DEMOGRAPHICS
Name:
Mrs. ABC
Age:
43 years
Gender:
Male
Education:
Matric Pass
Marital status:
Unmarried
Birth order:
Second
Religion:
Islam
Ethnicity:
Hindko
Cast:
Rajpoot
Reference Source:
Client’s family
The case is of the client named ABC who is 50 years old. He is unmarried. Client came with
the complaint about unrecognizable voices he heard often. His physician reported that he has
a history of medical and psychological issues but those were treated through proper
medications long time before his present problems. Now he is in rehabilitation centre for the
treatment of schizophrenic symptoms.
Presenting Complaints
The client reported the following conditions as related to her physical complaints;
Personal History
The client was born with the normal delivery. He was physically well at the time of birth. He
has normal childhood up till 7 years of age. At the age of 7 his friends forced him to smoke
and that was the time he started smoking.
Family History
He belongs to middle class family. His father is quite strict as compared to his mother who is
housewife and a simple woman. His father lives in Kuwait and provides him financial
assistance.
General House Environment
The house environment of the client was strict, he reported that his father sometimes
humiliate his mother that he find annoying. To avoid such environment he used to go out
with friends. He didn’t have good relation with his siblings. Even now he thinks they call me
mad and I don’t like it.
Sexual History
He is unmarried but he really wants to get married.
Educational History
He was an average student and only did matriculation.
Occupational History
The client has no occupational history as he involved himself in drug consumption at very
early stage.
History of Present Illness
When the client was 07 years old he started smoking. Due to his family negligence he didn’t
restrain from it. It leads to substance induction. And at the age of 17 he started taking
Cannabis too. When the family noticed this behavior they took him to rehabilitation centre.
And he recovered within 3 years. He said due to medication he started hearing different
voices that disturb his daily functioning.
Onset of Illness
As the illness was due to substance induction, the onset was by the age of 17 years when he
was young.
Preliminary investigation:
He was not very talkative whatever was asked during the session he didn’t reply or gave one
liner response. He was bizzare and had positive symptoms too. He was constantly moving his
leg and had irregular head and eye movement.
Previous Medical and Psychiatric History
He started the medication due to substance induction at the age of 17 but that leads to
psychotic symptoms like hearing voices.
Case Formulation:
He had fixated childhood. As he saw her mother being suppressed all the time and father
being the only authoritarian figure he stayed quit in house and usually didn’t stay at house.
According to the afforemwntioned details following are the possible factors:
1. Concept of escapism by Freud- it is a way to cope stress. Usually opt when you are not
able to cope or face the situation you try to escape from it. This is what he used to do
whenever anything goes wrong in house.
2. Developmental stage given by Freud- Freud focused on psychosexual needs and if the
fixation happens in childhood it goes long. Same as the case fixation is in early childhood
developmental time. He wants to get married but he hesitate due to his early experiences.
3. Developmental stages of Erickson: There is a fixation in almost every stage like mistrust,
doubt, Guilt, Confusion. All this leads him to be a fixated person.
Psychological Assessment
Formal Assessment
Beck Depression Inventory (BDI)
The client scored 18 on Beck Depression Inventory this according to the test scoring shows
borderline clinical depression. This is the indication of the existence of depressive symptoms
in client at mild level or shows over thinking on these particular issues related to health.
Rotter Incomplete Sentence Blank (RISB)
The client scored 138 on Rotter Incomplete Sentence Blank. This score is on the borderline of
normality and abnormality or seems higher but he has not crossed the limit of abnormal
social life but the sentence of “I need” of which he replied “peace” and in the next sentence
of “sometimes” she aid “I feel sad” shows his dissatisfaction in life.
House Tree Person (HTP)
These are the following indicators in the drawings of the client:
House

Sketchy shading indicates insecure and doubting, hyperactivity and stress.

Poorly drawn the drawings shows poor interpersonal relationships.

Closed doors and windows of house shows defensive personality.

One window, door and roof indicates severe mental and physical conditions.
Person

Excessive details of face shows the aggressive and socially dominant attitude
hiding inner inadequacy.

Irregualr contour of face shows the severe physical and mental condition.

Glamourous hair shows stress related physical conditions.

Unusually large eyes shows the suspicios and paranoid attitude.

Cupid bow mouth shows stress related physical illness.

Square shape body shows severe emotional conditions and thought disorder.

Uncertainity in drawing shoulders indicates the psychosomatic illness.

Breasts omitted indicates severe mental and physical conditions.

Omission of arms, hands, legs shows depressed condition, feeling inadequate
and immobile.
Tree

Numerous leaves shows obsessive-compulsive tendencies.

Sharply pointed leaves shows aggression.

Shading of trunk indicates conversion of emotional upset into physical
symptoms.

Roots entering ground shows regression and insecure behavior.
Overall view of the test shows the depressive symptoms, aggression, psycho-somatic
symptoms and feeling of dissatisfaction and poor relationships.
Diagnosis
According to DSM 5 and on the basis of symptoms the client has schizophrenia.