has not been submitted in part or full for any Diploma or Degree in this or any
other University.

Prof. Ashum Gupta Prof. Anand Prakash

(Internal Supervisor & Professor (Head of the Department,

Department of Psychology, Department of Psychology,

University of Delhi) University of Delhi)

Megha Aggarwal
 (Student, M.A. Psychology)

TABLE OF CONTENTS

Introduction about Delhi Psychiatry Center SECTION I

Cases Observed

Case1 : Case History of Attention Deficit

Hyperactive Disorder (hyperactive type)
SECTION II
Case2: Case History and MSE of Bipolar
disorder, Mania without Psychotic symptoms

Case3: Case History and MSE of Conduct

Disorder (confined to family) and Oppositional
Defiant Disorder (ODD)

Case 4: Case History and MSE of Paranoid

Disorder (?drug induced)

Case 5: Case History and MSE of Moderate

Depressive Episode with co-morbid
Claustrophobic Condition

Psychological Assessments observed SECTION III

My Personal Experience SECTION IV

Appendix
 SECTION- II

CASES OBSERVED
Following are the cases which I observed with clinical psychologists and MPhil interns at the
Delhi Psychiatry Center

CASE-1

CASE HISTORY

IDENTIFICATION DATA

Child’s name: Master Surya (name changed)

Age: 4 years, 1 month

Sex: male

Date of Birth: 2nd may, 2007

Child’s background: urban

Language spoken: hindi

Occupation: student of LKG

INFORMANT

Both mother and father of the index child accompanied him.

Father’s Age: 32 years

Educational Qualification: B.tech in electronics and communication

Occupation: manager in planning department

Income: 8 lacs p.a

Mother’s age; 31 years

Educational Qualification: MA Economics

Occupation: House-maker

Younger sister’s age: 4 months

PRESENTING CHIEF COMPLAINTS

Main problems of the child (as reported by parents)

 Difficulty in sitting at one place

 Fidgety and restless behavior
 Difficulties in concentration
 Stubborn attitude
 Aggressive behavior
 Periods of vomiting ( Mostly when scolded)

Onset and Duration : since childhood

Progress: deteriorating

PAST PSYCHIATRIC OR MEDICAL HISTORY

There was no past psychiatric illness or medical problem to the index child. Neither the child has
received any treatment
FAMILY HISTORY

Child lives in a joint family with parents and grandparents. Following is the family tree:

71 yrs retired MA English teacher

32 yrs B.tech in electronics. Currently manager in planning dept.

4 years old studying in LKG

Psychiatry: No past psychiatry history

Medical: No past medical history.

PERSONAL HISTORY

Early Development History

Mother’s mental health state was normal.

There were no complications during pregnancy.

Mother had bi-coronate uterus

Prenatal history
The child was delivered in the hospital

Pre-mature baby (born in 7th month)

Induced labor

Natural delivery

Neonatal history

Delayed birth cry

Incubated for first 18 days

Oxygen was given

Birth weight: 1.09 kg (underweight)

Unable to suck due to premature birth

Severe jaundice after birth (blood was changed)

Developmental history

Social smile in 4th month after birth

Head control in 6th month

Started sitting without support in around 8 months

Crawling in 9th month

No breast feeding because of inability to suck (doctor recommended spoon feeding)

Bottle feeding started in 6th month till 2 years.

Education History

The index child was 2 ½ years when was made to join play school at Ghaziabad where teacher
reported regarding the discipline. In April, 2011 was admitted in LKG in a convent school at
Ghaziabad.

Otherwise performed well in exams but had difficulty in coloring in the specific area and tracing
alphabet. Teachers’ used to complaint about difficulty in concentration and disturbing
neighboring children
PSYCHOMETRIC ASSESSMENTS FOLLOWED was SFBT with the child and Vineland
Social Maturity Scale (VSMS) and SNAP Check List with parents (The assessment was done by
child psychologist and the permission to observe the same was not given by the parents of the
child)

DIAGNOSIS: Attention Deficit Hyperactivity Disorder (Hyperactive type)

CASE: 2
CASE HISTORY

IDENTIFICATION DATA

Name: Ruhi Gupta (name changed)

Age: 25 years

Gender: female

Marital status: married

Educational qualification: graduate

Occupation: house maker

INFORMANT

Mother and elder brother accompanied the patient. The information provided by them was
inadequate and unreliable as the information provided by them is second-hand information
regarding patient’s in-laws house.

CHIEF COMPLAINTS

 Physically abusive towards mother and brother.

