UG DEPARTMENT OF PSYCHOLOGY
INTERNSHIP REPORT
SUBMITTED BY
RK NAMITHA
222210527
BATCH 2022-2025
B.Sc. Psychology
ACKNOWLEDGEMENT
I am deeply grateful to the Institute of Mental Health (IMH), Chennai, for their unwavering
support, encouragement, and guidance throughout my internship. I extend my heartfelt thanks
to the Director of IMH for providing me with this invaluable opportunity to learn.
I would also like to offer my sincere appreciation to Ms. Smitha Ruckmani, Associate
professor and Head of the Clinical Psychology Department, for the exceptional mentorship
and guidance she provided. Her insights, expertise, and continuous feedback have been
instrumental in my professional development and have significantly enhanced my
understanding of clinical psychology.
To all the faculty and staff at IMH, your encouragement and support have been pivotal in the
successful completion of my internship.
I am profoundly thankful to the Department of Psychology and to my classmates for creating
an environment that fostered my learning and development throughout this period.
TABLE OF CONTENTS
Institute of Mental Health (IMH), Chennai
Sr. No Topic
1. An Overview of My Learning
2. Profile of the Organisation
3. Case Report
4. Process Report
5. Attendance Report
7. Certificate
AN OVERVIEW OF MY LEARNING
Clinical Processes Observed
Outpatient Psychiatry Clinics:
● Observed consultations with patients presenting with a range of psychiatric conditions
including alcohol disorders, anxiety disorders, and schizophrenia.
● Gained insights into diagnostic procedures, case history recording, planning, and patient
management strategies and participated in discussions about case formulations based on
patient responses.
Acute Ward Interventions:
● Observed patients in the acute ward who were receiving long-term care for mental
illnesses.
● Learned about the management of acute psychiatric symptoms, patient safety, and
therapeutic approaches used in a hospital setting.
Recreational Therapy:
● Observed recreational therapy sessions aimed at aiding patient recovery and promoting
mental well-being.
● Engaged with patients in structured activities designed to improve social skills and
cognitive functions.
Clinical Assessments and Diagnoses:
● Attended clinical assessments conducted by psychiatrists and clinical psychologists to
evaluate patient conditions and develop accurate diagnoses.
● Observed the use of various assessment tools and techniques, including structured
interviews, psychological testing, and symptom checklists.
Interventions Observed
Psychiatric Medication Management:
● Observed the administration, and monitoring of psychiatric medications and gained an
understanding of psychiatric medication, including the mechanisms of action, side effects,
and patient adherence to medication regimens.
Patient Support and Psychoeducation:
● Observed patients and their families being educated about mental health conditions,
treatment options, coping strategies, and activities aimed at increasing patient and family
understanding of mental health issues.
Skills Developed
Effective Communication with Patients:
● Developed skills in communicating with patients in a therapeutic manner, including active
listening and empathetic responses.
● Learned to engage with patients about their mental health concerns in a compassionate and
professional manner.
Patience and Empathy:
● Cultivated patience and empathy while working with patients experiencing severe mental
health issues and gained experience in understanding patients’ perspectives.
Clinical Observation and Assessment:
● Improved observational skills for identifying symptoms, assessing patient progress, and
understanding the clinical manifestations of mental health conditions.
Report Writing and Documentation:
● Developed skills in documenting clinical observations, and writing reports on case history,
diagnosis, and patient observations.
PROFILE OF THE ORGANISATION
The Institute of Mental Health (IMH) in Kilpauk, Chennai, stands as one of the oldest and
largest mental health hospitals in Asia. Established with a rich historical legacy, IMH has
been a pioneering institution in the field of mental health care for over two centuries.
Historical Background
The origins of the Institute of Mental Health trace back to the early 19th century when it was
first acquired by Dr. Valentine Connolly of the East India Company. In 1794, the British Raj
purchased the institution from the East India Company, marking the beginning of its formal
development as a mental health care facility under British administration. Over the years, the
institute has evolved into a prominent center for psychiatric care and research.
