Panic Disorder Analysis - Essay Example

Functional Behavior Assessment Summary Individual: Primrose Carter 2. Assessment: 6th October 3. Birth: 16th July 1986 4. Diagnosis: Panic Disorder Major Depressive Disorder 5. Assessment Location: a. At a Café near the client’s place of residence where the client frequents. b. The client’s place of residence 6. Informants: a. Waitress at the Café where the assessment occurred b. The client’s next-door neighbor 7. Interviewer: Name of students + Group Name 8. Assessment Tools: a. Functional Analysis Interview (FAI) b. Functional Analysis Screening Tool (FAST) c. Becks Inventory Scale (BDI) 9. Background Information and Reason for Referral: Primrose is a 28-year-old woman born and raised in Cleveland. She is the only female child and the youngest of three children. Her father held the titles of vice president and general manager at the small manufacturing firm he worked in until his retirement seven years ago while her mother held several secretarial jobs on a part-time basis. One of her older brothers is divorced, lives in San Francisco and is an oncologist by profession whereas, the younger one of the two is a prominent engineer married to a successful real estate agent. According to Primrose’s account, her father was strict, quick to criticize, and slow to render praise or recognition. He was domineering over his wife. Unlike her elder brothers, Primrose has been unsuccessful in maintaining a serious relationship despite her career accomplishments, financial security and pleasant demeanor. She is a mechanical engineer by profession and is employed as a design manager at an automobile corporation. From an early age she loved cars taking it up as a full-time career as an adult. Her passion extends the formal working environment whereby, she restores cars in her fully equipped garage, subscribes to 11 car magazines and watches a car race every weekend. She cannot clearly pinpoint when she lost interest in the listed hobbies. However, she vaguely remembers that it was a couple of days after she heard that her father had passed away. She admits that the incident affected her; however, she is unable to comprehend why it did, as she was not particularly fond of her father. Prior to this, she has sought psychiatric intervention after a couple of friends and colleagues pointed out that she had become withdrawn, lost interest in participating in activities she liked, and was calling in sick frequently. The psychiatrist prescribed some medication after diagnosing her with Major Depressive Disorder, which was co-morbid with Panic Disorder. Aware of my professional background, Primrose’s neighbor thought that it would be beneficial to Primrose to seek professional help because of the bizzaire behavior she exhibited. According to the neighbor, Primrose began exhibiting queer behaviors about six months ago, after her father’s death. She was fearful of loud sounds and behaved in an agitated manner whenever somebody rung her door-bell. The emergency response personnel had shown up to her house and to the café she frequented right next to her place of residence severally after she called and reported she was having recurrent panic attacks. Primrose was also recently preoccupied with the subject of death. 10. Medical Status: a. Disorder #1 Primrose displayed six of the symptoms listed in Criterion A for Major Depressive Disorder, Single Episode, Melancholic type: Depressed mood throughout the day, as indicated by observations made by others and subjective reports Significantly diminished interest in activities Fatigue, loss of energy almost every day Diminished ability to think due to increased indecisiveness Recurrent thoughts of death Insomnia She also met the other Criteria described by the DSM. Criteria B: The symptoms do not meet criteria for a mixed episode (DSM V). Primrose reported that she had not struggled with depressive feelings before the last few months. Criteria C: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM V). Primrose reported heightened disinterest in his hobbies whereby, she gave up restoring the dilapidated cars, which she previously enjoyed doing. She also failed to attend events planned by friends and colleagues during the last few months. Primrose recently began using sickness as an excuse to miss work. Criteria D: The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism) DSM V). Primrose reported no recent use of substances. Criteria E: The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation (DSM V). Primrose’s symptoms persisted for approximately six months. b. Disorder #2 Primrose exhibited the following symptoms based on the DSM-IV categorization of symptoms of panic disorder: absence of agoraphobia, recurrent unexpected panic attacks. In addition, panic attacks manifesting in an individual are not due to a direct physiological effect such as use of drugs, medication or a consequence of any of the following mental disorders: phobias (social and specific), Obsessive Compulsive Disorder (OCD), separation anxiety disorder or Post-Traumatic