Abnormal Psych Case study Ch. 6 Major depressive disorder



Download 41.41 Kb.
Date18.08.2018
Size41.41 Kb.
#60874
Abnormal Psych Case study

Ch. 6 Major depressive disorder

Into


  • Adam doesn’t sleep, wakes Janet up

  • Janet depressed since husband left, 2hrs brooding, depressed

  • Blamed self for divorce, blame was vague and illogical

  • Failure in marriage = failure in life

Social History

  • Reversed as a kid

  • Rushed into David to fill vacuum of old BF

  • Strain when she went back into college

  • 1 month prior she lost interest in activates and had no friends

  • Depressed, anxious

Etiological Considerations

  • Freud/Psychoanalytic – link between comparison between depression and bereavement with disturbance of self-regard

  • Consistence with Janet’s situation, her dependence on men due to her separation and divorce from David

  • Stressful Life events play a causal role in the etiology of depression, bidirectional

  • Only if consequences were sever and long-term for women’s well being

  • Consistent with Janet

  • Social-learning theorists emphasize the importance of interpersonal relationships and skills

  • Other consideration is that some respond is passive, ruminative manner which leads to longer depression

Conceptualization and Treatment

  • Depression started with divorce which ruined her interpersonal relationships

  • Improve mood by developing new relationships and develop skills to be better parent

  • Had not engaged with many leisure activities

  • Concentrate on assessment of her interactions with other people (initiating a conversation, maintaining it, basic social skills)

  • Mood improved as she found a part-time job at riding stable

  • Worsening of finical situation lead to thoughts of suicide but did not want to die

  • Then started taking Prozac, an antidepressant and increase frequency of appointments

  • Problem solving and social skill improvement lead to better social life, got help from father.

  • Adam’s manipulative behaviour due to inconstancy, she then just tucked him into bed each time and left

Chapter 7 Bipolar Disorder

George Lawler



  • During college was losing interest in everything, depressed ant took antidepressant meds and counseling

  • Could cram without amphetamines (hypomanic episodes of increased energy that does not lead to mania, this was not pathological)

  • Symptoms of depression as well, sever symptoms as he was almost completely unresponsive, speak in monotone

  • Takes small things and blows them out of proportion, assistant coach leaving and he thinks he’s responsible

  • Threatened suicide and was given an appointment were he got Lithium carbonate

  • Past history of manic like behaviour and his positive family history of bipolar lead to bipolar disorder being diagnosed

  • Leads team with sword during a manic episode, did not return home after and rambled to a reporter for 3 hours, talks about having an affair

  • Director and George have an argument, G says he’s head of Olympic track team

Social History

  • Uncle had acute schizophrenic reaction

Etiological Considerations

  • Relatives of unipolar depressives are at increased risk for unipolar depression

  • Various experiences throughout the person’s life must also influence the onset of expression of psychotic symptoms as well as the course of the disorder

  • George may have been due to competitive nature of his university environment

  • Emotional atmosphere within a family related to the patients social function over the course of the disorder

  • Wife attributed mania behaviour to intent on his part

Conceptualization and Treatment

  • Given haloperidol, an antipsychotic but did not take it

  • Had therapeutic activities and visits from family

  • Had a manic episode during his time in hospital, extremely difficult during first few days.

  • Symptoms weakened over 2 weeks and was aware of his disorder

  • Wife leaves George after 6 months, has difficult believing what he said about affair was just product of mania

Chapter 15 Eating Disorder: Anorexia Nervosa

  • Joan struggled with eating disorder, treated at hospital

Social History

  • Slightly overweight as kid, perfectionist

  • Brother dies when she was supposed to be looking over him, parents become very worried about her safety

  • Used Randy to escape home, got over 200 pounds during pregnancy

  • Moved back after divorce and was in a very submissive role at home

  • Had surgery on knee which lead to her weight going down to 110

  • Met jack where she became a heavy drinker, moved back home after 2 months

Onset of Eating Disorder

  • Began dieting to get around 100 pounds, took laxatives

  • Focused on what others wanted out of her not what she wanted

  • Periods stops, hair was unhealthy

  • Viewed her symptoms as a sign of strength

  • Charlie’s diet was also restricted, rarely visits grocery store and ate what was in shopping cart and rarely bought anything