 Feelings of Restlessness

 Increase in appetite

 Frequently takes bath (4-5 times a day) and changes cloths often.
Onset: gradual

Duration: since march, 2011, excabbarate since past 1 month.

Progress: progressive and deteroiting

HISTORY OF PRESENT ILLNESS

The patient was asymptomatic till March, 2011, when her marriage was fixed. She was excited
and was enthusiastically involved in her shopping for marriage. During this, she would shop
aroung at different places and was spending excessively (i.e, going from lal quarter market till
Lajpat Nagar the very same day). Till May, 2006, on the day of her marriage, though she seemed
excited but all the rituals and functions happened normally. On the night of 7th May while she
was trying to make a conversation with her husband, she got irritable and angry as she felt that
her husband was not paying the required attention to what she was saying as he was busy
attending his phone calls, because of which the patient flushed her husband’s expensive his
phone cel phone. Husband became a little angry and tried to get back his phone when she again
flushed the phone by throwing a bucket full of water in the pot. According to the informant,
patient was normal till next 3 days. On 10th may, when the informant went to meet her, she was
over-excited and was showing her things (new cupboard, room etc). On the same night she was
invited to the husband’s maternal uncle’s home for dinner where she got offended as the
daughter in-law of the maternal uncle started conversing with her in English which she percieved
as a threat to her ego and then she started speaking irrelevantly and the content of her speech (?)
was marked by grandeous talk. She started banging on the table and on her return to home and
was restless followed by pacing throughout the night. On the next day, she was sent back to her
maternal home. The first three days were marked by patient being restless, pacing and agitated
with loudness in her speech and grandeous talk where she was talking about God and quoted
“quotes from the Geeta”. She would ring up her husband at 1am in the night but would become
agitated when he would deny to talk to her. Since 11th may till few days, patient’s parents noticed
increase in her religious behaviour as she used to collect all the idols of the god and godesses and
would lite two diyas each day. Patient’s mother also noticed two incidents where she was self-
talking. Since then her mother noticed increase in patient’s appetite and irrelevant behaviour like
tying knots of her dupattas, hiding everybody’s clothes, tying pillows together etc. As a result of
increase in her irrelevant behaviour her parents took her to Punjab for Faith healing but there was
no change in her behaviour. Since past 3 days patient’s family members have noticed that she
has become physically aggressive towards her family members, also there is excessive bathing,
repeated washing of hands and feet, changing of clothes several time, increased appetite with
both provoked and unprovoked aggression.

PAST MEDICAL OR PSYCHIATRY HISTORY

No past medical or psychiatry history of the patient.

FAMILY HISTORY

62 years old

38 years old married

Psychiatry: No psychiatric history in the family.

Medical: Patient’s parents are diabetic.

There was history of alcohol consumption in the family. Patient’s father consume alcohol (3-4
pegs daily)

PERSONAL HISTORY
(Prenatal history and childhood history could not be elicited.)

Education History

Graduate from Delhi University.

Completed a computer course from NIIT

Occupation History

Teacher in a primary school for 8-9 months (before marriage)

Now house-maker

PRE-MORBID PERSONALITY

The client was responsible, cheerful nature.

MENTAL STATUS EXAMINATION (MSE)

GENERAL BEHAVIOUR

General appearance: neat and tidy, adequate self-care, appropriate dressing

Attitude towards examiner: co-operative and appears to be interested

MOOD: Euphoric
AFFECT: Inappropriate

SPEECH: rate of speech was moderate, volume was audible and clear, flow was continuous
THOUGHT: Content of thought: pre-occupation about her marriage.
Form of thought: She was well connected throughout the conversation
PERCEPTION: no visual or auditory hallucination

COGNITIVE FUNCTIONS:

Consciousness: conscious

Attention and concentration: attentive throughout the session

Orientation: She was fully oriented to time, place and person.

Memory: Intact

ABSTRACT THINKING: Concrete

INTELLIGENCE: Seemingly average

JUDGEMENT AND REASONING: Concrete

INSIGHT: Awareness of being sick but she attributed it to physical factors (shivering of hands)
(Grade 3)

DIAGNOSIS: BIPOLAR DISORDER, MANIA WITHOUT PSYCHOTIC SYMPTOMS

CASE -3

Case History

IDENTIFICATION DATA

Name: Amit Mathur (Name changed)

Age: 17 years old, Adopted child

Gender: male

Educational qualification: 11th class passed

Occupation: student

Marital status: unmarried

INFORMANTS

Both the parents accompanied the child. The information was adequate and reliable as the
information provided by them is first-hand information.

