Psychology Case Study

Assignment #1 

Illness, symptoms, medical treatment, prognosis and statistics relating to the general population. 

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that may manifest in individuals who have experienced trauma in the past. Traumatic experiences and events such as war, natural calamities, sexual violation and severe injury are likely to result in PTSD in a victim’s lifetime. Each year, 3.5% of adults are bound to experience trauma and suffer Post-Traumatic Stress Disorder as a result. Globally, women are twice as likely to suffer PTSD. 

Symptoms 

Anxiety disorders 

PTSD patients may exhibit uneasiness and constantly display worrisome trends. Withdrawal and general disorientation are bound to affect an individual’s daily activities and their ability to adequately focus. Patients experience recurrent general stress, and their stress levels may be out of proportion, considering the severity of the underlying traumatic experience or event. A victim or survivor of a traumatic experience registers an increased heart rate. Constant worry may be prolonged and perpetuated at the slightest provocation on reminder of a traumatic occurrence. 

Dissociation 

Dissociation as a symptom of PTSD is generally characterized by a breakdown in a patient’s brain’s capacity to correctly and adequately receive and perceive stimuli or information pulses. An unhealthy disconnect between a patient’s thoughts and their physical actions or responses often becomes the end result of such dissociation. Victims may further fail to interpret environments correctly as a result of the dissociation they experience. A patient or victim may experience emotional numbness and reduced pain sensitivity (Pawloski et al., 2019). Possibly reduced pain sensitivity and emotional numbness would normally interfere with a PTSD patient’s responsiveness to their surroundings. 

Depression, Suicidal Thoughts and Self-harm or Incapacitation 

Recurrent thoughts of ending one’s life may become a dominant theme and psychological trend, considering victims and survivors of traumatic events. A patient may constantly write about or make drawings about suicide and other methods of self-harm and destruction (Pawloski et al., 2019). Following a traumatic experience, one may give away material possessions, a possible indication of an unwillingness to continue living. A patient or a victim is likely to constantly hear voices encouraging them to physically incapacitate themselves or even end their lives. 

Hypervigilance 

A patient or victim constantly looks out for danger. An extreme but often uncalled for sensitivity to objects and people characterizes hypervigilance, a PTSD symptom (Early, 2000) . An anticipatory behavior involving alertness over possible recurrences of traumatic events, and warning signs in personal relationships is likely to replace one’s normal or ordinary behavior. 

Panic Attacks 

Sudden moments of intense fear may translate to extreme physical reactions even when there is no solid cause for alarm. Chills, numbness in the limbs, and shortness of breath are common signs of panic attacks. A dominant sense of impending doom prompts recurrent panic attacks as a patient goes about their daily activities. 

Medical Treatment 

Cognitive Therapy ( Cognitive Behavioral Therapy/ Cognitive Processing Therapy ) 

Cognitive Therapy involves altering strictly negative patient personal evaluations of traumatic events. The purpose of this approach to treating PTSD is mainly to alter or realign the negative behavioral and thought patterns that affect a patient’s life (Pawloski et al., 2019) . The therapy highlights current thinking and behavior and emphasizes little on past events. 

Medications and Prolonged Exposure 

Therapists may prescribe PTSD management medications upon diagnosis. Fluoxetine, Venlafaxine, and Paroxetine are useful PTSD management drugs. Prolonged Exposure encourages patients to gradually face their memories involving disasters, injury or war (Pawloski et al., 2019) . Such exposure assess trauma to minimize resultant disturbances. 

The Person Environment Occupation model (PEO) highlights performance in one’s occupation as influenced by engagements with people, the surrounding and processes or procedures making up an occupation. Following the PEO model, occupational performance is defined by three domains; the person, the environment and the nature of an occupation (Early, 2000) . The person is made up of physical and mental health, cognitive capacity/ abilities, cultural inclinations, physical performance and the sensory aspect of the self. The environment is composed of an individual’s social, physical, cultural, institutional and economic life. Based on the PEO model, the occupation as a third domain, is the collection of tasks and duties or activities that may be engaged in by an individual to meet their needs of independence/ self-maintenance while adequately realizing fulfillment (Amini) . According to the PEO model, the quality of occupational performance is directly and almost entirely influenced by the interaction between the three domains, with greater synchronized interaction resulting in greater occupational performance and vice versa. 

