1

DEPARTMENT OF APPLIED PSYCHOLOGY

Internship Report

Submitted to: Sir Ahmad Mujtaba

Submitted By: MARIA KOUSAR

Roll No: 04

Semester: 4TH
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Acknowledgment

I Maria Kousar hereby certify that the work is being presented in the project report

entitled internship report in the partial fulfillment for the award of Master’s degree in Applied

Psychology and submitted to the department of Applied Psychology, Islami University of

Bahawalpur, Bahawalnagar Campus is an authentic record of my own work carried out under the

supervision of Javara Allah Bukhsh.

Maria Kousar

______________
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Table of Content

Sr. No Topic Page No.

History of Tehsil Head Quarter Hospital Fountain

1 5
House Lahore

2 History of Crime & Justice 6-7

Case No. 1
3 8
Schizophrenia

Case No. 2
4
Depressive Disorder

Case No. 3
5
Caffeine Intoxication

6 References

7 Appendix A

8 Appendix B
9 Appendix C
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History of Fountain House

Fountain House Lahore is a unique institute of its Kind offering mental health services in

Pakistan for the past 40 years. The institution was started as a project of Lahore Mental Health

Association with only 16 members (Patient) in a small Building Half-Way House. Presently,

Fountain House serving to the rehab needs of over 400 (300 males & 100 Females) Individuals

with mental health illnesses from all over Pakistan, as well as Pakistanis Living abroad come

here for psychological treatment.

Lahore Mental Health Association (LMHA) was formed in 1962 to mobilize efforts &

resources for the uplift and promotion of mental health in the country. In 1965, Prof. Dr.

Mohammad Rashid Chaudhry (Late) a founder member of the association, worked out a plan for

the establishment of a rehabilitation center for the mentally ill in Lahore. A formal proposal

entitled "Establishment of a Half-Way House and Day-Night Rehabilitation Unit for persons

with Mental Illness" was submitted to the Govt. of Pakistan in 1965.

After approval by the Govt. in 1968, the proposal was sent to the Social and Rehabilitation

Services, Department of Health, Education and Welfare, Govt. of USA for the purpose of

obtaining technical and financial assistance. In 1971 Mr. John H. Beard, Executive Director,

Fountain House, New York as a consultant of Social and Rehabilitation Services, Washington

USA visited the Rehabilitation Unit of Lahore Mental Health Association. The close relationship

that developed as a result of the technical collaboration between the two houses led to the adoption

of the name of Fountain House For The Rehabilitation Center In Lahore.

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Crime & Justice

Introduction:

Crime & Justice is an integration of science, theory and clinical knowledge for the

purpose of understanding preventing, and relieving criminology based distress or dysfunction

and to promote subjective well-being and personal development. Central to its practice are

criminological assessment and criminology, although crime & justicealso engage in research,

teaching, consolation, forensic testimony and program development and administration. To many

countries, crime & justice is a regulated mental health profession.

The field is often considered to have begun in 1986 with the opening of the first crime &

justice at the University of Pennsylvania by Lightner Witner. In the first half of the 20 th century,

crime & justice was focused on criminological assessment, with little attention given to

treatment. This changed after the 1940s when World War II resulted in the need for a large

increase in the number or trained in criminology.

Crime & justice are now considered experts in providing psychotherapy, psychological

testing, and in diagnosing mental illness. They generally train within four primary theoretical

orientation—psychodynamic, humanistic, behavior therapy/cognitive behavioral, and systems of

family therapy. Many continue clinical training in post-doctoral programs in which they might

specialize more intensively in disciplines such as psychoanalytic approaches or child and

adolescent treatment modalities.

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History of Crime & Justice:

Throughout the history of criminal justice, evolving forms of punishment, added rights

for offenders and victims, and policing reforms have reflected changing customs, political ideals,

and economic conditions.

Although modern, scientific criminology is often dated at the 1879 opening of the first

psychological laboratory by Wilhelm Wundt, attempts to create methods for assessing and

treating mental distress existed long before. The earliest recorded approaches were a

combination of religious, magical and medical perspectives, Early examples of such physician

included Patanjali, PadmasambhavaRhazes, Avicenna, and Rumi.

