6

Case No: 1
(Neurotic)
(Major Depressive Disorder)
 7

Bio Data

Name: Gulfam

Age: 22 years

Gender: Male

Birth Order: 1st

No. of Siblings: 6 (4 Brothers, 2 Sisters)

Marital Status: Nill

No. of Children: Nill

Religion: Islam

Education: 6th Class

Occupation: Tailer

Social Economic Status: Middle Class

Residence: Hafizabad, FSD

Admission: 2nd

Informant: By Self
 8

Identification Factors:

Patient name is Gulfam. He is 22 years old and belongs to middle class family. He has 6
siblings. His birth order is 1st. He is living in joint family system.

Reason & Source of Referral:

Patient is referred by his parents due to his unusual state of health and admitted in
Psychiatry Department of District Head Quarter (DHQ) Faisalabad.

Presenting Complaints: Duration: 4 years

 Low Mood
 Disturb Sleep
 Disturb Appetite
 Irritable Mood
 Mutism (5 months)
 Negative Symptoms
 Aggression
 Muscle Weakness
 Neck Pain
 Dissociation in memory

History of Present Illness:

After 4 years ago, he was saw a girl. She looks like a black shadow and cover her full
body with black long hairs. She is very horrible in sight. His father will take him to one of his old
men (‫)بزرگ‬. Now he does not see again her. But now, he terrified that he will see again her.

Now his marriage was fixed with his cousin and he himself wanted her to be married. But
he says that I should not get married until I get well. He used to have wet dreams. Because of
which he felt that he was weak. He thinks that he is not marriageable.

During the days of illness when he saw first time a horrible lady. He starts mutism for 5
months. His parent’s report that he lay down on bed silently. He did not talk another person even
 9

with us. We thought it was very disturbing. His father’s report that his sleep and appetite
also disturbed.

Patient does not care of himself. He just lay down on bed and he did not care about
cleanliness.

Past Psychiatric History:

No significant past psychiatric history.

Past Medical and Surgical History:

No significant past medical and surgical history.

Family History:

Patient Parents are alive. Both father and mother are uneducated. He has 6 siblings (4
brothers and 2 sisters). His birth order is 1 st. The relationship of patient with his parents was good
and cooperative. But during the days of illness his relationship with his parents are not good. He
showed aggressive behavior with his parents.

Personal History:

Patient education is up to 6th class. He working at a tailor shop. He likes play cricket. He
is the eldest among the siblings.

Forensic History:

There is no significant forensic history.

Present Social Circumstances:

He lived in 4 Marla house. He lives in joint family system. He belongs to middle class
family.

Premorbid Personality:

Before his disturbed level of behavior, he was living normal life. His mental functioning
was normal. He was very responsible among her siblings. He was friendly and nice to people.
 10

Mental State Examination:

 Appearance: Kempt
 Behavior: Cooperative
 Talk: Normal
 Mood: Happy
 Thought: About discharge from hospital
 Perception: Normal
 Orientation: Present
 Insight: Present

Psychological Assessment:

Informal Assessment

 Behavioral Observation
 Clinical Interview

Formal Assessment

 Human Figure Drawing (HFD)

 Rotter Incomplete Sentence Black (RISB)
 Slosson Drawing Coordination Test (SDCT)
 Depression, Anxiety and Stress Scale (DASS)

Formal Assessment:

Human Figure Drawing

(HFD)
Qualitative Analysis:

DRAWING EXPRESSION
Acceptance of task with minimal protest Depression
Features primitive, tinny Schizophrenia, Regressed schizophrenia
Small features Anxiety
 11

