A case study involves gathering detailed information about one individual or group.

Participant observation studies, such as Rachel’s, above, are often better termed case studies on

organizations. Festinger et al.’s study (1956), described above, would count as a case study of a

group. Typically, individual case studies would include a comprehensive case history, usually,

but not exclusively, gathered by interview. This would be the person’s record to date in

employment, education, family details, socio-economic status, relationships and so on, and might

include a detailed account of experiences relevant to the issue, which makes the person of

particular research interest. The interest might be in a rare medical condition that has

psychological implications, in cases of severe deprivation, in an extraordinary ability (e.g.,

astonishing memory) or in a person’s particular social position – single parent, manager,

psychiatric patient, criminal. the individual is selected for a forward-looking case study because

they are about to undergo a particularly interesting and possibly unique experience.

The person would be interviewed regularly, sometimes following the same issues along,

sometimes looking at new issues and all dependent on the specific type of research question

being asked. Psychological scales and tests might also be administered. There might be a role for

naturalistic observation, particularly where the person is a young child, as when, for instance, a

severely deprived child’s play activities and developing social interactions are monitored for

change.

If we trace the history of the case study method, it becomes obvious that Frederick Le

Play (1806-1882) had, for the first time, introduced this method into social science research in

his Studies of family budgets. Herbert Spencer, William Healy, and Sigmund Freud have

contributed to case study. The case study method is also employed by historians, anthropologists,

ethnologists and psychologists. The purpose of the case study method is to understand the
important aspects of the life cycle of the unit. In fact, such study deeply analyzes and interprets

the interactions between the different factors that influence the change or growth of the unit.

Thus, it is basically a longitudinal approach which studies the unit over a period of time. A

review of literature in this field reveals that case studies are not confined to the study of

individuals and their important behavioural characteristics, rather, case studies have been made

of all types of communities and individuals. Whatever the type of individual or community is,

the element of typicalness, rather than uniqueness, is the focus of attention in the case study.

Therefore, a case of the case study, as Bromley (1986) has suggested, is not only about a

‘person’ but involves a category of “’individuals’. In the light of this suggestion, the selection of

the subjects for the case study needs to be done very carefully so that it may be assured that he or

she is the typical of those to whom the generalization is to be made (Best & Kahn 1992).

In case study, data are gathered through several methods or techniques. Some of the

important ones are as follows:

(i) Observation of behaviour, characteristics, and social qualities of the unit by the

researcher

(ii) Use of questionnaires, opinionnaires, inventories, checklists and other

Psychological tests

(iii) Analysis of recorded data from newspapers, schools, clinics, courts or other

similar sources

(iv) Interviewing the subjects, their friends and relatives, and others

Characteristics of Case Study

The key characteristics of the case study method are as follows:

Using this method, the researcher can analyze a single social unit or a group of such units; he can

even study an entire situation. This strategy attempts to understand the complex of elements that

operate within a social unit as an integrated whole. In general, the study is conducted over a

lengthy period of time in order to determine the natural history of the unit and acquire enough

information to draw accurate conclusions. This method uses a qualitative, as opposed to a

quantitative, approach. Information that is only quantitative is not gathered. We are doing

everything we can to gather data about every facet of existence. Thus, a case study broadens our

perspective and provides us with a comprehensive understanding of life. For example, when we

are creating a case study on a man as a criminal, we will look into the circumstances that led him

to commit crimes in addition to counting the number of crimes he has committed. The study's

goal might be to offer recommendations about how to help criminals change. Regarding the case

study approach, an attempt is made to understand how the causal factors are related to one

another. The case study method directly examines the relevant unit's behavior pattern rather to

using a roundabout and abstract way. The case study technique produces useful ideas and data

that can be used to test them, meaning that generalized knowledge can only get richer. Without

it, generalized social science may suffer.

