CASE HISTORY (1) Name- Jhani devi Age/Sex- 47years, female Occupation- Housewife Education- Illiterate Socioeconomic status-

Average Informant (Source of information) - Self& HerHusband Complaints and their Duration (Chronological order) 1-Lack of sleeping since 2 months 2-Low appe.tite since 2 months 3-Feel pressure in head since 8 yeas after brother accident 4-Weakness 5-Feeling of fear in loneliness 6-Pulpitation 7-Gastric problem 8-Lack of interest in any work History of present illness (a) Onset: (Acute/Sub acutelFew week/Few months): 8 years

(b)Precipitating factors: (PhysicallPsychologicallDeathfLoss): Psychological.(Clients brother had been accident before 8 years after that problem started and after that 2 child was twins in which 1 had lost and her 4 children discharge) (c)Course of the illness: (Episodic/Fluctuation/Initial phase):. Fluctuation Her illness was fluctuated some time she was fine & some time she is ill

Associated disturbances: (These include disturbance in sleep, sexual life, oecupation & Disability) Client sleep was not so good, Loss of appetite, irritation, lack of interest in any work, gastric problem, depressed mood, restlessness. Family History: (Home Atmosphere) - (Unsatisfactory) Client lives in a joint family. She had 3 children in which 2 & 3rd no. of child was twins and in which 31 no. of child was dead and after then she loose her 4 male children. Present time she have 2 ciildren. Clients fear is related to situation. Home. atmosphere is stressful because critical commentsjy mother-in-law. Husbands occupation: (social position of Husband) * Clients husband is a shopkeeper and has no problem, social position is good. Her husband is normal and has an addiction of Tobacco. Pedigree Chart.II

Personal HistoryOccupation :( if any) - Housewife

Menstrual History (Age of First period) - First period starting in 1 lyears age. Sexual Information: Satisfactory relation between husbands. Marital History: (childrens) - She is married & present time she have 2 children (male). Medical History Detailed: Clients two time surgery of tumor and surgery of uterus after these problems she took medicine for restlessness, palpitation, gastric problem consult Dr. S.K. Poddar (NeurolQgist) till 8years and he referred to Dr. Ajay Tiwari Sir. Personality:

Before illness: Average Social relation: Family- Average with family. Friends- Clients like live in alone Soiety- Clients away from society due to mental illness Group- Client do not live group Attitudes to self: Clients think she is ill, Loneliness, Worthless Moral & Religious attitude & standard: Normal Mood (anger/depressed/worried): Her mood always worried about future. Leisure activities & Interest (play/music etc.): Client used to stay alone. Fantasy life: N/A Habits (iting/sleeping etc.): Sleeping Mental Status Examination (MSEI: (1) General Behavior & Appearance (eating, sleeping, spending, self care, hair & dress): All are normal (a) Eye Contact: Proper (b) Mannerism: Satisfactory (c) Response: Delayed

(2) Psychomotor activity: (catatonic) (a) Talk:(Fast/Slow) - Slow (Break to break) (b) Thought: (Flight of ideas, retardation of thinking, thought blocking) - Retardation of thinking (c) Obsession & compulsion: No any (3)Mood: (irritable/suspicion/constancy) Irritable mood

(4)Perception: (a)Delusion & Misinterpretation: (vision, hearing, smell, taste, pain) - No any (b)Hallucination: (auditory/visual) - Not found (5)Cognitive functions: (a)Attention & Concentration- Client have attention problem & concentration not so good. (b)Orientation: (own name & identify, time, date, place, etc.) -. Client knows about her name, time, date, place andher identity. (c)Memory: (immediate & remote memory) - Client has proper immediate memory as well as remote memory. She answered the questions related to her memory correctly. Client was able to recall three digit items which was presented to her. She also remembered what she had for dinner the previous night andin breakfast. So clients immediate & remote memory is satisfactory. (d)Intelligence: (subject & education) - N/A Judgment: - (a)Personal- Not satisfactory (b)Social- Not satisfactory . (c)Test: (paper, postal etc.) - Satisfactory Insight: (level of awareness of her illness) - Client is well aware about her problem. She thinks she has so many problems so follow the advice of the doctor.

SUMMARY On the basis of above of history I can say that my client Jhani Dcvi 47years old suffering from Tension-Headache because her problem lack of interest in any work, restlessness, palpitation, sleeplessness, feeling of fear in loneliness, headache since 8years after brother accident and she loss her 4 male child. She is living at ruler society. Her husband is a shopkeeper. Her mood always- worried about future. Disturbance in home environment and psychological trauma her family environment is very stressful. Investigations Treatment & Follow Up: She was referred to Dr. Ajay Tiwari by Dr. S.K. Poddar where medical treatment by Dr. Shreyansh Dwivedi (Psychiatric) and psychotherapy and relaxation exercise by psychology expert and family counseling. Follow Up: I met jh the client for twice now she feels more relaxed and present time client 75% improved. .

