PSYCHODAIGNOSTIC CASE 2

Case History
Socio demographical details
Name - Mrs. Y
Age - 24 years old
Sex - female
Marital status - Married
Address - kasana , Greater Noida
Occupation - Housewife
Education - Graduate
Religion - Hindu
Family structure - nuclear, rural family
Socio-economic - Middle SES status
Date - 07/03/2022
Referred by - GIMS Psychiatry
Patient ID - 93053

Informants
Relationship with the patient: patient herself and Husband
Reliability and adequacy: Reliable and adequate
The informants are concerned about the illness and were able to give consistent, coherent
account of the illness in the chronological orders and hence are considered as reliable
informants.

Presenting Chief Complaints

According to the patient-
● Sadness “mera kuch bhi krne ka maan nhi krta hai or maan bhot udaas rhta hai”
● Decreased Activity level “kuch bhi ghar kaam karne ka maan nhi krta hai
● Decreased Libido “mere andr se sex ki ichha hi khatam ho gai hai”
● Hopelessness “sab kuch khatam sa ho gaya hai ab kabhi bhi kuch bhi theek nahi
hoga”
● Disturb sleep
3 months
 ● Diminished appetite
● Fatiguability
According the informants-
● Decreased social Interaction “chup chaap rhti hai or kahi aati jati bhi nhi hai”
● Sadness “din bhar bethi rhti, na jane kya sochti rhti hai”
● Decreased activity level “ghar ka kuch kaam bhi nhi karti hai”
Onset Insidious
Course Episodic
Duration 3 Months
Episode Fifth Episode
Precipitating factor changes in medicines.
Maintaining Factor inability to develop inadequate sexual relationship with her partner.
History of the Present Illness
The patient was apparently well adjusted to the environment and functional 4 months back
while on psychiatric medication. Mid November 2021 the patient was able to perform
adequately on the medications which she was taking prescribed to her. According to the
patient when the doctor changed the mediacies she gradually started facing loss of libido, she
said “mere andar se sex ki ichaa hi khatam si ho gai hai”. Because of which she started
consistently thinking about inability to perform sexual activities and started feeling sad
because of loss of libido “mera maan bohot udas rheta hai or na hi kisi se baat krne ka hi
maan krta hai.”further her interest in day to day activities also decreased. she was not willing
to do her regular task also. As per the patient “mera kuch bhi kaam krne ka maan nhi krta ghr
ke kaam tak nhi kr pati hun.”
The patient observed these changes when she found herself that she is unable to maintained
her daily routine such as bathing, eating food, maintaining her hygiene level and decreased
social interactions. according to the patient “mera kisi se baat krne ka maan nhi krata phle
main aas pados main jaakar sab se baat krti thi pr ab main ghar se bahr nhi jati”
consequently, the patient developed fatiguability the patient stopped her household works and
unable to do her house hold work properly. “Mein yahi sochti thi ke leti rahu bass, koi mujhe
kuch na kahe”, “mujhse ghar ka kaam bhi nhi hota” further she reported that she faced
difficulties in falling asleep “theek se so bhi nhi pati hun bohot der baad jakr neend aati hai.”
In January 2022 the patient had an argument with her mother-in-law and got excessively
upset due to the argument and her condition got worsen. As per the patient’s husband
“mummy se ladai ke baad udas rhe lagi, khoi khoi rhen lagi jabki itna kuch hua bhi nhi tha”
further her husband also reported that she was being overly emotional over the pity issues
“kuch bhi khta to rone ko ho jati or muh phula kar beth jati haar dafa or ab to aisa hi chlta
rhta hai” and he also reported she was unable to do her house hold works and decreased self-
care routine "ye din bhar choti choti baton par roti rhti hai or ghar ka kaam bhi nhi kar pati
hai or na hi apna dhyaan rkhti hai, yha tak ki nahne ko bhi isska maan nhi hota hai” he also
reported that she lost her interest in the people round her “isska aas pass ke logo par or