Dim body line or no body line Compensatory

Dim features Withdrawal
Younger figure than subject’s age Immaturity
Hands drawn last Conflict over interpersonal relations
Small eyes Self-absorption, voyeuristic tendency
Heavy lines on mouth Passive, oral aggression
Neck omitted Immaturity, lack of impulse control
Weak arms over extended Dependency, Asthmatic, nurturance needs
Less than 5 fingers Dependency
Hands omitted Inadequacy, withdrawal
Trunk omitted Immature, primitive character structure, regression,
mental retardation, denial or repression of physical
drives (children as subject)
Head clearly indicated Feeling of anxiety or of inferiority relative to body
functions
Hands omitted Inadequacy, schizoid
Less long Needs for autonomy
Shoes shaded Insecurity
 11

Roter incomplete Sentence Blank

(RISB)
Quantitative Analysis:

Sr. No Responses Value No. of Responses Scored

1 Positive P1 = 2 P1 = 10 10 x 2 = 20
P2 = 1 P2 = 1 1x1=1
P3 = 0 P3 = 1 1x0=0
2 Conflict C1 = 4 C1 = 10 10 x 4 = 40
C2 = 5 C2 = 7 7 x 5 = 35
C3 = 6 C3 = 2 2 x 6 = 12
3 Neutrals N=3 N=9 9 x 3 = 27
4 Total = 135
 12

Qualitative Analysis:

Cut of Score: RISB score did not show the maladjusted behavior. The cut of score is 135 if the
score is increase from the 135 then they showed maladjusted behavior.

Family Attitude: Relationship with his family is good. RISB showed that patient attitude with
his parents is positive and very good. He loved his parents.

Social and Sexual Attitude: Social attitude is not clearly indicated but in sexual attitude patients
wants to be married.

Characteristics State: Patient hate the noise. Noise is become the patient aggressive. He thinks
that he does not doing powerful work. He wants to be a healthy person and he became married.

General Attitude: He has positive attitude. He likes play cricket. He upset when anyone does
not accept their opinions. He wants a healthy and be married.

Slosson Drawing Coordination Test

(SDCT)
Quantitative Analysis:

Total Score Error Percentage

36 34 2 94.44 %

Qualitative Analysis:

The score of SDCT is 94.44%. Patient has perfect hand-eye coordination.

 13

Depression, Anxiety and Stress Scale

(DASS)

Quantitative Analysis:

Depression Anxiety Stress

Score 9 Score 16 Score 21
Range 0-9 Range 15-19 Range 19-25
Category Mild Category Severe Category Moderate

Qualitative Analysis:

 Depression:

DASS result showed that patient has mild level depression.

 Anxiety:

DASS result showed that patient has severe level anxiety.

 Stress:

DASS result showed that patient moderate level stress

Informal Assessment:

Behavioral Observation:

The patient was clean. He was talking very well but his mood was too low. He was little
scared. He was sitting quite comfortably. His body postures showed that he was secure about
himself. His eye contact was good. His voice tone was low from normal.
 14

Clinical Interview:

His father reported that he showed aggressive behavior with his family. He stays in the
room alone. He also reported that he sees a girl who tells him to lie in the room and not worry
about cleanliness. And she comes and sits on my shoulders. She asks me to go out.

He says I am worried because of my weakness. I have wet dreams which make me weak.
I can’t lift heavy things. My body aches. I have pain in my shoulders and arms.

Tentative Diagnoses:

 Major Depressive Disorder

Recommendation:

 Psychoeducation
 Daily Activity Chart
 CBT
 Muscle Relaxation Therapy
 Deep Breathing.

Sessions

There are 4 sessions are held with patient.

1st Session:

In first session I build rapport and collect overall history and bio data from patient.

2nd Session:

In second session patient behavior is too much cooperative. Appearance was kempt.
Sleep and appetite were disturbed. Mood was normal. Thoughts were negative. Psychological
work has planned. In this session I talk with patient about its negative thoughts.
 15

3rd Session:

In 3rd session Psychoeducation is applied on patient and his family. Patient condition was
little bit improved. Behavior was cooperative. Appearance was kempt. Sleep and appetite was
little improved.

