Possible answers for Handout 14.1

1
1
Situation
2
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

3
2
Situation
4
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   withdrawn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

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3
Situation
6
3. Gwen

1. Scared by dog as a child traumatic event
2. Phobia due to irrational fear and life-changing
   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.

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4
Situation
8
4. Family

1. A lot of problems Dans alcoholism and Lisas
   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

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5
Situation
10
5. Cindy

1. Feels worthless, reality doesnt 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

11
6
Situation

• 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.

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6. Karl

1. Karl seems to have the inability to remember his
   past. Its almost as if hes 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
   ?

13

• 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.

14
7
Situation

• 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 its cold outside, and has
  terrible personal hygiene. He insists on eating
  in the dark and rarely shows any kind of emotion.

15
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 thats 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.

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8
Situation

• Steve appears to be a mild-mannered 20-something,
  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.

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8. Steve

1. Physical and  possible sexual abuse as a child
   normal male behaviors along with different
   identity (Suzy)
2. 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.
3. 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.
4. 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.

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9
Situation

• 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. Gerris doctors accuse her of making
  up her symptoms, but Gerri is adamant that she is
  paralyzed. Gerri doesnt seem very concerned with
  the paralysis, and is now exhibiting fewer
  behaviors associated with her previously
  diagnosed anti-social personality disorder.

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9. Gerri

1. Accident preceded paralysis of which there is
   no physical connection
2. 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 its also common
   for the symptoms of another, previously diagnosed
   mental disorder to become less prominent (less
   symptoms)
3. 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.
4. 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.

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10
Situation

• 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.

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10. Keshona

• Terrified of social situations not lack of
  ability incapacitating
• Social Phobia she fits the criteria and its
  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.

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11
Situation

• 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 parents 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 doesnt 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. Its likely
  that Frank was abused as a child, but he refuses
  to acknowledge much of his childhood

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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).

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12
Situation

• A couple of months ago, while she was on a visit
  to the Florida, Samanthas 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 doesnt want to hang out
  with the 2 friends with whom she went to Florida,
  and cant even order her favorite drink because
  it comes with a cocktail umbrella.

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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.

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13
Situation

• During early adolescence, Don became addicted to
  cigarettes, alcohol, and eventually marijuana.
  Now in his early 20s, Don has periods of time
  where he doesnt 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 cant lose. At other
  times, he feels like a loser, finds no joy in
  activities he used to enjoy, and is so down that
  he cant even get out of bed. Life seems
  purposeless. Don has attempted suicide at least
  twice in the past 2 years.

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13. Don

• Drug use in past promiscuous up and down
  emotionally
• Bipolar Disorder Mood swings, up and down
  nature of behavior, instability
• Most dont get better without treatment, and
  periods of depression or mania return in most
  patients, even with treatment. Suicide is a real
  possibility without treatment.
• 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

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14
Situation

• 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 hes nervous about what to do with the money
  and stressed about meeting his roommates
  girlfriend later this week.

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14. Ikimba

• Over-stressed, trouble concentrating, startled
  easily
• Generalized Anxiety Disorder b/c Ikimba has
  frequent, constant worry/anxiety over many
  different things
• If untreated, may not improve may get worse
  can be debilitating, but wide range of effects
• Medicine and CBT
• SSRI, SNRI (antidepressants)
• Cognitive-behavioral therapy helps you understand
  your behaviors and how to gain control of them

30
15
Situation

• 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.

31
15. Ken

• Ken has repeated unwanted thoughts and feelings
  and is driven to do it.
• Obsessive Compulsive Disorder unwanted,
  repeated no physical illness or drug use
  aware of problem, but cant control it
• 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.
• medications and therapy
• SSRIs or TCAs (antidepressants)
• CBT

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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.

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16. Trent

• Lack of female contact as child only sexually
  aroused by a specific, abnormal situation
• Fetishism due to the fixation on farm animals,
  Trent has conflict with potential partners.
• Sometimes fetish disappears and no treatment is
  needed Other times it can get worse (more
  extreme)
• CBT, medication, and/or psychoanalysis
• Meds to reduce testosterone or estrogen