chizo par dhyaan hi nhi rhta hai na kisi se baat krti hai na kisi se milti jhulti hai” the
patient’s condition deteriorated as reported by the husband “ye ab bilkul bhi bed se nhi uth ti
hai kuch kaam nhi krti yaha tak ki kbhi kbhi mujhe bhooke hi office jana padta hai, ghr main
saaf- safaibhi nhi hoti na hi koi saman kharedne hi bahr jati” According to the patient’s
husband this behavior was persistent most of the days.
Further, the patient started to believe that there is not much scope of improvement in her life
she reported “ab sab kuch bekar ho chuka hai, kabhi bhi kuch bhi theek nhi hoga mujhe
humesha dawaiyon pr hi jeena padega” according the patient sleep cycle has also disturbed
she took 6to 8 hours sleep earlier but now she is sleeping only 3 to 4 hours. As per the patient
“phle ke mutabik neend kam hai ab sirf 3 ya 4 ghanta hi so pati hun” she also said “khana
khane ka maan bhi nhi hota hai, kbhi kbhi bina khaye pura din bhi ho jata hai ” her appetite
also diminished she had three chapati in each meal but now, she is having only one chapati
in her each meal. Along all these things the patient lose her weight markedly and her sleep
cycle also worsen, she started wake- up early in the morning as reported by the patient “main
theek se so nhi pati hun ek baar aakh khulne k baad neend nhi aati hai or subha main bhi jldi
aankh khul jati hai par uthene ka maan hi nhi krata hai”
In March2022 She started to remain her own room constantly, She consequently started to
give intense emotional responses to any criticism by the family members and others. the
patient complains of loss of interest in people around her. she was discouraged and developed
a feeling of worthlessness due to loss of libido “main bohot bekaar hun main ab kisi ko bhi
khush nhi rkah pa rhi hun, na hi apne husband ko” she further said “mere andar feeling hi
nhi aati hai main bohot pareshan hun” this time the patient experiences reduced time of
sexual intercourse, loss of interest in performing intercourse with accompanying feelings of
worthlessness in basic components of her life. the patient complains of having difficulties
getting herself out of the bed. “mera bed se uthne ka maan hi nhi krta hai body main energy
hi nhi rhti hai yha tak ki ghar ki ssaf- safai bhi nhi kr pati himaat hi nhi hoti”
These disturbances occurred thought the day on regular basis leading to marked inability to
carry out his daily routine. Currently, patient’s biological, psychological socio-occupational
and functioning has been disturbed. The relationship with her family has been disturbed thus
she has consulted GIMS Psychiatry OPD.
Negative History
• No history of clouding of consciousness, any head injury, infections, epilepsy, or
metabolic disorders.
• No history of elated and elevated mood
• No history of any major medical condition.
• No history of alcohol or drug abuse/dependence.
• No history of irrational fears, suspiciousness.
• No history of hearing voices, seeing things.
• No history of recurrent involuntary, intrusive distressing memories of a traumatic
event.
Past Psychiatric and Medical Illness
Psychiatric history –
The first episode occurred 7 years back in 2016 when the patient had a fever In 2016 due to
this the patient became very weak and thin. According to the patient at that time the patient
decreased social interaction also reported that she stopped leaving the house (social
withdrawal). according to the patient due to being too slim people started making fun of her.
After all these things the patient started having a lot of anxiety and stress, thoughts of
unworthiness associated with tension and excessive thinking about her future. During this
time the patient experienced disturbed sleep, sadness of mood, low self-esteem.
The second episode occurred in end of the December 2016 the patient started having
disturbance in sleeping from October to December. due to this she also started feeling