Facilities and Capacity
The Institute of Mental Health is a sprawling campus with a significant capacity for patient
care. The hospital accommodates up to 1,800 in-patients across 21 specialized wards,
including:
● De-addiction Ward: Dedicated to the treatment and rehabilitation of individuals
suffering from alcohol and drug dependence.
● Ward for Mentally Ill Prisoners: A specialized unit for the management and care of
prisoners with severe mental illnesses.
● Intensive Psychiatric Care Ward: Provides intensive care for patients with acute
psychiatric conditions.
● Geriatric Ward: Focuses on the mental health care of elderly patients, addressing
age-related psychiatric issues.
Outpatient Services
IMH handles an average outpatient census of 500 patients per day, offering a broad spectrum
of mental health services. The outpatient department features six specialized clinics,
including:
● Child & Adolescent Clinic: Provides psychological assessments, counseling, and
treatment for children and teenagers.
● Geriatric Clinic: Offers mental health services tailored to the elderly population,
including cognitive assessments and therapy.
● Neuropsychiatry Clinic: Focuses on the intersection of neurology and psychiatry,
addressing conditions such as traumatic brain injuries and neurological disorders.
● Epilepsy Clinic: Specializes in the management of epilepsy and associated psychiatric
conditions.
● De-addiction Clinic: Provides treatment for substance use disorders and supports
patients in their recovery journey.
Mission and Vision
Mission: To provide comprehensive mental health care services to individuals suffering from
severe mental illnesses, while fostering a supportive and compassionate environment for
patients and their families.
Vision: To be a leader in mental health care, research, and education, offering innovative
solutions and setting standards for psychiatric care in the region.
Research and Education
IMH is committed to advancing the field of mental health through ongoing research and
education. The institute serves as a training ground for medical and psychological
professionals, offering internships, clinical training, and continuing education opportunities.
Key Achievements
● Historical Significance: Established as one of the oldest mental health institutions in
Asia, with a legacy of over 225 years in mental health care.
● Comprehensive Services: A wide range of specialized wards and outpatient clinics
catering to diverse psychiatric needs.
● Educational Hub: A leading institution for clinical training and research in mental
health.
CASE REPORT
Case History Report 1
Patient Information:
● Age: 40 years old
● Gender: Male
● Education: Completed up to 5th grade
● Marital Status: Married
● Children: 1 daughter
Presenting Concerns:
The patient reports the following concerns:
● Continuous alcohol consumption for the past 6 months, with the last drink taken at 3
AM on the day of reporting.
● Numbness in legs.
● Smoking 3 packets of cigarettes per day for the past 20 years.
● Frequent vomiting, with the presence of blood in the vomit for the past 2 days.
● Trouble sleeping.
● Excessive salivation.
● Hands shaking and loss of control in legs, leading to instability when standing.
● Decreased appetite due to frequent vomiting.
● Episodes of significant blood loss from the anus.
● High irritability and destructive behavior at home.
● Hyperglycemia post-alcohol consumption.
● Loss of taste senses.
● Non-compliance with regular medications due to itching sensation.
History of Present Illness:
● The patient initially started drinking alone every week, but now drinks daily.
● Drinking is primarily used as a means to alleviate pain.
● The patient begins the day with an alcoholic drink.
● Previous suicide attempts include hanging (5 years ago), ingesting 40 sleeping pills,
and self-harm with a blade.
Medical History:
● Diagnosed with diabetes.
● Significant weight loss from a previous weight of 130 kgs.
● Familial history of alcoholism; father died due to paralysis secondary to alcoholism.
● No family history of mental illness.
● The parents' marriage was consanguineous.
Psychiatric History:
● Heightened emotionality and irritability.
● History of suicide attempts and self-harm.
● History of increased anger and destructive behavior.
Substance Use History:
● Alcohol: Continuous daily use for the past 6 months, escalating from initial weekly
consumption.
● Tobacco: Smoking 3 packets of cigarettes per day for 20 years.
Functional Status:
● The patient is unable to work due to his condition.