Types of case study

Based upon the number of individuals, case study may be of two types: the individual case study,

and the community case study. In individual case study, the social unit consists of one individual

or person. Since there is only one individual, it emphasizes analysis in depth. Such an individual

case study may be fruitful in developing some hypotheses to be tested but it is not useful in

making broad generalizations. Such individual case study is a time-honored procedure in the

field of medicine and medical research. The community case study is one in which the social unit
is not a person, rather, a family or a social group. Such case study is a thorough observation and

analysis of a group of people who are living together in a particular geographical territory.

The community case study tries to deal with different elements of the community life such as

location, prevailing economic activity, climate and natural resources, historical development,

social structure, life values, health education, religious expression, recreation, impact of outside

world, etc. On the basis of the purpose, a case study may be subdivided into two categories

deviant case analysis and isolated clinical case analysis. In deviant case analysis, the researcher

starts with a difference already found between two persons or groups of persons and his task is to

read backward to deduce the condition that might have produced the difference (Warwick &

Osherson 1973). In isolated clinical case analysis, the emphasis Is on the individual units with

respect to some analytical problem. Such a study has been popular in psychoanalysis. Freud’s

study of little Hans is a well-known case which can be cited as an example of isolated clinical

case analysis. Freud’s theories of psychoneurosis were formulated through accumulation of

many isolated clinical case studies of individuals.

Major Phases Involved in Case Study

The major phases involved in case study are as recognition and determination of the status of the

phenomenon to be investigated or the unit of attention, collection of data, examination and

history of the given phenomenon, diagnosis and identification of casual factors as a basis for

remedial or developmental treatment, application of remedial measures i.e., treatment and

therapy (this phase is often characterized as case work) and follow-up programmed to determine

effectiveness of the treatment applied (Kothari 2004)

Advantages
The case study method has a number of benefits that flow from the several attributes listed

above. It is possible to mention the significant benefits here. The case study technique allows us

to completely comprehend the behavior pattern of the unit in question because it is an in-depth

analysis of a social unit. Charles Horton Cooley once said. "case study deepens our perception

and gives us a clearer insight into life.... It gets at behaviour directly and not by an indirect and

abstract approach." A case study provides an accurate and insightful account of an individual's

experiences, revealing the inner conflicts, aspirations, and pressures that propel people to behave

as well as the factors that influence them to follow particular behavioral patterns.

Using this approach, the researcher can follow the social unit's natural history and how it

relates to the social dynamics and environmental influences in its immediate surroundings.

It assists in developing pertinent hypotheses and the data necessary to test them. Thus,

case studies allow the generalized knowledge to become increasingly rich. The approach makes

it easier to conduct in-depth research on social units, which is typically not achievable when

employing the observation approach or the schedule-based information collection method. The

case study approach is often utilized for this reason, especially in social research. The data

gathered through the case study approach greatly aids the researcher in creating the right

timetable or questionnaire for the work at hand, which calls for in-depth understanding of the

relevant universe.

Depending on the prevailing conditions, the researcher may employ one or more of the

numerous research techniques covered by the case study approach. Put differently, the case study

method allows for the utilization of a variety of techniques, including depth interviews, surveys,

documents, individual study reports, letters, and the [Link] case study technique has been
useful in figuring out the nature of the cosmos and the units that need to be investigated. The

case study approach is sometimes referred to as a "mode of organising data" for this reason.

This method's concentration on historical study makes it a useful tool for understanding a

social unit's past. Furthermore, it is a method for proposing actions for enhancement within the

current framework of the studied social groups. Case studies are the best kind of sociological

material since they are an authentic documentation of individual experiences that most

competent researchers overlook while employing other methods. The case study approach

broadens the researcher's experience, which in turn improves his capacity for analysis. The study

of social transformations is made possible by this methodology. Because each aspect of a social

unit is studied in great detail, the researcher is able to comprehend how society has changed

throughout time. This aids in preserving the flow of the research process and makes it easier to

form conclusions. Indeed, it might be viewed as both the entry point and the ultimate destination

of abstract knowledge.