anxious, overtalkativeness, elevated mood and decreased need for sleep, and also had disturb
appetite. According to the patient people started taking about her “Ye pagal hai”, “isska
dimag khrab ho gya hai” etc. Further her parents took her for superstitious treatment. the
patient reported she wasn’t able to handle the stress, so she decided to end her life she
attempted suicide by poising herself . After consumption of the poison her family member
took her to the hospital immediately. Then, she visited from GSVM Medical College and
associated hospital Kanpur in January 2017 after being advised by the villagers of her mental
illness. The patient received medication for the same and was maintained well.
Third episode occurred In January 2019, the patient was maintaining well on psychiatric
medications. The patient got infatuated towards a male, to which her parents were completely
against. She was forced to remain confined at home by the family members. Her social
interaction was reduced, even her family members boycotted her. Due to this patient started
facing symptoms like, Headache; loneliness; loss of interest in pleasurable things
overthinking; disturbed appetite and sleep. As per the patient she also reduced her weight
markedly.
Fourth episode occurred In august 2020, according to the patient there was a pause in the
medication due to lockdown which led to increase patient headache; irritable mood; increased
activity level ‘‘mujhe gandagi dekh ke bohot chidhan hoti thi, “mera ghar main maan
ghabrta tha” ‘main baar baar safai krti thi, gandagi na hone par bhi’ increased
talkativeness, increased energy levels; reduced self-care; irritation because of hygiene;
feeling emotional on silly things; . whenever her family members tried to communicate with
her she showed aggressive behavior towards her family members. “mujhse koi kuch bhi
samjhane ki koshish krta to main chidh jati or mujhe bohot gussa bhi aata tha” In October,
the patient lost her voice. She was unable to speak and also increased above symptoms she
was immediately taken to the GSVM Medical College and Associated Hospital Kanpur.
The patient was maintaining well and well -adjusted to the environment on psychiatric
medication. The Fifth episode occurred in May 2021 the patient got married but did not tell
her husband about her illness and psychiatric treatment. she stopped her medication for short
period of time after her marriage. After 2-3 months of his marriage her husband gave the
resignation from the job. After resignation from the job the patient started feeling such as
overthinking, irritability, disturbed sleep reduced need for hunger, big talk, hypersexuality,
excessive smiling, over talkativeness, reduced selfcare and was unable to do house hold
work. Further, after all these symptoms the patient again visited to Dr. Ganesh Shankar.
After that the patient started medication again for the same.
November 2021 sixth episode occurred when the psychiatrist changed the medicines she
pause her medication herself because she was facing sleep disturbance mujhe dwaiya khaa
kr neend aane main bohot dikkt hone lagi thi to mene ek dwai ko bnd kr diya tha” then the
patient started facing symptoms such as loss of Libido, sadness, decreased need for sleep,
loss of interest in people around her and reduced energy level, started overly emotional on
silly things, diminished appetite and fatigability thus visited to the GSVM Medical and
Associated Hospital Kanpur for the same.
Treatment History
Past treatment
The patient first stared her psychiatric treatment in 2017 January from GSVM Medical
College and Associated Hospital Kanpur.
Current Treatment
The patient was bought to GIMS Psychiatric OPD. On 07/03/2022 with the chief complaints
of loss of libido, sadness, fatiguability and disturb sleep and appetite continued taking
treatment from there Tab Olanzapine 2.5mg., Tab elizolam 0.25mg. in the current date the
patient is taking only Tab olanzapine 5mg.
Family History Family Tree (Genogram)