  • Cycles back and forth between healthy and unhealthy eating patterns

  • Engaged in binge eating

Etiology

  • Hormones and neurotransmitters

  • Moderate rates of heritability

  • May be due to physical, emotional and cog changes during adolescence

  • Family factors not a role

  • Childhood involving social discomfort, anxiety and insecure attachments

  • Adults have no significant attachments

  • Cultural attitudes and standards play important role in development of anorexia

  • Emphasized thinness

  • Role of media has contradictory evidence, peer pressure is more of a factor as well as sociocultural pressures

  • Sexual issues are not necessarily the central problem, abuse not predictive

  • May have been created to flee famine

Treatment

  • Privileges were given for meeting calorie goals

  • Experienced constipation

  • Felt too weak outside of hospital

  • Own attitudes about eating and body were the problem

Chapter 16 Eating Disorder: Bulimia Nervosa

Tracy


  • Ambivalent about romantic experiences

  • Didn’t understand why men found her attractive

  • Pills did not stop binge eating, took laxatives

  • Binge after a day of work

  • Guilty afterword because of excessive eating and no control

Social History

  • Divorced parents when 2

  • Interested in mother who displayed interest in her life, 13 yrs.

  • Mother good looking and thin

  • Mom tells her she could lose a few pounds, intrusive and critical

  • Different eating patterns between mom and dad

  • Atmosphere with her mother was difficult when eating, sister could eat more and gain no weight, mom reminded her to watch weight

  • Would get high, get the munchies and binge eat during high school

  • Drop out of high school with boyfriend to leave high school and family

  • Bine and purging worse with BF

  • Ate to alleviate depression

  • Increased effort seemed to lead to more food

  • Returned home during early stages of expanding eating disorder

  • Depression begins to return, pressure was high

Etiology

  • Bio factors

  • Runs in the family, higher in mono twins

  • Low serotonin key

  • Psych Factors

  • Fear of being fat

  • Cultural idea of being thin affects women more than men

  • By teased for being fat a cause overestimate of body size (Tracy mom comments)

  • Combo of extreme weight concerns and dieting practices

  • Extreme diets increase likelihood of binge eating when person is stressed

Conceptualization and Treatment

  • Secretive nature prevents many from seeking help

  • Mix of cognitive procedures used for depression and behavioral approaches in obesity

  • Week 1 self-monitoring: had received accusation of weakness and provocation of guilt from friends and family. Carefully record everything they ate or drank but do not change anything about behaviour. Tracy was reserved

  • Week 2 Cues and Consequences: notice any patterns, Generate activities that replace binges. Replace binges with pattern of regular eating. Eat at prearranged times

  • Week 3 Thoughts, Feelings, and Behaviours

  • Week 4 Perfectionism and All-or-Nothing Thinking: Tracy stops monitoring , discuses distorted thinking and personality traits associated with binge eating

  • Week 5 Assertive Behavior: Tracy eats cake, train women to be more assertive and solve interpersonal problems

  • Week 6 Body Image: Reviewed facts about physiology (amount of body fat needed, low metabolism). Write things their bodies does for them. Report progress toward goals

  • Week 7 Dieting and Other Causal Factors: Different types of dieting and the onset of binge eating. Dieting plays a crucial role in most cases of bulimia. Focus on eliminating extreme forms of dietary restraint. Review of information about causes of bulimia and that no single factor is responsible

  • Week 8 Problem Solving and Stress Reduction: Binges more common during high stress, discuss warning signs such as negative mood and being alone

  • Week 9 Healthy Exercise and Relapse Prevention: Talked about benefits of healthy exercise (less stress, mood elevation, social interaction, better metabolism). Also the prevention of relapse, distinguish between temporary and full-blown relapse

