CASE HISTORY TAKING - PSYCHOPATHOLOGY-NAMITHA

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CASE HISTORY TAKING

• Submitted by,
• Namitha.P.Thamby

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HISTORY

• It was Frederick Le Play (1806-1882) who
  introduced this method for the first time into
  social science research in his studies on family
  budget .
• Herbert Spencer an English sociologist
  (1820-1903) was the 1st to use case materials in
  his ethnographic studies.
• William Healy a psychiatrist adopted this method
  for the first time to study juvenile delinquents
  .
• In the field of psychology exhaustive case
  studies have been done by Murray and his
  associates at the Harvard psychological clinic.

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WHAT IS CASE STUDY

• A case study is an in-depth analysis of a single
  person. Case studies are often used in clinical
  cases or in situations when lab research is not
  possible or practical
• A case study involves a particular method of
  research. Rather than using large samples and
  following a rigid protocol to examine a limited
  number of variables, case study methods involve
  an in-depth, longitudinal examination of a single
  instance or event

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• . A case study provides a systematic way of
  looking at events, collecting data, analyzing
  information, and reporting the results. As a
  result the researcher may gain a sharpened
  understanding of why the instance happened as it
  did, and what might become important to look at
  more extensively in future research

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MAJOR FEATURES

• It is an approach that views a social unit as a
  whole.
• A social unit need not be an individual, but it
  may be a family, a social group, social
  institution or a community.
• Here the researcher not only tries to explain the
  complex behavioural pattern of the social units
  but also tries to locate those factors which have
  given rise to such complex behavioural pattern.

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• Since it is a descriptive research no variables
  are manipulated here.
• It gathers data through methods of observation,
  interview, questionnaire, and other psychological
  tests. Analysis of recorded data from newspaper,
  court, govt. agencies and other similar sources
  is common.

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CHARACTERISTICS

• Under this method the researcher can take one
  single unit or more of such units for his study
  purpose. He may even take a situation to study
  the same comprehensively.
• Here the selected unit is studied in minute
  details which extends over a long period of time.
• It covers all facts and studies the social unit
  as an integrated totality.

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• Here the approach happens to be qualitative and
  not quantitative.
• An effort is made to know the mutual inter
  relationship of causal factors.
• Here the behavior pattern of concerning unit id
  studied directly and not by an indirect and
  abstract approach.
• It results in fruitful hypothesis along with data
  which may be helpful in testing them.

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MAJOR PHASES INVOLVED

• 1.Recognition and determination of the status of
  the phenomenon to be investigated or the unit of
  attention.
• 2. collection of data, examination and history of
  the given phenomenon.
• 3.diagnosis and identification of causal factors
  as a basis for remedial or developmental
  treatment.

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• 4. application of remedial measures that is
  treatment and therapy.
• Follow up program to determine effectiveness of
  the treatment applied.

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Case history structure

• 1.1 Introduction
• An introduction is necessary to establish the
  focus of your case and provide orientation to
  your reader. It should consist of a few clear and
  concise opening statements, which typically
  include information on
• Name (pseudonym)
• Age
• Marital status
• Occupation
• Referral details
• Central problem

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• 1.2 History of Presenting Complaint
• This should be a detailed account of
  the patient's central problem that you have
  already identified in your opening statement. Put
  details about the problem and related symptoms in
  a chronological order, as this will help with the
  clarity of your writing.
• Identify common psychiatric symptoms You should
  make connections between the isolated symptoms
  that the patient may have revealed to you
  somewhat randomly in their interview by grouping
  the symptoms together (i.e. depressive,
  psychotic, anxiety). This will help your writing
  to develop logical sequences. It may be necessary
  to comment on relevant negative as well as
  positive symptoms.
• Comment on the impact of the illness on the
  patient's life Consider work, social relations
  and self-care.
• Note details of previous treatment Include
  information on who administered management (when
  and where), what the treatment was (and
  preferably the dose and duration of treatment),
  and the patient's responses to treatment.
• Integrate current problem and psychiatric
  issues Consider the relationship between the
  patient's psychiatric state and concurrent
  medical conditions

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• 1.3 Past Psychiatric History

• The following points are relevant in this
  section
• details of previous episodes of illness
• previous psychiatric admissions/treatment
• outpatient/community treatment
• suicide attempts/drug and alcohol abuse
• interval functioning (what is the patient like
  between episodes/when "well')
• By including this sort of information, you will
  build a picture of the pattern of illness
  (chronicity, severity, coping strategies, crisis
  triggers, etc.), which will contribute toward a
  complete discussion of the illness

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• 1.4 Past Medical History
• In this section of the report, you need to show
  that you a) understand the relationship between
  medical conditions and psychiatric symptoms, and
  b) can appreciate the complexity of medical
  problems that might be exacerbated by psychiatric
  conditions.
• Record medications. Demonstrate an understanding
  of the significance of drug therapy on
  psychological function and, if appropriate, focus
  on medications taken by the patient that may
  influence the patient's psychological function.

