CASE STUDY ONE

DENMAR CLINIC
Adri Helliwell
27046614

CONTENT OF PRESENTATION
Personal Information Medical information Family Background Observational Report Assessment Level of Creative Ability Prognosis Treatment Sessions

PERSONAL INFORMATION

PERSONAL INFORMATION
Clients initials Doctor Diagnosis Axis I Axis II Axis III Axis IV :E.B. : Dr. Steenkamp : Severe Recurrent Major Depressive Disorder with psychosis : Defer : None applicable : Marital problems, relationship problems, financial stressors : 31-40 (on arrival as indicated by doctor) 51-60 (on discharge, indicated by doctor)

Axis V

PERSONAL INFORMATION
Date of birth
Age

: 22-01-1956
: 55

Sex
Marital status

: Female
: Married

Dependants
Level of education

: 3 (Two sons and a daughter)

: Standard 8

Occupation

: Housewife

PERSONAL INFORMATION
Race : White

Accommodation

: Lives with her husband and her youngest son and his wife
: Bonitas Medical Fund

Medical aid Socio-economic background Language Religion

: Middle class : Afrikaans : Christian (AGS)

MEDICAL INFORMATION

MEDICAL INFORMATION
Two surgeries to chest to remove fibroid tissue from lungs Tendon release to left foot Diagnosed with Severe Recurrent major Depressive Disorder with psychosis Have been to Denmar twice and multiple times to psychiatris in Newcastle Received psychiatric treatment, psychology and 7 electroconvulsive therapy sessions

MEDICAL INFORMATION
- MEDICATION (REPEAT FOR 6 MONTHS)
Type Adco-Paroxetine 20mg Epitec 25mg Adco-Alzam 1mg Arem 5 mg Estro-Pause 1mg Purpose Anti-Depressant Anti-Depressant Anti-Anxiety Sedative Hormone Regulator

FAMILY BACKGROUND

FAMILY BACKGROUND

Normal birth and development as childhood three brothers and two sisters

Domestic violence between parents

Traumatic incidents relocating every year to new schools

Left school at age 16 due to pregnancy

Worked for 6 months at post office

FAMILY BACKGROUND

Youngest brother committed suicide at 19

Two sons and one daughter

Currently tension in household husband had multiple affairs, son and wife moved in

Stays in Newcastle with her husband. Son and his wife recently moved in.

HISTORY OF ACTIVITY PERFORMANCE

Occupation
Personal management

Quality
Good

Use of Leisure Time

Limited

School

Standard 8

Work

Housewife for 38 years

OBSERVATIONAL REPORT

OBSERVATIONAL REPORT -PHYSICAL APPEARANCE

55 year old female 60 kg and 1,6 m tall Shaved grey hair Fashionable reading glasses Slouched posture and drag feet Neatly dressed in plain clothing appropriate to weather Clean, no body odours Limited eye contact Large personal space initially

OBSERVATIONAL REPORT -COGNITIVE FUNCTION

Functions Observation Easily distracted, answer questions well Psychomotor agitation when attention focused on her Limited range of emotions, flat affect, restricted affect

Cognitive

Conative

Affect

ASSESSMENT

ASSESSMENT METHODS
Method Ward File Description Ward behaviour, background information, diagnosis, medication Psychiatrist, Psychologist, Occupational Therapist in group therapy In workshop, groups, around ward Client factors, performance skills, occupations, performance patterns Score 19 Self-differentiation Spot the difference, Circle all the 5s, Sequencing cartoon strips, Christmas decoration, Kims game, Jenga, Collage, Pie diagram and daily schedule

Collateral Information Observations Interview Mini Mental Status Examination Creative Ability Checklist Activities

PROBLEM LIST
Cognitive Client Factors Limited orientation to schedule No sustained, divided attention No abstract concept formation No critical, social, abstract judgment Limited insight Emotional Client Factors Restricted affect Increased anxiety Depressed mood Poor self concept Poor recent, recent past, remote memory Poor visual, semantic, procedural, episodic memory No abstract thought content No decision-making (negative options)

PROBLEM LIST
Conative Client Factors
Low energy and drive Externally motivated only Psychomotor agitation Poor initiation of tasks

Communication and Social skills

Limited information exchange skills No observational skills Limited to basic relational skills Poor reciprocity skills

Emotional and Regulation skills No stress management skills No coping skills No assertiveness skills No anxiety control skills Poor conflict management skills

PROBLEM LIST
Cognitive skills
Poor time management No planning skills Performance Patterns Poor routines Areas of Occupation Poor problem solving skills

Poor IADL (low motivation)

Poor social participation

Poor leisure participation

LEVEL OF CREATIVE ABILITY

LEVEL OF CREATIVE ABILITY

Self

differentiation, moving towards self presentation

Largely due to poor social interaction and stereotypical handling of situations Does not explore environment Egocentric

PROGNOSIS

PROGNOSIS
Good Prognosis No other existing psychological conditions Excellent general health No alcohol abuse Responding well to medication Poor Prognosis Severe episodes of depression History of depressive episodes Multiple hospital admissions Presence of psychotic features

Successful course of electroconvulsive therapy

Poor social functioning

No history of solid friendships in past 5 years

Ultimate indicator of prognosis: Quality of support system and continuity of medication

Early onset Suicidal ideation Heavy smoker Severe Anxiety Unstable family functioning and support system at present

TREATMENT

INTERVENTION STRATEGY
Strategy
Remediation 20%

Rehabilitation

80%

GOAL

To improve Mrs. EBs ability to function in her role as independent human-being, wife, home maintainer, mother and friend, so that she can function optimally in her areas of occupation (which include ADL, IADL, Work, Leisure and Social participation) and ultimately function better in her home environment in Newcastle.

