Psychosocial assessment of patient with Psychiatric illness

2. 55 50 50
70
52 48
48
46
67
46
13
Graduation
Sports Teacher
Died at 33
year old d/t
stroke

3. • Patient belongs to Hindu nuclear family of upper socio-economic
status* residing in urban background of district Rohtak, Haryana
• He is currently living with his family members
• He is the eldest among his siblings
• Family Life Cycle stages (Carter and McGoldrick):
• The family with young children
*As per modified Kuppuswamy Socio-Economic Status Scale

4. Relation to
Patient
Age Education Occupation
Marital
Status
Mother 48 Post graduate Librarian Married
Step-father 46 B. Ed. Teacher Married
Step-brother 13
Studying in
8th class
Student Unmarried

5.  Family type : Nuclear
 Number of family members : 4
 Family income : 1.5 lac
 Family living condition : Living in a fully furnished house, having
both 4 wheeler and 2 wheeler vehicle
Impression : Adequate facilities

6.  History of substance use (Alcohol) in father
 No history of psychiatric illness in family
 No history of abscond in family

7. Parental sub-system:
 Interaction between parents is adequate and proper communication
present.
Patient and Parent : There is good communication and affection between
mother and patient but because of his illness the communication is not clear
and direct between patient and step-father.
Siblings sub-system:
 Healthy Interpersonal relationship among the siblings
Impression- Unhealthy interaction pattern between patient and step-father

8.  Role and functioning : The roles of the family members prescribed
and performed by the family members. Because of substance use the
patient unable to perform his roles.
 Boundaries : Boundaries are semi- permeable
 Cohesiveness : “We feeling” is present in the family. Adequate
belongingness and togetherness among the members of the family.
Adequate warmth and affection between the members of the family.

9.  Leadership & Decision making : Leadership pattern is gender-based.
Functional & Nominal Head – Step-Father, Family members accept
the leadership and it is democratic.
 Communication : The communication is direct and is positive among
family members. But there is minimal communication between step-
father and patient since disruption use of substance use.
 Family adaptive pattern : Mutual understanding and trust is
present in the family which leads to effective crisis management.

10.  Family has inadequate knowledge about the illness, that drives
them to consult with faith healers who directed them to consult in
PGIMS for treatment
 Now they believe the illness can be treated by the psychiatric
professionals
 Mother has enabling behaviour by providing him money, whenever
he asks money for substance use and betting

11.  Since, the patient has disruption use of substance he has no cordial
relationship and is breakdown in communication with step-father
 Mother plays role as chief caregiver and used to handle all the
matter of the patient alone
 She beliefs if she discuss the things with his step-father the things
will get worse and they again involve in feuds

12. Domains Obtained Score Impression
Financial Burden 6/12 Moderate
Disruption Of Routine
Family Activities
8/10 Severe
Disruption Of Family
Leisure
6/8 Severe
Disruption Of Family
Interaction
6/10 Moderate
Effect On Physical
Health To Other
1/4 Mild
Effect On Mental Health
of Other
2/4 Moderate
Impression – Severe burden – Disruption of routine family activities, disruption
of family leisure, disruption of family interaction. Moderate burden – Financial
burden and effect on mental health of other..

13.  Mother usually blame herself for not taking care of him properly
 And feel guilty for the patient’s substance use behaviour, and also
admits that she can do anything for his care, well-being and do
things which makes him comfortable

14. Domains Obtained Score Maximum Score
Critical Comments 4 10
Hostility 5 12
Dissatisfaction 4 12
Emotional over-
involvement
12 16
Warmth 4 10
Impression – Family attitude questionnaire shows that Expressed Emotions are high in
the form Emotional over-involvement

15. TYPE OF SUPPORT DESCRIPTION IMPRESSION
Primary
Patient is getting
appraisal, informational
and instrumental
support from the family
members.
Adequate
Secondary
Support available from
relatives & neighbours
Adequate
Tertiary
Institutional support is
available & accessible
by the patient
Adequate
Impression: Adequate Primary, Secondary & Tertiary
support.

16.  Pt S, 26 years old, unmarried male, studied up to Graduation,
currently unemployed, belonging to Hindu nuclear family of upper
socio-economic status of urban background of district Rohtak
 Psychosocial assessment reveals that – poor knowledge of illness,
poor role performance of patient, poor communication pattern
between step-father and patient, high express emotions, enabling
behaviour of mother, severe family burden, poor motivation of
patient

17.  Z56- Problems related to employment and unemployment
 Z 63.1 – Problems in relationship with parents
 Z 72.0 – Tobacco Use
 Z 72.2 – Drug Use
 Z 81.1 – Family history of alcohol abuse

18.  Poor knowledge of illness
 Poor role performance
 Poor communication pattern among step-father and patient
 High Expressed Emotion
 Severe Family Burden
 Enabling Behaviour from mother’s side
 Poor motivation
 Unemployment

19. Short term plan
 Psychoeducation to patient and
family members
 Supportive sessions
Long term plan
 Family intervention
 Motivational Enhancement Therapy
 Occupational Rehabilitation

20. Sessions Details
A total of Three session have been conducted with
patients and his family members
Session No intervention
1 Psychosocial History
2 Family assessment
3 Supportive counselling

21. Session No I
Date 26/01/22
Duration of session 50 Minutes
Session participant Pt. And His mother
Key issues/ Themes discussed • Rapport Establishment
• Taking the psychosocial
history
Method used Interviewing
Therapist observation and
reflection
Pt. mother gives the history
along with the attitude of illness,
she was crying in between the
interview.
Plan Assessment of family dynamic

22. Session No II
Date 27/01/22
Duration of session 40 minutes
Session participant Pt’s Mother
Key issues/ Themes discussed • Family Dynamic Assessment
• Assessment of family burden
and expressed Emotion
Method used Interviewing and questionnaires
Therapist observation and
reflection
There is poor knowledge about
illness in mother, family burden,
high expressed emotion of mother
towards patient.
Plan Supportive session

23. Session No III
Date 01/01/21
Duration of session 30 Minutes
Session participant Pt’s mother
Key issues/ Themes discussed Emotional ventilation &
assurance
Method used Supportive psychotherapy
Therapist observation and
reflection
Pt’s mother feel better although
she try to understand about the
problem and also shared her
experiences with patient.
Plan Psychoeducation session

24.  Continue Family Psychoeducation along with patient
 Continue supportive sessions
 Family intervention
 Motivational Enhancement Therapy
 Occupational rehabilitation

25. Thank
You