● Daily functioning is impaired by physical symptoms (shaking, instability, vomiting)
and psychiatric symptoms (irritability, emotional lability).
Mental Status Examination:
● Affect: Heightened emotionality, and irritability.
● Cognition: Likely impaired due to continuous substance use.
● Judgment: Impaired, evidenced by non-compliance with medications and self-harm
behavior.
Diagnostic Impressions:
Based on the DSM-V criteria, the tentative diagnosis includes:
● Alcohol Use Disorder, Severe.
● Alcohol Intoxication.
● Possible Alcohol Withdrawal Syndrome.
● Possible Diabetic Complications exacerbated by alcohol use.
Intervention Plan:
1. Immediate medical evaluation to address acute symptoms (vomiting blood, blood
from the anus, instability).
2. Psychiatric evaluation to assess suicide risk and plan appropriate interventions.
3. Substance use intervention to initiate detoxification and rehabilitation.
4. Medical management of diabetes and potential complications from chronic alcohol
use.
5. Supportive therapy to address emotional and psychological concerns.
Case History Report 2
Patient Information:
● Age: 19 years old
● Gender: Male
Presenting Concerns:
The patient presents with difficulties in academic performance, particularly in writing and
mathematics. He exhibits good reading skills but struggles with learning and mathematical
tasks. Additionally, he shows signs of anxiety and concentration issues.
History of Present Illness:
● Difficulty in writing and learning.
● Very poor performance in mathematics.
● Frequent nail-biting.
● Timidity and fearfulness when speaking to the psychiatrist.
● Difficulty answering logical reasoning and general knowledge questions.
● Inability to concentrate for extended periods.
Developmental and Medical History:
● Birth History:
○ The mother had high blood sugar during pregnancy, which normalized
post-birth.
○ Delivered via C-section.
○ Experienced fits one day after birth.
○ Did not cry immediately after birth.
○ Required surgery and was on a ventilator for 16 days post-birth.
○ Birth weight: 3.8 kg.
○ Irregular breastfeeding.
● Early Development:
○ Proper vaccination schedule.
○ Delays in developmental milestones, such as talking and walking.
○ Limited socialization as a child due to overprotection stemming from illness at
birth.
Educational History:
● Failed board exams in 2022.
● Studied under the matriculation board up to the 12th grade.
Family and Social History:
● No family history of mental illness.
● Mother experienced significant stress during pregnancy, with many unfavorable
prenatal conditions.
● Limited social interactions during childhood.
Mental Status Examination:
● Appearance: Timid and anxious demeanor.
● Behavior: Timid and fearful when responding to questions.
● Affect: Smiled and appeared happy when discussing personal interests.
● Cognition: Difficulty with logical reasoning and general knowledge questions.
● Attention: Short attention span and difficulty maintaining concentration.
Psychological Assessment:
● Standard Progressive Matrices Set A-E: Administered to assess cognitive abilities.
● Binet-Kamat Test (BKT) for IQ: Administered to evaluate intellectual functioning.
● NIMHANS SLD Battery: Administered to assess for Specific Learning Disorder.
Diagnostic Impressions:
Based on the DSM-V criteria, the tentative diagnosis includes:
● Specific Learning Disorder (SLD) with impairment in written expression and
mathematics.
Intervention Plan:
1. Comprehensive psycho-educational assessment to confirm the diagnosis of Specific
Learning Disorder.
2. Implementation of interventions such as tutoring in mathematics and writing skills.
3. Behavioral therapy to address anxiety and nail-biting.
4. Regular follow-up appointments to monitor progress and adjust interventions as
needed.
5. Family counseling to provide support and education about the patient’s learning
disorder.
Case History Report 3
Patient Information:
● Age: 38 years old
● Gender: Male
● Education: Bachelor of Arts in English Literature
● Occupation: Former Assistant Collection Manager at HDFC Bank
Presenting Concerns:
The patient presents with auditory hallucinations, visual hallucinations, irregular sleep
patterns, and episodes of aggressive behavior. He reports a significant history of job
instability and personal stress.