In the early 19th century, on could have his or her head examined, literally, using

phrenology, the study of personality by the shape of the skull. Other popular treatments included

physiognomy—the study of the shape of the face—and mesmerism, Mesmer’s treatment by the

use of magnets. Spiritualism and phineas Quimby’s “mental healing” were also popular. While

the scientific community eventually came to reject all of these methods, academic psychologists

also were not concerned with serious forms of mental illness. That area was already being

addressed by the developing fields of psychiatry and neurology within the asylum movement. It

was not until the end of the 19th century, around the time when signund Freud was first

developing the recent ideal of a “talking cure” in Vienna that the first scientifically clinical

application of psychology began.

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Case No. 1

Schizophrenia Spectrum and other Psychotic Disorder

Introduction

Schizophrenia is a chronic, sever, and disabling brain disorder that has affected people

throughout history. About I percent of Americans have this illness.

People with the disorder may hear voices other people don’t hear. They may believe other

people are reading their minds, controlling their thoughts, or plotting to harm them. This can

terrify people with the illness and make them withdrawn or extremely agiated.

People with schizophrenia may not make sense when they talk. They may sit for hours

without moving or talking. Sometimes people with schizophrenia seem perfectly fine until

they talk about what they are really thinking.

What are the different types of schizophrenia?

 Paranoid Schizophrenia –a person feels extremely suspicious, persecuted, or

grandiose, or experiences a combination of these emotions.

 Disorganized Schizophrenia – a person in often incoherent in speech and thought,

but may not have delusions.

 Catatonic Schizophrenia – a person is withdrawn, mute, and negative and often

assumes very unusual body positions.

 Residual Schizophrenia – a person is no longer experiencing delusions or

hallucinations, but has no motivation or interest in life.

 Schizoaffective Disorder – a person has symptoms of both schizophrenia and major

mood disorder such as depression.

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Definition:

A psychotic disorder in which personal, social, and occupational functioning deteriorate

as a result of unusual perception, odd thoughts, disturbed emotions, and motor abnormalities.

Symptoms of Schizophrenia:

 Positive Symptoms

 Hallucination

 Delusions

 Negative Symptoms

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative

symptoms, and cognitive symptoms.

Positive Symptoms:

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive

symptoms often “lose the touch” with reality. These symptoms can come and go. Sometimes

they are severe and at other times hardly noticeable, depending onwhether the individual is

receiving treatment. They include the following:

Hallucination:

Hallucinations are things a person sees, hears, smells,, or feels that no one else can see, hear,

smell, or feel, “Voices” are the most common type of hallucination in schizophrenia. Many

people with the disorder hear voices. The voices may talk to the person about his or her behavior,

other the person to do things, or warn the person of danger. Sometimes the voices talk to each

other. People with schizophrenia may hear voices for a long time before family and friends

notice the problem

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Other types of hallucinations include seeing people or objects that are not there, smelling odors

that no one else detects and feeling things like invisible fingers touching their bodies when no

one is near.

Delusions:

Delusion are false belief that are not part of the person’s culture and do not change. The person

believes delusions even after other people prove that the beliefs are not true or logical. People

with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can

control their behavior with magnetic waves. They may also believe that people on television are

directing special messages to them, or that radio stations are broadcasting their thoughts aloud to

others. Sometimes they believe they are someone else, such as a famous historical figure. They

may have paranoid delusions and believe that others are trying to harm them, such as by

cheating, harassing, poisoning, spying on or plotting against them or the people they care about.

These beliefs are called “delusions of persecution.”

Negative Symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These

symptoms are harder to recognize as part of the disorder and can be mistaken for depression or

other conditions. These symptoms include the following:

 “Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous

voice).

 Lack of pleasure in everyday life

 Lack of ability to begin and sustain planned activities

 Speaking little, even when forced to interact.

