Introduction:

Patients suffering from physical illness are given specific treatment because the causes are
specific and the signs and symptoms are also specific. In the psychiatric setting the treatment
may not be specific and most patients are given more than one treatment. These treatment
methods are varying from patient to patient. Some patients do not want treatment and may
not co- operate with the doctors and nurses. Some do not realize that they are ill and may
actively resist all forms of treatment.

Identification data

Name : Umesh Kumar Borah

Age : 15 years

Sex : Male

Address : Vill—Sonitpur, P.O— Do, P.S—Pipra, Dist-Nagao

CRF No. : 116852/A

Ward : Male ward, LGBRIMH

Date of admission : 16/02/2020

Education : Up to Class VI

Occupation : Daily labour

Marital status : Unmarried

Under treatment : Unit-I, Dr A. Arovind

Provisional diagnosis : Schizophrenia with cannabis abuse

Informant : Subodh Nath Borah(elder brother)

Reliability : Adequate and reliable

Chief complaints and their duration:

According to client:

Abhitoh main thik hoon.Mujhe kuch bhi nahi hua hai phir bhi yahape kyun rakha hai. Mera
mata pita ne mera pura life bigar diya.Maanai meri patni kobhi bharkayaaurapni side kiya hai.
Gharpe sab mujhe pagaal bolta hai.

According to case file (informant was elder brother)

 Decreased sleep and loss of appetite since last twelve days

 Self muttering, laughing and singing out loud
 Poor personal hygiene and decreased self care
 Forgetfulness and suspiciousness towards family and friends
 Physically and verbally abuses family members and friends
 Staying aloofness (20 days)
 Poor speech ( 20 days)
 Maintain a specific posture (15 days)
 Was taking cannabis since 5 years

History of present illness:

Mode of onset is sub-acute, course was continuous and intensity was increased and
detoriated in nature.

Patient was taking cannabis for the last 5 years and recently since 8 months ago his cannabis
intake increased in amount as well as in frequency. Then gradually he developed symptoms
like decreased sleep and loss of appetite. He used to laugh and sing songs out very loudly and
self muttering was present. He did not maintain his personal hygiene and had decreased self
care. He had forgetfulness behaviour. Usually he would forget where he had kept his
belongings and on having trouble finding them he would unnecessarily blame his wife. He
got angry without any reason and said that his parents are the culprits for destroying his life.
He verbally abused and blamed them. Once when his mother raised question upon him, he
went to attack her with sharp object. After few days of this incident patient started decreased
interaction with others and marked decreased in speech also. He was not maintaining
personal hygiene, self muttering, inappropriate laugh, cry and sit in a odd posture for last 15
days. His behaviour was becoming aggressive day by day and was being unmanageable at
home. For this reason his elder brother decided to bring the patient in LGBRIMH.
Past history:
Psychiatric History:

He has no past history of psychiatric illness

Medical history: Patient suffered from jaundice 6 years ago for which he was hospitalized.
No relapse occurred.

Surgical History: Nothing significant

Family history: He belonged from low socio-economic status. He lived with his mother and
elder brother. His father was died 5 years back, at the age of 56 years with the diagnosis
Asthma. 15 years back father was having behavioral problems but diagnosis was not made.

Personal History: He was the second boy of the family. There was no problem in childhood
and adolescent period. He studied up to class VI. He left school due to financial problem in
the family. He started work at the age of 12yrs.He used khaini,biri and cannabis for last 5
years.

Mental status examination:

General appearance and behaviour

He is mesomorphic, unclean, untidy, wear hospital dress, looked appropriate to age, blunted
and depressed but sometimes sily smile was there. He was non co-operated, not maintained
eye contact and head bend to downward always. sit quietly alone and not communicate with
other patients also.

Speech

He spoke when asked only , but not give all answers of the question, if asked repeatedly some
answer can give, otherwise mute. The rate, volume and productivity were decreased
markedly. Some information’s were given only but all are relevant.

Mood and affect

He was in depressed, sad and withdrawal type.

Thought

All information’s were not able to collected as the patient was mute. But there was no self
muttering except sometimes silly smile in response to question of interviewer.

