“CASE REPORT”

SUBMITTED TO

Dr. Nazia Iqbal

Chairperson Dept. of Psychology

SUBMITTED BY

Laiba Hameed
1469-FSS/BSPSY/F20
BS 8th B

Department of Psychology

INTERNATIONAL ISLAMIC UNIVERSITY

Amphetamine Type Stimulant-Induced

A man of age 37 years, having an average physique came to a hospital named Safe Care

Trust International with crisis intervention for the treatment of substance use. After MSE, it was

observed that the client is well-groomed, neat and clean, conventional uniform, coordinated

psychomotor behavior, and consistent eye contact. Symptoms of auditory and visual

hallucinations were present along with paranoid and aggressive behavior. The choice of drug was

Amphetamine & Opioid. The client had no insight into his illness and was at the pre-

contemplation stage of motivation.

Identifying Information

Name: M.I.

Age: 37 years

Gender: Male

Education: Primary

Marital Status: Married

Siblings: 7 brothers and 3 sisters

Father: Died

Mother: Died

Religion: Islam

Referral: Upon seeing his bad condition he was brought to the hospital by his wife and brother.
Presenting Complaints:

‫ غلط غلط تصویریں دکھائ دیتی ہیں۔‬،‫عجیب عجیب آوازیں آتی ہیں‬

‫ پتہ نہیں چلتا کون ہے۔‬،‫مرد عورت کی آوازیں آتی ہیں‬

‫لوگ میرے اور میرے بیوی کے بارے میں باتیں کرتے ہیں۔‬

‫شک و شبہ ہوتا رہتا ہے۔‬

‫پریشان موڈ رہتا ہے۔‬

Initial Observation:

The client was of average height and overall physique with quite a low mood. He had a

dependency on opioids and amphetamines. He was not willing to be treated and had no

motivation. He was alert and well-groomed. He maintained eye contact and answered every

question logically. He was defensive when asked for the reasons for his addiction.

History of Present Illness:

According to the client, he started smoking at the age of 12 years just to have fun and

pleasure. He had some friends who were addicted to smoking and because of them (peer

pressure) he started smoking too. Gradually he became involved in the habit of other drugs such

as cannabis. The client reported that his brother was also addicted to drugs and alcohol. He was

and still is dependent on his other brother for financial means. His average daily expense on

drugs is Rs. 1000/-. The client married at the age of 26 years and also started working at the shop

but became more addicted to the drugs. He is not motivated to leave the drugs because it gives

him pleasure. The client has paranoid tendencies and other psychiatric symptoms are also present

such as visual and auditory hallucinations.

Personal History:

Birth History:

The client was born through a normal birth procedure. The client achieved all his

developmental milestones at the appropriate time. The client had no significant report of head

injury or any sort of neurological problem of surgery.

Educational History:

The client did his primary schooling at a local school in his town. Then he was unable to

continue his studies due to the financial crisis in his household. He was good in behavior with

everyone till he was in school. He always respected everyone who was senior to him and also

had a cooperative and friendly attitude with everyone.

Occupational History:

The client started working 5 years ago as a shopkeeper and too left the job because he

was not attentive and had concentration issues as his health was getting worse. Now he is

dependent on his brother for financial means.

Sexual History:

The client had no issues due to his sexual desires and had good control over his impulses.

He did not report to be involved in any illegal sexual activity.

Client’s premorbid personality:

Before developing the illness, the client showed determination and resilience due to

strong family values. Growing up with limited opportunities, he might have had ambitions but

kept to himself, trying new things like experimenting with drugs out of curiosity and peer
pressure, his psychosis, later on, was likely influenced by a mix of these traits, life challenges,

and how amphetamines affect the brain, showing how complex mental health can be in such

situations.

Family history:

The client’s father and mother died at an early age so he lived with his siblings. He has 7

brothers and 3 sisters. He is a 9th born among them so there is a age gap between him and his

siblings so he has barely any communication with his siblings. He is not satisfied with the

environment of his home because according to him the people at home get into fights

occasionally. He married at the age of 26 years. It was an arranged marriage and now he has

three sons. He reported that his wife used to insist him to not take drugs, which shows that he is

responsive to his wife and considers his advice.

History of family psychiatry/ medical illness:

Family history of substance abuse was reported. He told that his brother is into taking

drugs and he is alcoholic.

Psychological Assessment:

To assess client’s problem two types of assessment were carried out that were as follows:

Informal assessment:

Informal assessment compromised of:

• Clinical interview

• Mental status of examination

Formal assessment:

• HTP

• RISB
Clinical Interview:

It's a professional face-to-face encounter with a clinician; who asks questions about the

client’s problems, along with the client’s reactions and all responses. The clinician collects all

types of detailed information of the client’s problem, lifestyle, feelings, emotions, relationships

and other personal history. A clinical interview was conducted with the client to get detailed

information about his personal history; finding the cause and starting of the problem, his family

history his relationship with his family and other relatives, his sexual history, educational

information, occupational, and social history. The client had no insight about the problem and

had no motivation to seek treatment.

