1 Situation 1. Madge 1. Wanders street, screams obscenities, has lucid moments, disordered thinking 2. Schizophrenia – illogical thought, difficulty deciphering real and imagined, abnormal emotions 3. Not good - symptoms likely get worse to the point of suicide 4. Hospitalized during episodes – antipsychotic meds – support programs (family and friends, etc.), and behavioral therapies 2 Situation 2. Kurt 1. Excessive mood swings, very productive vs. withdrawn 2. Bipolar Disorder –back and forth between periods of a very good or irritable mood and depression. 3. Suicide is a very real risk during both mania and depression. People with bipolar disorder or think or talk about suicide need immediate emergency attention. 4. Mood-stabilizing medication – Support programs and therapy –support for family and from family to person with BD 3 Situation 3. Gwen 1. Scared by dog as a child – traumatic event 2. Phobia – due to irrational fear and lifechanging behavior exhibited 3. Some get better without treatment, but most get progressively worse 4. Childhood (& brother) may suggest psychoanalytic, but this seems to be a case for systematic desensitization – slowly introduce fear producing objects to gradually relieve anxiety. 4 Situation 4. Family 1. A lot of problems – Dan’s alcoholism and Lisa’s depression, but focus should be on miscommunication and dysfunctionality of the family 2. Alcoholism, depression, family problems 3. Unlikely to get better without treatment 4. Family therapy – Along with AA for Dan and one of the insight therapies for Lisa – Family needs skills to communicate and support one another 5 Situation 5. Cindy 1. Feels worthless, reality doesn’t match perception – Blames herself to extremes 2. Low self-esteem, maybe depression 3. May learn to deal with irrational thoughts with support from others, but not likely to get much better without help. 4. Cognitive therapy, such as RET – would aim to change her irrational thoughts into more realistic views Situation 6 One day, Karl, a native of Hawaii, wakes up in Nebraska, with no memory of who he is, how he got there, or from where he came. He has never been a drug user, and has not suffered from any head trauma. Karl has no ability to discuss his childhood or produce any articles from his distant past. He has no social security documentation, and has no contact with any family members. 6. Karl 1. Karl seems to have the inability to remember his past. It’s almost as if he’s started a new life. 2. Dissociative Fugue – Because Karl has a type of amnesia that is unlike retroactive amnesia, in that he has no obvious signs of illness or injury. 3. Prognosis - The DSM-IV-TR states that the fugue may have a duration from hours to months and recovery is usually rapid. However, some cases may be unmanageable. An individual usually only has a single episode. 4. The goal of treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of his or her symptoms, but most likely will include some combination of the following treatment methods: • Psychotherapy – main treatment for dissociative disorders. – designed to encourage communication of conflicts and increase insight into problems. • Cognitive therapy – Focus on changing dysfunctional thinking patterns and resulting feelings and behaviors. • Medication – no medication to treat the dissociative disorders – Sufferers may also have depression or anxiety & might benefit from meds • Family therapy – to teach the family about the disorder and its causes, & recognize symptoms of a recurrence. • Creative therapies (art therapy, music therapy) – allow the patient to explore and express thoughts and feelings in a safe and creative way. • Clinical hypnosis – allows people to explore thoughts, feelings and memories they might have hidden from their conscious minds. – The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories. Situation 7 Julio believes he is an alien who has been left behind on Earth by his “pod.” He is often difficult to understand, because he speaks frequently in rhyme and makes up his own words to communicate with his alien friends. Julio regularly walks around wearing only a tube top, particularly when it’s cold outside, and has terrible personal hygiene. He insists on eating in the dark and rarely shows any kind of emotion. 7. Julio 1. Irrational thinking, very disorganized and confusing behavior 2. Disorganized Schizophrenia – by observing his behavior as illogical and irrational and his emotions are limited. It is recommended to use certain tests to be sure there is not some underlying health condition that’s causing the problems. 3. DS does not get better without treatment – patient may end up harming themselves or others if untreated. 4. Schizophrenia treatment involves medications and therapy to reduce the risk of future psychotic episodes and improve relationships. ECT is also used. Situation 8 Steve appears to be a mild-mannered 20something, but he sometimes believes he is a teenage female named “Suzy” who is a member of a high school dance team. At these times, he dresses in various matching outfits, carries pom-poms, and practices various dance routines. Steve is confused about why he sometimes awakens dressed in strange clothing. It has recently come to light that Steve was physically abused, and possibly sexually abused, as a child by his step-father. 