SCO 294 Rachel Bianca Mallari Case Study G.C. is a 48-year-old Hispanic male. His current marital status is separated. Prior to admission in Manhattan Psychiatric Center (MPC), Mr. G.C. is said to be living independently in his own apartment. According to the his chart, he denied having any close friends and hobbies and tends to isolate himself. He stated, “I don’t remember ever being happy” (Client‘s Chart, Summary of Clinical Findings). The client has 5 sisters, 3 brothers and 1 half-brother who committed suicide. His fathered died of liver cirrhosis. Mr. G.C. fathered a child but did not keep in contact with the child neither with the child’s mother. The client is of Columbian descent. He speaks both English and Spanish fluently. The client relates to his Hispanic culture as evidenced by his fond of listening to Spanish music. Mr. G.C. is of Catholic faith. He values his religion through reading the bible. The client is assessed to benefit from a Sexual Offender’s Program and an after care MICA program. The Client does not have a meaningful work history. He stated that he was employed as an office file clerck and receives SSI payments to supplement his income. Mr. G.C. mentioned that he dropped out of school in 7th grade and admits to be a poor speller. The client is diagnosed with the following: AXIS I: Anxiety Disorder NOS 300.0, Alcohol Abuse 305.0, Paraphilia, Voyeurism 302.82. AXIAS II: R/O Dependent Personality Disorder 301.6. AXIS III: Asthma, Pituitary Adenoma, Hepatitis C. AXIS IV: Incarceration, limited support system. AXIS V: GAF 45. 1 SCO 294 Rachel Bianca Mallari Case Study DSM IV Code 302.82 Voyeurism DSM IV-Criteria Mr. G.C. A. Over a period of at least 6 months, Pt. is stalking and harassing women. He recurrent, intense sexually arousing also sends letters to teenagers with sexual fantasies, sexual urges, or behaviors provocative content. involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. B. The person has acted on these sexual urges, or the sexual urges or fantasies caused marked distress or interpersonal difficulty. BEHAVIOR Patients derive sexual gratification from Nothing was noted in the pt’s chart seeing sex organs and sexual acts. regarding gratification from seeing sex organs and sexual acts. USUAL MEDICATIONS OR INTERVENTION A. GnRH analogues Pt. doesn’t take any medications for B. Psychotherapy voyeurism. His current medications are as follows: Seroquel (antipsychotic), Prozac (antidepressant), Protonix, Albuterol and Quetiapine. SIDE EFFECTS 2 SCO 294 Rachel Bianca Mallari Case Study PROGNOSIS Guarded This writer thinks that the client fits the description for someone with this diagnosis. The client is charged of stalking and aggravated harassment thus, suggests that he has poor control of his sexual impulses. His chart stated that he is putting letters under his neighbors apartment door containing sexual provocative messages. In addition, he has a pathologically low self-esteem related to his sense of masculinity. The client has no other medical conditions aside from the ones identified in AXIS III. INTERVENTION FOCUS OF OTHER PROFESSIONALS: Psychiatrist- The Psychiatrist prescribes medication to the client and decides whether the patient can be on the discharge list. Also, educating the patient regarding medications and target symptoms while emphasizing consistent compliance with medications to avoid decompensation is part of the responsibility of the psychiatrist. Psychologist- the Psychologist works with the client in providing information and understanding regarding his illness and ways he can recover. Social Worker- The Social Worker prepares the client for discharge and educates him on how to avail various programs in the community and makes the arrangement in the type 3 SCO 294 Rachel Bianca Mallari Case Study of residence the client will go to after being discharged. The Social Worker also helps the client to manage his financial needs and contacts his family. Nurse- The Nurse administers the client’s intake of medication and monitors side effects. Vocational Counselor- The Vocational Counselor is not involved in the client’s treatment or rehabilitation. School Teacher- The school teacher is not a part of the treatment team working with this client. Recreational Therapist (RT)- The RT is the primary treatment leader of Mr. G.C. The treatment goals are established and addressed by the Recreational Therapist for this particular client. He interacts with the client in the treatment mall and documents his progress. The RT engages the client in meaningful and self-expressive form of therapy. These health professionals work with each other as a team, in order to plan the goals and intervention program for this client. They work collaborately to provide the utmost care for the patients. In MPC, the treatment team works in tandem to establish the goals, intervention and progress or lack thereof of the patient in the team meeting. The interaction among these health professionals certainly have an effect on the patient. They were able to dicuss the effect of the client’s medication in relation to his behavior and make adjustments. Thus, the treatment team are aware that the behavior of the client may have to do with the side effects of his