MSE

MSE is done with patient at first presentation to the clinical psychologist to assess about

his/ verbal and nonverbal symptoms of illness.it provides basis for psychiatric diagnosis and

clinical assessment. The client’s appearance was alerted, well-groomed and neat in general. He

showed a coordinated psychomotor behavior and showed consistency. He maintained the eye

contact with the examiner. He was defensive about his drug using habit but was cooperative with

the clinician in every question he asks. He felt drowsiness and sleepy at times. He was a well-

oriented person but his attention was scattered and had difficulty in concentrating. He had an

average cognitive and spatial ability and was answering the question logically. He had the

symptoms of psychosis such as auditory and visual hallucinations, paranoid tendencies and

showing aggression from time to time. He had a poor control about his impulses and couldn’t

evaluate a situation. Overall, he had scored 28 out of 30 on MSE.

Beck Anxiety Inventory:

The client has scored 8 on BAI, which shows that he has a minimal level of anxiety.

HTP:

RISB:

According to RISB, the client was reported to be maladjusted and the problem was in family

domain.

Case Formulation:

The client having an average physique came to a hospital named Safe Care Trust

International with crisis intervention for the treatment of substance use. After MSE, it was

observed that the client is well-groomed, neat and clean, conventional uniform, coordinated

psychomotor behavior, and consistent eye contact. Symptoms of auditory and visual

hallucinations were present along with paranoid and aggressive behavior. The choice of drug was

Amphetamine & Opioid. The client had no insight into his illness and was at the pre-

contemplation stage of motivation.

Treatment Plan:

Creating an intervention plan for a case of amphetamine-induced psychosis involves a

comprehensive approach addressing both the immediate crisis and long-term recovery. Here's a

structured plan:

Modification of behavior: To manage the initial symptoms of illness and activities for behavior

modification, participate actively in all group sessions, and obey rules and regulations.
Family Involvement: Engage family members sensitively and educate them about psychosis

and substance use to gain their support in the treatment process.

Psychiatric Evaluation and Treatment: Conduct a thorough psychiatric evaluation to assess

the extent of psychosis and identify underlying factors. Conduct an RISB test.

Substance Abuse Treatment: Integrate substance abuse treatment alongside psychiatric care.

Offer counseling and support groups focused on addiction recovery, emphasizing culturally

relevant approaches to address substance use issues.

Psychoeducation and Coping Skills: Provide psychoeducation about psychosis, its causes, and

management strategies to the individual and family. Teach coping skills and stress management

techniques to enhance resilience and prevent relapse.

Long-Term Follow-Up and Support: Establish a long-term follow-up plan with regular

psychiatric appointments and ongoing support services. Ensure access to community resources

and peer support networks for sustained recovery.

Collaborative Care and Multidisciplinary Team: Coordinate care across multidisciplinary

teams including psychiatrists, psychologists, social workers, and community health workers.

Foster collaboration between healthcare providers and community stakeholders to optimize

outcomes.

Implementing this intervention plan requires a coordinated effort involving healthcare

professionals, family members, and community resources to address the complex needs of the

individual with amphetamine-induced psychosis within their cultural and socio-economic

context.
 Case 02

Anxiety Disorder Due to Another Medical Condition

293.8 (F06.4)
Case Summary

The client S.E was referred to the psychiatric department of Benazir Bhutto Hospital

from medical department. Her complaints were high blood pressure, headache, anger issues,

muscle tension, irritability, excessive worry, fatigue, sadness and insomnia. The client has been

suffering from these symptoms since 10 years. HTP was applied on the client and on the basis of

results it was assumed that client had some features of anxiety. It is suggested that anxiety test

should be applied on client. Psychotherapy should be initiated on client.

Identifying Information

Name S.E

Age 45 years.

Gender Female

Education Matric.

Occupation Qura’an Teacher.

Birth order 5th

Siblings 6 (4 brothers and 2 sisters)

Marital Status Married

Children 5 (3 sons and 2 daughters)

Socio-economic Status Middle class.

Residence Rawalpindi.

Informant Client.
Reason of Referral:

The client S.E was referred to the psychiatric department of Benazir Bhutto Hospital

from medical department. Her complaints were high blood pressure, headache, anger issues,

muscle tension, irritability, excessive worry, fatigue, sadness and insomnia. The client has been

suffering from these symptoms since 10 years.

Presenting Complaints:

‫بلڈ پریشر کنٹرول نہیں ہوتا اور سر درد رہتا ہے۔ نیند بھی نہیں آتی۔‬

‫تنگ آئی ہوئی ہوں اور بہت پریشان رہتی ہوں۔‬

‫پٹھے دکھتے ہیں اور تھکن رہتی ہے۔‬

‫اداسی رہتی ہے‬

‫غصہ آتا ہے بہت تو بچوں کو مارتی ہوں۔‬

History of Present Illness:

The client reported about the complaints that were high blood pressure, headache, anger

issues, muscle tension, irritability, excessive worry, fatigue, sadness and insomnia. The client has

been suffering from these symptoms since 10 years and due to these issues the client has been

experiencing severe anxiety and extreme worry.

