Topic: Case Study Submitted to: Mam Shumaila Submitted by: Qamar-ul-Islam Department of psychology University of Sargodha Gujranwala campus 1 Case report Bio data Name: R.Z Age: 20 years old Gender: Male Education: Matric Number of siblings: 3 siblings, 2 brothers and one youngest sister Birth order: Eldest Occupation: Nil Socio-economic status: Moderate Marital Status: Un-married Informant: Client himself Source of referral: Referred by client’s father Place of referral: Mian Afzal Trust Hospital (MATH) Reason for referral: Client was referred in Mian Afzal Trust Hospital because client has a habit of using drugs. Presenting complaints 2 History of present illness The client has been taking drugs nearly from 5 years. He was admitted in fountain house because of drug addiction. But his addiction was strong. He was not able to quit addiction of drugs. He discharged from the hospital on the responsibility of his parents. But he never quit his habit of drug addiction. Family history Client’s father was an officer. He belongs to family of moderate socio economic status. His father has 2 wives. They all live together. Client step mother has no child. Client has good relations with his family members except his brother. He lacks the feeling of acceptance from his brother. His father supports him financially. His mother comes to meet him in the hospital mostly. He is more attached to his mother. He has loving relation with his sister. Educational history Client has visited school. He is matric pass. He quit his study in I.com. Personal history Client is the eldest of all his siblings. He is 20 years old. He was sent to his aunt’s home without his will. His father enforced him to go to his aunt’s home. He left his home when he was in grade 3. He was not comfortable and happy in his aunt’s home. Occupational history He worked online for small duration than he shifted to Lahore. Love relation history Client had a love relationship with a girl. They broke up due to some reason which made the habit of addiction more strong. Break up boost up the addiction of drugs. History of present illness Client was 20 years old young boy. He came to the hospital with the complaint of drug addiction. He has the habit of drug addiction for 5 years. He was addicted to multiple drugs e.g. heroine, ICE and alcohol (occasionally) etc. He did not report any other psychotic problem. He was admitted to fountain house before coming to Mian Afzal Trust Hospital. His habit becomes stronger than before so his father admitted him in the Mian Afzal Trust Hospital for his betterment. Client’s current condition is not much better than before. Assessment tools The assessment tool used in the case report was Beck Anxiety Inventory. Beck Anxiety Inventory Beck anxiety inventory was used to evaluate anxiety of client as the client reported to be anxious at some time during day. Quantitative analysis Raw score Range Category 8 0-21 Low anxiety Qualitative analysis Beck anxiety inventory was used to measure the anxiety of client. The raw score was 8. It indicates low level of anxiety which does not seem to be problematic. 4 Case formulation The client was a 20 years old young boy. He came with the principle complaint of drug addiction. His habit of drug addiction was very strong. The client considered his family supportive. He has good relation with his family except his brother. He felt worthless in front of his brother. He had a love relation but they broke up which enhance clients drug habit. Client left his home when he was in grade 3 and went to his aunt’s home without his will. He felt lonely sometime at his aunt’s home. He was not comfortable. He has no other psychotic problems. However client reported complain of feeling anxious at some time of day so Beck anxiety inventory was used to assess anxiety. He scored 8 points in this test which indicates low anxiety, so it is not problematic.