AIMS

To encourage Mrs. EB to explore different leisure activities, so that she can identify meaningful ways to let out tension and function better as a wife, mother and home maintainer To facilitate participation in favorable leisure activities, so that she can live a balanced live with regard to areas of occupation and be able to regulate her emotions better as an independent human-being To practice good social interaction with the student, so that Mrs. EB can learn skills which she can apply to her husband, friends and children; so that Mrs. EB can develop a strong support system in times of need and function better in her role as independent human-being, wife, mother, friend and home maintainer To encourage Mrs. EB to maintain and manage her health (IADL) in terms of nutrition, fitness and taking of medication; so that she can fulfill her role as wife, mother, friend, home maintainer and independent human-being To educate Mrs. EB on safety procedures and emergency responses (IADL), so that she can function safely when alone around the home and fulfill her role as home maintainer and independent human-being

OBJECTIVES

To elevate Mrs. EBs mood, so that she will be encouraged to participate in social activities with her family and friends
To create an awareness of Mrs. EBs assets and limitations so that she will select appropriate leisure activities most effective and meaningful to her To increase Mrs. EBs insight to a level of intellectual insight, so that she will be able to manage and maintain her health as independently as possible To teach Mrs. EB coping skills relevant to her home environment in Newcastle, so that she will be able to manage her house hold and socially participate with her family to maintain a support system To teach Mrs. EB stress management skills so that she can get along with her family effectively To teach Mrs. EB anxiety management skills so that she can function better in social situations and well as when participation in new leisure activities To teach Mrs. EB appropriate relational skills as part of her communication skills, so that she can participate effectively in social situations with her family and friends in her community

CONCEPTUAL BASE

Vona du Toits theory of Creative Ability

Neuro-physiological Approach

THERAPEUTIC RELATIONSHIP
Therapeutic distance and therapeutic closeness Empathy, consideration, understanding Consistent Sincere desire to help Respect Consider culture, age, context. E.g. tannie Read patients non-verbal behaviour Never force Listen Constructive input Unconditional acceptance of person (not behaviour)

TREATMENT SESSIONS

SESSION 1

Aims

To encourage Mrs. EB to explore different leisure activities, so that she can identify meaningful ways to let out tension and function better as a wife, mother and home maintainer To facilitate participation in favorable leisure activities, so that she can live a balanced live with regard to areas of occupation and be able to regulate her emotions better as an independent human-being To practice good social interaction with the student, so that Mrs. EB can learn skills which she can apply to her husband, friends and children; so that Mrs. EB can develop a strong support system in times of need and function better in her role as independent human-being, wife, mother, friend and home maintainer

SESSION 1

Objectives:

To elevate Mrs. EBs mood, so that she will be encouraged to participate in social activities with her family and friends To teach Mrs. EB coping skills relevant to her home environment in Newcastle, so that she will be able to manage her house hold and socially participate with her family to maintain a support system To teach Mrs. EB anxiety management skills so that she can function better in social situations and well as when participation in new leisure activities

SESSION 1

Session Targets:
Mrs. EB Should participate in the painting activity which will last for 2 minutes. Mrs. EB should express a more elevated mood at the end of the treatment session than before the session started. Mrs. EB should demonstrate an understanding of how to reproduce the hand scrub activity at home by explaining it.

SESSION 1

Session Targets continue:

Mrs. EB should participate in the entire hand scrub activity without removing herself from an unfamiliar activity due to her anxiety. Mrs. EB should be able to practice two anti-anxiety skills with the student therapist. Mrs. EB should be able to identify at least one example of when she needs to implement her coping skills. Mrs. EB should identify the hand scrub activity as an activity that she can reproduce in her home context as a coping strategy when you needs some alone time or mood upliftment.

SESSION 1

Conceptual Base
Vona du Toits theory of Creative Ability Neuro-physiological Approach

SESSION 1

Activities:
Hand Painting on vertical surface (2 minutes) Elevation of mood, initiate social interaction Practicing of two anxiety skills (2 minutes) Anxiety control skills Hand scrub activity (7 minutes) leisure exploration and participation, coping skill, social interaction Conclusion of session (2 minutes) Repetition of integration

SESSION 1

Structuring
Grading Presentation

SESSION 2

Activities:
Balloon Volleyball (3 minutes) Elevation of mood, social interaction Practice anxiety skills from session 1 (1 minute) Anxiety management skill Peppermint Crisp Pudding (11minutes) Leisure exploration and participation

SESSION 3

Activities:
Learn and practice new anxiety coping skill (1 minutes) Anxiety management skill 10 minute exercise plan (requested by client) (10minutes) Elevation of mood, social interaction Leisure exploration and participation

SESSION 4

Activities:
Practice anxiety skills from sessions (2 minute) Anxiety management skill Ring throwing game (5 minutes) Leisure exploration and participation Elevation of mood Social interaction Basic Relaxation techniques (7 minutes) Coping skills, anxiety management skills Leisure exploration and participation

THANK YOU
Any Questions?