CASE HISTORY (2) Name- Priyanka Tiwari Age/Sex- I 9years Occupation- Student Education- B.A. 1st year Informant (Source of information) - JLoU,r p Jwse./ch 4- 1- Vomiting 8-9 days 2- Low appetite 3- Palpitation 4- Lack of interest 5- Sleep disturbance since 2 weeks 6- Depressed mood before 2 weeks History f present illness (b)Onset: (Acute/Sub acute/Few weeklFew months) - Few weeks (b)Precipitating factors: (Physical/PsychologicallDeath/Loss) - Psychological (Poor adjustment with family and love affair) (c)Course of the illness: (Episodic/Fluctuation/Initial phase) - Initial phase

Associated disturbances: (These include disturbance in sleep, sexual life, occupation &. Disability) - Client sleep was not good, loss of appetite, irritation, restlessness. Family History: (Home Atmosphere) - Client lives in a joint family. Client father is in service (District Police). He has no 1,roblem. He is normal. But has a addiction of tobacco. Her mother is a housewife. Clients have 3 sisters and one brother. Her relationships with family members are good.

Fathers occupation: (social position of Father) - Client father is a District Police. Social position is good. Her father is normal and has a addiction of Tobacco.

Date of birth & place- 7/11/1992 (b)Mothers condition during pregnancy: (Normal/Full term) - Normal delivery at Ramanagar hospital. (c)Early Lvelopment; (talking, walking etc.) Normal (d)Nenrotics & Symptoms in childhood: (night-terror, walking in sleep, wetting the bed, thumb sucking, tears) - Not found (e)Elealth during childhood: (infection, convulsions etc.) Not found (f)Schooi (hobby & interest) - Interest in playing badminton & kho-kho, also interest in art subject like Geography. (g)Occupation :( if any) - Student

(h)Menstrual History (Age of First period) - First period started when she was read in class 8th Her menstrual age cycle is normal. No any problem in menstrual history now. (i)Sexual Information: Unmarried (j)Marital History: (childrens) - Unmarried (k)Medical History Detailed: N/A

Personality: (a)Before illness: She is adjusting with any situation easily. Her nature is naughty with family & friends. (b)Social relation: Family- Normal with family Friends- Satisfactory Society- Unsatisfactory Group- Unsatisfactory Attitudes to self: Client thinks she is ill, she feel hopeless and loneliness (Negative attitudes) Moral & Religious attitude & standard: Normal Mood (anger/depressed/worried): Depressed mood and her mood always worried bout future hand carrier. Leisure activities & Interest (play/music etc.): Play badminton, watching T.V, enjoy with aunty and wearing sari & bangles. Fantasy life: Normal Habits (eating/sleeping etc.): Normal habits Mental Status Examination (MSE):

(1) General Behavior & Appearance (eating, sleeping, spending ,self care, hair & dress): All are normal (a) Eye Contact: The clients eye contact was not proper. (b) Mannerism: Satisfactory. The client was well mannered. (c) Response: Delayed. (2) Psychomotor activity: (catatonic) (a) Talk:(Fast/Slow) - Clients talking speed was normal it was neither to fast nor to slow.

 (b) Thought: (Flight of ideas, retardation of thinking, thought blocking) - Retardation of thinking. (c) Obsession & compulsion: A lot of obsession in insecurity feeling. (3)Mood: (irritable/suspicion/constancy) - Irritable (4)Perception: (a)Delusion & Misinterpretation: (vision, hearing, smell, taste, pain) - Not seen (b)Hallucination: (auditory/visual) - Not seeI (5)Cognitive functions: (a)Attention & Concentration- Not so good (b)Orientation: (own name & identify, time, date, place, etc.) - Client knows about her name, time, date, place and her identity. (c)Meory: (immediate & remote memory) - Satisfactory. Client has proper immediate memory as well as remote memory. (d)Intelligence: (subject & education) - Satisfactory Judgment: (a)Personal- Unsatisfactory (b)Social-. Unsatisfactory (c)Test: (paper, postal etc.) - Satisfactory

Insight: (level of awareness of her illness) - Client is well aware about her problem. Her insight is clear.