8. Steve 1. 2. 3. 4. Physical and possible sexual abuse as a child – “normal” male behaviors along with different identity (Suzy) Dissociative Identity Disorder – Dissociation is recognized as a symptomatic presentation in response to psychological trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder. DID does not resolve spontaneously, and symptoms vary over time. Individuals still attached to abusers face the poorest prognosis. Individuals with the condition commonly attempt suicide. There is a general lack of consensus in the diagnosis and treatment of DID. Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral (CBT) and insight-oriented therapies, as well as medications. Situation 9 Driving back from a concert, Gerri fell asleep at the wheel and crashed her Jaguar convertible. Her best friend perished in the crash. Ever since, although doctors can find nothing physically wrong, Gerri has been paralyzed in the arm with which she was steering, and cannot mover her right foot. Gerri’s doctors accuse her of making up her symptoms, but Gerri is adamant that she is paralyzed. Gerri doesn’t seem very concerned with the paralysis, and is now exhibiting fewer behaviors associated with her previously diagnosed anti-social personality disorder. 9. Gerri 1. 2. 3. 4. Accident preceded “paralysis” of which there is no physical connection Conversion Disorder – a condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation, often developing after a stressful experience – it’s also common for the symptoms of another, previously diagnosed mental disorder to become less prominent (less symptoms) Symptoms usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life threatening, but complications can be debilitating. Psychotherapy and stress management training may help reduce symptoms. The affected body part or physical function will need physical or occupational therapy until the symptoms disappear. For example, paralyzed limbs must be exercised to prevent muscle wasting. Situation 10 Keshona is terrified of speaking in public and attending social gatherings. Although highly knowledgeable and competent, whenever she has to address a gathering of adults, her heart pounds, she feels nauseous, trembles, and her mouth gets dry. Keshona has some awareness of her problem, sharing her fear of potential scrutiny or judgment with her closest friends. Keshona rarely goes out of the house, and has an irregular attendance pattern at work. She has begun to drink alcohol often, particularly when faced with social situations. 10. Keshona 1. 2. 3. 4. Terrified of social situations – not lack of ability – incapacitating Social Phobia – she fits the criteria – and it’s interfering with normal function - different from shyness. Shy people are able to participate in social functions. People with social phobia are constrained by their condition to the point that it affects their ability to function in work and relationships. Typically will get worse The goal of treatment is to help you function effectively. The success of the treatment usually depends on the severity of the phobia. • Medications, behavioral treatment, cognitive behavioral therapy, systematic desensitization, social skills training, role playing and modeling, & lifestyle changes. Situation 11 Frank has been arrested on numerous occasions for disturbing the peace and for illegally producing and selling alcohol and drugs to minors. Although a number of his clients have died from overdoses, he feels no remorse. Frank has been arrested many times, starting 15 years ago when he was caught using firecrackers to blow up frogs near the creek by his parent’s farm. Needless to say, Frank was always in trouble during his school years, even getting kicked out of high school as a 10th grader and being forced to complete his education at the local adult school. Frank has a very charming personality, which he uses to manipulate others to get what he wants. However, when he doesn’t get what he wants, he becomes violent. His most recent arrest was for fighting with (hitting) his Dad because he wanted to “borrow” money and his Dad said no. It’s likely that Frank was abused as a child, but he refuses to acknowledge much of his childhood 11. Frank 1. Arrested often – no remorse – hit Dad 2. Antisocial personality disorder – long-term pattern of manipulation, and criminal activity 3. Symptoms tend to peak in late teens/early 20s. Imprisonment, drug abuse, violence and suicide are all likely outcomes. 