55 years 50 years

22 years 20 years
26 years 24 years

The patient is 24 years old, belonging to a middle SES, Hindu, nuclear rural family currently
residing at Kasana Greater Noida, U.P. on rent with her husband only. The patient father is a
farmer and mother is homemaker. The patient is eldest sibling among the three and has
younger brother and sister. As per the patient the patient had conflict with her family. She
does not have any special bound in her family too. The patient is married from the past one
year. There is no significant history of Major psychiatric illness in the family.
Family Dynamics
The family’s current social situation is good. They follow healthy communication pattern.
All the major decisions are made by the head of the family (i.e., his husband). However, the
patient reported that she has cordial relationship with her husband and also a special
connection with her husband. The patient does not live with her in-law’s because she cannot
cooperate with them also she has many conflict with her mother-in law. The interpersonal
relationship with in-law’s has been disturb but the interpersonal relationship with her husband
is good. The family’s attitude towards patient’s illness has been adjusting and cooperative.
Personal History
Perinatal History: could not be elicited.
Developmental History: could not be elicited.
Childhood History:
the patient is brought up by both the parents. Maternal deprivation could not be observed the
patient was cheerful and talkative person since her childhood she had many friends she used
to play with them.
Educational History:
The patient took admission directly from the 1 st class. The patient started her formal
schooling at the age of 4 years and did her intermediate at the age of 17. Then She took the
admission for her graduation in Janta Mahavidhyalya (Ghatampur) Kanpur and completed
her graduation with 2nd division from the same college. According to the patient she was an
average student. The relationship with his peer group was good she also like to participate in
extra-curricular activities. She enjoyed playing with her friends.
Occupational history:
The patient is housewife.
Religious History:
The patient is religious. She went to temple for worship on regular basis but the patient is
unable to do worship since few months as per the patient “Mein bhagwan ji ko manti hun par
main kuch samaye se mandir nhi ja pa rhi hun”
Sexual and marital history:
Marital History -The patient has been married from the past one year. It was an arrange
marriage with the consent of both the partners. The patient had good marital relationship with
her husband both the partner understands each-others and accept each-others and respect each
other’s decisions. There had been no report of any conflict and disagreement among the
partners.
Sexual relationship- Initially the sexual and marital relationship was good and satisfactory.
However, the patient reported that she is being sexually inactive from the past few months. it
has been disruptive because not able to perform adequately sexual activities and unable to
maintain the physical relationship with the husband which is a cause of deep concern for the
patient. Currently, the patient is dissatisfied with her sexual life. The patient herself added
that she herself avoids being in physical relationship with her husband. However, the husband
understands that the patient is suffering and having problems. So, the marital relationship is
not being hampered by the patient’s inability to maintain active sexual relationship with the
husband.
Alcohol and Substance History: No history of alcohol and substance use.
Premorbid Personality (PMP)
The patient was extroverted and social, always finding opportunities to make friends. She
was not close to anyone in her family. She had many friends and she enjoyed to paly with
them. Her predominant mood was cheerful. According to the patient she was a moody type of
person she did thinks as she liked and in her leisure time she used to play with her friends, did
her household works and liked to reads the books some times. Her attitude towards others has
been caring and supportive. The patient respected elders around her and helped family
members in doing small household chores. The patient was a irresponsible child. The patient
believes in God and respects the socially acceptable norms.

Mental Status Examination (MSE)

A) General Appearance and Behavior: The patient was of mesomorphic built, well-
groomed and dressed neatly. She was appropriately dressed according to the weather
and culture. However, the patient was getting emotional (crying) in very first session.
Otherwise, She was sitting in comfortable manner and was making less eye-contact.
Her attitude towards the examiner was cooperative and showed willingness to
interact. Initially, the rapport with the patient could be established with ease.
B) Psychomotor Activity: slightly decreased
C) Speech:
Rate – Normal
Tone - Normal
Volume – Normal
Pitch - Normal
Pressure of Speech – Normal
Reaction Time - Normal
D) Mood & Affect:
Mood: sad
Affect: “abhi aap kse mehsoos kar rhi hain?”
Subjective: “main bohot paresh hun low mehsoos kr rhi hun”
Objective: dysphoric
Range: restricted
Lability: Stable
Congruity: Congruent
Appropriateness: Appropriate
E) Thought:
Flow - Normal
Form - No presence of any Formal Thought Disorder (FTD)
Content - Questions: Ap adhikhtar samey kis cheez ke barein mein sochtey hai?
Answers: “main humesha yhi sochti rhti hun ki main bilkul bekaar hun , ab kabhi
kuch thik nhi ho payga”
Impression – pessimistic thought and hopelessness could be observed.
F) Perception: No perceptual abnormality could be observed
G) Cognitive Functioning:
Orientation to:
Time
Place Oriented/Intact
Person
The patient could tell the time, date, day and; present location and city; and could identify
people around himself.