SUMMARY On the basis of above history I can say that my client Priyanka Tiwari 19 years old suffering from Dissociative conversion disorder (D.C.D) due to very poor adjustment because she likes a boy and family was not agree after that problem started. Her problem lack of interest in any work, low appetite, sleep disturb, depressed mood. She lives in joint family. Investigations treatmeflt & follow up: In this time she takes treatment continues in Nai Sibah Dr. Ajay Tiwaris clinic. Treatment planning: 1-Individual counseling 2-Family counseling 3-Bio-feedback 4-RelaxatTn exercise Follow up: - I met with client for thrice now she feels more relaxed.

CASE HISTORY (3) Name- Irfan Ahmad Age/Sex- 30/Male Occupation- Tailor Education- High school Informant (Source of information) - Self Complaints and their duration (chronological order) 1- Vomiting 2- Feel Restlessness 3- Sleep disturbed 4- Palpitation History of present illness (c) Onset: (Acute/Sub acufe/Few week/Few months) - 6 months (b)Precipitating factors: (Physicall.PsychologicallDeathlLoss) - Psychology (c)Course of the illness: (EpisodicfFluctuationllnitial phase) - Episodic Associated disturbances: (These include disturbance in sleep, sexual life, occupation & Disability) Occupation & Sleep disturbance

Family History: (Home Atmosphere) - Client live in nuclear family and home atmosphere is not satisfactory. Client has 3 brothers and 1 sister. Fathers occupation: (social position of Father) - Worker and social position of father normal but has an addiction of tobacco.

Date of birth- 10 august 1982 School: obby & Interest) - Playing carom Occupation: (if any) - Tailor Menstrual History (Age of First period) - N/A Sexual Information: Satisfactoiyrelation V MaritQl Iistory: (childrens) - ,He is married and has 2 cjilldren. V Medical History Detailed: He took medicine for vomiting, palpitation, gastric problem, restlessness consults Dr. S.K. Yadav till 6 months and he referred to Nai Subah Dr. Ajay Tiwaris clinic. V V V Personality: Before illness: Normal Social relation: Family- Unsatisfactory V V

Friends- Satisfactory Society- Satisfactory Group- Satisfactory Attitudes to self: Helpless Moral & Religious attitude & standard: Normal V

Mood (anger/depressed/worried): Her mood always worried about future and irritable. V Leisure activities & Interest (play/music etc.): Moving on friends. Fantasy life: N/A Habits (eating/sleeping etc.): N/A Mental Status Examinatiofl (MSE): (1) General Behavior & Appearance (eating, sjeeping, spending, self care, hair & dress): All are normal (a) Eye Contact: Not so good (b) Mannerism: Satisfactory (c) Response: Delayed (2) Psychomotor activity: (catatonic) (a) TaIk:(Fast/Slow) - Slow (b) Thought: (Flight of ideas, retardation of thinking, thought blocking) - N/A (c) Obsession & compulsion: No any (3)Mood; (irritable/suspicion/constancy) - Irritable (4)Perception: (a)Delusion & Misinterpretation: (vision, hearing, smell, taste, pain) -Noany V

(b)Hallucination: (auditory/visual) - Not found (5)Cognitive functions: (a)Attention & Concentration- Normal (b)Orientation: (own name & identify, time, date, place, etc.) - Client knows about her name, time, date, place and her identity. V (c)Memory: (immediate & remote memory) - Normal

(d)Intelligence: (subject & education) - N/A Judgment: (a)Personal-. Unsatisfactory (b)Social- Unsatisfactory (c)Test: (paper, postal etc.) - Satisfactory Insight: (level of awareness of her illness) - Client is well aware about her problem.

SUMMARY On the basis of above history I can say that my client Irfan Ahmad 30 years old suffering from Dissociative conversion disorder due to very poor adjustment. He lives in nuclear family. His family environment is not satisfactory. His problemsvomiting, gastric, palpitation, restlessness etc. Investigations treatment & Follow up: In this time his treatment continues in Nai Subah Dr. Ajay Tiwaris clinic. Treatment planning: 1. Individual counseling 2. Relaxation exercise 3. Pawanmuktasan 4. Mandukasan Follow up: I met with client 4 times now he feels better than before.

CASE HISTORY (4) Name- Pankaj Kumar Age/Sex- 35 Occupation- N/A Education- B.Tech Socioeconomic status- Middle class Informant (Source of information) - Mother-?ather& Self Complaints and their duration: (chronological order) 1- Disturbed sleep (6 months) 2- Lack of skill 3- Aggression (2 years) 4- Irritable 5 lstlessness 6- Loss of appetite 7- Excess spending money History of present illness (a) Onset: (Acute/Sub acute/Few week/Few months) - Gradually recognized approximate 2 years ago

(b)Precipitating factors: (PhysicallPsychological/DeathlLoss) - Psychological (Poor adjustment, family quarrel) (c)Course of the illness: (Episodic/Fluctuation/Initial phase) - His course of illness is episodic Associated disturbances: (These include disturbance in sleep, sexual life, occupation & Disability) Sleep disturbance & occupation Family History: (Home Atmosphere) - Client belong to nuclear family. Client has 1 brother & 2 sisters. His relationship with family members not satisfactory. Client is not capable to adjust his family iiiembeis.