4th Session:

In this session patient’s conditions was little bit improved. Behavior was cooperative. He
was paying attention properly. He agreed all my conversation. Appearance was kempt. Sleep and
appetite were little improved. In this session I applied deep breathing and muscle relaxation
technique. This is my last session with patient’s.

Conclusion:

The patient’s has major depressive disorder. After diagnosing CBT suggest to overcome
his problem. After 4 sessions, the patient’s condition improved significantly. Patient thinking
significantly change in to positive thinking. At the end his sleeping pattern was improved. His
appetite has also improved. And depression level also reduced.
 16

Appendix I
17
18
19
20
21
22
23
24
 25

Case No: 2
(Psychotic)
(Bipolar With Manic Episode)
 26

Bio Data

Name: Muhammad Younis

Age: 35 years

Gender: Male

Birth Order: 1st

No. of Siblings: 6 (4 Brothers, 2 Sisters)

Marital Status: Married

No. of Children: 1 Daughter

Religion: Islam

Education: Primary

Occupation: Stitching

Social Economic Status: Middle Class

Residence: Chak no 182, FSD

Admission: 1st

Informant: By Self
 27

Identification Factors:

Patient name is Muhammad Younis. He is 35 years old and belongs to middle class
family. He has 6 siblings. Her birth order is 1st. He is living in joint family system.

Reason & Source of Referral:

Patient is referred by his brother due to his unusual state of health and admitted in
Psychiatry Department of District Head Quarter (DHQ) Faisalabad.

Presenting Complaints: Duration: 20 years

 Aggression
 Physical Aggression
 Grandiosity
 Low Sleep
 Talkative
 Excessive Talk
 Irrelevant Talk
 Low Mood

History of Present Illness:

The disturbances are started when the patient age was 15 years. In the beginning he was
just anger. Getting angry on small things. He was irritated. Getting angry at siblings, getting
angry at parents. Gradually his anger increased and he started hitting.

Now its too much talkative and irrelevant talk. He said that many famous people know me.

Past Psychiatric History:

No significant past psychiatric history

Past Medical and Surgical History:

No significant past medical and surgical history.

 28

Family History:

Patient’s father is alive and mother is died. His father gets second married. He has 6 step
siblings (4 brothers and 2 sisters). His birth order is 1 st. His relationship with his siblings is very
good. They also are very cooperative.

Personal History:

Patient is uneducated. He working in the factory in stitching department. He is eldest

among the siblings. He wants to be a successful person.

Forensic History:

There is no significant forensic history.

Present Social circumstances:

He lived in own1 kanal House. He lived in joint family system. He belongs to middle
class family.

Premorbid Personality:

Before his disturbed level of behavior, he was living normal life. His mental functioning
was normal. He was very responsible among her siblings. He was friendly and nice to people.
Patient has extrovert personality.

Mental State Examination:

 Appearance: Kempt
 Behavior: Cooperative
 Talk: Irrelevant, low pitch
 Mood: Happy
 Thought: Nill
 Perception: Normal
 Orientation: Present
 Insight: Absent
 29

Psychological Assessment

Informal Assessment:

 Behavioral Observation
 Clinical Interview

Formal Assessment:

 Human Figure Drawing (HFD)

 Rotter Incomplete Sentence Blank (RISB)
 Slosson Drawing Coordination Test (SDCT)
 Beck Depression Inventory (BDI)

Formal Assessment:

Human Figure Drawing

(HFD)

Qualitative Analysis:

DRAWING EXPRESSION
Acceptance of task with minimal protest Depression
Sex organ shown Schizophrenia
Disturbed symmetry Incoordination
Left side drawing Egocentric
Upper left corner drawing Regression
Combination heavy and firm lines Assaultiveness
Hand drawn last Conflict over interpersonal relations
Body distortions Psychotic tendencies
Bizarre detail Schizophrenia
Mouth omitted Asthmatic
 30