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• 1.5 Family History
• Include details of
• Parents and siblings, nature of the relationships
  between family members
• Any family tensions and stresses and family
  models of coping
• Family history of psychiatric illness (incl.
  drug/alcohol abuse, suicide attempts)
• Include a geneogram (drawing of family tree).

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• 1.6 Personal History/Development
• Use the list in Bloch and Singh (200193) as a
  guide for selecting and organising the
  information in this section
• Early development
• Childhood
• School
• Adolescence
• Occupation
• Menstrual history
• Sexual history
• Marital history
• Children
• Social network
• Habits
• Leisure
• Forensic history

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TYPES OF CASE STUDY

• Based upon the number of individuals
• Individual case study in this the social unit
  consist of one individual, it emphasizes analysis
  in depth.
• Community case study In this the social unit is
  a family or a social group.

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Types of case study

• 1.Illustrative case studyAn illustrative case
  study describes a domain they utilize one or two
  instances to analyze a situation. This helps
  interpret other data, especially when researchers
  have reason to believe that readers know too
  little about a program. This case study serves to
  make the unfamiliar familiar, and give readers a
  common language about the topic. The chosen site
  should typify important variations and contain a
  small number of cases to sustain readers'
  interest.
• 2.Exploratory case studyAn exploratory case
  study condenses the case study process
  researchers may undertake them before
  implementing a large-scale investigation. Where
  considerable uncertainty exists about program
  operations, goals, and results, the exploratory
  case study helps identify questions, select
  measurement constructs, and develop measures
  they also serve to safeguard investment in larger
  studies.

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• 3.Critical instance case studyThe critical
  instance case study examines one or a few sites
  for one of two purposes. A very frequent
  application involves the examination of a
  situation of unique interest, with little or no
  interest in generalizability. A second, rarer,
  application entails calling into question a
  highly generalized or universal assertion and
  testing it by examining one instance. This method
  particularly suits answering cause-and-effect
  questions about the instance of
  concern.Inadequate specification of the
  evaluation question forms the most serious
  pitfall in this type of study. Appropriate
  application of the critical instance case study
  crucially involves probing the underlying
  concerns in a request.4.Program implementation
  case studyA program implementation case study
  helps discern whether implementation complies
  with intent. This case study may also prove
  useful when concern exists about implementation
  problems. Extensive, longitudinal reports of what
  has happened over time can set a context for
  interpreting a finding of implementation
  variability. In either case, researchers aim for
  generalization and must carefully negotiate the
  evaluation questions with their customer.

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• 5.Program effects case studyProgram effects
  case studies can determine the impact of programs
  and provide inferences about reasons for success
  or failure. As with the program implementation
  case study, the evaluation questions usually
  require generalizability and, for a highly
  diverse program, it may become difficult to
  answer the questions adequately and retain a
  manageable number of sites. But methodological
  solutions to this problem exist. One approach
  involves first conducting the case study in sites
  chosen for their representativeness, then
  verifying these findings through examination of
  administrative data, prior reports, or a survey.
  Another solution involves using other methods
  first. After identifying findings of specific
  interest, researchers may then implement case
  studies in selected sites to maximize the
  usefulness of the information.

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• 6.Cumulative case studyThe cumulative case
  study aggregates information from several sites
  collected at different times. The cumulative case
  study can have a retrospective focus, collecting
  information across studies done in the past, or a
  prospective outlook, structuring a series of
  investigations for different times in the future.
  Retrospective cumulation allows generalization
  without cost and time of conducting numerous new
  case studies prospective cumulation also allows
  generalization without unmanageably large numbers
  of cases in process at any one time.

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ADVANTAGES

• Intensive study of the social unit is possible.
• Provides sufficient basal facts for developing a
  suitable hypothesis.
• Researcher gets sufficient facts for making a
  comparison between two similar social unit.
• It provides opportunity for careful examination
  of all those relevant facts and data on the basis
  of which questionnaire or opinionnaire or any
  psychological test is to be developed.

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LIMITATIONS

• The chief danger in the case study is the
  response of the researcher itself. Here the
  researcher comes to feel false sense of certainty
  about conclusions arrived at.
• The case study method looks deceptively simple
  ,thus it is essential that the researcher must be
  thoroughly familiar with the existing theoretical
  knowledge of the concerned field and must be
  skillful in isolating the important variables
  from other irrelevant ones.

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• It is a costly method in terms of both money and
  time.
• The subject bias of researcher is a constant
  threat to objective data gathering in case study.
  As a consequence the conclusion loses its
  dependability and validity
• Cause and effect relationship is not established
  in this method.

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THANK YOU