This model (the Person Environment Occupation model) works best with my case study involving a PTSD patient since it may serve an assessment purpose and provide a suitable framework for evaluating and monitoring her condition. The model further best suits my case study since alterations to the patient’s surrounding can be properly guided by the model, considering the model’s three domains. The PEO’s domains are all encompassing, and would suit determining and initiating treatment aimed at developing the client entirely as a conscious human being. She is affected in more than one facet of life, including her day job and interactions in her workplace, making the PEO’s all inclusive design the most suitable for my case study. 

Choose an OT model/ FOR based on the psychological theory you have chosen. Explain how this model/ FOR addresses your client’s limitations. 

The Person Environment Occupation Model addresses my client’s limitation in varied ways. She has been diagnosed with loss of peripheral vision in her left eye which was a result of an accident during her childhood. The PEO model encompasses the developments around her partial loss of peripheral vision within the ‘person’ domain, to accommodate considerations in establishing congruence between her as a person, her occupation and her environment. She is haunted by recurring thoughts about the fire in her family home and persistently recreates sights of the fire tragedy while asleep and sometimes while wide awake. Since the model adequately considers a client’s mental state, still under the ‘person’, the recurrent themes and visions will have a significant bearing in laying out possible solutions around stabilizing her train of thought. 

Fires from objects and tools such as lighters are a major memory trigger for her, and such fires are a component of her surroundings. These fires, alongside other varied external stimuli or simple reminders while she is at work or spending time at home, will be addressed by the PEO model under the environment domain. At work, she has become a loner since the accident and limits interaction with other individuals and groups. She lacks energy and zeal, and often appears to be withdrawn. The PEO model’s occupation domain is appropriate for addressing her new personality and social inclination while she is at her workplace. Her short term memory is affected by her inability to adequately focus or concentrate ad this would be rich input into the model. The PEO model further addresses her limitations by having the capacity to establish the extent of possible positivity or negativity in results following variations in changes in her acquired habits, patterns or trends. 

List three referral sources for services from which the client would benefit (i.e. community; additional therapies, specialties). Indicate why this patient needs these particular referrals. 

The client needs to join a support group, become a participant in the activities of a community or communities, and register herself on a psychological support internet-based application. A community activity such as participation in communal psychological education around coping and realignment skills will be useful for the client to fully internalize the nature of traumatic experiences, the dark side, and the hopeful post-traumatic phase (Pawloski et al., 2019) . Such a community activity will expand her awareness and consciousness around the need to relevantly, timely and adequately align with existing researched guidelines on trauma management. 

A support group will be essential for the client to meet and interact with other individuals who have had equally traumatic experiences. Engagements within the support group will build in her a sense of not being alone in her struggles dealing with her scary past. Opening up, venting and laying bear her fears while engaging her group members will be an invaluable gateway to healing and properly coping. Support groups universally have a reputation of grouping experiences, interests, and goals through creating a common avenue for people with certain similarities. The support group will most likely promote her personal re-development into her former self. 

A psychological support web-based application will be useful to help the client keep personal records of treatment progress upon inputting defined metrics. Modern psychological and social support applications will provide her with real-time useful statistics and updates around psychology and the proper management of her condition. Input from a third party such as a healthcare professional’s recommendations and observations regarding treatment or therapy progress may be accommodated by such an app, to create a central tracking and correspondence unit. A psychological support web application will additionally present her with a virtual avenue for productively interacting with distant individuals walking a similar path (more like a bigger support group that would not be limited by physical distance).

Assignment #2 

Develop a list of strengths and weaknesses for your client 

Weaknesses . Her short-term memory is fairly unstable, negatively impacting her memory performance patterns. This stems from the difficulty she finds trying to focus or concentrate wholly.

She exhibits a substantially deteriorated social life, from accounts of failing to engage others in leisure activities and hobbies. This means that adequately improving her condition may require intensive treatment.

Her reaction/ responses are delayed and lapses limit the possibility of fully engaging her in conversations or interrogations. For this reason, my client’s responses are unreliable to an extent.

Strengths. Besides her shortcomings and trials, my client demonstrates clear and definite willingness to strive to better her condition.