4. Antisocial personality disorder is one of the most difficult personality disorders to treat. People with this condition rarely seek treatment on their own. They may only start therapy when required to by a court. The effectiveness of treatment for antisocial personality disorder is not known. Treatments that show the person the negative consequences of illegal behavior seem to hold the most promise (Cognitive). Situation 12 A couple of months ago, while she was on a visit to the Florida, Samantha’s hotel was demolished by a hurricane while she took refuge in a storm shelter. Ever since, she has been plagued by terrible nightmares and occasional flashbacks, in which she truly feels like she is experiencing the hurricane all over again. In fact, she finds herself become very agitated when she learns that rain is in the forecast. Friends have noticed that Samantha has displayed an emotional “numbness,” and a general lack of interest in normal activities. She doesn’t want to hang out with the 2 friends with whom she went to Florida, and can’t even order her favorite drink because it comes with a cocktail umbrella. 12. Samantha 1. Hurricane – trauma – becoming withdrawn 2. PTSD – lasted more than 30 days, affecting normalcy, traumatic event triggered 3. Likely to persist without treatment, but memories and severity of PTSD should fade over time. 4. Early treatment can help prevent PTSD. Good social support system is helpful. Desensitization shows promise. Situation 13 During early adolescence, Don became addicted to cigarettes, alcohol, and eventually marijuana. Now in his early 20s, Don has periods of time where he doesn’t sleep much, gets angry easily, is promiscuous, launches new get-rich-quick schemes, and goes on gambling sprees. During these times in his life, he feels invincible, on top of the world, like he can’t lose. At other times, he feels like a loser, finds no joy in activities he used to enjoy, and is so down that he can’t even get out of bed. Life seems purposeless. Don has attempted suicide at least twice in the past 2 years. 13. Don Drug use in past – promiscuous – up and down emotionally 2. Bipolar Disorder – Mood swings, up and down nature of behavior, instability 3. Most don’t get better without treatment, and periods of depression or mania return in most patients, even with treatment. Suicide is a real possibility without treatment. 4. Drugs, called mood stabilizers, are usually used first – The main goals of treatment are to: • Avoid moving from one phase to another • Avoid the need for a hospital stay • Help the patient function as well as possible between episodes • Prevent self-injury and suicide • Make the episodes less frequent and severe 1. Situation 14 No matter what he is doing, Ikimba always feels a little tense. The apprehension has no apparent cause, and he seems to feel stressed about “everything.” In fact, Ikimba experiences constant uneasiness during weekends and vacations. He has shared that he is always nervous and tired, has difficulty concentrating, and is startled easily. When Ikimba resolves one issue, several more seem to crop up. For example, he recently inherited a large sum of money, and now he’s nervous about what to do with the money and stressed about meeting his roommate’s girlfriend later this week. 14. Ikimba 1. Over-stressed, trouble concentrating, startled easily 2. Generalized Anxiety Disorder – b/c Ikimba has frequent, constant worry/anxiety over many different things 3. If untreated, may not improve – may get worse – can be debilitating, but wide range of effects 4. Medicine and CBT • • SSRI, SNRI (antidepressants) Cognitive-behavioral therapy helps you understand your behaviors and how to gain control of them Situation 15 Ken is plagued by constant worries that what he has planned will not occur as scheduled. He makes hundreds of to-do lists each day and often checks these lists to make sure they are correct. Ken incessantly reminds his colleagues of upcoming deadlines, sometimes 15 or 20 times each day. Often, Ken is aware of the incessant thoughts, but he is overwhelmed with the feeling that he must “do it.” Ken has been declared physically healthy by his primary physician and does not use drugs of any kind. 15. Ken 1. Ken has repeated unwanted thoughts and feelings and is driven to “do it.” 2. Obsessive Compulsive Disorder – unwanted, repeated – no physical illness or drug use – aware of problem, but can’t control it 3. OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment. 4. medications and therapy • • SSRIs or TCAs (antidepressants) CBT 16 Situation Trent was raised in a rural, isolated area. Interactions with members of the opposite sex were minimal. Now Trent can be sexually aroused only by farm animals or someone dressed up as a farm animal. He has not had sex with animals, yet, but he fantasizes of a day where his preference is socially accepted. He has his bedroom decorated to look like the prototypical dairy farm and works as a handyman at the local sheep farm. He has had girlfriends in the past, but they break up with him not long after he requests they dress up as a cow, sheep, or rooster. 16. Trent 1. Lack of female contact as child – only sexually aroused by a specific, abnormal situation 2. Fetishism – due to the fixation on farm animals, Trent has conflict with potential partners. 3. Sometimes fetish disappears and no treatment is needed – Other times it can get worse (more extreme) 4. CBT, medication, and/or psychoanalysis • Meds to reduce testosterone or estrogen