H) Memory:
Immediate – slightly impaired
Digit Forward - Intact (Numbers given - 5,9,3, Response given – 5,9,3, 6743- 6743)
Digit Backward – Not intact (Numbers given -3,7,2, Response given- 372
4,1,7,3 Response given -3413)
Recent- Intact
The patient was asked to repeat three words watch, spoon and car what did she have for
dinner yesterday and breakfast today.
Response: watch, spoon and car
Response: “aaj subha aalu gobhi ki sabji or roti khai thi”
Remote: Intact
The patient was asked marriage anniversary date and Place.
Response: 13/may 2021
The patient was able to recall her marriage anniversary date and place.
Attention and Concentration: could be aroused but couldn’t sustained
Calculation - Serial subtraction of 3’s from 40
Response – 47,42………….
J) Abstract Thinking: Slightly impaired
The patient was asked the proverb “similarities between apple and orange”.
Response: ‘dono gol hote hain’.
The patient was asked about the similarity between the light and fan.
Response: ‘pankha chalta hai tubelite jalti hai’
K) General Intellectual Ability: impaired
The patient was asked few general questions such as: how many colors are in the national
flag?
Response: “mene kabhi usspr gour nhi kiya”

Judgment:
a) Social Judgment – Intact
The patient was asked on a formal gathering with school friends how will the patient react?
Response: “sab se baat cheet karenge khaynge peeynge bhot maza karenge hum”.
b) Test Judgment - Intact
Question asked: 1) If there is a fire in the next room what will you do?
Response: - ‘khud ko bachane ki koshish karenge’.
c) Personal Judgment – intact
stamped envelope containing money what will you do?
“agar usspar pata likha hai to hum use usske pate par waps bhejenge”
Insight: Grade- 4/6 (awareness of being sick, due to something unknown in self)
Question: Kya aapko lagta hai aapko koi maansik bimari hai? Aapko kya lagta hai ye kis
vajah se hai?
Answer: “mujhe lagta hai ki mere pass dimag nhi hai main pagal hun, mujhe dwa ki jarurat
hai lekin mujhe dwai kha kr aaram ho jata hai”
DIAGNOSTIC FORMULATION
The patient Mrs. Y, 24 years old, female, R/O kasna, Greater Noida, belonging to middle
socio-economic status, nuclear, rural Hindu family was brought by her husband to GIMS
Psychiatry OPD with complaints of loss of libido, decreased activities level, sadness,
reduced ability to manage day-to-day routine, increased negative thoughts for future and
social withdrawal, disturbed sleep and diminished appetite with an insidious onset, episodic
course, with a time duration of three months, fifth episode, with no h/o alcohol or drug
abuse/dependence, no h/o elated and elevated mood, No h/o recurrent compulsive
acts/rituals, no history of irrational fears, suspiciousness, hearing voices and seeing things,
no h/o free floating anxiety or restlessness, no h/o intrusive distressing memories of traumatic
events, and significant findings on MSE of slightly decreased psychomotor activity,
depressed mood and pessimistic thought, poor abstract thinking, attention and concentration
problem was diagnosed as a case of Bipolar Affective Disorder, current episode of
moderate depression.