She is cooperative, quiet and composed. These characteristics would make it easy to offer her the much needed medical help and improve her overall psychological performance skills.

She has an adequate understanding of the usefulness of her possibly using medication alongside therapy to better herself within, and externally, considering her environment.

Write one long term goal for treatment 

Goal: Within four weeks, the client will initiate an enrolment process with minimum assistance, to increase school performance.

Develop two short term goals to obtain LTG 

Short term goal #1 : In thirty minutes, client will demonstrate/ recall 75% of the time during group session in order to increase memory function for school.

Short term goal #2 : In thirty minutes, the client will verbalize five of five coping strategies in order to increase social participation.

Create a purposeful EBP activity to obtain each of the two STGs 

The emoji cards game is my group activity. The game entailing matching emoji character impressions on flipped cards to one pre-revealed emoji character on a single card.

For each of the STG’s, establish medical necessity 

Short Term Goal #1 

It is necessary to increase/ improve the client’s memory function/ memorability since her personal development involving essential activities like acquiring new or fresh useful knowledge will depend on her improved memory function. Memory is entirely essential to the client’s life since without it, she will not be able to effectively carry out tasks in the present or properly plan for her future. Her growth and progress in recovery based on response to her therapy will also only be measurable or quantifiable based on her memory (Pawloski et al., 2019) . The client will only manage adhering to her therapist’s guidelines if each piece of therapy will properly wrap itself around her memory. Her therapy’s success then directly relies on her improved memory. If the client fails to remember the exact timelines/ dates and time on which she must take specific medications or engage in defined self-therapy procedures, her health will have been directly compromised due to her failed memory (Early, 2000). Her independence in carrying out tasks and performing developmental routine checks will be compromised if her memory fails to improve.

Short Term Goal #2 

Increased or improved social participation would be invaluable to the client as the most important aspects of non-physical life such as emotional support stem from social engagements. The client might fail to fully re-develop the capacity to draw a sense of meaning and belonging from the individuals and groups around her if treatment to address her altered social participation is not properly addressed by the thirty-minute verbal occupational treatment. Her probably anticipated relief from social isolation too, relies on the occupational treatment, hence her social redefinition may fail to take shape.

Prepare two activity samples/ protocol (refer to protocol provided) 

Activity goals

The activity (memory emoji cards game) aims at testing and improving the memory of my group’s members. The activity is further aimed at identifying common memory pattern flaws and working around improvising memory adaptability amongst the group members. Since this memory card game involves emoji characters in place of the conventional and normal card impressions, the activity is tailored to test memorization around modern communication trends and characters that may be encountered more often. The emoji memory cards game will also be a test of memory and memorization speeds, swiftness in character matching based on vision and short-term memory, and the overall memory adaptability to small changes in known norms and trends.

Through the emoji memory cards game/ activity, the group targets improving their brain functions including attention, focus and concentration. The activity is an avenue to test certain short-term memory limits and be able to better analyze the regularity or possible irregularity in memory functioning. Based on the activity, there is also the goal of establishing the relationship between the critical thinking and memory.

Norms 

Usually, the memory cards game does not involve emoji characters. The goal in the conventional memory cards game is normally to collect the most pairs of cards. Mismatching cards and card impressions or patterns would be turned face down as soon as a player flips them and then then the next player in line takes their turn. The player with the most pairs of matching cards at the end of the game normally becomes the winner. Throughout a memory cards game, the one recurrent theme would be an unmatched attention to managing potential card matches before initial flips. Establishing provisional, stage and final scores as awarded points in memory card games does not normally include score deductions prompted by negative scores as character or impression mismatches. Such mismatches would often simply be ignored, leaving only the matches to cumulatively count as scores. 

Session Outline 

The emoji memory cards game will involve group members rotationally picking up a single card making card flips to make matches with the emoji characters they uncover in the one initially picked up card. A count on of the correctly picked and flipped emoji-bearing cards will total to a participant’s score and be a memory adaptability gauge. 

Warm-up or Ice Breaker 

Ahead of the main activity (the emoji cards game), a participation guide will be read out to every participant to create a familiarity with the activity and enable the participants’ establishment of possible links of the game to the normal memory cards game. Hints on the possible winning trend indicators throughout all the levels of the memory game will be highlighted to better equip the participants for the main activity. 