PRESENTING CHIEF COMPLAINTS

 Aggressive

 Non-compliance to study

 Makes excuses for not going to school

 Threatens parents (by locking them in a room)

 Blackmailing behaviour

 Uses abusive words

HISTORY OF PRESENT ILLNESS

The index child was asymptomatic since 2004. In 2004, patient started becoming verbally
abusive and violent towards parents and teachers. Verbally retaliated with a teacher in class 5th
once. In 2005 the child was taken to the psychologist in Jhansi where certain psychometric
assessments were carried out (IQ test, Bhatia battery of Performance test and Koh’s Block
design) . Over the years his aggressive behaviour was present. In 2008 the child was made to
repeat the 9th class as adviced by a school teacher because of poor academic performance. For
this reason the patient crushed his father’s specs and stopped going to school from December
2008 to feb 2009. In January, 2009 the patient locked his parents in the room stabbed them with
blonde knife. On 25th January, 2009, he forced parents out of home. During this period he had
irregular sleep patterns, stays awake at night and sleeps during day. On 27th January the patient
was admitted to Mental Hospital Jhansi for 3 days during which he was provided counseling for
his problem. In april, 2009 the patient was admitted to boarding school (New Delhi). In july
2009 the child refused to school after coming back home for summer vacations. In August 2009,
the parents forcibly took him to hostel. There he was motivated by some teachers as a result of
which he scored 90 percent in half yearly and 63 percent in Xth CBSE boards. There was no
schooling since july 2010 to august 2010 and during this period the patient was threatened and
humiliated by his cousins staying in delhi for not going to school. In august 2010, the child was
made to join day boarding in the same school at New Delhi (Col. Satsangi Kiran Memorial
Public School). From January 2011 to February 2011, patient went to his hometown in jhansi
and again there was no schooling during which the patient was again bullied by his cousins
through text messages. March 2011, patient came to Delhi from jhansi to appear for class 11th
exams. After the exams he again went to jhansi where his mother was staying. After a week
patient again refused to come back to school. On 2nd July 2011, the patient was forcibly brought
to Delhi and was admitted in the current institute.

PAST MEDICAL OR PSYCHIATRY HISTORY

No past medical or psychiatry history of the patient

FAMILY HISTORY:
.

42 years old
currently
working in
Chandigarh

17 years old,
studying

Psychiatry: Mother has paranoid problem since 2000 and the medication is still on.

Medical: Father was diagnosed with heart problem (moderate positive TMT) in 2011.

PERSONAL HISTORY

Early development history

Mother’s fallopian tube was blocked

Small uterus as a result she could not bear a child

Prenatal history

It could not be elicited

Neonatal History

Birth place: hospital in Ajmer

Birth weight: 2kg

(as the child was adopted, only this much information could be elicited)

Developmental history
Physically weak when born

Normal weight gain

No breast feeding (was spoon feed with cow milk)

Childhood history

Since childhood patient made excuses for not going to school. He used to lock himself in the
toilet. Also during childhood patient once ran away from his home and was found the same day
after 10 hours in a nearby temple.

Education History

Studying in school. Passed class 11th this year.

Occupational history

Student

Alcohol and substance History

There was no history of alcohol consumption.

MENTAL STATUS EXAMINATION (MSE)

Since the child was brought forcibly to the institution therefore he was not co-operative for MSE
to be done. Later, he was admitted in IPD and was taken special care by nursing staff and
psychologists.

DIAGNOSIS: CONDUCT DISORDER (confined to family context) AND

OPPOSITIONAL DEFIANT DISORDER (ODD)
CASE-4

CASE HISTORY

IDENTIFICATION DATA

Name: Tarun Kumar (name changed)

Age: 28 years

Gender: male

Educational Qualification: Graduate, BCA

Occupation: student

Marital status: Unmarried

INFORMANT

The patient was accompanied by his elder brother.

CHIEF COMPLAINTS

 Lack of concentration during studies

 Suspicious about the fact that someone is following him

 Physically and verbally abusive

 Do not interact much within family.

 Most of the time stays alone

HISTORY OF PRESENT ILLNESS

The patient was asymptomatic before July 2010. In July 2010, the patient went from Ghaziabad to
Allahabad for civil coaching. There initially everything was going fine but soon the patient started feeling
suspicious about his classmates as well as teacher. He felt that they all are planning against him. This was
increased to the extent that he started voice recording whatever phone calls he gets. During this period the
patient goes through a relationship break-up which affected his study. In December, 2010 the patient left
Allahabad and came to Delhi. He did not used to study much, used to stay alone most of the times. Also
after coming back to Delhi the patient started feeling suspicious that someone follows him whenever he is
walking on the road (most probably some classmate from Allahabad).