Fathers occupation: (social position of Father) - Retired D.L.W employee and has addiction of tobacco. Social position of father is normal. Pedigree Chart-

Mothers condition during pregnancy- (Normal/Full term) - Delivery was normal and delivered at hospital. Early development- Breathing Neurotics & symptoms in childhood (night-terror, walking in sleep, wetting the bed, )aumb sucking, tears) - Not found Health during childhood (infection, convulsions etc) - Not remembered School (Hobby & interest) - Talk with friends Occupation :( if any) - Student Menstrual History (Age of First period) - N/A Sexual Information: Unmarried Marital History: (childrens) - Unmarried Medical History Detailed: N/A

Personality: Before illness: His physical and psychological condition was good Social relation: Friendship and other social relation was good but family relationship is not satisfactory Attitudes to self: His attitude toward self is positive, over confidence Moral & Religious attitude & standard: Average

Mood (anger/depressed/worried): Anger mood Leisure activities & Interest (play/music etc.): When he had gone to oman. Fantasy life: N/A Habits (eating/sleeping etc.): sleeping (sleeping tendency due to presenting complaints) Mental Status Examination (MSE): (1) General Behavior & Appearance (eating, seping, spending, self care, hair & dress): All are normal (a) Eye Contact: Excessive (b) Mannerism: Unsatisfactory (c) Response: Quick

(2) Psychomotor activity: (catatonic) (a) Talk:(Fast/Slow) - He is talking so fast (b) Thought: (Flight of ideas, retardation of thinking, thought blocking) - Flight of ideas (c)Obsession & compulsion: Obsession is present (grandiose delusion) (3)Mood: (irritable/suspicion/constancy) - Some time clients mood was normal but other time irritable (4)Perception: (a)Delusion & Misinterpretation: (vision, hearing, smell, taste, pain) - Clients has grandiose delusion (b)Hallucination: (auditory/visual) - Not seen (5)Cognitive functions: (a)Attention & Concentration- His concentrat on is poor (b)Orientation: (own name & identify, time, date, place, etc.) - Client knows about her name, time, date, place and her identity.

(c)Memory: (immediate & remote memory) - Satisfactory (d)Intelligence: (subject & education) - Satisfactory Judgment: (a)Personal- Unsatisfactory V (b)Social- Unsatisfactory (c)Test: (paper, postal etc.) - Satisfactory Insight: (level of awareness of her illness) - Client is not aware about his problem. He thinks he is perfect no any problem

SUMMARY On the basis of above history I can say that my client Pankaj Kumar 35 years old suffering from Mood Disorder (Bipolar). His problem highly aggression some time normal and other time irritable disturbed sleep live alone flight of ideas He lives in nuclear family His relationship with family members not satisfactory. Investigation & TreatmentIn this time his treatment continues in Nai Subah Pr. Ajay Tiwari clinics Treatment pIannin Client was treated through individual counseling family counseling and relaxation exercise.

CASE IIIST0RY (5) Identification Data Name- Barkha Vishwakarma Age- 1 1 years Sex- Female Education- Functional junior group Occupation- Student Languages/spoken- Hindi Informant- All information given by Special Educator of Kiran Center Date- 16/01/2014 Demographic Data (Parents/Guardian) Fathers Name- Gopal Vishwakarma Fathers Education- High school Fathers Occupation- Carpenter Mothers Name- Anita Devi Mothers Education- Intermediate Mothers Occupation- Housewife Address local- D.LW, Varanasi

Permanent- Mohalla- Nathupur, Post- Bhullanpur, Disft- Varanasi Income/Month- 3000/Presenting Complaints(1) Hyper active behavior due to attention seeking (2) Rigid behavior (3) Poor eye contact (4) Problem in attention and cnncentrtinn

(5) Lack of communication (Dont communicate problem with other (6) Walking problem in specific area such as co-operation balance between legs (7) Speech problem History (Prenatal, NataJ, Postnatal) Prenatal- Mother was week during pregnancy had anemic problem she had problem of sleepiness during 6 months which continues till 9th,month Natal- Delivered through operation Post natal- Not satisfactory Family History- Barkha has nuclear family which includes father mother and one younger brother. Barkha is first in her family who is suffering from cerebral palsy with type of athatoid.

