Case Study 1 Instructions
Make sure to fully respond to each question and to use the
rubric to guide your writing (the rubric is used to determine your grade). Your assignments should be written in accordance with APA 6th edition guidelines and contain two professional sources (your text-book may count as one of your resources). Although there is no minimum page length requirement for this assignment, you will likely write a minimum of five to six pages to full address all of the prompts.
Case Scenario
The Case of Bob
Bob is a 42-year-old Caucasian male who presented for assessment and treatment for nervousness, anxiety, frustration, irritability, anger outbursts, and insomnia. Bob was somewhat disheveled in the initial assessment.
Bob married his wife at the age of 19. They divorced after 4 years because he had an affair. He has been married to his current wife, Anna, for 16 years and they have two children, James 14, and Teresa 12. The children are active in school extracurricular activities and both make better than average grades. James was diagnosed with ADHD and takes medication for that. Bob and Anna have recently had conflicts in their marriage and argue frequently.
Bob’s mother and father are alive at the ages of 62 and 66, respectively, and he is the second of three children from his family of origin. Bob gets along well with his mother, older brother, and younger sister, but has a distant relationship with his father. His mother and father divorced when he was 10 and he lived with his mother until he graduated from high school. He later found out his father had affairs while married to his mother. He briefly attended collage where he met his first wife but dropped out to go to work so they could marry. He and Anna met several years later through a mutual friend, dated for about six months and married.
He reported no remarkable family history of psychiatric difficulties, alcohol or substance abuse, but said his cousin twice attempted suicide. He did not know much about his father’s family. Bob reported no inpatient or outpatient mental health admissions or treatment with the exception of the two visits to a counselor.
He was diagnosed with Generalized Anxiety Disorder by a counselor. He saw the counselor twice but did not return for additional psychotherapy. He was prescribed Xanax 1 mg as needed, with a monthly quantity of 30, for anxiety by his PCP. He reported no other current medical conditions.
In the first assessment, he was given the Beck Anxiety Inventory and scored 21, placing him in the moderate anxiety category. He did not report any other symptoms at that time and said he was confused as to why his physician said he would not prescribe a higher dosage of Xanax. He addressed his anxiety and irritability in session and was educated on mindfulness techniques, controlled breathing, and guided imagery to help reduce his anxiety and irritability. He was educated and encouraged to use the components of the anger wheel of choice to initiate anger management cognitive awareness.
He returned for therapy one week later, reported he had implemented the interventions with only slightly noticeable improvement. He was re-educated on the techniques and encouraged to continue with them. He reported no anger outbursts but said his wife had “been nagging me to come here.” During that session he was quiet and reserved with a low energy level. He was prompted several times for session continuity but reported no new problems or difficulties during the session. He was encouraged to continue implementing the interventions and given additional education and material on anger management techniques.
In the third session he was accompanied by his wife who came because she wanted to ensure complete communication. She reported domestic disharmony, said they have arguments frequently and have recently talked of divorce. His wife said he becomes angry and isolates himself after they argue. She also reported he cries often and tells her he cannot “stand the pressure at work.” They seldom have sex and, when they do, he frequently is unable to engage satisfactorily.
She reported suspicions of infidelity in the first few years of their marriage but there had been no specific evidence other than her suspicions based on his behavior of being gone without explanation at times. He stopped that behavior years ago and she reported no current suspicions of infidelity.
The client said little as his wife talked and he became more withdrawn. He volunteered little information in that session but said he will work with his wife to improve their marriage when she suggested that. She reported Bob’s mother struggled with depression when he was young and his cousin attempted suicide twice. She also said his mood changes, oftentimes abruptly, moving from anxiousness and irritability to withdrawal from the family and isolation accompanied by crying spells. The client made no comment to her assertions.
When asked, he did not want to talk about his use of anxiety interventions and anger awareness communication and said he preferred to wait until the next session. Bob did not address his goal of reducing his anger and anxiety until his wife left the room. Bob then talked of his wife “nagging me to be happier and do more things around the house.” He reported anger outbursts and said he has difficulty remaining pleasant to her. He commented on the stresses at his job and said people there “do not understand me.” He reported instances of conflicts with others at his job but no major anger outbursts. He sometimes goes into the restroom to cry while at work.
Directions: Please answer all the following questions and provide scholarly support. Your responses should be written in APA format.
Questions
· Given the diagnosis originally made by the first counselor, the prescription written by the PCP, and the information given and comments made by the client in the first session, analyze and discuss the rationale for the diagnosis and treatment plan from that assessment.
· What might account for the client’s mediocre response to the suggested interventions? What points of discussion might be incorporated into the next session?
· Describe the benefits and detriments of using the class of medications Xanax is in and potential for impact on the client. Provide an analysis of the pharmacodynamics and pharmacokinetics of the anxiolytic class of drugs. Include at least five pharmacodynamic and pharmacokinetic principles and a chart that summarizes the information.
· What ethical considerations should be included in the discussion with the client about medications? Describe the advisability of consultation with the original prescribing physician, topics for discussion and communication points. Describe concerns to be taken into consideration when speaking with the prescribing doctor about medications and related disease states.