ONSET: Approximately around September, 2010

DURATION: 10 months

PROGRESS: deteriorating

PAST MEDICAL OR PSYCHIATRY HISTORY

No past medical or psychiatry history of the patient

FAMILY HISTORY

50 years working in bank

28 years working in handloom

26 year graduate BCA
23 years working in air force

8 months

Psychiatry: There is no past psychiatry history.

Medical: Youngest brother has undergone a neurosurgery.

No alcohol and substance abuse history.

PERSONAL HISTORY

Prenatal history, developmental history and childhood history could not be elicited due to absence of
parents.

Education history

Completed graduation in BCA

Occupation history

Student

Alcohol and Substance use:

Alcohol consumption in 2008 for some months but now stopped.

Taking some unknown white colour tablets (as reported by the informant)

PREMORBID PERSONALITY

Good inter-personal relationships, was interactive, happy and religious.

MENTAL STATUS EXAMINATION

GENERAL BEHAVIOUR

General appearance: Neat and Tidy

Attitude towards examiner: co-operative

MOOD: sad

AFFECT: Euthymic

SPEECH: Pausity

THOUGHT: Content: Delusion

Form: thought insertion, Thought blocking

PERCEPTION: No visual or auditory hallucination

COGNITIVE FUNCTIONS;

Attention: attentive

Orientation: well oriented with time, place and person

Memory: intact

INTELLIGENCE: seemingly average

JUDGEMENT AND REASONING: concrete

INSIGHT: denial of illness (Grade 1)

DIAGNOSIS: PARANOID DISORDER (? Drug Induced)

CASE -5

CASE HISTORY

IDENTIFICATION DATA

Name: Mrs. Kavita Bakshi (name changed)

Gender: female
Age: 51
Education: graduate
Occupation: housewife
Socio-economic status: upper middle class
Marital status: married

CHIEF COMPLAINTS:

 Avoids lifts and metro

 Avoids crowd and crowded places
 Fears locked doors where escape is difficult
 Weakness in the body
 Frequent crying spells

HISTORY OF PRESENT ILLNESS

As per the informant, the patient was apparently well 21 years ago where she encountered an
accident while she was pregnant and could not get out of a locked bus and symptoms such as a
heart palpitations, trembling , sweating and nausea were experienced. Since then the patient
started fearing closed places and locked doors. The treatment plan was started after one year of
this incident and the symptoms were persistently maintained. In 2011 February, the patient’s
mother expired and these symptoms were aggravated to frequent crying spells and a feeling of
weakness in the body.
 
PAST PSYCHIATRY OR MEDICAL HISTORY
The patient has been seeking treatment for anxiety and claustrophobia from past 20 years.

FAMILY HISTORY

60 years old

30 years old
28 years old

Psychiatry: No past psychiatry history

Medical: Patient’s mother hypertensive

PERSONAL HISTORY
Prenatal History
Normal delivery
Developmental History
All milestones were achieved in time
Childhood History:
Low self confidence and introvert
Education History:
Graduate
Occupation History:
Housewife
Substance use:
No substance use

PREMORBID PERSONALITY
Low self confidence, introvert ,average intelligence,  and doubting
 
 
 

MENTAL STATUS EXAMINATION

 
GENERAL DISCRIPTION:
Appearance: neat and tidy
Attitude towards examiner: friendly and co-operative
 
MOOD:  sad
AFFECT: sad and fearful
SPEECH:  audible, high pitch
 
THOUGHT: Content: preoccupation that door would be locked and she won’t be able to
escape.
Form-There was continuity in the thought.
PERCEPTION: No auditory or visual hallucinations
 
 
COGNITIVE FUNCTIONS:
Attention: easily aroused and sustained
Orientation:  oriented to time, place and person
Memory: - recent memory was intact
 
JUDGEMENT AND REASONING: functional
 INTELLIGENCE: seemingly average
 DIAGNOSIS:  MODERATE DEPRESSIVE EPISODE WITH COMORBID
CLAUSTROPHOBIC CONDITION
 SECTION IV

MY PERSONAL EXPERIENCE

“KNOWING is not enough; we must APPLY. WILLING is not enough; we must DO.”

- John Wolfgang Von Goethe

This is exactly how I felt about this summer field training experience. To say the least it was an
enriching experience which in my opinion has paved an excellent platform for me to progress on;
for I want to see myself as an effective clinical psychologist one day.