Personal History:

The client S.E of 45 years reported her personal history as;

Birth History: She was born in Sindh with normal delivery and completed all the milestones in

proper age. No neurological complaints were reported at her birth.

Educational History: Client studied in a government school which was far away from her home
and her mother couldn’t afford a nearby private school so she send her to Islamabad with her

uncle. Client completed her matriculation from Islamabad.

Social History: The client before the onset of disorder was very friendly, social and caring

person. She used to help her mother in cooking and other house chores. But after illness she got

aggressive to everyone including her husband an children.

Family History: Her father died when she was 5 years old. After her father’s death, client’s

mother started to work in her own field and in this way she was feeding her children. She came

to her uncle’s home for matriculation and living at that home she felt that her aunty was very

strict with her. At the age of 18 years she was married with a Navy officer and she moved to

Karachi. Her husband was of very suspicious and harsh with her. Being a wife she is suffering a

lot. She has 5 children and they move to Rawalpindi. Her husband didn’t allowed any of his

children to study after matric. Client’s children didn’t respect her and they use to fight with her

on minimal issues.

Client’s Premorbid Personality:

The client was very polite and caring to everyone before the onset of this order, she felt

the medical symptoms such as muscle tension, fatigue and insomnia after her marriage and and

due to these medical conditions, she experienced severe anxiety and worry.

Family history of medical / psychiatric illness:

His mother is sugar patient while his father had blood pressure issue . While no other

psychiatric or medical illness found in family history.

In order to assess client’s problem two types of assessment was carried out that were as follows:

Informal assessment:

Clinical interview

Formal assessment:

HTP

Clinical Interview:

Its professional face to face encounter with clinician; who ask questions about the client’s

problems, along about client’s reactions and all responses. Clinician collects all type of detail

information of client’s problem, lifestyle, feelings, emotions, relationships and other personal

history. (Comer,2004).clinical interview was conducted with the client to get detailed

information about her personal history; finding the cause and starting of the problem, her family

history, her relationship with her family and other relatives, her sexual history, educational

information ,occupational, and social history. The client has no insight about her problem, and

she was motivated to seek treatment. During the initial interview session the client was not

showing cooperative behavior, but after building good rapport after 3 -4 sessions almost she

opened up with true responses provided by her. Onwards session information provided b yher

started to get cleared and major important details of client problem were obtained, helping to

provide appropriate treatment.

HTP: House-Tree-Person Test (HTP)

HTP was administered on the client to find out psychological, emotional, and mental health

status of client.
Result of HTP. Inquiry about the drawings shows that the client had drawn the picture of his

child and said that he is 20 years old, sad and wants freedom. She has drawn 2 years tree and she

didn’t related it with any specific tree. Inquiry about house indicated that she wants her own

small house.

Qualitative interpretation. Drawing person first indicated preoccupation with self, narcissism or

hedonism. Drawing all pictures in the center of the page indicated rigidity.

House. Strong lines of walls indicated problems with anxiety need of protection. Extra attention

and shading on roof indicated extra attention to fantasy and ideation. Locked door indicated

defensiveness. Many windows indicated exhibihitionism. Missing chimney indicated lack of

psychological warmth in client’s home life. Pathways leading up to door indicate as sociability

and openness to others.

Tree. Heavy lines or shadings indicate anxiety about one's self. Excessive attention to detail on

the leaves could be Obsessive Compulsive tendencies or anxiety. Heavily drawn bark on trunk

indicated anxiety and depression. Large trunk indicated more ego strength. Limbs moving up

indicated she is ambitious. Excessive branches indicated compensation or mania. Lack of roots

means insecurity and no feeling of being grounded.

Person. Drawing opposite sex indicates emotional difficulties. Enlarge eyes indicate unusual

visual alertness. Over emphasis on nose shows sexual features. Close tight mouth shows denial

of needs. Omitted neck indicates impulsivity. Omission of abdominal area indicates severe

deterioration and hypochondrias. Absence of feet indicate child abuse, helplessness and loss of

autonomy. Emphasis on facial features indicates compensatory social domination. Emphasis on

nose indicates impulsivity. Button on clothes indicated immaturity.

Case Formulation:
 On tree heavy lines or shadings, excessive attention on the leaves and heavily drawn bark

on trunk and heavy lines of walls of house indicated features of anxiety and it is related with the

client’s presenting complaints that are ‘excessive worry, muscle tension, irritability, fatigue and

insomnia’.

Treatment Plan:

Based on this case formulation, treatment goals included cognitive-behavioral therapy

(CBT) to address maladaptive thought patterns and behaviors. Exposure therapy helped the client

gradually confront her fears and reduce avoidance. Additionally, stress management techniques,

such as mindfulness and relaxation exercises, assisted in regulating her physiological arousal.

Medication was also considered for symptom management, in conjunction with psychotherapy.

Building social support and enhancing coping skills was integral to the client’s treatment plan to

promote long-term recovery and resilience.