INTRODUCTION
The internship was at the University Teaching Hospital
(UCH), Ibadan. It was held between, 3rd January to 31st march
for the fulfillment of the Masters program. Maters in Clinical psychology, at
the University of Ibadan, Oyo state.
Activities performed
Basically, most of what was done was clerking of
patients. There also was going for seminars, organized by other department of
the hospital besides the Clinical Psychology department and organizing seminars
for staffs.
There was internal posting to various department of
the hospital for understanding of medical disorders in relations to mental
disorders. Places like the Clinical Psychology department at the general
outpatient department (GOPD), Pediatrics, Hospice and Palliative care…………………………………..
GOPD
(general outpatient department)
The clinical psychology section, GOPD is majorly the
base for the clinical practicum. It is from this office the internship is
planned.
The clinical
psychologist, Mr Kolade put us through basic tools to have in practical
therapy. Also, topics were discussed and issues were clarified. He also
monitors the way clerking is done, how to arrive at diagnosis and what to look
out for in clerking.
The clinical psychology office organized a
communication skill seminar for staff of GOPD. The presenters were the preceding
interns.
Below are cases attended to at the GOPD clinical
psychology office,
CASE1
Biodata
Name: Mrs A.I
Age: 42
years
Sex: female
Address:
Sango Ota
Marital status:
married
Religion:
Christian (Jehova witness)
Presenting complains,
She complains of stomach pain, which moves to the
chest and then the hand. She feels like she has no power anymore, dead limbs,
leg pain, crawling sensation on her head, headache, itching of the lower
abdomen, hotness in the stomach, hot temperature. She also said after using the
toilet her vagina itches, so also the anus. She feels heart pain, heart
palpitation, back pain, dryness of the throat and frequent urination.
Family history,
She is from a monogamous home. She has six siblings,
two males and four females. Her relationship with them is very cordial. Two
older and two younger siblings of hers are married.
Personal history,
She is a sowing mistress with workers. Her husband is
57 years and a bricklayer. She worries about the fact that there is no sex
between her and her husband. Her relationship with her husband has reduced to
only greeting, serving him food and talking only when necessary
Medical history,
She had fibroid operation in 2007. According to her
husband, anyone that goes through such an operation will have to stay away from
sexual intercourse for at least 2years. Because of her present illness she has been to at least
five hospitals.
Psychosexual history,
Since 2007 fibroid operation she has had sex for only
two types with her husband. For the past two years there had not being any
sexual relation with her husband. She says sex is not enjoyable for her. She
also said her husband fears to have sex so that there would not be another
reason for operation.
Mental state
examination
Appearance and behavior: she wore a neat blue top and skirt. Her
behavior has nothing spectacular to it.
Mood: she claims to worry a lot about her health,
believing that it may be a big deal. Also, there is fear that her
illness may lead to
another operation which she is scared of. She feels distressed because
of her sleeplessness. She worries a lot about her health and used to
worry a
lot about her lack of sex filled life with her husband.
Diagnostic impression
Axis I:
Somatization co-morbid sexual dyfunction
Axis II:
N.A
Axis III:
Fibroid operation
Axis IV:
Unhappy home, poor communication with husband and daily fight with
husband.
Axis V: 75,
moderate symptoms. When symptoms are present it is due to psychological
stressor.
Treatment plan
Psycho education
Sexual education
Cognitive restructuring
Relaxation therapy
Follow up
treatment
Mrs A.I was asked to come back with her husband two
weeks after she came to the clinic. She looked more happy, lively and hopeful.
She said the pain reduced to few intermittent pain.
The follow up therapy
was basically sex education for the husband, which entails how the sexual
organs are, what they functions for, how to seduce and have sex with his wife.
These were done since it became apparent that the man has either forgotten how
to have sex or does not know how.
Another appointment was scheduled for a month after.
CASE 2
Biodata
Name: Mrs O
Age: 42
years
Sex:
female
Address: Ibadan
Marital status:
married
Religion:
Christian (catholic)
Presenting
complains,
She complained of severe headache. Due to this headache
she was admitted at a private hospital for two days. She does not sleep well.
The headache started after her husband hit her on the head. She feels dizzy,
drowsy and there is pain at her neck area. There was itching two days before
today. Hooking feeling at the waist then it moves to the knee and she
palpitates.
Family
history,
She has no parents anymore. There are three of them.
The eldest, who brought her to Lagos died two years ago. She is left with her
only sister.
Personal
history,
She studied to the stage of SSCE and also learnt and
practice as an auxiliary nurse. Her husband is a secretary at a seminary. She
worked at a hospital but because her boss was not forthcoming with the payment
of salary her husband asked her to leave the job which she did.
She says she is naturally friendly but do not easily
open up to people about herself.
She has four children, two of which are written SSCE
and JAMB.
Medical
history,
She wears glasses and had been admitted to a private
hospital because of her present severe headache. Also, after the birth of her
last child she was admitted.