When I studied Abnormal Behaviour as a subject in my final year of graduation I had never
thought that it would interest me so much. Just one year and I was completely hooked on to this
field. This was the time when I decided I would intern at a place where I can increase my
understanding for disorders. Today I am extremely happy to say that this field training has
helped me to learn so much and also further narrow down my interest area in clinical psychology
i.e. working with children.

It has been four years since I have been studying psychology as a subject but never got the
chance to have a practical exposure of the same. But to apply the knowledge that I have just read
in books and to see the cases in reality was altogether a different experience. I felt I could
understand the concepts much better and remember the details about the disorders better than
when I used to read them only in books. The discussion of each case that I observed with the
clinical psychologist and psychiatrist further increased my conceptual knowledge of
psychological disorders which I have not even read in books.

Each day was a learning experience; each patient taught me something in a different manner.
One thing I would definitely like to mention which I learnt during my field training was virtue of
patience. I remember I was asked to sit in the session of a 4 years old boy and his parents who I
was told was suffering from ADHD. I sat with the child psychologist, Esha Manchanda, and for
the first 15-20 minutes that kid didn’t let me hear anything what mam was instructing to his
parents. I kept on telling the child to sit, do this, don’t do that, only to later realize that by doing
so I was giving him all attention that he wanted and thus may be aggravating his behaviour. I
hereafter learnt how such children had to be handled. Some cases arouse lot of emotional
sympathy within me especially of a patient who was suffering from Bipolar disorder, Mania
without Psychotic symptoms. It was heart rendering to hear her story and see her condition. I
remember I almost had tears in my eyes, but thereafter Dr. Mitali told me that its very important
to and good to get affected by the feelings of the patients. It would help to understand the patient
better but one should not involve in a way that spoils the therapist-patient relationship. Apart
from this I also gained a lot of experience on how to take and write case histories which I have
never been taught before.

The team at the clinic was extremely cordial, cooperative and skilled. Everyone was very
welcoming and soon I was part of the team. Dr. Mitali Shrivastav who was my supervisor is an
effective therapist who not only follows all skilled at handling patients of all kinds who were
suffering from a severe psychiatric ailment. Her professionalism inspired me beyond words. The
first day she made me feel very comfortable and asked me to observe everything that was going
on and make as many notes as possible. Whenever I used to make mistakes, she always took a
role of a teacher and make me understand everything from the crux (without paying much heed
to the fact that I was a post-graduate student). She also made it very clear that everybody has to
be on time i.e. at sharp 9’o clock in the clinic. So last but not the least I also learn to be punctual.

In sum, it was a brilliant experience. It has cultivated in me seed of grasping as much as I can
about the subject. I am planning to work again in the same clinic during my winter break and
wish to further deepen my knowledge as much as I can. I believe these experiences are essential
for my growth, both as a person and as a psychologist.
APPENDIX
 ACKNOWLEDGEMENTS

This report will be incomplete without a proper acknowledgement of the debt to many persons
who made it possible.

First of all, I would like to express my sincere gratitude to Professor Dr. Ashum Gupta, my
internal supervisor for always giving me guidelines on what to expect and how to successfully
make most out of my field training. It was a great opportunity for me to learn from mam not only
about psychology but also about life and how to approach the patients and it will serve as a
foundation of my career.

Secondly, I am indeed indebted from the deepest depths of my heart to Dr. Sunil Mittal head of
DPC, my field supervisor Dr. Mitali Shrivastav and all other psychologist and psychiatrist in
DPC for teaching me so much and for being so warm always. Also I would like to thank all the
patients whom I worked and interacted within DPC. They reflected my shortcomings. They were
the source of my personal growth and experience in practical discipline.

However, this field training would not be complete without the special mention of my family-
Mummy, Papa and my younger brother and sister; and my dear friends Naina Kapoor, Varun
Tuteja and Swati Gupta. All my love and thanks to them for their continuous and unconditional
support in accomplishing this task

Above all, I would like to thank God, for blessing me, and for giving me strength and being a
continuous support to my life.

SECTION- I
 ABOUT DELHI PSYCHIATRY CENTER

DELHI PSYCHIATRY CENTER

This centre is associated with Cosmos Institute of Mental Health and Behavioral
sciences(CIMBS) .CIMBS is an integrated system of psychiatry, rehabilitation, hospital, and
community care through Delhi Psychiatry Centre ,Certified psychiatry facility Licensed under
the Mental Health Act 1987 , well as multi –specialty Cosmos Hospitals.

The team comprises of psychiatrists, clinical psychologists, social workers, counselors and
nurses, under the senior psychiatrist Dr.Sunil Mittal.

