2017/2018

Cabanillas, Alicia / Gonzalez, Greta / Hernndez, Ana

PSYCHOGERIATRIC

CASE STUDY

Degree in Psychology

Universidad Europea de Madrid

1. What information do you miss? Ask the professor and make a summary of the information
collected:

- Is there any other behavior that you noticed differently?

- Have you talked to her?

- Have you thought about doing an evaluation?

- Is there a history of any disease?

- Since when do not you remember things?

- Have you taken or taken any medication?

-What are the ages of the children?

-How did her die husband died?

She began to feel that she could not remember the cards and everything that happened in the
game after the event, she knew how to play the game, and it was just that she could not
remember everything when she was performing.

Before there were no changes in his activities, after the event he forgot things and had problems
where he opposed things, the problem of letters and stopped making himself eat. Any situation
that she could handle became difficult to handle later, she began to have sadness and if she
continued doing activities but did not have the same satisfaction.

Once a month before the accident if her children visited her to see her grandchildren, she usually
did not like her grandchildren staying at the same time and asked her to stay two to take care of
them. Later every weekend they visited her, with the daughter 3 or 2 days, the son fewer times.

She stopped cooking because she felt nervous and stopped doing it. In general, she feels agitated
all the time as nervous but without any stimulus, if the event happens she feels nervous all the
time, when she is playing with her grandchildren without her children present she feels calmer.
When playing cards it feels good but suddenly when you start to feel that you cannot continue the
game you start to feel worse.

Age children: 40 and 47

She worked as a house cleaner. She lived with her father but decided that she wanted to live alone
and be able to be with her friends to be where she had lived before.

She asked for help because she could not sleep and after that she had problems when her
husband died, for a while afterwards she stopped taking it because the sleeping problems did not
disappear.
Medicine to sleep 2 years and aspirin CV high pressure. Father dies by stroug and his mother dies
of cancer stomach, there are no cases of dementia.

2. What do you think the problem is? Explain your hypothesis.

According to the diagnostic criteria of the DSM 5 and its similarity to the facts in this case, we have
concluded that it presents a picture of post-traumatic stress, because:

The DSM-V (APA), 2013) defines post-traumatic stress disorder as:

A.Exposure to death, serious injury or sexual violence, whether real or threatened, in One (or
more) of the following forms:

1. Direct experience of the traumatic event (s).

2. Direct presence of the event (s) occurred to others.
3. Knowledge that the traumatic event (s) has occurred to a close family member or to a in
the cases of threat or reality of death of a family member or friend, the Event (s) must
have been violent or accidental.
4. Repeated or extreme exposure to repulsive details of the traumatic event (s) (ex,
lifeguards who they collect human remains, police repeatedly exposed to details of child).

Note: Criterion A4 does not apply to exposure through electronic media, television, movies or
photographs, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic
event (s), which begins after the traumatic event (s):

1. Recurrent distressing memories, Involuntary and intrusive traumatic event (s).

2. Recurrent distressing dreams in which the content and / or affect of sleep is related to the
traumatic event (s).
3. Dissociative reactions (ex, retrospective scenes) in which the subject feels or acts as if the
traumatic event (s) were repeated. (These reactions can occur continuously, and the extreme
expression is a complete loss of awareness of the present environment.)
4. Intense or prolonged psychological discomfort when exposed to internal or external factors,
which symbolize or resemble an aspect of the traumatic event (s).
5. Intense physiological reactions to internal or external factors that symbolize or resemble an
aspect of Traumatic event (s).
C. Persistent avoidance of stimuli associated with the traumatic event (s), which begins after the
traumatic event (s), as evidenced by one or both following characteristics:

1. Avoidance or efforts to avoid distressing memories, thoughts or feelings about or closely

associated with the event (s) traumatic (s).
2. Avoidance or efforts to avoid external reminders (people, places, conversations, activities,
objects, situations) that awaken distressing memories, thoughts or feelings about or closely
associated with the traumatic event (s).

D. Negative cognitive and mood disturbances associated with the traumatic event (s), which begin
or worsen after the traumatic event (s), as evidenced by two (or more) of the characteristics
Following:

1. Inability to remember an important aspect of the traumatic event (s) (typically due to
amnesia) dissociative and not to other factors such as brain injury, alcohol or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the
world (p. ex, "I'm wrong," "I cannot trust anyone," "The world is very dangerous," My nerves
are destroyed ").
3. Perceived distorted perception of the cause or a consequence of the traumatic event (s)
that causes the individual accuses himself or others.
4. Persistent negative emotional state (ex, fear, terror, anger, guilt or shame).
5. Significant decrease in interest or participation in significant activities.
6. Feeling of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (ex, happiness, satisfaction or loving
feelings).