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People with negative symptoms need help with everyday tasks. They often neglect basic personal

hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are

symptoms caused by the schizophrenia (Comer, 2015)

DSM-V-TR Diagnostic Criteria for Schizophrenia 295.90 (F20.90)

A. Characteristic symptoms: Two (or more) of the following each precent for a significant

portion of time during a 1-month period (or less if successfully treated):

 Delusions

 Disorganized speech (e.g. frequent derailment or incoherence)

 Grossly disorganized or catatonic behavior

 Negative symptoms, i.e. affective flattening, a logia, or a volition

Note: Only one criterion A symptoms is required if delusions are bizarre or hallucinations consit

of voice keeping up a running commentary on the person in behavior or thoughts, or two or more

voices conversing with each other.

B. Social/occupational dysfunction:

For a significant portion of the onset of the disturbance, one or more major areas of

functioning such as work interpersonal, interpersonal relation or self-care are markedly below

the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to

achieve expected level of interpersonal, academic, or occupational achievement). This 6-month

period must include at least 1 month of symptoms (or less if successfully treated) that meet

criterion a (i.e. active-phase symptoms) and may include periods of prodromal or residual

symptoms.

C. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood

disorder with Episode, Manic Episode, or Mixed Episode have occurred concurrently with
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the active phase symptoms their total duration has been brief relative to the duration of the

active and residual periods.

D. Substance/general medical condition exclusion:

The disturbance is not due to the direct criminological effects of a substance (e.g. a drug of abuse

a medication) or a general medical condition.

E. Relationships to a Pervasive Development: if there is a history of Autistic Disorder or

another pervasive development Disorder the additional diagnosis of Schizophrenia is made

only if prominent delusions of hallucinations are also present for at least a month (or less if

successfully(American Criminological Association, 2013).

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Summary:

The client was A.B and her age was 35 year old. She was suffering from schizophrenia

from last 10 months. The cause of the disorder that she was being beaten by her school

teachers due to low grades it made her introverted and she felt inferior in front of others and

later on in her married life she had bad relationship with her spouse and got divorced.

Through informal assessment it was observed that her general appearance was inappropriate

and she was suffering with auditory hallucination and persecutory delusion. Her behavior

was distorted. For the formal assessment HTP tests was applied on the client. The

interpretation indicated that the client had problems in the maintaining good relationship with

the spouse and other family members. The client had difficulty in the adjustment of the

environment; Relaxation techniques and cognitive behavior therapy were applied on the

client.
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Identification:

Name: A.B

Age: 35 Years

Education: Middle

Gender: Female

Birth Order: 2nd

No. of Sibling: 03

Marital Status: Divorced

Source of Referral:

Her brother in law referred her in THQ Hospital.

Date of Referral:

12-04-2015

Main Reason for Referral:

1. Irritability

2. Loss of appetite

3. Insomnia
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4. Auditory hallucination

5. Paranoia.

Presenting Complaints:

Duration Client

‫ ماہ‬8 ‫ مینوں آوازاں سندیاں نے‬1

‫ ماہ‬10 ‫ سارے مینوں مارنا چاندے اے‬2

‫ ماہ‬8 ‫ مینوں نیند نئی آندی‬3

‫ ماہ‬9 ‫ مینوں نیند وی نئی آندی‬4

‫ ماہ‬8 ‫ کج وی چنگا نئی لگدا‬5

Duration Informants

‫ ماہ‬8 ‫ اپنے نال گالں کر دی‬1

‫ ماہ‬9 ‫ انوں لگدا اے کہ او کچ وی کر سکدی اے‬2

‫ ماہ‬9 ‫ چڑچڑی ریندی اے‬3

‫ ماہ‬9 ‫ لوکاں چی پیندی اے‬4

‫ ماہ‬9 ‫ کج کھاندی وی نئی‬5

History of Present Illness:

The client was suffering from schizophrenia from last 10 months. She was introverted

and sensitive because she was below average student and she was being beaten by her school.
 16

Teachers because of low grades his made her introverted. Later on the relationship of the

client with her husband was not good, they fought with each other and she got divorced. The

problem got severed because there was no family support.