Neck omitted Immaturity, lack of impulse control

Arm and leg distortion Sexual role conflict or confusion
Cartoon figure and clown Adolescent with feelings of inadequacy and
rejection
No hands Assaultiveness, infantile aggression
Petal fingers Infantile traits, insecurity
Few curves many sharp edges Aggression tendencies, poor adjustment
 30

Rotter Incomplete Sentence Blank

(RISB)

Quantitative Analysis:

Sr. No Responses Value No. of Responses Scored

1 Positive P1 = 2 P1 = 8 8 x 2 = 16
P2 = 1 P2 = 4 4x1=4
P3 = 0 P3 = 0 0x0=0
2 Conflict C1 = 4 C1 = 10 10 x 4 = 40
C2 = 5 C2 = 6 6 x 5 = 30
C3 = 6 C3 = 1 1x6=6
3 Neutrals N=3 N=9 9 x 3 = 27
4 Total = 123

Qualitative Analysis:

Cut of Score: RISB score did not show the maladjusted behavior. The cut of score is 135 if the
score is increase from the 135 then they showed maladjusted behavior.

Family Attitude: Relationship with his family is good. RISB showed that patient attitude with
his parents is positive and very good. He loved his parents.
 31

Social and Sexual Attitude: Social attitude is not good. Patient think that most of the people
talk here and there. And sexual attitude is not clearly indicated.

Characteristics State: Patient hate the abusive language. Abusive language become the patient
aggressive. He is optimistic about his future.

General Attitude: He has positive attitude. He likes play cricket. He upset when anyone does
not accept their opinions. He wanted to be like his father.

Slosson Drawing Coordination Test

(SDCT)
Quantitative Analysis:

Total Score Error Percentage

36 32 4 88.88%

Qualitative Analysis:

The score of SDCT is 88.88%. Patient has perfect hand-eye coordination.

Beck Depression Inventory

(BDI)

Quantitative Analysis:

Score 24
Range 21-30
Category Moderate

Qualitative Analysis:

BDI result showed that patient has moderate level of depression.

 32

Informal Assessment:

Behavioral Observation:

The patient was clean. The mood was low. He was talked too much and do irrelevant talk.
He body postures showed grandiose personality. His eye contact was good. Some time feels that
he is angry. His voice tone low but he speaks frequently.

Clinical Interview:

His brother reported that he showed aggressive behavior with his family. He talks too
much. He showed strict behavior. He beat the little brothers and sisters.

Patients claims that he is totally fine. I don’t know why they call me crazy. My family members
say that I talk a lot. And they also said that I get angry but I only get angry about wrong things.
Every time they are wrong.

Tentative Diagnoses:

 Bipolar With Manic Episode

Recommendation:

 Psychoeducation
 Daily Activity Chart
 CBT
 Muscle Relaxation Therapy
 Deep Breathing

Sessions:

There are 4 sessions are held with patient.

1st Session:

In first session I build rapport and collect overall history and bio data from patient.
 33

2nd Session:

In second session patient behavior is cooperative. Appearance was kempt. Sleep and
appetite were disturbed. Mood was normal. Thoughts were negative. Psychological work has
planned. In this session I collect some more history from his attendant.

3rd Session:

In 3rd session Psychoeducation is applied on patient and his family. Patient condition was
little bit improved. Behavior was cooperative. Appearance was kempt. Sleep and appetite were
little improved.

4th Session:

In this session patient’s conditions was little bit improved. Behavior was
cooperative. He was paying attention properly. He agreed all my conversation. Appearance was
kempt. Sleep and appetite were little improved. In this session I applied deep breathing and
muscle relaxation technique. This is my last session with patient’s.

