Presentation on theme: "D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker."— Presentation transcript:
D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker
D. T.’s Story 15-year-old freshman at Byrd that lives with his mom, younger sister, and stepfather D. T. and his father had a close relationship, often going on fishing trips together Father was an alcoholic, drank early in the day and was inebriated by the evening When drunk, he was verbally and physically abusive towards D. T. When D. T. was 10 years old, he and his father were arguing about his father’s driving after a fishing trip, and his father gave D. T. a black eye. When D. T.’s mom confronted his father, he stormed out in rage and never returned home. Mom remarried when D. T. was 12, simultaneously, D. T.’s troubled behavior at school worsened
D. T.’s Behavior Blames himself for the breakup of his family but won’t admit it Appeared to accept disappearance of his father Spent most of his time alone, either playing video games or skateboarding around the neighborhood Sneaks out at night without his parents knowing Suspended many times for skipping class and talking back to teachers Diagnosed with ADHD but his mom does not let him take medicine because she is worried about the side effects
Troubled behavior When his mom asked D. T. to take out the trash, an argument ensued and D. T. angrily did the chore D.T. began to use his slingshot to shoot out the window When his stepdad came out to confront him, D. T. aimed it at him, screaming at cursing His mom called the police and D. T. was arrested At the police station, he tested positive for methamphetamines and cannabis Transferred to Brentwood Hospital for a 30-day inpatient substance abuse program
D. T.’s Medical Report Diagnosed with polysubstance abuse, ADHD, and truancy with a poor academic performance Bipolar Disorder ruled out “The police think I have a problem with anger and drugs, so they sent me here.” –D.T.’s chief complaint D.T. stated he snorted ¼ gram of meth at a party, came home at 2AM and smoked 2 joints of marijuana to sleep Felt ‘very strung out’ when mom asked him to take out the trash Perceived stepfather’s confrontation as threatening physical violence; he pointed slingshot in defense; his mom overreacted
Maladaptive Strategies D. T. stated feeling depressed and worthless for a long time Scored a 33 on the Beck Depression Inventory (severe depression) Verbalized suicide ideation with no intent or plan Problems with school and parents make depression worse Long, thin scars on upper abdomen from D. T. cutting his torso with a razor to relieve dissociative feelings “I feel like I am not real, like this is all a really bad dream and I get scared so I have to cut myself to get relief”
Social History Repeated 2 nd grade due to academic behavior problems Currently in 9 th grade Admitted skipping classes and forging excuses Stated having few male friends, and a girlfriend of whom he denied sexual activity with Relationship with parents is “stressful” because they expect too much from him, academically D.T. explained discipline involves yelling and being grounded, but his parents will usually forget about his grades within a few days
Current Treatment Buproprion (100mg 3x/day) Antidepressant Trazodone (50mg before bed) Antidepressant, anti-anxiety, sleep-inducing Can help prevent suicidal thoughts Suicide precautions, inpatient activities, meals on unit only, no day pass, OT eval and treat
Social Worker Note 1 st drink at 3-4 years old from dad’s beer when they were on a fishing trip At 7 years old, he drank up to 10oz of beer with his dad Now drinks alcohol when opportunity arises At 12 years old, he smoked his first joint, and said that it helped him relax and easily interact with friends Now smokes 1-2x a week, usually before class At 14, used meth (1/4g) and said it gave him a euphoric feeling and he felt like he was normal Now smokes 1-2x a week when he has money for it At 14, had first sexual experience, has had a number of partners (all while under the influence) Stated being sexually exclusive with his current girlfriend
Drug Withdrawal Symptoms 30-90 days can pass after the last drug use before the user has any sign of withdrawal Depression, loss of energy, anhedonia, craving, suicidal, Painful and difficult, 93% people using methamphetamines will relapse
OT Initial Note “Leave me alone, I just want to sleep” Given Adolescent Role Assessment and Magazine collage test
Adolescent Role Assessment Positive – most childhood play (rules, interactions, interests); peers/community; fantasy with future work Neutral – role models during childhood; family responsibility and economics; choice of occupation, and future work goals Negative – family interactions; school consistency, responsibilities, and activities; peer activity
Magazine Collage Task Minimal insight for reasoning of drug addiction Moderate insight for personal responsibilities for actions Themes Drug use, escape to rural setting, feelings of anger and frustration Able to think abstractly Stated he had poor motivation for drug abstinence and did not want to ID consequences of past drug usage
Motivation D. T. is in pre-contemplative stage according to trans- theoretical model of behavior change Benefit from structured OT groups that increase motivation and interpersonal communication skills to avoid relapse D. T. identified family emotional strain as a trigger for relapse, so family involvement in OT and counseling groups is necessary Client will participate in OT psycho-educational group 1x/week and OT skills group 3x/week for 4 weeks
FOR: Cognitive Behavioral D. T. can benefit from CBT because he presents with cognitive errors, irrational thoughts, and poor executive functioning. He becomes overwhelmed when triggers are presented, causing him to have a negative view of his environment. Treatment with this FOR will focus on helping D. T. react to triggers in a healthier way.
Goal 1 D.T. will identify triggers and develop strategies for coping and preventing relapse by the end of acute treatment.
Interventions for Goal 1 REBT Self-Help Form (CBT) D.T. will complete REBT self-help form to identify stressors for determining triggers that lead to drug usage. D.T. will collaborate with the OT on adaptive strategies to assist in preventing relapse Coping Strategy Practice with Role Playing Therapist plays roles of both an authority figure and a peer Therapist first challenges/provokes D.T. to better ID triggers, and can then come up with coping strategies specific to D.T.’s triggers
Goal 2 D.T. will improve self-efficacy as measured by receiving a score of at least a 29/40 on the general self-efficacy scale (OA)
Intervention for Goal 2 Improve self-efficacy by attending psychosocial group therapy for 50 minutes 2x/week Maintain a log of activities requiring 5 points of positive feedback and 2 points of constructive criticism
Generating an Adaptive Response Adaptive Response Mechanism Adaptive Response Behavior- Stable Adaptive Energy- Secondary Adaptive Response Mode – New
References Botvin, G. (2000). Preventing drug abuse in schools: Social and competence enhancement approaches targeting individual- etiologic factors. Addictive Behaviors, 25(6), 887-897. Custer, V., Wassink, K. (1990). Occupational therapy intervention for an adult with depression and suicidal tendencies. American Journal of Occupational Therapy, 45(9), 845-848 Kursurkar, R. (2013). Critical synthesis package: General self-efficacy scale. Mededportal, doi:9576 Hogarty, S. S. (1987). A suicide precautions policy for the general hospital. Journal of Nursing Administration (17)10. 37-42. Schultz, S., & Schkade, J.K. (1992). Occupational adaptation: toward a holistic approach for contemporary practice, part 2. American Journal of Occupational Therapy, 46(10), 917-925. Stoffel, V.C., & Moyers, P.A. (2004). An evidence-based and occupational perspective of interventions for persons with substance-use disorders. American Journal of Occupational Therapy, 58, 570-586. Weaver, W. (n.d.). Retrieved from http://brentwoodbehavioral.comhttp://brentwoodbehavioral.com
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