Family History:

Her father name was A.A and he was businessman. He died couple of years ago. When

he died he was 65 years old. He had an extroverted personality. He wasn’t suffering from any

psychiatry problem when he died. Her mother was 63 years old. She also had an extroverted

personality. She had two brothers and one sister. And her relationship with her parents and

siblings was satisfactory. There was no criminological issue reported in the family.

Personal History:

Her birth and early developmental stages were normal. She had not any criminological

problem before suffering from schizophrenia. She was being beaten in the school due to low

grades as she had a problem in recalling her school lesson. Her relationship with her spouse was

not normal and she got divorced.

Premorbid Personality:

She was introverted and had lack of interest in social activities. Her father’s behavior

towards her was good. She had good relationship with her siblings.

Previous and present Physical Illness:

No any previous and present physical illness was reported.

Previous Psychiatric Illness:

No psychiatry illness was reported.

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Physical Examination Report:

Her pulse rate (72/m) and temperature (98 C) and BP (120/70) was normal.

ASSESSMENT:

Criminological Assessment

 Formal

 Informal

 Informal Assessment:

Behavioral Observation:

The client’s height was 5 feet and 4 inches and shw was overweighed according to her

height. She was wearing shalwer & kameez. Her hair was organized. She wasn’t in stable mood

at that time and was able to maintain eye contact. Her speech was comprehensive and tone was

high. She gave all the answers in detail with confidence.

Mental Status Examination:

Her speech was comprehensive. Her mood was unstable. Her speech was not normal at

present time. She had no suicidal ideation. She wasn’t aware of time, place and person present

around her at the moment. She reacted to the stress according to the situation. Her remote and

recent past memories were not good. Her arithmetic reasoning was poor.

 Formal assessment:

HTTP:
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The client draw person with no ears, displacement of ears show suspicious tendencies.

The client draw dummy figure which indicated withdrawal in interpersonal relation. The client

draw thin and flat legs which indicated insecure and dependency. The client draw no arms and

legs it showed withdrawal from reality or difficulty in interpersonal relationship and also the lack

of confidence.

The client draw no doors which indicated the insecurity. The client did emphasis on the

boundaries which indicated that the client was overwhelmed.

The client draw cloudy tree which indicated confused thinking.

Etiology:

1- She was sensitive

2- She had fight with his husband and got divorce.

3- There was no family support.

Diagnosis:

According to above mentioned problem the client presents complaints and behaviors that are

consistent with DSM-V diagnosis of Schizophrenia 295.90 (F20.90).

Recovery/Prognosis

 Favorable Points

 Will power

 Less severe condition

 Unfavorable Points

 No family support

 Poor insight
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Management Plans

 Short-term goal

 Psychoeducation

 Diversion Technique

 Long Term goal

 Cognitive behavior therapy

 Relaxation therapy
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Case No. 2
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Depressive Disorder

Introduction:

A low sad state marked by significant levels of sadness, lack of energy, low self-worth,

guilt, or related symptom. The word depressed is a common everyday word. People might say

“I’m depressed” when infect they mean “I’m up because I’ve had a row, or failed an exam, or

lost my job”, etc. these ups and downs of life are common and normal. Most people recover quite

quickly. With true depression, you have a low mood an other symptoms each day for at least two

weeks. Symptoms can also become severe enough to interfere with normal day-to-day activities.

Types of Depressive Disorder

 Disruptive Mood Dysregulation Disorder

 Major depressive disorder

 Presitent Depressive Disorder (dysthymia)

 Premenstrual Dysphonic disorder

 Substance/Medication-induced Depressive Disorder

 Depressive disorder sue to another medical condition

 Other specified depressive disorder

 Unspecified depressive disorder

 Specifiers for Depressive disorder

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Definition of Major depressive disorder:

A severe pattern of depression that is disabling and is not caused by suc factors as drugs

or a general medical condition

Symptoms

1. Depressed mood

2. Loss of interest or Pleasure

3. Significant weight loss

4. Insomnia or hypersomnia

5. Fatigue or loss of energy

6. Suicidal ideation

7. Feeling of worthlessness

8. Psychonomotor agitation

9. Diminished ability

Criteria for Major Depressive Disorder 296.23(F32.2)

A five (or more) of the following symptoms have been present during the same 2-weeks period

and represent a change from previous functioning; at least one of the symptoms is either (1)

depressed mood or (2) loss of interest or pleasure.