Conclusion:

Patient’s symptoms are matched with Mania. Patient contact with reality is disrupt. After
applied different techniques on patient the severity level of disorder is decrease. I tried to make
them better lives. The patient used to have a lot of anger, so I used anger management technique
to reduce it. At the end, the patient’s condition was much better than before.
 34

Appendix II
35
36
37
38
39
40
41
 42

Case No: 3
(Drug)
(Substance Used Disorder)
 43

Bio Data

Name: Sadaqat Ali

Age: 38 years

Gender: Male

Birth Order: 3rd

No. of Siblings: 6 (3 Brothers, 3 Sisters)

Marital Status: Married

No. of Children: 4 (1 Son, 3 Daughter)

Religion: Islam

Education: F. A

Occupation: Metal Workshop

Social Economic Status: Middle Class

Residence: Jaranwala

Admission: 1st

Informant: By Self

Drug: Opium

Cost: 1500
Quantity: 6 grams/day
 44

Identification Factors:

Patient name is Sadaqat Ali. He is 38 years old and belong to middle class family. He has
6 siblings. His birth order is 3rd. He is living in neutral family system.

Reason & Source Referral:

Patient was referred by himself due to his unusual state of health. Now he is admitted in
Fatima Ward.

Presenting Complaints: Duration: 5 years

 Aggression
 Irritation
 Body Ache
 Body Weakness
 Disturb Sleep
 Disturb Appetite

History of Present Illness:

Patient was reported with unusual state of health. He starts taking drugs from last 5 years
ago. He starts with three types of sleeping pills (Lexotanil, Nazi 2mg and Pronex 0.5mg) as a
drug. He also takes opium with cigarette. He taking these drugs because he wants get more
energy to do his hard work. The quantity of opium is 6 grams and the cost of opium is 1500 per
day. He was consistently using these all drugs without any gap. His last intake is 3 days ago after
he admit. Now he wants to quite this because he realizes that due to the usage of these drugs, he
is not capable live in society respectfully. And he also feels that he is not capable to take care of
his daughter.

Past Psychiatric History:

No significant past psychiatric history.

Past Medical and Surgical History:

 45

No significant past medical and surgical history.

 45

Family History:

His father and mother were died. He has 6 siblings. All are married and educated. He
lived in nuclear family system. The relationship of patient was good and cooperative with his
family and friend.

Personal History:

Patient birth was normal. All milestones achieved at age. Patient is 38 years old. His
education is F. A. He is married and has four children.

Forensic History:

There is no significant forensic history.

Present Social Circumstances:

Patient live in his own 5 Marla house. And all house expenses are mat by himself. He
belongs to a middle-class family.

Premorbid Personality:

His premorbid personality is introvert.

Mental State Examination:

 Appearance: Kempt
 Behavior: Cooperative
 Talk: Normal
 Mood: Normal
 Thought: ‫وہ یہ چیزہ چھوڑ کر صحیح ہو کر گھر واپس جاۓ گا اور اپنی بیٹیوں کی پرورش کرے گا۔‬

 Perception: Normal
 Orientation: Present
 Insight: Present
 46

Psychological Assessment:

Informal Assessment

 Behavioral Observation
 Clinical Interview

Formal Assessment

 Human Figure Drawing (HFD)

 Slosson Drawing Coordination Test (SDCT)
 Standard Progressive Matrices (SPM)

Formal Assessment:

Human Figure Drawing

(HFD)

Qualitative Analysis:

DRAWING EXPRESSIONS
Acceptance of task with minimal protest Depression
Left side drawing Egocentric
Large centered figure Manic tendency, paranoid grandiosity
Small features Anxiety
Faint lines Low energy, apprehensive neurosis,
depression, catatonics, chronic schizophrenia
Dim body line Compensatory defense
Dim features with emphasis on head contour Withdrawal
Younger figure than subject’s age Immaturity
Back to male figure to observer (male subject) Desire to be a woman, feminine identification
(men)
 47

Stand tight, rigid postures Schizoid, constriction, defensiveness,

defensive restriction of activity
Hand drawn last Conflict over interpersonal relations
Trim eye brows Disdain
Eye a dot with pressure, enlarged and Paranoid
emphasized eye
Nose cut off Castration fears and wishes
Single line mouth Passive and oral aggression, simple
schizophrenia
Thin neck Repression
Less than 5 fingers Dependency
Hands omitted Inadequacy, withdrawal
Square trunk Masculinity, aggressive tendencies, criticality
Arms dangling by sides Conception of self as dependent, helpless,
insignificant
 47

Slosson Drawing Coordination Test

(SDCT)

Quantitative Analysis:

Total Score Error Percentage

36 20 16 55.55 %

Qualitative Analysis:

The score of SDCT is 55.55%. Patient has defect hand-eye coordination.