Limitations

Since case circumstances are rarely identical, the data acquired for case studies is

frequently not comparable. The investigator must read logical notions and scientific

classification units into or out of the case study since the subject narrates history in his own

words

According to Read Bain, the case data lacks scientific significance because they do not

provide light on the "impersonal, universal, non-ethical, non-practical, repetitive aspects of

phenomena." Real data is frequently not gathered for case studies since the researcher's

subjectivity affects the data collection process.

 Because there are no strict guidelines followed in the information gathering process and

only a small number of units are examined, there is always a risk of making incorrect

generalizations.

It takes a lot of time and money to complete. Since the case study method examines

social unit natural history cycles in great detail, more time is required.

According to Read Bain, the subject may write what he believes the investigator wants,

and the more rapport there is, the more subjective the entire process is, which taints the case data

frequently.

The case study technique relies on a number of assumptions that are occasionally not

particularly realistic; as a result, there is always room for question regarding the applicability of

case data. The case study approach has limited applicability; it cannot be employed in the case of

a large society. Sampling is also not permitted when using the case study method.

The investigator's response represents a significant case study technique restriction. He

frequently believes he knows everything there is to know about the unit and can provide all the

answers. If this is not the case, there will be repercussions. Actually, the researcher is more at

blame for this than the case approach is.

Case History Taking

In psychiatric assessment, history taking interviews and mental status examination need

not always be conducted separately (though they must be recorded individually). During

assessment, the interviewer should observe any abnormalities in verbal and nonverbal

communication and make note of them (Ahuja, 2011). It is helpful to record a patient's response
verbatim rather than only naming the signs. It is best done in the patient’s own spoken language,

whenever possible (Ahuja, 2011). A comprehensive psychiatric interview often requires more

than one session. The psychiatric assessment can be discussed under the following headings

(Ahuja, 2011).

Identification of Data

It is best to start the interview by obtaining some identification data which may include

name, age, sex, marital status, education, address, religion, and socioeconomic background, as

appropriate according to the setting. It is useful to record the source of referral of the patient

(Ahuja, 2011).

Informants

Sometimes the history provided by the patient may be incomplete, due to factors such as

absent insight or un cooperativeness, then it is important to take the patient’s consent before

taking this collateral history unless the patient does not have capacity to consent. A comment

should be made regarding the reliability of the information provided. The reliability of the

information provided by the informants should be assessed based on the relationship with

patient, intellectual and observational ability, familiarity with the patient and length of stay with

the patient, and degree of concern regarding the patient (Ahuja, 2011).

Presenting (chief) Complaints

The presenting complaints and / or reasons for consultation should be recorded. If

relevant, both the patient’s and the informant’s version should be recorded. If the patient has no

complaints (due to absent insight) this fact should also be noted. It is important to use the
patient's own words and to note the duration of each presenting complaint. Some of the

additional points which should be noted include: onset of present illness/ symptoms, duration of

present illness/ symptoms, course of symptoms/ illness, predisposing factors, precipitating

factors (include life stressors) and precipitating and/ or relieving factors (Ahuja, 2011).

History of Present Illness

When the patient was last well or asymptomatic should be clearly noted. This provides

useful information about the onset as well as duration of illness. Establishing the time of onset is

also important as it provides clarity about the duration of illness and symptoms. The symptoms

of the illness, from the earliest time at which a change was noted (the onset) until the present

time, should be narrated chronologically, in a coherent manner (Ahuja, 2011).

Past Psychiatric and Medical History

History of any past psychiatric illness should be obtained. Any past history of having

received any psychotropic medication, alcohol, and drug abuse or dependence and psychiatric

hospitalization should be enquired. A past history or any serious medical or neurological illness,

surgical procedure, accidents or hospitalization should be obtained. The nature of treatment

received, and allergies, if any, should be ascertained (Ahuja, 2011).

Treatment History

Any treatment received in present and/ previous episodes should be asked along with

history of treatment adherence, response to treatment received, any adverse effects experienced

or any drug allergies which should be prominently noted in medical records (Ahuja, 2011).