Note: do not include symptoms that are clearly attributable to another medical condition.
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 Depressed mood most of the day, nearly every day, as indicated by either subjective report

(e.g., feels sad empty, hopeless) or observation made by others (e.g., appears tearful). (Note:

in children and adolescents, can be irritable mood.)

 Markedly diminished interest or pleasure in all, or almost, activities most of the day nearly

every day (as indicated by either subjective account or observation).

 Significant weight loss when not dieting or weight gain (e.g., a change of more than

5% of body weight in a month) or decrease or increase in appetite nearly every day.

(Note: in children, Consider failure to make expected weight gain.)

 Insomnia or hypersomnia nearly every day.

 Psychomotor agitation or retardation nearly every day (observable by others,not

merely subjective feelings of restlessness or being shlowed down.)

 Fatigue or loss of energy nearly every day.

 Feelings of worthlessness or excessive or inappropriate guilt (which may be

delusional) nearly every (not merely self-reproach or guilt about being sick).

 Diminished ability to think or concentrate, or indecisivenss, nearly every day (either

by subjective account or as observed byothers)

 Recurrent thought of death (not just fear of dying), recurrent suicidal ideation with-

out a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The disturbance is not attributable to the criminological effects of a substance (e.g., a

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

C. The episode is not attributing to the criminological effect of substance or to another

medical condition.

Note: Criteria A-C represent a major depressive episode.

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Note: Responses to a significant loss (e.g., Bereavement unless six persist for two months or

show marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation,

psychotic symptoms, or psychomotor retardation.

D. The occurrence of the major depressive episode is not better explained by schizoaffective

disorder, schizophrenia, schizophrenia from disorder, delusional disorder and other

psychotic disorder.

E. There has never been a manic episode or a Hypomanic episode. (American

criminological Association, 2013).

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Summary:

The client was R.R and her age was 25 years. She was suffering from depression from

last 4 months. Her mother died last year and she was being abused by her father. Through

informal assessment it was observed that her general appearance was not appropriate and show

flatted expression. In formal assessment BDI –II was applied, According to this test score was 45

which indicated serve depression level. Cognitive behavioral therapy and relaxation technique

were applied.
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Identification:

Name: R.R

Age: 25 Years

Gender: Female

Birth Order: 3rd

No. of Sibling: 04

Marital Status: Single

Source of Referral:

Her brother referred her to the THQ Hospital Chishtian.

Date of Referral:

12-02-2015

Main Reason for Referral:

1. Sad mood most of the day

2. Lack of interest in social activities

3. Fatigue or loss of energy

4. Irritability
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‫‪5. Hopeless‬‬

‫‪6. Suicide attempt‬‬

‫‪Presenting Complaints:‬‬

‫‪Duration‬‬ ‫‪Client‬‬

‫‪ 4‬ماہ‬ ‫‪ 1‬مجھے بھوک نہیں لگتی‬

‫‪ 4‬ماہ‬ ‫‪ 2‬لوگوں سے بات کر نے کو دل نہیں کر تا‬

‫‪ 4‬ماہ‬ ‫‪ 3‬مرنے کو دل کر تاہے‬

‫‪ 4‬ماہ‬ ‫‪ 4‬کوئی کام کر نے کو دل نہیں کر تا‬

‫‪ 3‬ماہ‬ ‫‪ 5‬تھکن محسوس ہوتی ہے‬

‫‪Duration‬‬ ‫‪Informants‬‬

‫‪ 4‬ماہ‬ ‫‪ 1‬سارا دن اداس رہتی ہوں‬

‫‪ 4‬ماہ‬ ‫‪ 2‬کھانا نہیں کھاتی‬

‫‪ 4‬ماہ‬ ‫‪ 3‬زیادہ سوتی نہیں‬

‫‪ 4‬ماہ‬ ‫‪ 4‬کوئی کام نہیں کر تی‬

‫‪ 4‬ماہ‬ ‫‪ 5‬زیادہ تر بیمار رہتی ہے‬

‫‪ 4‬ماہ‬ ‫‪ 6‬ایک دفعہ خود کشی کی کوشش کی تھی‬

‫‪ 4‬ماہ‬ ‫‪ 7‬چڑچڑی رہتی ہے‬

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History of Present Illness:

The client was suffered from depression from last 4 months. She was depended on her

mother and she was sensitive. Her mother died last year and she was being abused by her father.