  • Week 10 Coping with Future Events

Chapter 9 Schizophrenia: Paranoid Type

Bill


  • Scruples

  • Delusional beliefs and hallucinations

Social history

  • Dislike father and hoped for his death, felt guilty about it later

  • No close friends

  • No desire for career advancement , unconcerned about punishment

Etiology

  • Higher rate in MZ twins

  • Do not know hot genetic factors interact with environmental events to produce schizophrenia

  • Expressed emotion is critical for patients, High EE leads to relapse (Bills mom had high EE)

Conceptualization and Treatment

  • Difficulties in social and occupation roles

  • Absence of floridly psychotic symptoms, instead many negative symptoms

  • Describe sex in unemotional manner

  • Scruples first-rank symptom, though insertion

  • Early sessions difficult

  • Talk about gay, helped him explore concerns, provide info and develop skills to improve social and sexual relationships

  • Reinforce appropriate behaviour

  • Self-talk not due to social reinforcement

  • Used stimulus-control to reduce frequency of self-talk

  • Behavioural rehearsal to reduce anxiety

  • When he learned of delusions he gave antipsychotics

  • Positive but not dramatic effect

Chapter 10 Psychotic disorder, substance and violence

Angela


  • Mix of psychotic and drugs

  • Suffered from hallucinations, chasing the first high

Violence and Mental Disorders

  • Most aggressive crimes committed by people with no disorders

  • There is an association

  • Co-occurring with drugs and alcohol more likely for violence

  • Major mental disorder with features of antisocial more likely lead towards violence

  • Paranoid and BDP as well

  • Violence relating to disorders same across gender

  • Psychotic symptoms are associated, prominent is command hallucinations and paranoid delusions

  • Violence likely when no treatment, actively psychotic, using drugs, agitated

  • Victims most often are family and friends

  • Angela assaults was unusual in that regard, the man did provoke her, desperate emotional state

Etiological Considerations

  • Schizoaffective disorder is heterogeneous

  • Genetic factors play a role

  • Between schizophrenia and mood disorders

  • Angela raises issues about analysis of specific symptoms rather than global diagnosis categories

  • hallucinations have been found in people without mental disorders

  • Two views on hallucinations

  • Due to issues with lobes and prefrontal cortex

  • Attributing internal sensations to external events (can’t tell own thoughts from other peoples voices )

Chapter 19 BPD

Amanda Siegel – social history



  • Divorced dad rarely shows up

  • Largely unattended as a kid

  • Assumed caregiver role towards younger sister

  • Stepdad sexually abuses her

  • IQ of 130 despite poor grades

  • Unable to refuse sexual advances

  • Never wanted to be alone by 16

  • During hospital extreme mood swings, thought she had a boyfriend and threatened suicide to get his attention

  • Therapy than began with focusing on psychodynamic and establishing a trusting relationship

  • Fear of being abandoned due to thinking she’s responsible for divorce

  • Self-injury during stressful interpersonal events

Conceptualization and treatment

  • Focus on solving specific problems and behave in ways that are personally rewarding

  • Problem was lack of direction, feelings of depression, poor impulse control, excessive and poorly controlled anger

  • Studied for GED which boosted self-esteem, solved first problem

  • Depression treated with cognitive therapy, written record of her mood 3 times a day and what she was thinking. Negative predictions about events lead to depression

  • write down the worst, best, and most likely situations as she would feel she was gonna be fired after every negative event

  • rehearse the most likely helped keep her job

  • Joined NA, called whenever she had urge for drugs

  • Telephone psychologist or hospital if feel urge to cut

  • Time-delay procedures to deal with anger

  • Conflicts at home set her back

  • Would make progress then lose it for the next few years

  • Idealized new boyfriend and went to college

Etiological Considerations

  • Environmental factors key

  • High conflict

  • Invalidating environment (feelings are disrespected and communication is ignored or punished)

  • Such as in sexual abuse

  • BPD runs in families, one trait is high neuroticism

  • Integrative model

  • Genes that affect serotonin and dopamine that lead to impulsivity/emotional instability

  • Exposed to poor environment which leads to insecure attachment

Treatment

  • Medication effectiveness in question

  • Object relations psychotherapy

  • Psychoanalytic

  • Mental representations of self and others

  • Analyses process of putting things into all good or all bad categories

  • Dialectical Behavioural therapy

  • Empathy mixed with behavioural problem solving. Acceptance of clients contradictions and behaviours because client is sensitive to criticism and rejection