Family History
 The family history usually includes the ‘family of origin’ (i.e., the patient’s parents,

siblings, grandparents, uncles). The family of procreation (i.e., patient’s spouse, children and

grandchildren) is conventionally recorded under the heading of personal history. Family history

usually recorded under the following headings which are, family structure (drawing family tree),

family history of similar or other psychiatric illness, major medical illness, alcohol/ drug

dependence and suicide (suicidal attempts) should be recorded, and current social situation

(Ahuja, 2011).

Personal and Social History

In older patients, it is sometimes harder to get a detailed account of the early childhood

history. Personal history can be recorded under the following headings:

Perinatal History.

Difficulties in pregnancy (particularly in the first three months of gestation) such as any

febrile illness, medications, drugs and/ alcohol use; abdominal trauma, any physical or

psychiatric illness should be asked. Other relevant questions may include whether the patient was

a wanted or unwanted child, date of birth, whether delivery was normal, any instrumentation

needed, where born, any perinatal complications, birth cry, any birth defects, and any pre-

maturity (Ahuja, 2011).

Childhood History

Whether the patient was brought up by mother or someone else, breast feeding, weaning

and any history suggestive of maternal deprivation should be asked. The occurrence of neurotic

traits should be noted. These including stuttering, stammering, tics, enuresis, encopresis, night
terrors, thumb sucking, nail biting, head banging, body rocking, morbid fears or phobias,

somnambulism, temper tantrums, and food fads (Ahuja, 2011).

Educational History. The age of beginning and finishing formal education, academic

achievements, and relationships with peers and teachers should be asked (Ahuja, 2011).

Play History . The questions to be asked include, what games were played at what stage,

with whom and where. Relationships with peers, particularly the opposite sex, should be

recorded. The evaluation of play history is obviously more important in the younger patients

(Ahuja, 2011). 011).

Puberty. The age at menarche, and reaction to menarche (in females), the age at

appearance of secondary sexual characteristics (in both males and females), nocturnal emissions

(in males), masturbation and any anxiety related to changes in puberty should be asked (Ahuja,

2011).

Menstrual and Obstetric History. The regularity and duration of menses, the length of

each cycle, any abnormalities, the last menstrual period, the number of children born and

termination of pregnancy (if any) should be asked (Ahuja, 2011).

Sexual and Marital History .Sexual information how acquired and of what kind;

masturbation (fantasy and activity); sex play, if any; adolescent sexual activity; premarital and

extramarital sexual relationships, if any; sexual practices (normal and abnormal); and any gender

identity disorder are the areas to be enquired about (Ahuja, 2

Premorbid Personality. It is important to elicit details regarding the personality of the

individual. Instead of using labels such as schizoid/ histrionic, it is more useful to describe the
personality in some detail. The following headings are often used for the description of

premorbid personality which are namely, interpersonal relationship, use of leisure time,

predominant mood, attitude to self and others, attitude to work and responsibility, religious

beliefs and moral attitude, fantasy life and habits (Ahuja, 2011).

Alcohol and Substance History . Although alcohol and drug history are often elicited as

a part of personal history, it is often customary to record it separately. Alcohol and drugs can

often contribute to causation of several psychiatric symptoms and are often present co-morbidly

alongside many psychiatric diagnoses (Ahuja, 2011).

Physical Examination

A detailed general physical examination (GPE) and systematic examination is a must in

every patient. Physical disease, which is an etiologically important or accidently co-existent

secondarily caused by the psychiatric condition or treatment, is often present and can be detected

by a good physical examination (Ahuja, 2011).

Mental Status Examination (MSE)

Mental status examination is a standardized format in which the clinician records the

psychiatric signs and symptoms present at the time of interview. MSE Should describe all areas

of mental functioning (Ahuja, 2011).