And she didn’t get any help form family.

Family History:

Her father name was R.S and he was 57 years old. Her mother was 50 years old when she

died. She had three brothers and one sister. Her relationship with siblings was normal but she

was a neglected child and her relationship with father was not satisfactory. Family atmosphere

was not normal as the client’s father was a strict person so he usually scolds his child.

Personal History:

Her birth and early developmental stages were normal. There was no criminological

problem reported before suffering from Depression. But she was suffering from migraine. She

was a depended child. She was sensitive.

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Premorbid Personality:

She was introverted and bad lack of interest in social activities. She was dependent child

who depends on her mother. Her father behavior with her was not satisfactory. She tool little

interest in moral and religious values.

Previous and Present Physical Illness:

She was suffering from migraine.

Previous Psychiatric Illness:

No Previous psychiatric illness was reported.

Physical Examination Report:

Her pulse rate (82/m) and her temperature was (100 F) and BP was (120/80) normal.

ASSESSMENT:

 Informal

 Formal

 Informal Assessment:

Behavioral Observation:

The client was 25 years old with normal height of 5 feet 2 inches and having below

average weight according to her height. Shw was wearing shalver & kameez with dupatta.

Her hair were very short and her nails were also cut properly. She was in low sad mood at

the time and was able to maintain eye contact. Her speech was comprehensive and tone

was low. She was well aware of time, place and person around her at that time.
 30

Mental Status Examination:

Her speech was not comprehensive. Her tone was low at present time. She had suicidal

ideation. She was well aware of ther ailment and the place where she was admitted. Her remote

and recent pas memories were good.

 Formal assessment
 31

Qualitative Analysis:

Category Range

Minimal depression 0-9

Mild depression 10-16

Moderate depression 17-29

Severe depression 30-63

Conclusion:

The test administered on the client wad BDL. The client’s total score of depression was 45 it

means that the client lied in severe level of depression.

Etiology:

1) She experienced a traumatic event that her mother died in an accident.

2) She was being abused by her father.

3) She didn’t get help when was being abused by her father.

Diagnosis Assessment:

According to above mentioned problem the client presents with complaints and behaviors

that are consistent with DSM -5 diagnosis of Major Depressive Disorder, 296.23 (F32.2).
 32

Recovery/Prognosis:

 Favorable Points:

 Will Power

 Good insight

 Unfavorable Points:

 No Family support

 Disturb Life styles

Management plan:

 Short Term goal:

 Psycho education

 Activity scheduling

 Diversion technique

 Long Term goal:

 Cognitive behavior therapy

 Family therapy

 Relaxation therapy.
 33

Case No. 3
 34

Substance Related and Addictive Disorders

Introduction:

Drug addiction, also called substance use disorder, is a dependence on a legal or illegal

drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also

considered drugs. When you’re addicted, you’re not able to control your drug use and you may

continue using the drug despite the harm it causes. Drug addiction can cause an intense craving

for the drug. You may want to quit, but most people find they can’t do it on their own. Drug

addiction can cause serious, long-term consequences, including problems with physical and

mental health, relationships, employment, and the law. You may need help from your doctor,

family, friends, support groups or an organized treatment program to overcome you drug

addiction and stay drug-free. The DSM-V recognizes substance related disorder resulting from

the use of ten separate classes of drugs: alcohol, caffeine, cannabis, hallucinogens (phencyclidine

or similarly acting aryleyelohexylamines), other hallucinogens such as LSD, inhalants, opioids,

sedatives, hypnotics, anxiolytics, stimulants (including amphetamine-type substances, cocaine,

and other stimulants), tobacco, and other or unknown substances . therefore, while some major

groupings of psychoactive substances are specifically identified, use of other or unknown

substances can also form the basis of a substance related or addictive disorder (Comer, 2015).