Stress Disorder (PTSD). c. Medication #1 i. Name: paroxetine ii. Dosage: 10 mg per day This was to be increased to 20mg in the next week and used for the next six months in order to prevent Jeff’s relapsing after termination of psychotherapy. iii. Delivery: oral iv. Reason: Paroxetine is an antidepressant classified under the Selective Serotonin Reuptake Inhibitors (SSRIs). It is useful in treating symptoms of depression and anxiety disorders. v. Side Effects: General side effects include dizziness, confusion, skin rash, chest pains, cold chills. More rare side effects include fever, absence of body movement, dry mouth, convulsions (seizures). d. Medication #2 i. Name: Restoril ii. Dosage: 5mg per day Used only for two weeks, after which, persistence of insomnia mandates a review of the medication by the psychiatrist. iii. Delivery: Oral iv. Reason: Used to treat insomnia by helping the individuals fall asleep faster, lessen frequency of waking up or helping one sleep longer. v. Side Effects: Temporary memory loss. 11. Language Preference: a. Primary Language: English b. Secondary Language: Spanish 12. Articulation: The client struggled to express their thoughts and feelings especially when it came to discussing her relationship with her father from childhood leading up to his death. She answered most questions with short phrases or one-worded responses. Her diction is fluent, as she possesses a good command over the English language. She can also speak Spanish fluently, which she credits to her parents who made it mandatory for all their children to take up a second language in school. 13. Non-Vocal Communication: Primrose often fidgets with her hands during the sessions. She rarely meets my gaze, choosing instead to focus on an object on the table or surrounding area. She slumps her shoulders and leans forward especially when discussing uncomfortable issues. In addition, she shrugs her shoulders prior to answering emotion-laden questions. 14. Verbal Operants: Intraverbal operant- refers to itraverbal behavior characterized by answering questions or conversational responses. Primrose uses intraverbal operant throughout the sessions whereby, she responds to questions when asked. 15. Imitation: Primrose reaches for her cup of coffee each time I reach for mine. She also frequently imitates behaviors exhibited by customers seated in her line of sight. For example, Primrose behaved in the same manner with one of the customers who kept looking at the door each time someone walked in. 16. Activity Schedule: Weekday Time Activity 8:00am Arrive at work 9:00am Record in journal how the first hour at work has been 10:00am Work on project report 11:00am Engage a colleague in a discussion during tea break 12:00pm Work on project report 1:00pm Eat lunch 2:00pm Work on project report 3:00pm Review the day’s work with a close colleague at work 4:00pm Record in journal how the entire day at work has been 5:00pm Leave work 6:00pm Stop at the café to read a favorite magazine 7:00pm Have dinner 8:00pm Read a favorite book while in bed Weekend Time Activity 8:00am Have breakfast 9:00am Watch an interesting program on television or on the internet 10:00am Call relatives to check-in 11:00am Record in journal your plans for the day 12:00pm Check-in on next door neighbor 1:00pm Clean the house and laundry 2:00pm Leave to meet some friends at a place that interests all of you 3:00pm Hang out with friends 4:00pm Shop for things you need 5:00pm Return to the house 6:00pm Retreat to the garage and work on restoring the automobile 7:00pm Watch or read an interesting show or magazine respectively 8:00pm Record in journal how the day has been 17. Stimulus Preference Assessment: a. Free Operant i. Automobile magazine- Prior to her depressed state, Primrose was an automobile enthusiast. Therefore, observing her behavior when presented with an automobile magazine during different stages of her recovery is integral to compiling a stimulus preference assessment. b. Forced Choice i. In her activity schedule, Primrose must set aside some time to read her favorite automobile magazine each day. c. MSWO i. Automobile magazines and programs are both areas of interest to Primrose. Together, these stimuli help to evoke positive reactions from Primrose. 18. Results from FAST: a. Behavior #1 i. Suicidal ideation b. Behavior #2 i. unsocial behaviors (avoiding family and friends) c. Behavior #3 i. Absenteeism d. Behavior #4 i. Disinterest in hobbies 19. Analysis of Behaviors to be Reduced: a. Behavior #1 i. Operational Definition 1. Suicidal ideation refers to an individual’s preoccupation with thoughts of suicide. ii. Antecedents/Motivating Operation 1. Primrose’s depressed state triggered by her father’s death predisposed her suicidal ideation iii. Consequences 1. Primrose might attempt to commit suicide. iv. Hypothesized Function 1. By dealing with the aversive emotions and behaviors that defined her relationship with her father prior to his death, Primrose is likely to resume to optimal functioning characterized with her renewed interest