Psychological
history,
Two years prior now when her elder sister died she had
crawling sensation over her body, there was sleeplessness, tonlititis. She was
unable to belge and numbness of the left leg
Marital history,
She said that since her marriage she has not been
happy. She said her husband is keeping extra marital affair. The husband is
stingy at home but generous to outside people. The husband do not give
preference to decision they both make at home, he always do come back home to
change the initially decided issue. He gets the new advice from his uncle’s
wife.
Mental state
examination,
Appearance:
she is neatly dressed in Ankara top and skirt.
Mood: her
mood is characterized by excessive worry, unhappiness and thought of
hopelessness
Affect: she
is sad and dull.
Diagnostic
impression
Axis I:
somatization co-morbid with depression
Axis II: N.A
Axis III:
Headache
Axis IV: the burden of feeding and catering for the
home financially is on her,
Axis V: 75
Treatment
plan
Psycho education
Cognitive restructuring
Relaxation therapy
Follow up
treatment
Mrs O, came back two weeks after the initial session.
She looked better and was lively. She said the headache had reduced to a
minimal level but still comes.
Her follow up treatment still involved her search for
a job since she had not gotten any and continuation of the relaxation
technique. She was given a stressor chart, this is to help us know when the
pains come, what happened before and after and how she perceived it.
Another appointment was scheduled for two weeks.
CASE 3
Biodata
Name: Mr F.G
Age: 31 years
Sex: male
Address:
Ibadan
Marital status:
married
Religion:
Christian (winners)
Presenting
complains,
Since late 2010, he has had pains at his back, a
blocked feeling at the side which has prevented him from running. He feels his
two legs go numb; there is intermittent shock feeling at both legs at different
times. There is uneasiness to defecate and cannot hold urine.
Family
history,
Both parents are still alive, the father is a retired
civil servant and his mother is still a teacher. He has two siblings. He has a
brother who is 29 years and a banker and he also has a sister, who is 27 years
and a pharmacist. His brother is also married.
Personal
history
He just got married last year November to his wife. Of
all his league of friends he is less successful. His siblings are also more
successful than he is.
He is a sport man. He loves running and used to run
well before the pain started.
He is done is post graduate.
Medical history
He is asthmatic but do not usually have attacks nor
takes drugs.
Mental state
examination
Diagnostic
impression
Axis I: pain
disordser
Axis II: N.A
Axis III: N.A
Axis IV: his
friends and siblings are more prosperous than he is at the moment
Axis V: 80,
moderate symptoms.
Treatment plan
Psycho education
Validating complains
Cognitive restructuring
Pain diary and exercise
PEDIATRICS
The pediatric section of the hospital was visited. A
week was spent with the department. We were under the supervision of Dr, Mrs
Lagunju.
At the pediatrics department the ward round was
attended alongside Dr, Mrs Lagunju and other pediatric doctors.
At the ward majorly children with meningitis, tetanus
infection, hydro-encephalus and head tumor were seen. Parents were counseled by
us on how to care for their children when they are ill, what to do to them and
what not to do. Also, immunization is paramount many of these mothers never
immunized their children.
Sickle cell
clinic
This clinic is held every Tuesday, from 2pm till when
all the children are attended to.
The clinic has been on for over two years. This is due to the fact that it is empirical
that children with sickle cell are highly prone to stroke at tender ages. Stroke
test is run for them to know who is prone and who is not. Also, pre treatment is
given to the children that are prone to stroke. The children are asked to come
back a year after each test.
I ran an intelligence test for one of the sickle cell
patient;
Case
Name:
master T
Age: 8
years, 10 months
Sex:
male
Address:
Akete, Bashorun
Religion:
Christianity
Class:
PRY 4
School: Oritamefa
school.
Family
history,
Master T is the first child of his parents. They are
just two children, him and his sister. His mother is 38 years and an Estate
surveyor while his father is also 38 years old and a Quantity surveyor by
profession. His parents do not have plans for more children. His sister is
genotype AA.
Health
history,
He is a sickle cell patient. His crisis started when
he was 2 years old. At least he has crisis thrice in a year now. He has been on
the stroke test for more than a year.
Result of
the I.Q test
The test used is standard progressive matrices sets A,
B, C, D and E.
The test was held on the 21st February,
2012. The test is to run for 45minutes but Master T used 42min. is test score
is 32 and test grade is 75%.
The test grade is interpreted as “definitely above the
average on intellectual capacity”. Young master T is intellectually sound. The
test scores correlates with his school performance according to his mom. His
environment and the school he goes to also contribute his level of
intelligence.
Neuro-pediatric
clinic
At the neuro-pediatric clinic, a lot of children were
brought in for one neural problem or the other. Majority of the children have
seizure (epilepsy) of varying kind, cerebral palsy and so on.
CASE4
Biodata
Name:
Age:
Sex:
Address:
Marital status:
Religion:
Presenting
complains
Family
history
Personal
history
Medical
history
Psychosexual
history
Mental state
examination
Diagnostic
impression
Treatment
plan
Seminars
Presentation
Meetings