This institute provides a range of inpatient as well as outpatient services to address a wide variety
of mental health and behavioral issues. These include Depression , Mood Disorders, Addictions,
Eating Disorders, Child and Adolescent Mental Health Services, Stress Management,
Counseling, Sleep Disorders, Anxiety Disorders etc. other services include IQ and Aptitude tests,
Career counseling, Anti-Drug procedures, specialized Geriatric Psychiatric Services, Family
Therapy, etc.

More services also include rTMS, EEG, Biofeedback, Neuro-feedback, Sleep Lab studies and
Neuro –Cognitive Tests.

SERVICES

Repetitive Transcranial Magnetic Stimulation (rTMS)

DPC is equipped for Transcranial Magnetic Stimulation which is US FDA approved

(2008)treatment for depression. The role of rTMS in Auditory Hallucinations has been highly
significant as shown by various studies carried out all over the world.

rTMS is a non – surgical, non invasive, non – pharmacological technique where an

electromagnetic field , roughly the strength of an MRI scan , non – invasively passes multiple
pulses per second through the skull. These magnetic pulses stimulate the targeted areas of the
underlying brain tissue to produce therapeutic changes.

De-addiction Services
This institution’s de-addiction services include Alcohol and Drug de-addiction. The services
include Detoxification, Counseling and Rehabilitation.

Outpatient Services

The institute provides consultancy services through out patient settings. Wherein the team of
psychiatrists, clinical psychologists and counsellors deals with a range of issues under the
guidance of the senior psychiatrist Dr Sunil Mittal.

In-patient services

DPC also provides psychiatric care in the form of inpatient services. In addition to personalized
care, including nursing, and psychiatric counseling, patients are involved in variety of adjunctive
therapies including psycho-educational groups, relaxation techniques, recreational and activity
therapies.

PSYCHOLOGICAL SERVICES

 Services Rendered

This institute offers clinical evaluation and treatment services for various behavioral,
emotional and cognitive disorders. These are available in out-patient as well as in-patient
services.

 Psychological Evaluation

These include evaluations specific to the disorder with comprehensive ratings, diagnostic
evaluations, personality dynamics, neuropsychological assessments, and guidance
evaluations.

 Psychotherapy and counseling services

The institute also offers varied therapeutic services as Cognitive Behavior Therapy,
Supportive Therapy, Alcohol and Drug De-addiction, Rehabilitation, Hypnotherapy,
Stress Management, Crisis Intervention, Family Therapy, Marital Therapy and Child and
Adolescent Therapy.
  Cosmos Research :Department of Clinical Research

The Cosmos Research, where the clinical trials are conducted to collect the safety and
efficacy data for new drugs in psychiatry.

 Training /Internship Programs

The institute has training and internship program for selected candidates in associated
centers.

 Community Services

The centre also runs community project in village Gazipur.

STRUCTURE OF ORAGANIZATION
DPC consists of a building with three floors. The ground floor is for OPD services. The case
history taking, psychological assessments, rTMS and dealings with outpatients take place here.
The first floor is the multi-specialty Cosmos Hospital and the second floor is the IPD section.
IPD consists of seven rooms for the admitted patients, in which four of them are single bedrooms
and one with five beds. Also, there is an guard to control the gate .Usually the rooms are for the
inpatients, but many times they are used for the therapy, relaxation and psychological
assessments.
There is another building nearby which is centre for all the accountings and business issues of
DPC. Buying equipments, facilities and other useful material for the hospital is under the
responsibility of this section.

WORKING SCHEDULE
DPC works 6 days a week except for Sundays and the important holidays of the year. The
timings of OPD is from 9:00 am morning till 5:00 pm in the evening. The timings fir IPD is
24hours, and all 7 days of the week. For interns the schedule of working is between 9:00 am to
5:00 pm only Sundays are off.
The OPD days are Monday, Tuesday, Wednesday and Friday. The psychological assessments,
therapeutic sessions and the relaxation could be done in any of the working days. The OPD days
are for the new cases.
 
HIERARCHY AND SYSTEM
DPC consists of four psychologists and three psychiatrists and Dr Sunil Mittal, is the head of the
organization. There are interns in th centre from M.Phil, masters and even undergraduate
students .
M.A students usually collaborate with the M.Phil interns in taking case history of the new cases.
After the case history taking , the case is discussed with the senior psychologists and then the
discussion moves on to the Dr. Mittal . He will decide about the diagnosis and the intervention
processes. Within the collaboration of M.A students and M.Phil students, the latter ones have
more hands in psychological assessments, relaxation therapy and interpretation of the tests. The
CBT, Hypnotherapy, Counseling and other processes are done exclusively by the psychologists
and the interns are not allowed to attend.
Psychiatrists usually  are in the IPD  and their responsibilities are to prescribe the medicines of
the patients  and also to observe the effects of the medicines on the patients and change the
quantity or the type of medicine if they had excessive side effects or no progresses were
observed.
There are several nurses who give medicines to the patients and also they daily write down each
patients sleeping, eating and the activity records in the file of the patients. Nurses are assigned in
the shifts i.e. the day and night shifts.
 