Developmental History (a)Neck holding (2-6 months) - No (b)Sitting (5-10 months) - No

(C) Walking (9-14 months) - No (d)First words (7-12 months) - No (e)Two word pirases (1-3O months) - No (f)Sentences (3-4 years) - No (g)Toilet control (3-4 years) - No (h)Monetary tninsaction (YesiNo) - No

(i)Avoids simple hazards (Yes/No) - No (j)Problem in school/scholastic backwardness (Yes/No) - No (k)Physical deformity (Yes/No) - Yes (l)Sensory impairments (Yes/No) - No (m)Fits (Yes/No) - Yes School History- She got admission in 6 years in functional junior group of Kiran Center. Present time she is 11 years old. She learns about 5 fruits name, 5 vegetable names, 5 colors name, 5 parts of tody name, numerical, Hindi letters etc. Occupation History- Student of functional group Behavior problems (if any) (1) Problem in attention (2) Rigid behavior (3) Spetch problem (4) Dont obey orders properly Assessment Motor- She is not capable to do anything such like fine motor (buttons) and gross motor movements.

Self Help- She is try to do simple work like brushing, dressing, eating, comb hair etc. She co-operate with her family who work are related him. Communication- Her words is not clear having speech problem. Speech is surd. No clarity in speech her receptive and expressive speeches both are poor. Academics- N/A Socialization- She interacts with unfamiliar people with gradually not quickly. Educational status (1) Can write 1 to 10 by watching S (2) Can write Hindi letters (3) She recognize 5 fruits name (4) She recognize 5 vegetable name (5)Can write A to Z Vocational status- N/A Intellectual/Psychological Assessment General behavior during assessment- Not so good Attention and ConcentrationHer attention and concentration both are verypoor Activity levelModerate level, trainable and teachable to improve self help skill like Brushing and combing

Comprehension- Poor Ernotidflality and behaviorExcessive emotional and attention seeking behavior Relationship with in/outside family (significant stressors) She feels comfort with her mother and teacher and feels uncomfortable with outsiders Medical Examination Height- 128 inch Weight- 24 kg Head circumference- Normal Respiratory- Normal Abdomen- Normal Visual- Average Auditory- Normal

Provisional Diagnosis- Cerebral palsy (C.P) moderate level child Management plan (1) Speech therapy (2) Special education like self help skill (3) Behavior modification (4) Recognize Hindi letters by cards (5) Recognize name of family members (6) Recognize 1 tol 0 number (7) Hand function (8) Practice of pattern writing Consultants: *p eflts *Specjal educator psychologist

SUMMARY On the basis of above history I can say that my client Barkha Vishwakarma II years old suffering from Cerebral Palsy, treatment continues since 5 years in Kiran Center. In this center special education like brushing wearing cloth write alphabet recognized fruits, vegetables name etc. speech therapy hand function & behavior. In these therapy client improve her activities so her family member happy for thes improvement.

9 CASE HISTORY-I Name Avinash kumar age/sex- 27year/male occupation-N/A Education 10+2 Socioeconomic status-middle Informant (source of information)-self Complaints and their duration (chronological order) I. sadness ii. loneliness iii. low in interest iv. paralysis in both hands(two days) History of present illness(a)Onset-(acute/sub acute/few week/few months)- few month (b)precipitating factors (physical/psychological/death/loss)psychological, loss of be loved, one (c) Course of the illness (episodic/fluctuation/initial phase) - episodic Associated disturbances-(these include disturbance in sleep, sexual Life occupation and disability) - sleep

disturbance

Family history (past physical/psychiatric illness)

Fathers occupation-good V -Social position of father (alcoholism/abnormal/MI/epilepsy)V satisfactory -Home atmosphere (emotional relationship) - satisfactory Personal history(a)Date of birth and place-N/A V V (b) Mothers condition during pregnancy (Normal/full term)-N/A (c)Early development (talking, walking etc)-N/A V (d) Neurotics and symptoms in childhood (night terror, walking in sleep, wetting the bed, thumb sucking, tears)-N/A (e) Health during childhood (infection, convulsions etc)-NO (f) School (hobby and interest)-PLAY V V (g) Occupation (if any)-No (h) Menstrual history (age of first period)-N/A (I) Sexual information-N/A (j) Marital history (childrens)-N/A .

