Cases for Psychopathology Spectrum Worksheet



Cases for Psychopathology Spectrum Worksheet

Case #1: Dan, single software engineer

30 year old, shy, college-educated, single man with depression, anxiety, and low self-esteem. Patient describes a long-standing history of feeling insecure in social situations, especially in romantic relationships. He developed symptoms of a major depression about six months ago, precipitated by moving from northern California to Seattle for work (got a good new job at Microsoft about 9 months ago.) He feels like it hard been difficult to adjust to his new life and misses his old friends and co-workers, even though he has made a couple of news friends and met a woman (current GF.) He likes his job and is doing well. He has always done well in school and professional settings and feels pretty confident in this area, but he sometimes feels overwhelming anxiety and shame when he is “under scrutiny” or receives feedback such as “normal constructive criticism.” At Microsoft, annual performance reviews were very stressful for him, despite the fact that he did pretty well. No SI, no psychotic sxs, no manic sxs.

Past Psych HX: no SA, no hospitalization, no prior txt

Sub HX: social etoh use 2-4 drinks/week, tried MJ in college, no other drug use, no hx of etoh abuse

Social HX: B&R in northern CA, parents married to one another throughout pt’s life, #2 of 3 kids with older sister and younger brother, no physical or sexual abuse. Parents are both college-educated professionals, mom worked part-time while kids grew up. Education and grades were highly prized in the family, and father’s expectations were especially high. Parents were generally supportive and loving but pt felt like he was “always letting them down and felt like I could never do anything well enough to really please my Dad.” Pt’s brilliant older sister was in gifted programs throughout school and attended a prestigious Ivy college (same college as father.) Sister is now an attorney (like father.) Pt was not as good at school and struggled to make mostly B’s but discovered that he had a natural aptitude with computers, attended college for BS in computer science, worked in IT industry since graduation. He has always been reserved but usually had a small group of 2-3 close friends rather than being part of big crowd or socializing widely. He is still close with his best friend from college. He is heterosexual and had a two year relationship which ended approximately one year ago. He describes stable relationships with his family, closer with mom than dad, in touch with siblings. Never married, no children.

Family Psych HX: paternal GF alcoholic, pt suspects that father may be depressed and anxious (no txt)

During today’s session, he describes a recent, painful experience. He tells you that he went to a party in a friend’s crowded apartment. He had planned to meet his girlfriend there and was waiting for her at the party. After a few minutes, she walked in, saw her best friend, and walked right past the patient without acknowledging him. She talked excitedly with her girlfriend for about 10 minutes before she looked for the patient. The patient felt hurt and concluded that his girlfriend had intentionally slighted him because she did not really want to see him. You decide to challenge his assumptions about the girl friend’s actions with the goal of helping him develop some alternative explanations.

Case #2: Rick, 44 year old college-educated, financial industry executive

Rick is an extroverted, talkative, superficially-charming man with a history of two major depressive episodes. The first was precipitated by the break-up of a short marriage when he was 30 years old. “I felt really down and depressed because of the way that she treated me. Pretty quickly, I realized that she didn’t deserve me and was a fool for leaving me. When we first got together, everything seemed perfect – she was beautiful and exciting – heads turned when she walked into a room. She was crazy about me and seemed like my soul mate. We couldn’t get enough of each others. But later, I saw her true colors when she stopped appreciating me and it seemed like she just changed or something. It took me a little while to figure it out, but I knew that I could have something better with someone else. It never would have lasted; she just beat me to the punch and that knocked me off balance for a while.” Since then, Rick has been “playing the field. You know,not all that glitters is gold, there are a lot of real vixens out there who don’t turn out to be as perfect as they seem at the beginning.” Most of his relationships have fizzled after a few weeks.

Currently, he is experiencing symptoms of depression, anhedonia, insomnia, decrease appetite, and impaired concentration. No SI, no psychotic sxs, no manic sxs. He has been working in the banking industry for the past 8 years, at various instititutions, often leaving jobs after a initial period of notable success because “people would screw me because they were jealous of my successes.” The current sxs started after he was laid off by the WAMU. He feels that he did not deserve to be laid off and should have been kept on by the new management. “Hell, I knew more about that part of the organization that most of those bozos. Some of the higher-ups knew it, too, but the deck was just stacked against me. If anybody had had any brains, they have kept me around to help bail them out.” He admits that he misses his job – “dealing with that kind of big money is a rush, and I love to close the deal. Frankly, I’m pretty good at it, too. Not to brag, but I was the highest performer in my part of the organization in the second half of 2007.” He has a couple of friends, but he admits that he has a hard time relating to many people because “they aren’t on my level or they get jealous too easily – a lot of people are insecure idiots – I am just being blunt here.”

Pt came to treatment for help with his depressive symptoms and “to learn how to pick better women.”

Past Psych HX: no SA, no hospitalizations, no prior txt, no prior therapy. “I once saw a therapist a couple of times, but I felt like I knew more than he did, so I quit. God, he was so smug, too --it was a complete waste of time.”

Sub HX: “partied a lot in college” but now drinks approximately 5-7 drinks/week, no drugs

Case #3: Doris, 55 year old woman with chronic mental illness

Doris was admitted to the hospital with worsening auditory hallucinations and paranoid ideation. She lives subsidized housing managed by Sound Mental Health (community mental health agency.) She was diagnosed with Schizophrenia in her mid-20s and had numerous hospitalizations until around age 40, always for psychotic decompensations. When the atypical antipsychotics came out in the mid 1990s, Doris started taking olanzapine. Per her case manager, she was more compliant with this medicine and her psychotic sxs diminished but did not go away completely. At her baseline, she always hears voices commenting on her activities, but she ignores them or distracts herself by turning on the TV or listening to music through headphones. She attends a day-treatment program three days per week and is “one of our star clients,” per case manager. She makes the coffee for the other patients and is friendly with a couple of the patients and participates in the sheltered work program. Sometimes, people take advantage of her by borrowing money or bumming all of her cigarettes, so her case manager tries to help her with saying “no” and is her protective payee. Most of her family lives in the Midwest and has not been involved in her daily life in years, but she does talk to them on the phone about once per month. Her sister lives about one hour away and sees her about twice per month. Recently, her case manager went on maternity leave, and Doris stopped taking her meds because the AH told her that they were poisoned. Her psychotic symptoms became more severe, AH louder, Doris showed up at day treatment disheveled and talking to herself. She became very agitated when staff approached her and threw the coffee pot, yelling about, “poison!”

Sub HX: denies currently, remote drinking history in her 20s and 30s

Family Psych HX: mother was in a mental hospital for unknown reasons, maternal GF completed suicide

Social HX: B&R in Midwest, high school graduate, worked in school cafeteria in her early 20s, on disability for years. Lives alone, has protective payee. Never married, no children, no romantic partners. Pt has a beloved pet cat.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download