The DSM 5 explains that activation of the brains’ reward system is central to problems

arising from drug use – the rewarding feeling that people experience as a result of taking drugs

may be so profound that they neglect other normal activities in favor of taking the drug. While

the pharmacological mechanisms for each c lass of drug are different, the activation of the

reward system is similar across substances in producing feelings of pleasure or euphoria, which

is often referred to as a “high”.

 35

Definition of Caffeine:

The world’s most widely used stimulant, most often consumed in coffee. Most of this

caffeine is taken in the form of coffee; the rest is consumed in tea; cola; so called energy drinks

chocolates, and numerous prescription and over-the-counter medication.

Caffeine intoxication:

Recent consumption of caffeine typically a high dose will in excess of 250 mg (Comer,

2015).

Diagnostic Criteria 305.90 (F15.929)

A. Recent consumption of caffeine (typically a high dose well in excess of 250 mg).

B. Five (or more) of the following signs or symptoms developing during, or shortly after

caffeine use:

1. Restlssness.

2. Nervousness.

3. Excitement.

4. Insomnia.

5. Flushed face.

6. Diuresis.

7. Gastrointestinal disturbance.

8. Muscle twitching

9. Rambling flow of thought and speech.

10. Tachycardia or cardiac arrhythmia.

11. Periods of inexhaustibility.

12. Psychomotor agitation.

 36

C. The signs or symptoms in criterion B cause criminological significant distress or impairment

in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better

explained by another mental disorder, including intoxication with another substance (Aerican

criminological Association, 2013).

 37

Summary:

Client’s name was U.J and he was 28 years old. He was suffering from caffeine

intoxication from last 6 years. The cause of his disorder was the inherited tolerance for caffeine.

Through informal assessment it was observed that his behavior was aggressive. For the formal

assessment DAST-20 test was applied on the client. The total score was 12 which indicated that

client suffered from substantial level of caffeine intoxication. The client had problem in

adjustment of environment. The relaxation techniques, relapse prevention technique and

cognitive behavior therapy were applied.

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Identification:

Name: U.J

Age: 28 Years

Gender: Male

Birth Order: 2nd

No. of Sibling: 04

Education: Masters

Marital Status: Single

Source of Referral:

His sister referred him to THQ hospital Chishtian.

Informal:

The information was collected by client’s sister.

Date of Referral:

11-03-2017

Main Reason for Referral:

1. Restlessness

2. Gastrointestinal disturbance

3. Caffeine craving

4. Insomnia
 39

5. Nervousness

6. Excessive use of caffeine.

Presenting Complaints:

Duration Client

‫ سال‬6 ‫ ہر وقت چائے پینے کو دل کر تا ہے‬1

‫ سال‬6 ‫ تھکن محسوس ہو تی ہے‬2

‫ سال‬6 ‫ چائے نہ پیو تو لگتا ہے سب کام غلط ہو جائیں گے‬3

‫ سال‬6 ‫ چائے نہ پیو تو سر درد کر تا ہے‬4

‫ سال‬6 ‫ معدہ میں جلن ہو تی ہے‬5

Duration Informants

‫ سال‬6 ‫ دن میں کئی دفعہ چائے پیتا ہے‬1

‫ سال‬6 ‫ کپ چائے پی جا تا ہے‬15 ‫سے‬10 ‫ دنمیں‬2

‫ سال‬6 ‫ زیادہ چائے پینے کی وجہ سے جاگتا رہتا ہے‬3

‫ سال‬6 ‫ چائے نہ ملے تو غصہ کر تا ہے‬4

History of Present Illness:

The client was suffering from caffeine intoxication and problem started last 6 years ago.

The client had inherited tolerance for caffeine. The intoxication increased because of the

influence of the peers. He was dependent on caffeine, he intake more caffeine in stressful

situation.