General Appearance and Behavior

A rich deal of information can be elicited from examination of the general appearance

and behavior. While examining, it is important to remember a patient's socio-cultural

appearance, attitude towards examiner, comprehension, posture, motor activity, social manner,
presence of any hallucinatory behavior in the individual is assessed (Ahuja, 2011). background

and personality. The factors included in general appearance and behavior are general

Speech

Speech can be examined under the following things which are:

Rate and Quantity of Speech

Whether speech is present or absent (mutism), if present, whether it is spontaneous,

whether productivity is increased or decreased.

Volume and Tone of Speech

Increased/decreased (its appropriateness), Low/high/normal pitch. Flow and Rhythm of

Speech. Presence of any stuttering/ stammering, clang associations, neologisms, any

accent, circumstantiality, etc. (Ahuja, 2011).

Mood and Affect

Mood is the pervasive feeling tone which is sustained (lasts for some length of time) and

colors the total experience of the person. Affect, on the other hand, is the outward

objective expression of the immediate, cross-sectional experience of emotion at a given

time. The assessment of mood includes testing the quality of mood, which is assessed

subjectively (‘how do you feel’) and objectively (by examination). The affect is similarly

described under quality of affect, range of affect (of emotional changes displayed over

time), depth or intensity of affect (normal, increased or blunted) and appropriateness of

affect (in relation to thought and surrounding environment (Ahuja, 2011).

Thought

A thought process that is not goal-directed, or not logical, or does not lead to a realistic

solution to the problem at hand, is not considered normal. In the clinical examination,

thought is assessed (by the content of speech) under the four headings of stream, form,

content and possession of thought. Here spontaneity, obsessive thoughts, phobias, flight

of ideas, loosening of association, perseveration, delusions and the like are assessed

(Ahuja, 2011).

Perception

Perception is the process of being aware of a sensory experience and being able to

recognize it by comparing it with previous experiences. Perception is assessed under the

following headings:

Hallucinations. The presence of hallucinations should be noted. A hallucination is a

perception experienced in the absence of an external stimulus. The hallucinations can be

in the auditory, visual, olfactory, gustatory or tactile domains (Ahuja, 2011).

Illusions and Misinterpretations. Whether visual, auditory, or in other sensory fields;

whether occur in clear consciousness or not; whether any steps taken to check the reality

of distorted perceptions (Ahuja, 2011).

Depersonalization/Derealization. Depersonalization and derealization are

abnormalities in the perception of a person’s reality and are often described as ‘as-if’

phenomena (Ahuja, 2011).

 Somatic Passivity Phenomenon. Somatic passivity is the presence of strange

sensations described by the patient as being imposed on the body by ‘some external

agency’, with the patient being a passive recipient. It is one of the Schneider’s first rank

symptoms (Ahuja, 2011).

Cognition (Neuro psychiatric) Assessment

A significant disturbance of cognitive functions commonly points to the presence of an

organic psychiatric disorder. Here factors such as level of consciousness, attention,

memory, orientation, abstract thinking, concentration and intelligence of the individual is

assessed (Ahuja, 2011).

Consciousness. The intensity of stimulation needed to arouse the patient should be

indicated to demonstrate the level of alertness. For example, by calling a patient's name in

a normal voice, calling in a loud voice, light touch on the arm, vigorous shaking of the

arm, or painful stimulus. Grade the level of consciousness: conscious / confusion /

somnolence / clouding / delirium / stupor / coma. Any disturbance in the level of

consciousness should ideally be rated on Glasgow Coma Scale, where a numeric value is

given to the best response in each of the three categories (eye opening, verbal, motor)

(Ahuja, 2011).

Orientation. Whether the patient is well oriented to time (test by asking the time, date,

day, month, year, season, and the time spent in hospital), place (test by asking the present

location, building, city, and country) and person (test by asking his own name, and

whether he can identify people around him and their role in that setting). Disorientation

in time usually precedes disorientation in place and person (Ahuja, 2011).

Attention. Is the attention easily aroused and sustained: Ask the patient to repeat digits

forwards and backwards (digit span test; digit forward and backward test), one at a time

(for example, patient may be able to repeat 5 digits forward and 3 digits backwards). Start

with twodigit numbers increasing gradually up to eight-digit numbers or till failure occurs

on three consecutive occasions (Ahuja, 2011).