As a intern our job was basically observation in the IPD settings, every day the IPD patients have
activity schedule which makes them engaged in various activities all through the day.
The first session is YOGA session at 10:00 to 11:00 am in which the yoga instructor teaches
various yoga and relaxation techniques to the patients as a part of the physical activity.
After the yoga session there is a prayer session from 11:00 to 12:00. The session in charge also
controls the play session from 12:00 to 01:00 pm in which the patients used to play various
indoor games like chess, carom ludo etc. many patients preferred drawing to do at that time.
After lunch at 01:00 pm, they were given time to rest. Then around 3:30 pm, there is a counselor
who takes the group counseling sessions.

SECTION- III
 PSYCHOLOGICAL ASSESSMENTS

Following are the assessments which I observed being administered on different patients by
psychologists or MPhil interns:

Beck Depression Inventory (BDI)

The Beck Depression Inventory (BDI) is a series of questions developed to measure the
intensity, severity, and depth of depression in patients with psychiatric diagnoses. Its long form
is composed of 21 questions, each designed to assess a specific symptom common among people
with depression. A shorter form is composed of seven questions and is designed for
administration by primary care providers. Aaron T. Beck, a pioneer in cognitive therapy, first
designed the BDI. The BDI was originally developed to detect, assess, and monitor changes in
depressive symptoms among people in a mental health care setting. It is also used to detect
depressive symptoms in a primary care setting. The BDI usually takes between five and ten
minutes to complete as part of a psychological or medical examination. A second version of the
inventory (BDI-II) was developed to reflect revisions in the Fourth Edition Text Revision of the
Diagnostic and Statistical Manual of Mental Disorders. Individual questions of the BDI assess
mood, pessimism and sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-
accusation, suicidal ideas, crying, irritability, social withdrawal, body image, work
difficulties, insomnia, fatigue, appetite, weight loss, bodily preoccupation, and loss of libido.

Sentence Completion Test

Herman Von Ebbinghaus is generally credited with developing the first sentence completion test
in 1897. Ebbinghaus’s sentence completion test was used as part of an intelligence test. Sentence
completion tests are a class of semi-structured projective techniques. Sentence completion tests
typically provide respondents with beginnings of sentences, referred to as “stems,” and
respondents then complete the sentences in ways that are meaningful to them. The test has
typically 40 incomplete sentences which the person is required to complete The responses are
believed to provide indications of attitudes, beliefs, motivations, or other mental states. There is
debate over whether or not sentence completion tests elicit responses from conscious thought
rather than unconscious states. This debate would affect whether sentence completion tests can
be strictly categorized as projective tests.

 
Rorschach Inkblot Test
The Rorschach inkblot test is a method of psychological evaluation. Psychologists use this test to
try to examine the personality characteristics and emotional functioning of their patients. The
Rorschach is currently the second most commonly used test in forensic assessment, after the
MMPI, and has been employed in diagnosing underlying thought disorder and differentiating
psychotic from non-psychotic thinking in cases where the patient is reluctant to openly admit to
psychotic thinking. There are ten official inkblots. Five inkblots are black ink on white. Two are
black and red ink on white. Three are multicolored. The psychologist shows the inkblots in a
particular order and asks the patient, for each card, "What might this be?”. After the patient has
seen and responded to all the inkblots, the psychologist then gives them to him again one at a
time to study. The patient is asked to list everything he sees in each blot, where he sees it, and
what there is in the blot that makes it look like that. The blot can also be rotated. As the patient is
examining the inkblots, the psychologist writes down everything the patient says or does, no
matter how trivial. The psychologist also times the patient which then factors into the overall
assessment. A common misconception of the Rorschach test is that its interpretation is based
primarily on the contents of the response-what the examinee sees in the inkblot. In fact, the
contents of the response are only a comparatively small portion of a broader cluster of variables
that are used to interpret the Rorschach data.