.
 40

Family History:

The client’s father was 58 years old when he died and he was educated person. His father

was a religious person and he also had caffeine intoxication. Client’s father had an extroverted

personality. Client father’s temperament toward him was good. Client relationship with his father

was good. Client’s mother was 48 years old when she died. She was a school teacher. The

relationship of the client with his mother was satisfactory. Client had two sisters and one brother.

The relationship of the client with his siblings was quite good.

Personal History:

His birth was normal. His early development stages were also normal. He was educated

person. His physical health was not normal. Due to peer pressure, he tool caffeine regularly. His

schooling was moderate. Hi was single. His social relationship were normal but sometimes he

showed too much aggressive behavior with his friends or family whin he didn’t get caffeine.

Premorbid Personality:

Before caffeine intoxication he was not as aggressive as now. He was an extroverted.

Previous and present Physical Illness:

No Previous physical illness was reported. Because of caffeine intoxication he was

suffering from gastrointestinal disturbance.

Previous Psychiatric Illness:

There is no previous psychiatric illness was reported.

Physical Examination Report:

His B.P was (120/80) and temperature was (98) and his pulse rate was (82/s) which was normal.

ASSESSMENT:
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Criminological Assessment

1. Formal

2. Informal

 Informal Assessment:

Behavioral Observation:

The client was a young man. He was wearing pant shirt. His hair were short and his nails

were also cut properly. He was in stable mood. He gave all the answers in detail and answers

were related to the question. He was sitting in appropriate posture. He was nervous in the

beginning then he got relaxed after some time.

Mental Status Examination:

His speech was comprehensive. His mood was stable. Rather he gave all the answers in

detail. His speech was quite normal at present time. He was well aware of time, place and person

present around him at that moment. His remote and recent past memory were good. He knew his

ailment and the place where he was currently admitted. His arithmetic reasoning was also good.

 Formal assessment:

The DAST-10 was applied on the client.

DAST-20 interpretation Guide

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DAST-20 Score Severity Intervention Recommended

0 N/A None at this time

1-5 Low Brief intervention

6-10 Intermediate (likely meets Outpatient (intensive)

DSM criteria)

11-15 Substantial Intensive

16-20 Severe Intensive

Total Score: 12

Conclusion:

The test administered on the client was DAST-20. The client’s total score was 12, it

means that the client’s had substantial level of caffeine intoxication.

Etiology:

1. He had inherited tolerance for caffeine.

2. He used caffeine under the influence of peers.

3. He use more caffeine in the stressful situation.

Diagnosis:

According to above mentioned problem the client presents with complaints and behaviors that

are consistent with DSM-V diagnosis of Caffeine intoxication 305.90 (F15.929).

Recovery/Prognosis

 Favorable Points

 Treatment is not prolonged

 Social support
 43

 Family support

 Unfavorable Points

 Will power

 Poor insight

Management Plans

 Short-term goal

 Psycho Education

 Activity Scheduling

 Copping Statement

 Long Term goal

o CBT

o Family Counseling Session.

o Relapse prevention therapy.

 44

References:

1. Compas, R.M, Bruce, P.S., & Gotilb, M.F. (2013). Introduction of crime & justice. In

crime & justice (12ed.,pp.263-275).

2. American criminological Association. (2013). Schizophrenia. In Diagnosis Statitical

Menual (S ed., pp. 99-100). Washington DC.

3. American Psychological Association. (2013). Major Depressive Disorder. In Diagnosis.

Satistical Menual (5ed., pp. 160-161). Washington D.C

4. American Psychological Association. (2013). Alcohol Related Disorder. In Diagnosis

Statistical Manual (5 ed., pp. 490-491). Washington D.C

5. Iftekhar , M.S. (2016). Tehsil Head Quarter Hospital Chisjtoam/

6. Neale, J.M. (2012). Schizophrenia. In Abnormal Psychology (12 ed., pp. 253-258).

7. Neale, J.M. (2012) Major Depressive disorder. In Abnormal Psychology (12 ed., pp.134-

135). California: Brekely.

8. Neale, J.M. (2012). Substance use Disorder. In Abnormal Psychology (12 ed., pp. 282-

290). California: Berkely.