Mentor Assessment #1: Case Study #1

Date: March 16, 2016

Topic: Psychiatry
Preview:
The following Mentor Assessment details the first case study given to me by my mentor
Dr. Arturo Arauzo on my third mentor visit. While explaining the case study, Dr. Arauzo would
allow me to learn more about psychological theories that related to the particular patient. This
made the meeting interesting because I was able to see what behavioral patterns that Dr. Arauzo
focused on in a patient and why. I was able to gain more insight to the ways that an experienced
psychiatrists mind worked.

Patient Background:
The case study that Dr. Arauzo began telling me about was a young woman who was 24
years old and worked as an ICU nurse in a hospital. She had been married for almost three years
and had a loving family and friend group. This woman was being treated by Dr. Arauzo for
depression and had been on antidepressants for a couple of years. Her job required her to work
the night shifts and her husbands job had him working in the daytime, so they had little room to
behave like a normal married couple, but still she saw no red flags in her marriage. A few weeks
ago, her husband, out of blue, told her that he was leaving her and there was no way to salvage
the relationship. The news, understandably, crushed her and she scheduled two emergency
therapy sessions with Dr. Arauzo the same week. Dr. Arauzo had to help her through the
acceptance of the end of the marriage and that she would be able to survive without her husband.

What To Look For:

This woman, referred to as Patient A, had previously been treated for depression and had
shown favorable results to the antidepressants she was receiving. Dr. Arauzo explained to me that
for patients who had previously experienced a disorder and then are hit with a new event in their
lives, he uses a system called crisis control. Crisis control consists of
Breathing Treatments- patients who are confronted with stressful events have a tendency to
experience a higher frequency of panic attacks and anxiety. To help calm and prevent this, Dr.
Arauzo teaches his patients to breathe through diaphragm in order to get a deeper, more soothing
airflow going through the body. Even if the literal breathing does not calm the patient, the focus
that must be put into diaphragmatic breathing helps take their minds off of the stress.
Cognitive Distortion Prevention- Another frequent occurrence in patients with depression and
anxiety is cognitive distortion. This is when a patient blames the negative occurrences on
themselves and tries to focus on what they could have done differently to change the results. In
order to prevent this, Dr. Arauzo has to be alert for any comments that place the blame on the
patients self, and remind her that she cannot control other peoples actions. This will help
alleviate stress from the patients worries and funnel more positive thoughts into their minds.
 Support System- The role of a psychiatrist is to support a patient through their problems in their
office and outside of it. Since a psychiatrists session lasts strictly within the office parameters, a
crucial part of Dr. Arauzos job is to ensure that a patient has a good support system outside of
the office. This includes family, friends, and any significant others who can affect the patient
positively or negatively in daily life. Dr. Arauzo explained that in order to keep track of these
people and their relations with the patient, he has each patient create a genogram of their family
and talk about each person included. The genogram and outer support system of a patient all help
to determine if medication is needed and a guide to therapy for the patient.
Through the use of crisis control, Dr. Arauzo helped patient A reach a state of acceptance that her
marriage was not meant to be and will not be able to continue. He ended his sessions with her by
modifying her pre-existing dosage of antidepressants and prescribing her Xanax for her
frequenting panic attacks. She will continue to see Dr. Arauzo for check ins and updates but
should be able to heal and get better with the help of her medications and support group.

Lesson:
Instead of automatically prescribing medications to a patient, Dr. Arauzo carefully
analyzes their medical history, their adaptiveness and responses to past antidepressants, family
history and relations, as well as their current behavior in a situation. For Patient A, she stated
multiple times that she would be unable to survive without her husband and that she could fix it.
Dr. Arauzo, using the theory of transactional analysis, recognized that she was acting out of her
childish ego state and was feeding off of the fear of being left behind. Since she was struggling to
maintain the composure of the competent adult she normally behaved as, as well had previous
treatment with antidepressants, Dr. Arauzo made the decision to alter her levels of
antidepressants to help alleviate her struggles. This showed how, as a psychiatrist, it is important
not to impulsively prescribe medications to a patient if they are not truly in need of them. Just as
Dr. Arauzo does, one must take a step back and interpret all factors influencing the patients
behavior before making such a decision.

Terminology:
Cognitive Distortion- A way in which the mind convinces one of certain thoughts, usually
pertaining to negative and self deprecating thoughts.
Diaphragmatic Breathing- A type of deep breathing through the abdomen that is performed by
expanding the diaphragm, which is a muscle just under the lungs.
Theory of Transactional Analysis- This psychological theory states that every adult personality is
made up of a child, an adult, and, if applicable, a critical parent. This theory is used to study and
analyze adult interactions, as one of the three ego states will appear in each interaction.
Genogram- A pictorial display of a persons family relationships and medical history.