(k) Medical history detailed-no Personality- V

(a) Before illness- self confidence high (b) Social relation (family, friends, societies, groups etc)- good (c) Attitudes to self-negative, low self confidence (d) Moral and religious attitudes and standard-normal (e)Mood (anger/depressed/worried)-worried (f) Leisure activities and interest (ply/music etc)-play (g)Fantasy life-no (h)Habits (eating/sleeping etc) - sleeping Mental status examination (MSE) 1. General behaviour and appearance & Appearance (eating, sleeping, spending; self-care, hair and dress) - excessive eating and excess sleeping after treatment, self care low, hair and dresses are well. (a)Eye contact: proper (b)Mannerism: proper (b)Response- late response 2. Psychomotor activity :( catatonic): (a)Talk (Fast/slow)-slow (b)Thought :( flight of ideas, retardationof thinking, thought blocking) retardation of thinking (c)Obsession and compulsion- obsession

3. Mood :( lrritable/fear/suspicion/constancy)-future fear 4. Perception: (a)Delusion & Misinterpretation (vision, hearing, smell, taste, pain)

(b)Hallucination (Auditory/visual) - visual and auditory both 5. Cognitive function: (a)Attention & concentration- not good (b)Orientation :( Own name & Identity, time place etc) - clear (c)Memory:( Immediate & remote memory)-good (Some common question: breajfast, eat previous night, digits) General information :-( G.K) 6. Intelligence :( subject & educational area) - average 7. Judgement :( a) Personal-poor (b)Social- proper (c) Test:( Paper, postal etc)- proper 8. Insight (Level of his awareness of his illness)- good SUMMARY Provisional diagnosis: paranoia.disorder Investigations treatment 1.mediication 2. Councilling 3.relaxation Follow up: He feels better in present situation

CASE HISTORy4 Name Sanjeev prakash age/sex-45yea r occupation- job Education B.A Socioeconomic status- high Informant (source of information)- wife Complaints and their duration (chronological order) i. palpitation ii. restlessness iii. depressed mood iv. less apatite v. slow talk vi. less talk History of present illness(a) Onset-(acute/su b acute/few week/few months)- few months (b)Precipitati ng factors (physical/psychological/death/loss) i. Unsatisfactory job ii. Hard work

iii. Unprotocal insecurity in job iv. Far away for family. (c) Course of the illness (episodic/fluctuation/initial phase) Seasonal/ Episodic Associated disturbances-(these include disturbance in sleep, sexual Life occupation and disability) : life occupation

Family history (past physical/psychiatric illness)

Fathers occupation-Social position of father (alcoholism/abnomal/Ml/epilepsy)satisfactory -Home atmosphere (emotional relationship)- satisfactory Personal history(a)Date of birth and place-N/A (b)Mthers condition during preghancy (Normal/full term)-N/A (c)Early development (talking, walking etc)-N/A (d) Neurotics and symptoms in childhood (night terror, walking in sleep, wetting the bed, thumb sucking, tears) N 0 (e) Health during childhood (infection, convulsions etc)-NO (f) School (hobby and interest):N/A (g) Occupation (if any)-Private Job (h)Menstrual history (age of first period)-N/A (I) Sexual information-N/A (j) Marital history ( childrens):Twct girls. (k) Medical history detailed-no

Personality(a) Before illness-Satisfactory personality. (b)Social relation (family, friends, societies, groups etc)unsatisfactory because he is suffering from along with irritating mood. (c)Attitudes to self- Negative (d)Moral and religious attitudes and bstandard: proper (e)Mood (anger/depressed/worried)-depressed (f) Leisure activities and interest (play/music etc)-nothing now (g)Fantasy life-normal (hHabits (eating/sleeping etc)-sleeping Mental status examination (MSE) 1. General behaviour and appearance & Appearance (eating, sleeping, spending, self-care, hair and dress)-proper (a)Eye contact : proper (b)Mannerism: proper (c) Response- slow 2. Psychomotor activity :( catatonic): (a)Talk (Fast/slow)-slow (b)Thought :( flight of ideas, retardation of thinking, thought blocking)-slow (c)Obsession and compulsion-not now

3. Mood :( lrritable/tear/suspicion/constancy)-depressea

4. Perception: (a)Delusion & Misinterpretation (vision, Hearing, smell, taste, pain) - No (b)Hallucination (Auditory/visual)-No 5. Cognitive function: (a)Attentibn & concentration-not good (b)Orientation :( Own name & Identity, time place etc)-clear (c)Memory:( Immediate & remote memory)-good (Some common question: breakfast, eat previous night, digits) General information :( G.K) 6. lntellience :( subject & educational area)-average 7. Judgement :( a) Personal-proper (b)Social-proper (c) Test :( Paper, postal etc)-proper. 8. Insight (Level of his awareness of his illness)-proper SUMMARY Provisional diagnosis-affective mood disorder Investigations treatment: 1. Cognative behaviour therapy2.Relaxation 3. Counselling 4. Low doses of medication