Provisional Diagnosis
According to ICD 11 – 6A60.4- bipolar type 1 disorder, current episode depressive, moderate
without psychotic symptoms.
According to ICD 10 - F31.3 bipolar affective disorder, current episode moderate depression
 Psychodiagnostics Assessment

Rationale of Assessments:
The patient had complaints of Sadness, Decreased Activity level, Decreased Libido,
Hopelessness, Disturb sleep, Diminished appetite Fatiguability thus there was a need to
assess the psychopathology and its severity. Further for effective management of the patient it
is essential to understand the interaction of intellectual functioning, personality and
interpersonal relations with the psychopathology of the patient. So, it was planned to assess
these four areas. Areas to be investigated-
 Intellectual and cognitive functioning
 Personality
 Psychopathology
 Interpersonal deficits

The purpose of conducting Bender-Gestalt Test II was to rule out the intellectual and
cognitive functioning of the patient. To assess the patient’s intelligence Wechsler’s Adult
Performance Intelligence test was used. For the assessment of personality objective and
subjective personality test were used. The objective personality test used was NEO- FFI to
elicit the information on personality traits. The projective techniques used for assessment of
personality included Rorschach Inkblot test and Draw-a-person test were conducted to gather
information on both the patient’s perceptual-cognitive world and inner fantasy world.
Thematic apperception test (TAT) and SSCT was conducted to elicit the patient’s feelings in
non-direct way and themes related to the patient’s personal life experience, associated
feelings and emotions and ways of thinking. To assess the severity of Depression HAM-D
was used.
Test Administered
● Bender-Gestalt Test II
● Wechsler’s Adult Performance Intelligence (WAPIS)
● Draw- a Person Test (DAPT)
● NEO Five factor inventory (NEO FFI 3)
● Rorschach Inkblot Test (RIBT)
● Sack’s Sentence Completion Test (SSCT)
● HAM -D

Test Behavior and Observation

The Rapport established easily with the patient. Attention could be aroused and sustained for
the desirable period of time. The patient was cooperative and comprehend all the instructions
adequately and attempted to perform appropriately on all the test administered.

Test Findings
Bender-Gestalt Test II The cognitive ability of the patient was assessed using Bender
Gestalt Test- II (BGT-II), and it was observed that his motor and perceptual ability was within
the normal percentile range which further indicate no involvement of any organicity in the
patient.

WAPIS –
The cognitive ability of the patient was assessed using Wechsler Adult Performance
Intelligence Scale (WAPIS-PR) on which the patient scored 98 which falls under the
category of Average Intellectual Ability.

Draw-a-Person Test
Observations on Indices
Drawing
Drawing opposite Strong attachment to or dependency upon
sex first parents or person of opposite sex.

Disheveled, low self-esteem

unkempt figure
Younger figure then Emotional fixation at age depicted or wish to
subject return to youth
Ear emphasized or Sensitivity to attitude of others
enlarged

Arms thin, weak Lack of achievement

Eye emphasized Externalized aggression

Large eyes, no pupil Tendency with guilt

Straight lines Aggressiveness

Unbroken Isolation
reinforced line
outlining figure
Features child like Infantile social behavior
 Arms extended from Difficulty in social contact, fear of aggressive
body and overlong impulses
Profile head and Poor judgement
legs, full face trunk

Inadequate detailing Depression, lack of energy, withdrawal

tendency

Opposite-sex figure Opposite sex viewed as more powerful

larger
Button in middle Maternal dependency
Shoulders squared Aggressiveness

Hair emphasized Infantile or regreased sex drive, sensuality or

sensual need

The finding of DAPT revealed that the patient has dependency, low self-esteem,
repression of feelings, sense of lack of achievement, overt aggressive tendencies,
depressed mood, lack of impulse control and energy and, maternal dependency, poor
judgement, tendency with guilt and withdrawal tendency also has guilt tendency.

Sentence Completion Test (SSCT)-

On SCT, the principal areas of conflict identified are people with people supervised,
fears, guilt feeling, own ability, past life and heterosexual relationship. The finding
indicate that the subject seems to hold negative attitude towards her own ability, past
life, fears, self- guilt, future and her goals. She feels pessimistic view and wishes to
work hard to achieve her goal for her better future. She also holds ambitious view
regarding her friends, and family members. Also, she has fear regarding her goals and
abilities and experiencing guilt feelings over her past mistakes; however, she views
the future pessimistic.