 48

Standard Progressive Matrices

(SPM)

Quantitative Analysis:

Discrepancy -1, -1, 1, 2, 0 =1

Total score 37
Percentile 50%
Grade III +

Qualitative Analysis:

SPM score is 37 which is lies in Grade III +, he is definitely above the average in his
intellectual ability.

Informal Assessment:

Behavioral Observation:

Patient was very confident in seeing. He was talking very well and confidently. Firstly, he
looked angry. His body postures showed that he did not like the environment. He showed
aggressive behavior.

Clinical Interview:

After building rapport, patient said reported that he starts opium due to get more energy
to do his hard work. He said that I get tired easily which is why I use opium. Since I started using
it, I am not tired and feel very alert. And I used to do heavy work easily. Initially I found it
beneficial to use but over time it started to damage me.

But now I want to leave it. I do it for my wife and children. He was highly motivated for
this purpose. And he himself came to the hospital to quite this addiction.
 49

Tentative Diagnoses:

 Substance Used Disorder (SUB)

Recommendation:

 Psychoeducation
 Cost Benefit Analysis
 Daily Activity Chart
 Muscle Relaxation Therapy
 Deep Breathing

Sessions

There are 4 sessions are held with patient.

1st Session:

In first session I build rapport with patient and collect overall history and bio data from
patient.

2nd Session:

In second session patient behavior is too much cooperative. Appearance was kempt.
Sleep and appetite were disturbed. Mood was aggressive. Thoughts were positive. Psychological
work has been planned. In this session I taught him muscle relaxation technique.

3rd Session:

In 3rd session Psychoeducation is applied on patient and his family. Patient condition was
little bit improved. Behavior was cooperative. Appearance was kempt. Sleep and appetite were
disturbed.

4th Session:

In this session patient’s behavior was cooperative. He was paying attention properly. He
agreed all my conversation. Appearance was kempt. Sleep and appetite were little improved. In
 50

this session I applied deep breathing. And give some motivation. This is my last session with
patient’s.
 50

Conclusion:

After few weeks patient condition was much improved. He wants to go back home and
became able to do something for his children’s, his wife and for his parents. And live happily
with his siblings and family.
 51

Appendix III
52
53
54
 55

Case No: 4
(Child)
(Post Traumatic Disorder + Depressive Episodes)
 56

Bio Data

Name: Amina Ramzan

Age: 15 years

Gender: Female

Birth Order: 2nd

No. of Siblings: 3 (1 Brothers, 2 Sisters)

Marital Status: Nill

No. of Children: Nill

Religion: Islam

Education: Under Matric

Occupation: Nill

Social Economic Status: Middle Class

Residence: Ropa wali

Admission: 2nd

Informant: her self

 57

Identification Factors:

Patient name is Amina Ramzan. She is 15 years old and belongs to middle class family status.
She has 3 siblings. Her birth order is 2nd. She is living in joint nuclear system.

Reason & Source of Referral:

Patient is referred by his parents due to her unusual state of health and admitted in Psychiatry
Department of District Head Quarter (DHQ) Faisalabad.