medications. Also, in the team meeting they can decide whether the patient is ready for discharge or refer the client in the appropriate program that is suitable for him. OCCUPATIONAL THERAPY OR ACTIVITY THERAPY EVALUATION 4 SCO 294 Rachel Bianca Mallari Case Study A. Problems experienced using the assessment: Since this writer was instructed by her supervisor not to write in front of the patient during the interview, one believes that the assessment was long thus, all of the patient’s comments may have not been remembered. B. Summary of the information obtained: Although, the client is compliant with the treatment regimen and motivated to be discharged, the client shows deficits in areas such as social/psychosocial, communication and recreational interest. Furthermore, he has no insight regarding his illness. During the assessment interview, the client said that he still doesn’t know his diagnosis; the reason why he was admitted to MPC was because of a misunderstanding. C. Supervisor’s comments: See attached Rehabilitation Services Assessment. AREA OF OCCUPATION ASSESSMENT USED SUMMARAZE THE FOR THIS AREA EVALUATION RESULTS Psychosocial/Interpersonal Occupational Therapy Pt. states he doesn’t have (Self-concept/Self-esteem) Questionnaire any achievements. He prefers to be alone. However, he acknowledges the need to socialize with peers. 5 SCO 294 Rachel Bianca Mallari Case Study Communication Occupational Therapy Pt. mentioned having a Questionnaire hard time verbalizing his feelings. Thus, he prefers writing letters. He admits to be a poor speller. Pt.’s speech was somehow pressured especially when anxious. Leisure (Recreational Occupational Therapy Pt. expressed not having Interest) Questionnaire any hobbies and does not play any board games. However, he enjoys watching t.v., reading the bible and listening to music. He also indicated interest in playing bowling when discharged. Occupational Performance Intervention area #1: Social Interaction/Participation Problem: Mr. G.C. is often times withdrawn and tends to isolate himself. Goal: Client will initiate and sustain conversation with 3 peers twice a week during the group sessions by one month with minimal prompting. Method: (Be sure to include the specific tasks, how they will be used, any adaptations to the task and/or the environment, and how you will approach the person). The client will attend Social Skills and Relationship group 2x a week for 1 hr session in the treatment mall. The client will be prompted to seat next to the person who is active and would likely engage him in a conversation. Mr. G.C. will also be directly 6 SCO 294 Rachel Bianca Mallari Case Study asked open-ended questions and respond to the comments of other patients in the group. The group will engage in activities such as social skills for life, social bingo, friendship quilt and my play which will build up the client’s social skills. Also, the client will be encourage by the group leader to communicate and interact with fellow patients or staff in the day room. This approach is chosen to develop the client’s ability to relate with peers and increase his ability to express thoughts and ideas. Occupational Performance Intervention Area # 2: Interpersonal Skills Problem: Mr. G.C. declared to have low self-esteem. Goal: Client will state one positive thing about himself in the beginning of the group sessions twice a week by 2 weeks with minimal cuing. Method: (Be sure to include the specific tasks, how they will be used, any adaptations to the task and/or the environment, and how you will approach the person). Client will attend Interpersonal Skills once a week in the treatment mall. Activities such as Woulda Shoulda Coulda and Self-Disclosure will develop the client’s ability to reframe self-defeating statements and increase self-confidence. In addition, Self-Disclosure will increase and enhance understanding of oneself. This procedure is chosen to improve client’s view of oneself and selfunderstanding. Through self-awareness activities, the client may be able to strengthen his relationship with others. Occupational Performance Intervention Area # 3: Leisure 7 SCO 294 Rachel Bianca Mallari Case Study Problem: Client states not having any hobbies. However, he enjoys watching t.v., reading the bible and listening to music. Goal: Client will choose one of the two preplanned leisure activity (e.g., exercising routine or dancing) and initiate it twice a week with minimal cuing for 3 weeks. Method: (Be sure to include the specific tasks, how they will be used, any adaptations to the task and/or the environment, and how you will approach the person). Client will attend Leisure Education twice a week for 1 hour in the treatment mall. Mr. G.C. will be encourage to discuss and plan alternative leisure activities. He will be asked to select one new leisure activity and reports to the group about the activity selected. The client may demonstrate ,or if possible teach the group on how it is done. This method is chosen for the client to explore and open up possibilities to have a positive and productive use of leisure time. This may also increased his social participation. Thus, avoiding depression and suicidal ideation. 8 SCO 294 Rachel Bianca Mallari Case Study 9