Follow Up:: He feels better in present situation

CASE HISTORY-B Name Nilam patel age/sex-18 year occupation-N/A Education preparation of P.M.T Socioeconomic status- middle Informant (source of information)-patient Complaints and their duration (chronological .order) i. high headache ii. tremorsin body iii. loneliness iv. tension v. sapfiocatjon History of present illness(a)Onset-(acute/sub acute/few week/few months)-few month (b)precipitating factors (physica I/psychological/death/loss)psychological,study pressure,family pressure, break up with friends. (c)course of the illness (episodic/fluctuation/initial phase)fluctuation Associated ciisturbances-(these include disturbance in sleep, sexual Life occupation and disability)- sleep disturbance

Family history(past physical/psychiatric illness)

Fathers occupation- private job -Social position of father (alcoholism/abnormal/M l/epilepsy)-alcohol -Home atmosphere (emotional relationship)-stressful Personal history(a)Date of birth and place-26/O1/1995 (b) Mothers condition during pregnancy (Normal/full term)normal at home (c)Early development (talking, walking etc)-N/A (d) Neurotics and symptoms in childhood (night terror, walking in sleep, wetting the bed, thumb sucking, tears)-NO (e) Health during childhood (infection, convUlsions etc)-no (f) School (hobby and interest)-dance (g) Occupation (if any)-N/A (h)rnenstrual history (age of first period)-12 TO 13 .(l) Sexual information-N/A (j) Marital history (childrens)-N/A (k) Medical history detailed-NO Persona lity (a) Before illness-satisfactory persoiality (b)Social relation (family, friends, societies, groups etc)-friends (c)Attitudes to self-negative (d)Moral and religious attitudes and standard- high

19 (e)Mood (anger/depressed/worried)- anger (f) Leisure activities and interest (play/music e.t.c) listening music (g)Fantasy life-no (h)Habits (eating/sleeping etc)-sleeping Mental status examination (MSE) 1. General behaviour and appearance & Appearance (eating ,sleeping, spending ,self care ,hair and dress)-proper (a)Eye contact : proper (b)Mannerism: proper (c)Response: late 2. Psyc4omotor activity:(catatonic): (a)TaIk(Fast/sloW)-proper (b)Thought:(flight of ideas,retardationof thinking ,thought bloking)normal (C)Obsession and compulsion-no 3. Mood: (lrritable/fear/suspicion/constancy)-irritabl e, worried 4. Perception (a)Delusion& Misinterpretation(vision,Hearing,smell,taste,pain)-no

(b)Hallucination(Auditory/visual)- no 5Cognitive function: (a)Attention & concentration- not good (b)Orientation:(Own name & Identity ,time place etc)-clear (c)Memory:(lmmediate & remote memory)-good (some common question:breakfast,eat previous night, digits) General information :(G.K) 6.lntelligence:(subject & educational area)-avearage

(b)Social- normal (c)test:(Paper, postal etc)-normal 8.lnsight (Level of his awareness of his illness) -poor SUMMARY: Provisional diagnosis: dissociative conversion disorder Investigations treatment & follow up: 1.bio feed back therapy 2.psycho therapy 3.cognjve behavioural therapy Follow Up:recovery of her illness 70%.

CASE HISTORY-p7 Name Anubhav tiwari age/sex- 22 year, male occupation-no Education 10+2 Socioeconomic status-middle Informant (source of information)-self. Complaints and their duration (chronological order)-loneliness, interest low, stomach pain, low activity, depressed mood. History of present illness(a)Onset-(acute/subacute/few week/few months)-few weeks (b)precipitating factors (physical/psychological/death/loss)psychological,career tension (c)course of the illness (episodic/fluctuation/initial phase)episodic Associated distu rba nces-(these include disturbance in sleep, sexual Life occupation and disability) Family history(past physical/psychiatric illness)

22 Fathers occupation-business -Social position of father(alcoholism/abnormal/Ml/epilepcy)satisfactory -Home atmosphere(emotional relationship)-satisfactory Personal history(a)Date of birth and place-05/O1/1992 (b) Mothers condition during pregnancy(Normal/full term)-N/A (c)Early development( talking, walking etc)-N/A (d) Neurotics and symptoms in childhood(night terror,walking in sleep ,wetting the bed, thumbsucking, tears)- N/A (e) health during childhood( infection,, convulsions etc)-N/A. (f) School (hobby and interest)- play (g) Occupation (if any)-no (h)menstrual history (age of first period)-N/A (I) Sexual information-NO (j) marital history( chidrens)-N/A (k) medical history detailed-no Personality (a) Before illness-satisfactory,high interest level, proper interest making. (b)Social relation(family ,friends, societies, groups etc)-friends (c)Attitudes to self-negative