Thematic Apperception Test (TAT)

The TAT is popularly known as the picture interpretation technique because it uses a standard
series of provocative yet ambiguous pictures about which the subject is asked to tell astory. The
subject is asked to tell as dramatic a story as they can for each picture presented, including the
following:

 what has led up to the event shown

 what is happening at the moment
 what the characters are feeling and thinking
 what the outcome of the story was
If these elements are omitted, particularly for children or individuals of low cognitive abilities,
the evaluator may ask the subject about them directly.
There are 31 picture cards in the standard form of the TAT. Some of the cards show male
figures, some female, some both male and female figures, some of ambiguous gender, some
adults, some children, and some show no human figures at all. One card is completely blank.
Although the cards were originally designed to be matched to the subject in terms of age and
gender, any card may be used with any subject. Most practitioners choose a set of approximately
ten cards, either using cards that they feel are generally useful, or that they believe will
encourage the subject's expression of emotional conflicts relevant to their specific history and
situation.
The Standard Progressive Matrices (SPM)
The Standard Progressive Matrices (SPM) is a group or individually administered test that
nonverbally assesses intelligence in children and adults through abstract reasoning tasks. It is
sometimes called Raven's, although the SPM is only one of three tests that together comprise
Raven's Progressive Matrices. Appropriate for ages 8-65, the SPM consists of 60 problems (five
sets of 12), all of which involve completing a pattern or figure with a part missing by choosing
the correct missing piece from among six alternatives. Patterns are arranged in order of
increasing difficulty. The test is untimed but generally takes 15-45 minutes and results in a raw
score which is then converted to a percentile ranking. The test can be given to hearing and
speech-impaired children, as well as non-English speakers. The Standard Progressive Matrices is
usually used as part of a battery of diagnostic tests, often with the Mill Hill Vocabulary Scales.
The SPM is part of a series of three tests (Raven's Progressive Matrices) for persons of varying
ages and/or abilities, all consisting of the same kind of nonverbal reasoning problems. The SPM
is considered an "average"-level test for the general population.

High School Personality Questionnaire (HSPQ)

HSPQ is a personality questionnaire which evaluates 14 personality characteristics with in-depth

self-report inventory. The High School Personality Questionnaire (HSPQ) addresses Warmth,
Intelligence, Emotional Stability, Excitability, Dominance, Cheerfulness, Conformity, Boldness,
Sensitivity, Withdrawal, Apprehension, Self-Sufficiency, Self-Discipline, and Tension.

HSPQ is useful in predicting and understanding human behavior. It is an effective tool for
adolescents with behavior problems. The administration takes about 40-45 minutes.

State-Trait Anxiety Inventory (STAI)

The STAI was developed by charles D spielbregs. The STAI Form Y is the definitive instrument
for measuring anxiety in adults. It clearly differentiates between the temporary condition of
“state anxiety” and the more general and long-standing quality of “trait anxiety”. It helps
professionals distinguish between a client’s feelings of anxiety and depression. The inventory’s
simplicity makes it ideal for evaluating individuals with lower educational backgrounds. Adapted
in more than forty languages, the STAI is the leading measure of personal anxiety worldwide.
The essential qualities evaluated by the STAI-Anxiety scale are feelings of apprehension,
tension, nervousness, and worry. Scores on the STAI-Anxiety scale increase in response to
physical danger and psychological stress, and decrease as a result of relaxation training. On the
STAIT-Anxiety scale, consistent with the trait anxiety construct, psychoneurotic and depressed
patients generally have high scores. It can be used for Psychological and health research, Clinical
diagnosis, Differentiating anxiety from depression, Assessment of clinical anxiety in medical,
surgical, psychosomatic, and psychiatric patients.
Yale Brown Obsessive Compulsive Scale (Y-BOCS)
The Yale–Brown Obsessive Compulsive Scale, sometimes referred to as Y-BOCS, is a test to
rate the severity of obsessive–compulsive disorder (OCD) symptoms.
The scale, which was designed by Dr. Wayne Goodman and his colleagues, is used extensively
in research and clinical practice to both determine severity of OCD and to monitor improvement
during treatment. This scale, which measures obsessions separately from compulsions,
specifically measures the severity of symptoms of obsessive–compulsive disorder without being
biased towards the type of obsessions or compulsions present. In general the items depend on the
patient’s report; however, the final rating is based on the clinical judgement of the interviewer.
Before starting the administration patient is told the difference between obsessions and
compulsions.
The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme
symptoms). The scale includes questions about the amount of time the patient spends on
obsessions, how much impairment or distress they experience, and how much resistance and
control they have over these thoughts. As well, the same types of questions are asked about
compulsions (i.e., time spent, interference, etc). The results can be interpreted based on the score