  • Move client toward change while have empathic validation

  • Behavioural aspect is learn ways to solve problems socially acceptable ways and improve interpersonal skills

  • Few patients complete process of intensive psychotherapy and often terminate as opposed to adjust to environment

Chapter 20 Antisocial personality disorder Psychopath

Bill


  • Dad was a drinker, not very involved

Discussion

  • Constellation of personality traits for psychopath

  • Poverty of emotions

  • No sense of shame

  • Superficially charming and manipulative

  • Do not learn from mistakes and behave irresponsibly toward others

  • inadequately motivated

Etiological

  • Abnormal amygdala

  • Psychological and cognitive factors

  • impulsivity and difficulty learning from punishment

  • low autonomic reaction

  • Difficult to arose negative emotions

  • Effect of smoking during prenatal development

  • Physically abusive homes leads to antisocial behaviour

  • Bill had harsh and inconsistent discipline from dad

  • Children also influence parent parenting style

  • Evolution perspective

  • Psychotics give the group experience with manipulation (societal)

  • Developmental style for harsh environments (individual)

Treatment

  • Treatment often unsuccessful

  • Little evidence that treatment works

  • Too dishonest and untrustworthy to engage with therapist

  • Possible guide lines are to be vigilant, assume their lying, and that trust comes vary late

  • Possible to lower elements that would lead to at risk development

  • Antisocial behaviour

  • behavioural parent training to increase adaptive to environment

Chapter 21 Autistic disorder

Conceptualization and Treatment



  • Placed in special school to learn proper behaviour

  • Use behavioural techniques (rewards him for proper behaviour, show the proper behaviour) to reinforce proper eyesight, vocabulary, dressing himself, toilet training, eating, playing with other children

  • For potty training was told to check pants, associate potty with toilet, etc.

  • Playing with other children rewarded him with food,

  • They were unable to stop his tantrums

  • Given Haldol but to no effect after violent incident

  • Punished his screaming by putting Tabasco in his mouth

Etiological Considerations

  • Bigger head, abnormal amygdala, hippocampus and cerebellum

  • Higher concordance in Monozygotic twins

  • Controversial view is that autism is due to excess Testosterone during fetal stage

  • Cog explanations

  • Deficit in social cognition, no theory of mind due to mirror neuron system (activate when watching someone)

  • Vaccine study was incorrect

Treatment

  • Medication does not improve core symptoms of autistic disorder

  • Major treatment is behavior treatment

  • Autistic kids have trouble with

  • Changes in routine

  • Self-stimulatory behaviour interferes with teaching

  • Difficulty finding reinforcer to motivate them

  • Desirable behaviour reward and undesirable punished

  • Desired behaviour broken down into small manageable parts

  • Intensive behaviour intervention has shown to be effective

  • Treat kids 40hrs a week and at home

  • Treatment may cost more than it benefits for society

Chapter 22 ADD/Hyperactivity disorder

Ken


  • A difficult child

  • Immune to verbal reprimands

  • Aggressive with other children and during mealtime

  • Low attention span for problem solving

Current problem

  • Only paid attention to teacher after she yells at him

  • First sessions focused on home behaviour as ken had a daredevil quality to his behaviour (the only way to get a positive response)

  • Father had similar issues when he was a boy

  • Cause of inconsistent punishment

Conceptualization and Treatment

  • Believe that structured system of rewards and punishment (contingency management) would be sufficient

  • Two target behaviors, leaving seat and bad behaviour at meal time

  • Record instances of behaviours, intervention was reward if he was below a certain threshold

  • Since it worked it expanded to temper tantrums, fighting with siblings and compliance with parental requests

  • Noncompliance biggest issue so there was an end of the week reward if he meet the criteria

  • Time out was still ineffective, due to toys he had in his room so they removed them and a point system was implemented