(d)Moral and religious attitudes and standard-no

23 (e)Mood (anger/depressed/worried)-worried (f) Leisure activities and interest (play/music e.t.c)-play (g)Fantasy life-no (h)Habits(eating/sleeping etc)-playing Mental status examination (MSE) 2. General behaviour and appearance & Appearance (eating ,sleeping, spending ,selfcare ,hair and dress) (a)Eye contact :fluctuate (b)Mannerism: proper (d)Response- fast 2Psycibmotor activity:(catatonic): (a)Ta lk(Fast/slow)-fast (b)Thought:(flight of ideas,retardation of thinking ,thought blocking)- flight of ideas (C)Obsession and compulsion- obsession is present mood irritable and worried. 3.Mood:(lrritable/fear/suspicion/constancy)- irritable 4.Perception: (a)Delusion & Misinterpretation(vision,Hearing,smell,taste,pain)-no (b)Hallucination(Auditory/visual)-no

5.Cognitive function: (a)Attention & concentration-poor (b)Orientation:(Own name & Identity ,time place etc)clear

(c)Memory:(Immediate & remote memory)(some common question:breakfast,eat previous night, digits) General information :(G.K)-good 6.lntelligence:(subject & educational area)- avearage 7.Judgement:(a)Personal-poor (b)Social-poor (c)test:(Paper, postal etc)-good 8.Insight (Level of his awareness of his illness)-poor SUMMARY: Provisional diagnosis: bipolar mood disorder Investigations treatment & follow up: 1.medication 2.relaxation 3.cognitive behavioural therapy Follow Up: Recovery of his illness 75%.

CASE RECORD PROFORMA-5 /0 SECTION -1 IDENTIFICATION DATA (CASE) NAME: Luv singh date-26/O1/2014 Age: lOyear Sex: male Informant-teacher Education: junior functional group Occupation: N/A Language/s-Hindi SECTION-2 DEMOGRAPHIC DATA(PARENTS/GUARD1AN) Fathers name Swarjeet singh Father education Intermediate Fathers occupation former Mothername Santara devi Mothereducation illetrate Motheroccupation housewife Address local: Village-mudhadav, post-tikari, home no.137, dist- Varanasi, thana rohania Permanent: V Village-mudhadav, post-tikari,.home no.137, dist- Varanasi, thana -rohania

Income/Month: 2000per month. rresenting Complaints: I. low vision V

27 i)Avoids simple hazards (no) j)Problems in school/scholastic backwardness (yes) k)Physical deformity (no) l)Sensory Impairment (yes) m)Fits (yes) School history: Occupation history: Behaviour problems,if any: ASSESMENTS Motor: hyper motor activity without purpose. Gross movement activities normal but fine motor movement is not appropriet. Coordination of motor activity of complex type is not appropriet ii. Self help: he helped himself for a simple problem .he help himself with support of family for a difficult problem. Hi. Communication: his word is not clear speech is slured ,his expressive and receptive speech both are poor. iv. Academics: recognizes the five fruits name, five animal,five vegetable name,parts of body name his learning capacity is low due to this improvement is low.

v. Socialization: his socialization is poor his does not interact with others . he communicate with family person ,his social connection is so limiteJ. vi. Educational status: he is student of junior functional group in which he primary thing and self care. vii. Vocational status: N/A

28 MEDICAL EXAMINATION Height- l24inch Weight-25kg Head circumference-normal General appearance- normal CVS:normal Respiratory: normal abdomen :normal CNS:sensory visual:low Auditory: normal I NTELLECTUAL/PSYCHOLOG ICAL ASSESSMENT a. General behaviour during assessment- no information b. Attention and concentration- poor c. Activity level- hyper activity d. Comprehension- poor e.EmotionaI and behaviour- normal f. Relationship within/utside family (significant stressors) - no g. Psychological test used: SFB-mental age four years one month, lQ-53 Social adaptation- social age: five year two month SQ-55.7

Provisional diagnosis- cerebral palsy of athitoid type with moderate retardation. Management: 1.Restructuring the environment and rescheduling the activities. 2. Monitoring him to do desirable behaviour. 3. Restraint to enough to punish for any desirable behaviour. 4. Planning for leisure time. 5. Engage in peer group to improve socialization. 6. Parental counselling for home situation. 7. To make concept of coin and simple letters through fleshing card. 8. To improveself care