E. Significant alteration of the alert and reactivity associated with the traumatic event (s), which
begins or worsens after the traumatic event (s), as evidenced by two (or more) of the
characteristics Following:

1. Irritable behavior and outbursts of fury (with little or no provocation) that are typically
expressed as verbal or physical aggression against people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems of concentration.
6. Disturbance of sleep (ex, difficulty in reconciling or continuing sleep, or restless sleep).

F. The duration of the alteration (Criteria B, C, D and E) is greater than one month

G. The disturbance causes clinically significant distress or impairment in social, occupational or

other important areas of functioning.

H. The disturbance cannot be attributed to the physiological effects of a substance (ex,

medication, alcohol) or to another medical.
 3. Elaborate the functional analysis.

1
Discriminative Conditional
Stimulus Response
(- Nios (- Nervios
- Cocina) - Bloqueo)

Operant Consistent
Response (- Alivio (R+)
(Llamar a la hija) - Alivio (R-))
(Bloqueo)

2: Problema actual:

Conditional Conditional
Stimulus Response
(Propuesta de (- Bloqueo
estar ellos) - Ansiedad
- Malestar)

Operant Consistent
Response (- Alivio (R-)
(Evitar estar a
a solas con ellos) Consecuencia: perder relacin con sus nietos

3: Juego de cartas:

Discriminative Conditional
Stimulus Response
( Cartas) (Miedo al olvido)
Frustracin
Discriminative Conditional
Stimulus Response
( Olvidos) (- Miedo
- Malestar)
 Conditional Conditional
Stimulus Response
(Jugar) (- Miedo al olvido
- Mlestar)

Operant Consistent
Response (Jugar)
(Seguir jugando) (R+)

4. - Base on this problem. What would the intervention objectives be?

Objectives:

1. Offer resources and tools to combat situations of stress or / and discomfort.

2. That you can resume a family relationship without worries.

3. Recover the activities you have lost.

4. Eliminate associations and distorted thoughts.

5. - How would you achieve the objective? Design an intervention program.

There are three types of symptoms in PTSD and they are as follows:

Re-experiencing symptoms in which the individual may have vivid flashbacks, however these
symptoms provoke both physical and emotional reactions.

Avoidance and numbing this includes evading certain things that may aggravate any
memories they may have ofthe traumatic event andthe numbing refers to making themselves
emotionally distant from others or shutting down entirely.

Arousal meaning the individual feels as if they constantly have to be alert, which can lead to
irritability, difficulty sleeping, and a hard time concentrating (Nebraska Department of Veteran
Affairs, 2007).

She is experimenting between the last two, "Avoidance and Arousal".

Focus psychoeducational

The psychoeducational approach involves promoting the patient / family basic information
about their illness, basic symptoms and various coping strategies.

This first category of treatments includes sharing basic information with the subject, through
books, articles and other documents of interest that allow the patient to acquire essential
notions of concepts related to the disorder such as knowledge of psychophysiology,
introduction to the concept of stress response, basic legal knowledge related to the problem
(such as in cases of rape, delinquency, etc.)

At the family level, it includes the teaching of coping strategies and problem solving skills to
facilitate the relationship with the person affected by the disorder.

The psychoeducational approach, at the family level, seems to considerably reduce the
feelings of stress, confusion and anxiety, which usually occur within the family structure and
can go so far as to de-structure it, helping significantly in recovery of the patient.

In any case, it is important to highlight the need for a collaborative approach where, both
patient and therapist, share relevant information, in both directions, thereby facilitating the
process Therapeutic.

Restructuring Cognitive

Hierarchy of situations in which you feel capable and not to do.

For example: See how much fear you have in being with your grandchildren.

What activities do you feel?

Taste in different situations?

Put a scale from 1 to 10, in which each level means different degrees of fear, anxiety or stress.
Propose that she be the one to tell us how she feels and if not give her the options.

It has to be done progressively.

How capable do you feel of taking care of your grandchildren 15 minutes or half an hour? This
week we will ask your daughter to stay with them for half an hour.

Techniques of Relaxation / control of The Activation Emotional

- Jacobson's progressive relaxation

- Autogenic training

Meditation - Breathing techniques

- Techniques of Biofeedback