History of Present Illness:
● Auditory Hallucinations: Hearing a female voice that gives him instructions, which
he attributes to a ghost named Abirami.
● Visual Hallucinations: Seeing a black figure, which he believes to be a ghost,
especially during a specific episode at night.
● Behavioral Episodes: Described an incident involving a confrontation with police
and subsequent aggression towards his father.
● Insomnia: Irregular sleep patterns for the past year.
● Aggression: High temper, especially when feeling confined or under pressure.
● Paranoia: Believes someone is trying to kill him and suspects his in-laws are doing
something bad to him.
Psychiatric History:
● Reports a significant episode involving hallucinations and paranoia while working
night shifts at a call center.
● He was admitted to an acute ward and prescribed medication for his symptoms.
Medical History:
● Hand Injury: Left pinky finger cut.
Employment History:
● Current Employment: Unemployed for the past 1.5 years.
● Previous Employment:
○ Assistant Collection Manager at HDFC Bank (fired for sending an
unprofessional email).
○ Call center worker at Southern Land (1.5 years, resigned).
○ Sales assistant at Lifestyle showroom (1 year, resigned).
○ Bank caller at ICICI Bank (resigned).
○ Employee at Nitya Amardham sweets company (fired due to a significant
order mistake).
Family and Social History:
● Marital Status: Separated from wife (married in 2019, separated after 3 years).
● Children: None.
● Family Stressors: Financial pressures, marital discord due to unmet dowry
expectations, and pressure to have children.
● Social Behavior: Increasing use of phone and social media, limited social
interactions.
Mental Status Examination:
● Appearance: Appears anxious, with frequent changes in behavior.
● Behavior: Exhibits high temper, aggression, and signs of paranoia.
● Affect: Anxious and distressed.
● Mood: Depressed and helpless.
● Cognition: Alert but demonstrates disorganized thinking.
● Perception: Auditory and visual hallucinations.
● Insight: Acknowledges having a mental illness and links anger to symptom
exacerbation.
Psychological Assessment:
● The patient has been referred by SCARF and admitted for acute observation and
medication management.
Current Medications:
● Sleeping pills and other mental health medications for hallucinations and paranoia.
Diagnostic Impressions:
Based on the DSM-V criteria, the tentative diagnosis includes:
● Schizophrenia.
Intervention Plan:
1. Continue antipsychotic medication and monitor for efficacy and side effects.
2. Implement cognitive-behavioral therapy (CBT) to address hallucinations and
delusional thinking.
3. Regular psychiatric evaluations to monitor symptoms and adjust treatment as
necessary.
4. Provide psychoeducation to the patient and family about schizophrenia and its
management.
5. Explore potential triggers for aggressive behavior and develop coping strategies.
6. Engage in occupational therapy to explore potential employment opportunities and
improve daily functioning.
7. Family counseling to address family dynamics and support the patient’s mental health
needs.
Case History Report 4
Patient Information:
● Age: 74 years old
● Gender: Female
● Education: Not educated
● Occupation: Has never worked outside the home
Presenting Concerns: The patient presents with severe insomnia, delusional thoughts, and
significant behavioral changes. She reports experiencing delusions of persecution and
demonstrates signs of psychosis.
History of Present Illness:
● Duration: Symptoms started 6 months ago.
● Insomnia: Not sleeping at all, wakes up in the middle of the night to roam around the
streets.
● Delusions:
○ Believes incidents that have not occurred (e.g., her son fighting with someone,
her son being dead).
○ Thinks she is being poisoned and refuses to eat anything at home.
○ Believes one of her sons is plotting against her.
● Behavioral Changes:
○ Stopped performing household chores.
○ Experiences anger and frustration when the door is locked, leading to breaking
the lock.
○ Sudden episodes of crying about nonexistent events (e.g., her son's death).
Social History:
● Marital Status: Widow (husband died 4 years ago from alcohol-related liver
problems).
● Children: 5 surviving children; the first two children died (one due to birth
complications, the other due to jaundice), and one other child died between the first
and second child.
● Living Situation: Lives with her son, daughter-in-law, and their children.