· Describe how you will integrate the information presented by his wife, Anna. Include additional therapy topics to be addressed in the next session, possible assessment instruments to use, diagnoses to consider, and potential medication changes.
· This assignment is worth 100 points.
· All assignments should be written in APA format. Please include a title page, the body of your paper, and a reference page. All papers should include an introduction and conclusion.
· Submit the assignment by 11:59 CST on Day 7 of the week.
Week One Case Study Rubric
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Criteria |
Exemplary |
Well Developed |
In Development |
Needs development |
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14-15 points Question is accurately and thoroughly answered. Provides clear information about the diagnosis and the treatment plan. (2 paragraphs). |
11-13 points Question is partially accurate Thoroughly addressed for diagnosis or treatment plan with basic analysis of the other. (2 paragraphs). |
7-10 points Question is partially accurate for diagnosis and treatment plan OR is complete for one and missing for the other. Provides minimal information. |
0-6 points Question is not thoroughly addressed, is inaccurate, or missing. Information about the diagnosis and treatment plan is minimal, has errors, or is missing. |
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Accuracy of responses Question 2 15 points |
14-15 points Questions are accurately and thoroughly answered. Clearly identifies response rationale and identifies potential discussion points. |
11-13 points Questions are partially accurate but most to all are answered. Identifies more than 1 reason for response and more than 1 point for future discussion. |
7-10 points Answers are more inaccurate than accurate OR are unanswered. Identifies at least 1 reason for response and 1 point for future discussion. |
0-6 points Answers are completely inaccurate or missing. Minimally identifies response rationale and future discussion points. |
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Accuracy of responses Question 3 – 12 points Benefits and disadvantages of the anxiolytic class of medications. 8 points Include an analysis of the pharmacodynamics and pharmacokinetics of the substances used in the case study (provide a chart that summarizes the information). |
11-12 points Benefits and disadvantages of anxiolytics are accurately and thoroughly discussed. 7-8 points Provides a comprehensive analysis of at least five pharmaco-dynamic and pharmacokinetic principles. Chart is included and complete. |
9-10 points Benefits and disadvantages of anxiolytics partially accurate. 6-7 points Provides an examination of 3-5 pharmacodynamic and pharmacokinetic principles. Chart is included and mostly complete. |
7-8 points Benefits and disadvantages of anxiolytics are more inaccurate than accurate. 4-5 points Provides a minimal review of pharmaco-dynamics and pharmacokinetics. |
0-6 points Benefits and disadvantages of anxiolytics are completely inaccurate or missing. 0-3 points Answers are inaccurate or missing. Review of pharmacodynamics and pharmacokinetics is inaccurate or missing. Chart is incomplete or missing. |
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Accuracy of responses Question 4 – 15 points |
14-15 points Questions are accurately and thoroughly answered. |
11-13 points Questions are partially accurate but both client and physician discussions are included |
8-10 points Responses are more inaccurate than accurate OR inadequately addressed. |
0-9 points Responses are completely inaccurate or missing. |
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Accuracy of responses Question 5 – 20 points |
18-20 points Questions are accurately and thoroughly answered. Clearly analyzes and discusses how Anna’s information will be used, provides at least 3 topics for future discussion, at least 2 possible assessment instruments to consider, and potential for medication change. (1-2 pages) |
16-17 points Questions are partially accurate but most to all are answered. Questions are accurately and thoroughly answered. Provides a broad analysis and discussion on how the mental health issues in the case study are either caused by or exacerbated by substance addiction (1-2 pages) |
14-15 points Answers are more inaccurate than accurate OR many are unanswered. Provides a minimal analysis and discussion on how the mental health issues in the case study are either caused by or exacerbated by substance addiction |
0-13 points Answers are completely inaccurate or missing. Analysis and discussion on how the mental health issues in the case study are either caused by or exacerbated by substance addiction is missing or inaccurate. |
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Writing Mechanics and APA Grammar and Format: 10 points Papers are written using APA 6th edition formatting |
9-10 points No more than three grammatical, spelling, punctuation, and/or APA errors. Clarity of paper was not influenced by the errors. |
7-8 points More than three grammatical, spelling, punctuation, or APA errors. Clarity of paper was not strongly influenced by the errors. |
4-6 points More than three grammatical, spelling, punctuation, or APA errors that had a negative influence on the clarity of the paper. |
1-3 points More than three grammatical, spelling, punctuation, or APA errors that had a strong negative influence on the clarity of the paper. |
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Sources: 5 points Two professional sources are used to support points |
5 points 2 professional source (e.g., journal article, textbook) or more are used throughout the paper as appropriate to thoroughly support ideas, and was documented in the references list. |
4 points 2 professional sources were used to adequately support ideas and was documented in the reference list. |
3 points 1-2 sources/not a professional source was used to support ideas and is documented in the reference list. |
1-2 points 0-1 sources were used. Ideas were insufficiently supported. |
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Total: 100 points |