Presenting Complaints: Duration: 2 years ago

 Low Mood
 Fits (10 days ago)
 Irritable Mood
 Isolated
 Active mutism
 Aggression
 Suspiciousness
 Muscle Weakness
 Low Appetite
 Disturb sleep

History of Present Illness:

Patient was reported with USOH and USOM. She suffers from these symptoms from last 2 years
back with the gap of few days and months consistently. She has thus symptoms due to a trauma
which is the death of her grandmother. After the death of her grandmother, she had these
symptoms and suffered from these conditions. Firstly, she admitted in Allied hospital
Faisalabad for her medical equipment. After the testing process of the hospital, they referred her
for cheak up and have a good treatment there. Her first admission in this department is 1 year
back. Now he admitted in second time for treatment.
 58

Past Psychiatric History:

 No significant psychotic features patient has.

Past Medical and Surgical History:

No significant past medical and surgical history.

Family History:

Patient Parents are alive. Both father and mother are uneducated. He has 3 siblings (1
brothers and 2 sisters). Her birth order is 2 nd. The relationship of patient with her parents was
good and cooperative. But during the days of illness his relationship with his parents are not
good. She showed aggressive behavior with his parents and siblings even she had fighting with
her siblings.

Personal History:

Patient birth was normal. All milestones achieved at age; birth order is 2 nd. Patient education is
Under Matric. She is un- married and till studied in class 9th.

Forensic History:

There is no significant forensic history.

Present Social Circumstances:

She lived with her family in her own 10 kanal house. She lives in joint family system.
She belongs to middle class family. Her all-house expenses mat by her father and her elder
brother.

Premorbid Personality:

Before his disturbed level of behavior, she was living normal life. Her mental functioning
was normal. She was very responsible among her siblings. She is a friendly and nice girl to
people.

Mental State Examination:

 59

 Appearance: Kempt
 Behavior: Cooperative
 59

 Talk: Normal
 Mood: normal
 Thought: About discharge from hospital
 Perception: Intact
 Orientation: Intact
 Insight: Present

Psychological Assessment:

Informal Assessment

 Behavioral Observation
 Clinical Interview

Formal Assessment

 Human figure drawing (HFD)

 Standard Progressive Matrix (SPM)

Formal Assessment:

Human figure drawing

(HFD)

DRAWING EXPRESSIONS
Acceptance of task with minimal protest Depression
Inability to complete drawing, marked paucity Significant depression
of detail
Right side drawing Egocentric
Upper right corner drawing Regression
Tiny drawing Withdrawal, emotional dependency
Heavy pressure Antisocial personality, epileptics, organicity,
retardates, aggressive tendencies
Erasure Neurotic tendency possibly
 60

Dim body line or no body Compensatory defense

Younger figure than subject’s age Immaturity
Hand drawn last Conflict over interpersonal relation
Open mouth Orality
Neck long Schizoid, hysterical swallowing inhibition,
inhibition
Thin neck Depression
Off balance figure Pre-schizophrenic possibility
Grape finger Immaturity
Fingers without hands Mach-over indices differentiating assaultive
from non-assaultive subject
 60

Standard Progressive Matrix

(SPM)

Quantitative analysis:
 Total score 15
 Percentile 5%
 Grade +111

Qualitative Analysis:
 Patient is intellectually defective

Informal Assessment:

Behavioral Observation:

The patient was clean. She was talking very well but her mood was too low. She was
little scared. She was sitting quite comfortably. Her eye contact was good. Her voice tone was
low from normal.
 61

Clinical Interview:

Her sister reported that she showed aggressive behavior with her family. She stays in the
room alone. And don’t doing things well. But when she suffering from these symptoms, she is
not able to do anything and any work. She reported that she feels dizzy and restless and couldn’t
able to do something.

Tentative Diagnoses:

 Post traumatic disorder + depressive episodes.

Recommendation:

 Psychoeducation
 Daily Activity Chart
 Muscle Relaxation Therapy
 Deep Breathing.

Conclusion:

After 2 weeks patient condition was much improved. She wants to go back home and became
able to do something for her parents and don’t want to continue her study. And live happily with
her siblings and parents.
 62

Appendix II
63