Concentration. Can the patient concentrate; Is he easily distractible; Ask to subtract

serial sevens from hundred (100-7 test), or serial threes from fifty (50-3 test), or to count

backwards from 20, or enumerate the names of the months (or days of the week) in the

reverse order. Note down the answers and the time taken to perform the tests (Ahuja,

2011).

Memory. Immediate Retention and Recall (IR and R). Use the digit span test to assess

the immediate memory; digit forwards and digit backwards sub tests (also used for

testing attention; are described under attention) (Ahuja, 2011). Recent Memory: Ask how

did the patient come to the room / hospital; what he ate for dinner the day before or for

breakfast the same morning. Give an address to be memorized and ask it to be recalled 15

minutes later or at the end of the interview (Ahuja, 2011). Remote Memory Ask for the

date and place of marriage, name and birthdays of children, any other relevant questions

from the person's past. Note any amnesia (anterograde or retrograde), or confabulation, if

present (Ahuja, 2011).

Intelligence. It is the ability to think logically, act rationally, and deal effectively with

the environment. Ask questions about general information, keeping in mind the patient's

educational and social background, his experiences and interests, for example, ask about
the current and the past prime ministers and presidents of India, the capital of India, and

the name of the various states. Test for reading and writing; Use simple tests of

calculation (Ahuja, 2011).

Abstract thinking. Abstract thinking testing assesses a patient's concept formation. The

methods used are, Proverb Testing , The meaning of simple proverbs (usually three)

should be asked (Ahuja, 2011). Similarities (and also the differences) between familiar

objects should be asked, such as: table / chair; banana / orange; dog / lion; eye / ear. The

answers may be overly concrete or abstract. The appropriateness of answers is judged.

Concretization of responses or inappropriate answers may occur in schizophrenia (Ahuja,

2011). It is characterized by the ability to assumes a mental set voluntarily, shift

voluntarily from one aspect of a situation to another, keeps in mind simultaneously the

various aspects of a situation, grasps the essentials of a ' whole ' (for example, situation or

concept), and to break a ' whole ' into its parts (Ahuja, 2011).

Insight. Insight is the degree of awareness and understanding that the patient has

regarding his illness. Patient’s attitudes towards his present state; whether there is an

illness or not; is any treatment needed; cause for illness and whether there is hope for

recovery is asked. Depending on the patient’s responses, insight can be graded on a six-

point scale (Ahuja, 2011).

Judgement. Judgement is the ability to assess a situation correctly and act appropriately

within that situation. Both social and test judgement are assessed. Social judgement. It is

observed during the hospital stay and during the interview session. It includes an

evaluation of ‘personal judgement’.Test judgement , It is assessed by asking the patient

what he would do in certain test situations. Judgment is rated as Good/Intact/Normal or

Poor/Impaired/ Abnormal (Ahuja, 2011).

Formulation

After a comprehensive psychiatric assessment, a diagnostic formulation

summarizes the detailed positive (and important negative) information regarding the

patient, before listing differential diagnosis, prognostic factors, and a management plan.

The diagnostic formulation focuses on etiological factors based on the bio psychosocial

model. Similarly, it is useful to devise the management plan based on the bio

psychosocial model. Thus, psychiatric assessment is an initial step towards diagnosis and

management of psychiatric disorders .

References

Ahuja, N. (2011). A Short Textbook of Psychiatry (7th ed.). Jaypee Brothers Medical Publishers

(P) ltd.

Coolican, H. (2009). Research Methods And Statistics in Psychology(5th ed.). Hodder Education

Group

Kothari, C.R. (2004). Research methodology, Methods and Techniques. New Age International

(P) ltd.

Sing, A.k. (2017). Tests,measurements and research methods in behavioral sciences( 5 th ed.).

Delhi, Bharati Bhawan Publishers.