in living. b. Behavior #2 i. Operational Definition 1. Unsocial behaviors refer to behaviors to that deter a person from social activities such as interacting with family and friends. ii. Antecedents/Motivating Operation 1. Primrose’s depressed state made her retreat into her own space away from those who cared about her. iii. Consequences 1. Limited social interaction caused her to wallow in her depressed thoughts whereby, she began toying with the idea of suicide and further developed panic attacks. iv. Hypothesized Function 1. Social interaction would provide Primrose with an opportunity to share her burden; therefore, foster healing. c. Behavior #3 i. Operational Definition 1. Absenteeism at work refers to consciously choosing to miss work without a genuine reason. ii. Antecedents/Motivating Operation 1. Primrose’s depressed state devoid her of her sense of responsibility. iii. Consequences 1. Absenteeism freed up her time whereby she had more idle time to engage in destructive behaviors. iv. Hypothesized Function 1. Faithfully attending work would ensure Primrose did not have a lot of idle time to wallow in self-misery. d. Behavior #4 i. Operational Definition 1. Disinterest in hobbies means the loss of interest in doing activities that fascinated someone. ii. Antecedents/Motivating Operation 1. Primrose’s depressed state made her lose interest in her hobbies. iii. Consequences 1. Lack of engaging in hobbies was guaranteed to create more time for Primrose to engage in destructive behaviors. iv. Hypothesized Function 1. Hobbies help to occupy someone’s time, as they engage in constructive activities. 20. Summary of Findings: Primrose suffers from Major Depressive Disorder, which is co-morbid with Panic Disorder. Her father’s death, which occurred about six months ago, triggered her depressed state, as the neighbor and waitress at the café she frequents noted that she began exhibiting bizarre behaviors then. She cannot clearly pinpoint when she lost interest in the listed hobbies. However, she vaguely remembers that it was a couple of days after she heard that her father had passed away. She admits that the incident affected her; however, she is unable to comprehend why it did, as she was not particularly fond of her father. Prior to this, she has sought psychiatric intervention after a couple of friends and colleagues pointed out that she had become withdrawn, lost interest in participating in activities she liked, and was calling in sick frequently. The psychiatrist prescribed some medication after diagnosing her with Major Depressive Disorder, which was co-morbid with Panic Disorder. According to the neighbor, Primrose began exhibiting queer behaviors about six months ago, after her father’s death. She was fearful of loud sounds and behaved in an agitated manner whenever somebody rung her door-bell. The emergency response personnel had shown up to her house and to the café she frequented right next to her place of residence severally after she called and reported she was having recurrent panic attacks. Primrose was also recently preoccupied with the subject of death. The psychiatrist prescribed some medication after diagnosing her with Major Depressive Disorder, which was co-morbid with Panic Disorder. 21. Impression: Primrose’s depressive state is attributable to psychological factors and not biological factors. Information from her personal history does not highlight any history of depression among other family members ruling out the role of genetic factors in predisposing her depression. This leaves psychological factors as the root cause of Primrose’s problems. The Psychoanalytic and Parental Acceptance-Rejection models shed light on possible causes of Primrose’s problems. The psychoanalytic model advanced by Sigmund Freud presumes that past childhood experiences and unconscious motives influence behaviors exhibited by individuals. Freud was of the opinion that conflicts recur in an individual’s life. This is because suppressed traumatic memories during childhood influence an individual’s future behaviors unconsciously. The death of Primrose’s father triggered her depression, which in turn triggered recurrent panic attacks. Her depressive state indicates deep-seated unresolved issues between Primrose and her father. His death meant the irresolution of these feelings. The fact that she is unaware of these feelings on a conscious level creates an incongruent state between her unconscious and conscious self. Closely related to the psychoanalytic theory is the Parental acceptance-rejection theory (PAR Theory), which is a socialization theory that attempts to explain and predict global causes, implications and other correlates arising from parental acceptance or rejection. Furthermore, the theory tries to expound on the impact of parental acceptance or rejection in influencing the formation and duration of other primary inter-personal relationships such as intimate or romantic adult relationships. The theory does not discriminate against any parent (mother and father). Primrose’s father was domineering, strict and readily criticized his children. Her lack of affirmation from her father left her with both intrapersonal and interpersonal deficits. Primrose finds it difficult to establish and maintain intimate relationships. Her father’s death likely triggered feelings of despair whereby, she might associate his demise with the dysfunctional nature of her future romantic relationships. 