  • Same for being in seat

  • Criteria was progressively raised over time

  • Ken less moody, more pleasant and better with frustration

Etiological Considerations

  • Strong genetic component

  • Heritability at 60-90%

  • More in MZ twins

  • Children inherit inability to inhibit activity when environment calls for it and ignore distracting stimuli

  • Impairment in frontal lobes

  • Low grades due to genetics (hyperactivity)

  • Bio risk factors like low birth weight and birth complications, maternal smoking and alcohol

  • Emotional state of pregnant mom important, high anxiety affects brain through stress hormones

  • Other environmental factors like artificial food colouring and sodium increases hyperactivity

  • Watching a lot of TV

  • Fast-paced events lower attention span

  • Not a problem with educational content

  • 2-3 hrs as a kid predict attention problems

  • Being raised in a chaotic or impoverished environment

  • Poor parent child relationship (bidirectional the behaviours one of cause the other)

Treatment

  • Most common is stimulant medication (methylphenidate) like Ritalin and Adderall (amphetamine)

  • Benefits lost if discontinued

  • Side effects with drugs

  • Concerns that stimulants have been overused, may cause substance abuse in adulthood

  • Operant learning/contingency management approach most studied psychological therapy

  • Use of positive reinforcement for desired behaviour and negative reinforcement for undesired behaviour

  • Combined treatment best

  • Behavioural treatment first for preschool, then parent training for nondrug approach

Chapter 11 Alcohol dependence

Michael Patterson



  • First wife explained negative consequences of drinking

Social history

  • Drinking was relaxing, calmed him in social situations (like talking to women)

  • Drank more in university

  • Drank during graduate school as well, noticed he drank more than others

  • Drinking increased when passed over for promotion

  • Drank on the way home from work

Treatment

  • Mike did not want abstinence but doc said to do it for 1 month

  • Had withdrawal symptoms

  • When asked unable to come up with many positives for drinking

  • Unaware of how abnormal his behaviour was

  • Ignore urges and focus on longer-term consequences of getting drunk (divorce, drunk driving, forever alone)

  • Keep himself busy or call grace

  • Cravings were felt as vague hungers, taught deep muscle relaxation to cope

  • No more than 2 drinks a day, drink only in wife company, sipped

  • Distinguish between lapse and relapse

Follow-up

  • Drinking picked up when passed over for promotion

  • Doc tried to say there was no failure in relapse

  • Treatment was similar but no abstinence period

  • Mike thought being passed over was a catastrophe

  • Mike did not attend group meetings

Etiological Considerations

  • Multiple causes, genes interact with environment (about half and half)

  • GABA and dopamine genetic factors

  • Dopamine develop during environmental factors, abusive or neglectful family

  • Relatives have higher rates of drug abuse and antisocial disorder

  • Alcohol rates due to protective presence of a specific gene found more in Chinese Americans

  • Affect heavily by environmental factors

  • Mike had no family history of problem drinking

  • Prenatal exposure to alcohol is additional risk factor separate from family history of abuse

  • Personality traits may affect a person’s risk for alcohol dependence

  • Mike had high levels of negative emotions

  • Alcohol reduces stress anxiety, prevents people from paying attention the stressful stimuli

  • Alcohol used to regulate mood, reflect a failure of coping with emotion

  • Effect on mood depends on situations in which it is consumed

  • Increase negative mood if no distractors

  • If distractors present lowers stress

  • Become dependent by drinking it with more quantity and frequency

  • Men over 21 per week

Treatment

  • Many believe that they have no problem

  • Only 1 in 7 receive treatment

  • Benzodiazepines used to manage alcohol

  • Hospital and outpatient therapy equal as effective

  • Disulfiram and naltrexone prevent relapse

  • Treating anxiety and depression improves odds of successful treatment of drinking

  • AA most common

  • Behavioural group and interactional group more effective than AA

  • Focus on relationship patterns

  • Sobells

  • Moderate training

  • Teach social skills, relaxation and assertiveness

  • Increase exercise

  • Complete abstinence may alienate some, may not always be possible


Download 41.41 Kb.

Share with your friends:




The database is protected by copyright ©sckool.org 2022
send message

    Main page