● Support System: Her daughter took her jewels away to prevent theft, which the
patient resents.
Behavioral Observations:
● Travel: Capable of traveling alone for long distances.
● Autonomy: Not afraid to go out alone or perform tasks alone.
● Interaction with Family:
○ Feels persecuted by her family.
○ Experiences anger and frustration towards family members.
Psychiatric History:
● Trauma: History of domestic abuse from her husband.
● Marital History: Married her blood relative.
● Mental Health: No reported family history of mental illness.
Mental Status Examination:
● Appearance: Appears older than her stated age, possibly due to stress and lack of
sleep.
● Behavior: Restless, often roaming at night; angry and frustrated when restricted.
● Mood: Anxious and fearful.
● Thought Process: Disorganized, with persistent delusions of persecution.
● Perception: Experiencing auditory and visual hallucinations.
● Insight: Lacks insight into her condition, and believes her delusions are real.
Diagnostic Impressions:
Based on the DSM-V criteria, the tentative diagnosis includes:
● Psychosis.
● Delusion of Persecution.
Intervention Plan:
1. Immediate safety measures to ensure the patient is in a safe environment to prevent
harm from wandering at night and social support services to assist with daily living
activities.
2. Initiate antipsychotic medication to manage delusions and hallucinations.
3. Cognitive-behavioral therapy (CBT) to address delusional thoughts and improve
reality orientation.
PROCESS REPORT
Date: June 3 - June 15, 2024
Location: Institute of Mental Health, Kilpauk
Tasks Assigned by Agency
1. Taking case history in the psychiatry outpatient (OP) department.
2. Visiting patients in the acute ward.
3. Observing clinical assessments and recreational activities of the patients.
My Engagements and Interactions
Case History Taking in Psychiatry OP:
I observed and made comprehensive case histories of patients in the psychiatry OP
department through interviews conducted by the doctors, gathering detailed information
about their backgrounds, symptoms, medical history, and psychosocial factors.
Visiting Patients in the Acute Ward:
During visits to the acute ward, I interacted with patients admitted for psychiatric conditions,
observed their behavior, and saw them doing recreational activities.
Observing Clinical Assessments:
I observed various clinical assessments conducted by psychiatrists, and psychologists
including diagnostic interviews, mental status examinations, and cognitive assessments.
My Observations
Role of Clinical Psychologists:
Clinical psychologists diagnosed patients using clinical assessment, formulated treatment
plans, and provided therapeutic interventions.
Role of Psychiatrists:
Psychiatrists diagnosed mental health conditions, prescribed medications, monitored patients'
progress, and conducted regular rounds in the acute ward.
Role of Nurses:
Nurses administered medications, monitored patients' physical health, and provided
day-to-day care, ensuring patient safety and well-being.
Learning Outcome
Case History Taking:
I learned the importance of asking open-ended questions and interacting with the patient to
gather comprehensive information to aid in accurate diagnosis and treatment planning.
Assessing Patients:
Observing and participating in patient assessments helped me understand the application of
various theories in treating mental health conditions.
Interacting with the Patients:
Interacting with patients allowed me to develop empathy, active listening skills, and the
ability to provide emotional support, highlighting the importance of therapeutic
communication in building trust and facilitating treatment adherence.
On-Site Supervision:
Receiving supervision from experienced professionals enhanced my clinical skills, and
provided insights into best practices and ethical considerations, and the importance of
ongoing professional development.
My Reflections
Areas for Improvement:
I need to improve my skills in managing challenging patient interactions, particularly with
those exhibiting aggressive or uncooperative behavior, by developing strategies for
de-escalation and maintaining professional boundaries.
Insights and Feelings:
This internship reinforced my passion for clinical psychology care and my commitment to
pursuing a career in this field. Overall, this internship at the Institute of Mental Health,
Kilpauk, provided a comprehensive understanding of the roles and responsibilities of various
mental health professionals, enhanced my clinical skills, deepened my knowledge of mental
health conditions, and prepared me for future professional challenges in the field.
ATTENDANCE REPORT
CERTIFICATE
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