NEO FFI3
Interpretation table-

Domain Neuroticism Extraversion Openness Agreeableness Conscientiousness

 Row score 24 28 27 30 27

t-score 52 48 46 44 41

Category Average Average Average Low Low

On the basis of above findings revealed that the patient has low score in Domain A and
Domain C. the low score on domain A indicates that disagreeableness, competitive rathe
then cooperative. On the other hand, low scores on domain C indicates that the patient is
more lackadaisical in working towards their goals.

Rorschach Findings --

Rorschach Findings
Indicators
Form (22 responses) The Rorschach protocol was indicative of average
production. The patient gave total 22 number of
responses which was indicative of presence of average
organization & Average level of cognitive functioning

High Animal High animal responses indicate Primitive thought pattern, poor
Responses (A%) adjustment, and pleasure-seeking behavior.

Popular responses Low response is indicative of and frequently depressed.

(Low)

Increased affective Indicated emotion dominated thinking and emotional

ratio (Afr=0.69) excitability. The patient’s actions are guided more by
how she feels than by what she thinks., in judgement
she thinks and acts impulsively.

Low: high form It Is suggestive of impulsive or aggressive behavior.

color ratio (0:2) Depicting that person has poor control over her
impulses and experiences satisfying interpersonal
relationships.
Blends The patient got only one bland which falls under normal
(low blend score:1) range for adults and its indicative of simplistic way to
look at situation.
 Processing Is indicative of depressiveness (withdrawn), when subject faces
(economy index) any threat from the external world.
low:high ratio of
W:D: Dd
Ideation A<P (2:6) Indicates that the subject feels helpless, looks towards outside
world for gratification, feels acted upon and is prone to
depression.

Introversive To satisfy her basic needs uses their inner experiences. She
Experience Balance may be less physically reactive having problem solving
(EB=6:2) approach as internalizing to the situations.

Interpersonal Indicates Most of the time the patient feels aloof, somewhat
cluster uncomfortable in social situations. and the patient’s sometime
COP=0 & AG=2 the patient shows aggressive and hostile in social situation. The
FD = 2 FD responses indicates of dependency behaviors.

The Rorschach protocol of the patient indicates Depression.

HAM D-
The score on HAM-D was found to be 15 which falls in the category of moderate level of
Depression.

Overall impression
 The assessment of cognitive and intellectual functioning using BGT and WAPIS
revealed that the patient cognitive functioning falls within the normal percentile range
and average level of IQ. The assessment of psychopathology using RIBT and HAM-D
releveled that the patient has features of Depression which falls under the category of
Moderate level of depression. The assessment of personality using NEO-FFI revealed
that the patient has gloomy pessimistic, Maladaptive, temperamental, under
controlled, lethargic and undistinguished personality traits.
 case formulation
ENVIOURNMENTAL
STRESSORS
VALNARABILITY
Inability to maintain adequate sexual
disturbed family
relationship with her husband
environment
Financial problems

DYSFUNCTIONAL
COGNITION
ACTIVATING EVENT
Hopelessness to future
Decreased Libido
pessimistic thought

PERSONALITY TRAITS
Lethargic
Temperamental
Pessimistic

AUTOMATIC NEGATIVE THOUGHT

SELF WORLD FUTURE

“Main kisi bhi chiz ke “Ye dunia bohot khrab hai majak udati hai ” “Kabhi kabhi lgta hai
layak nhi hun” main kabhi thik nhi ho
pangi.”

SYMPTOMS OF DEPRESION AND MANIA

SOMATIC
BEHAVIURAL COGNITIVE AFFECTIVE
Fatigability
Reduced work Low concentration Aggressive
productivity Negative sexual behaviors Reduced sleep
thoughts of loss of
Social withdrawal Low mood Reduced
libido
appetite
Feeling crying
Submitted By Supervised By

Vasundhara Dr. Shivani Pandey

MPhil Clinical Psychology Trainee Faculty, GBU
1st year Department of Psychology &
Mental Health