Perception

No information was collected as the patient was mute and non verbal expression of
hallucinating behaviour was seen.
Cognitive function

He was fully conscious. Oriented to time, not place and person.In atttention he normally
aroused but concentration was not sustained. Immediate and recent memory was intact and
remote memory was distorted. Personal judgement and social judgement was satisfactory

Insight: Slight awareness being sick. So insight is Grade – II

Description of behaviour therapy in book:

Definition:

A form of psychotherapy, the goal of which is to modify maladaptive behaviour pattern by

reinforcing more adaptive behaviour.

It is a form of treatment for problems in which a trained person deliberately establishes a

professional relationship with the patient , with the object of removing or modifying existing
symptoms and promoting positive personality, growth and development.

Total duration of therapy was 6-8 weeks.

Advantages of behaviour therapy:

 To identify the maladaptive behaviour of the patient.

 To modify the maladaptive behaviour into more adaptive behaviour.
 To help the patient to regain insight about the problem.
 To relief anxiety from the patient.
 To promote positive personality

Techniques of behaviour therapy:

1. Systemic desensitization: Patient attain a state of complete relaxation & then

exposed to stimuli
2. Flooding: The patient is directly exposed to the phobic situation.
3. Aversion therapy: Pairing of the pleasant stimulus with an unpleasant response.
4. Operant conditioning produces for increasing adaptive behaviour:
 Positive reinforcement
 Token economy
5. Operant conditioning produces to teach new behaviour:
 Modeling
 Shaping
 Chaining
6. Operant conditioning produces for decreasing maladaptive behaviour
 Extinction or ignoring
 Time out
 Over correction
 Response cost
 Premack principle
 7. Assertiveness and social skill training

Indications of behaviour therapy for the patient:

For the index patient following are main indication for psychotherapy of choice:

 Not maintain eye- to-eye contact.

 Forward bending of head always.
 To improve communication skills.
 Lack of insight.
 Lack of motivation for daily activities and maintenance of hygiene

Process of psychotherapy for the patient:

a) Maximum effort was given to establish and maintain good interpersonal and
therapeutic relationship with patient, for this end, various therapeutic communication
techniques is used.

b) Unconditional regard and acceptance was shown to patient. Adequate attention given
to patient every time when he came in contact with staffs.

c) Repeatedly encouraged the patient to ventilate his feeling. Everyday contact was
made with the patient and social skill training was given to established eye-to eye
contact and straightening of head by the following ways:

Role play and again encouraged the patient to practice it.

During conversation always encouragement was given to his to maintain eye
contact with me.
 Helped the patient to practice this with other patient in front of me.
 Positive reinforcement was given to the patient.
 Explanation was given to the patient about the necessities of maintaining eye –
to eye contact, as it improve the self esteem of the patient.
 Practiced the patient whenever he sit and talk must keep head straight.
d) To improve communication skill following steps were taken:
 Assertive behaviour training was given, first role play and then practiced in
real situation.
 Encouraged the pt to communicate with other patient. Assignment was given
like go and asked the five patient names who were stay in your room and next
day therapist take the feedback from the patient.
 Gradually patient was encouraged to know the address of the five patients and
again feedback was taken.
 In this was the conversation was increased day by day.
 Sometimes conversation was practice regarding any topic like maintenance of
personal hygiene, purpose of ward activities etc in front of the therapist.
 Positive reinforcement was given each time.
 Encourage the patient to attended daily group meeting session and helped the
patient to participate in group meeting gradually.
 Practiced the patient the in regular exercise activities.
 e) Health education also given regarding maintenance of personal hygiene regularly and
eating of drug proper tome. Patient was encouraged and practiced to took mouth care,
bath, cutting nails and changing cloths.

f) All the staffs were encouraged to give special attention to the patient. He was
encouraged and given positive reinforcement whenever he joined in group or ward
activities.

Conclusion:

I was in contact with the patient for three week (07/02/20—24/02/20) during which the above
mentioned treatment strategies were implemented. It was felt that small progress was made
with the patient given the time limitation for interaction. At the end of the three week, it was
possible to establish eye- to- eye contact and straightening of head, some improvement in
communication skills was developed to the patient. Patient was also regularly maintain
personal hygiene and participate in regular exercise and group meeting programme

ASSIGNMENT
 ON
BEHAVIOURAL THERAPY

Submitted To: Submitted By:

Madam Anuradha Mukherjee Shrabani Pramanik
Senior Lecturer M.Sc.Nursing 2nd Year Student
W.B.Govt.College of Nursing W.B.Govt.College of Nursing