22. Recommendations: a. Panic Control Therapy The ultimate goal of PCT encompasses fostering a patient’s ability to identify and rectify maladaptive thought patterns, beliefs and behaviors that trigger, maintain and exacerbate feelings of anxiousness, which in turn develop into full-blown attacks. Mental health practitioners achieve this goal by exposing patients afflicted with PD to sensations that mirror their panic attacks; for example, activities that fastens heart rate or arouses fear in the patient. They then follow the exposure therapy with a debriefing session whereby, they guide the patient through the exploratory phase aimed at uncovering attitudes and beliefs responsible for triggering panic attacks. The therapist strives to create awareness in the patient with the sole intention of empowering the patient to take charge over their disparaging fear resulting from negative thought, attitudes and beliefs. The final step of therapy entails equipping patients with coping skills customized to help reduce frequency in occurrence of panic attacks; for example, breathing and relaxation exercises. By following these steps, Primrose will be able to realize that her father’s death triggers the recurrent panic attacks. By addressing her unresolved thoughts and feelings towards her father by thinking about his death (trigger of panic), she will be able to deal with his death in a well-adjusted manner. b. Interpersonal Therapy Interpersonal Therapy (IPT) is most often used on a one-on-one basis to treat depression or dysthymia (a more persistent but less severe form of depression). The current manual- based form of IPT used today was developed in the 1980s by Gerald Klerman, M.D., and Myrna Weismann, M.D. This is a time-limited treatment for major depression that addresses the connection between interpersonal problems and mood. IPT varies depending on the needs of the patient and the relationship between the therapist and patient. The therapist using IPT helps the patient identify troubling emotions and their triggers. In addition, therapy focuses on the following interpersonal problems; role transition, grief, role dispute and interpersonal deficits. In Primrose’s case, IPT will reinforce PCT by helping her deal with grief and rectify her interpersonal deficits. c. Psychoanalytic Therapy Freud’s psychoanalytic theory placed great emphasis on the role of childhood experiences, and unconscious thoughts in influencing behaviors manifested by individuals in their adult life. Through psychoanalysis, Primrose will be able to address past issues, which contributed to her strained relationship with her father. After which, she can face her father’s death and undergo the grieving process. d. Grief Therapy Grief therapy will help Primrose deal with her father’s death. Through the various stages, Primrose can move from a state of denial to acceptance. Her father’s death will stop being a trigger of her recurrent panic attacks and depressive state. The behavior stopped is her suicidal ideation, which is replaced with engaging in behaviors that contribute to her living a meaningful life. Talk therapy allows clients to discuss their feelings. 23. Medical Necessity: Common treatment for panic disorder is in the form of psychotherapy or in the administration of medication. Cognitive Behavioral Therapy (CBT) proves to be the most efficient form of psychotherapeutic intervention for individuals diagnosed with panic disorder. CBT encompasses restructuring of negative thought patterns, beliefs by replacing them with more positive and realistic thoughts and beliefs respectively. Behavioral adjustment also teaches individuals afflicted with panic disorder coping mechanisms aimed at managing future attacks. For example, the use of breathing techniques to calm one when dealing with the stress resulting from panic attacks. Psychiatrists resort to psychopharmacological intervention in extreme cases of panic disorder. They administer antidepressants, which help regulate anxiety and fluctuating moods, and reduce frequency of panic attacks. Psychopharmacological intervention is necessary in the treatment of Major Depressive Disorder. The medication administered is almost similar to those administered to treat Panic Disorder. When used concurrently with therapy, the probability of the client relapsing reduces. In Primrose’s case, medical intervention was necessary, as her Major Depressive Disorder was co-morbid with Panic Disorder further complicating the treatment process. Primrose stands to benefit from both medication and therapy. 24. Service Recommendations: a. BCBA- 1 hours a week b. BCaBA- 1 hour a week c. Therapist- 3 hours a week Read More