Supplies 

A custom emoji-themed pack of cards and an upgraded cards game deck would be the main requirements for the activity. A deck scores tracker and match identifier would serve to instantly verify matches from the initially picked cards and the subsequently flipped ones bearing varied emoji impressions. 

The Format 

The activity follows one-time participation by each participant in every complete rotation. Double participation (mistaken or deliberate) during any rotation would be unacceptable. Any initial rotation is continuous until the emoji-bearing cards to be flipped are used up. The activity would be psychologically aligned, with outcomes being recorded as relationships with medical goals. A standard memory scorecard guides the award of points. For every new participant emoji card flip that reveals a match, positive points are awarded, and these are linked to pre-determined medically perceived short-term memory ability. A negative score is awarded for every flip revealing an emoji mismatch. Emoji mismatches during the activity serve to guide determining the necessity of treatment or medication and will cumulatively point to the most suitable treatment options for each participant. 

Discussion 

The emoji memory cards game presents an activity pegged on short term memory and an individual’s ability to correctly or at least satisfactorily relate images formed in the mind to real life situations, objects or activities. The activity sets the pace for gradual memory re-orientation following a fairly significant change in a variable or facet. The nature of the memory game remained but a shift in characters was prominent. PTSD and its underlying perpetuating factors presents a scenario whose partial treatment may involve memory realignment through activities like the emoji cards game. 

From the emoji cards game, an adaption that would be relevant to my client’s functional needs is the flexible memory ability to shift towards creating new ‘normal’ views of previously strange and completely out-of-proportion occurrences and experiences. My client needs to initiate an internal drastic shift in her perception of her past traumatic experience, while maintaining a neutral view of life’s foundation on dynamic yet arguably ‘captive’ patterns. Since she needs to begin to cope better at her workplace, creating useful links between the need to face her recurring or new concerns while creating a window wide enough for therapeutic help would be key for her, and this is a theme in the cards game. 

Subsequent therapy or medication approaches would rely on the practicalities around outcomes registered by the client during the emoji memory cards game. Her current memory ability, capacity, and trends would be a useful foundation for establishing medical comparisons to her mental state before the family home fire tragedy. These mental state comparisons, coupled with other relevant medically established personal client variations prompted by the fire tragedy would guide her treatment in the days, weeks, or months ahead. 

Activity Grading 

Simple : The activity follows basic matching skills and capabilities. Laying the entire pack of emoji cards on the deck, for instance, is a fairly simple approach for most card games and is commonly understood. Considering graphics, an emoji is a simplified representation of actual faces, objects, activities or feelings. Based on this, the emoji cards game presents an aspect of realism that would promote familiarity hence an efficient memory test. 

Average/ Manageable : The emoji cards game may appear simple to sections or a section of the participants but present a substantial yet manageable level of difficulty to another section or other sections. This mix of possible views of the activity would be a middle ground, representing average levels of both simplicity and complexity. 

Complex : When examined closely, the emoji memory cards game is an intricate mind game involving the differentiation of color, shapes, and minute details. Scaled facial twists in varied emoji characters may be difficult to alienate. 

SOAP note (Group member) 

Subjective : He says he has difficulty establishing small differences in emoji characters representing faces and some hand signs. He seemingly misses sharply contrasting colors and themes of these characters. 

Objective : I established that the group member easily misidentifies and misrelates shapes. 

Assessment : The group member suffers memory loss and the condition manifests clearly (at least during this short-term memory improvement activity) 

Plan : For the group member’s treatment, medications will be most helpful to improve his memory. Controlled therapy and self-help practices at home will be essential to realigning his short-term memory with identities of common facial impressions and hand signs. 

References 

Amini, D. The OTPF-4: Continuing our Professional Journey through Change.

Early, M. B. (2000). Mental health concepts and techniques for the occupational therapy assistant. 

Pawlowski, T., Daroszewski, J., Czerwinska, A. and Rymaszewska, J., 2019. Reduction of Posttraumatic Stress Disorder (PTSD) Symptoms in PTSD and Major Depressive Disorder Comorbidity After Acute Hypoglycemia—A Case Report. Frontiers in Psychiatry, 10.