Using the biopsychosocial theory, provide aetiology and a theoretical intervention to a specific case study [provided by staff]
- The case study forms the basis of this task it drives/shapes/structures your answer. Students are required to select and answer questions on one of the following case studies [see separate file]
Students are required to use direct quotes from the case study to illustrate links they make to both the causation and treatment recommendations intext citation of quote [Case name, page #, paragraph #, beginning line #]
- For each element of the biopsychosocial theory address the possible theoretical cause by completing the following:
- explain the background to the theory [reference]
- describe and link the case material that supports the theoretical causes
Note: the theoretical causes should fit within information contained in the case study students need to make links between theory and the applied case material
Finally, using the biopsychosocial explanation that has been linked to case material, describe theoretically a successful intervention with this case [theoretical intervention should be based on published research demonstrating efficacy [reference]
Note:
- there should be logical links between the theoretical cause and theoretical intervention that could realistically apply to the specific case study
- the intervention may focus on one of the biopsychosocial causes in this instance, students need to identify which part of the biopsychosocial theory informs the intervention
BESC1453 Case studies 2025
Case Study: Depression [Cecilia]
Presenting Problem: The client is a 29-year-old Caucasian female who presented with symptoms of depression. She stated that she had daily crying spells, felt sad “all the time”, had trouble sleeping at night, and was overeating. She reported that her sleeping was disturbed in that it frequently took her several hours to fall asleep, that some nights she could not fall asleep at all, and if she did, she slept for only a few hours. She stated that she spent the time awake “thinking” and “worrying”. She acknowledged that some of her worries included thoughts that she was not a good mom, and she felt that she was a problem to her husband. She reported that she thought about her family of origin and her unsatisfactory relationship with her mother. She stated that she thought her depression had worsened after the birth of her third child ten months ago. During the initial intake interview, the client noted that she felt “all right, always down”. The “all right” response came out immediately, almost automatically. After a pause, she added “always down”. She revealed that she was constantly thinking and worrying, and that she felt “like everyone is looking at me”. She denied suicidal behaviour and ideations. She said it would be nice to run away from her problems, but she added that she knew she could not do that. Cecilia’ acknowledged that depression was affecting her life in a number of ways. For one, she reported that it was affecting her relationship with her husband and children. 1. The name of the client and some details has been changed to protect confidentiality. Secondly, she stated that depression affected her socially because it was keeping her from participating in family events. She reported that she felt unable to work outside her home at this time, therefore, it was having a financial impact. She expressed unhappiness that she was not the person she wanted to be, and she stated that her depression was “wrecking my life”. History of the Complaint: Cecelia reported that she sought help for post-partum depression six months ago following the birth of her third child, Zeke. She stated that she became depressed when she found out she was pregnant, and the depression continued to worsen after the child’s birth. During the initial months of her pregnancy, she recalled being tired, sad, having no energy, and crying several times a week. She reported that she felt exhausted but could not sleep. She stated that she felt like she “lost control of her life”. She acknowledged that these feelings continued after Zeke’s birth. Her gynaecologist prescribed 20 mgs. of Paxil, which she continued to take for a few months. She reported that she discontinued the medication because she did not think it was helping her. She said that it did not work, and she felt no difference in her depression. She also stated that she did not like taking medications. She reported no other periods of depression in her life. Household Composition: The client lives with her husband, Jerome, 32, her nine-year-old daughter, Larissa, (from a previous relationship), four-year-old son, Samuel, and ten-month- old son, Zeke. The family owns a home in a residential area.
Early Development/Neurological History: The client did not recall any problems with her birth or prenatal history. She stated that there were no unusual events that occurred during this time. She reported no head injuries or trauma. She acknowledged having no history of neurological problems. She reported no problems with her developmental milestones. Family of Origin: Cecilia’s family of origin includes her younger sister, Margaret, currently 27 years old, her younger brother, Brian, 23, her mother Alice, 52, and father, Roger, 57. Cecilia recalls having a chaotic childhood characterized by a great deal of stress and instability. She lived with her father, mother, and younger siblings while growing up. She reported that her parents argued frequently, usually over her mother’s use of alcohol. At age 11, her mother left the home and the family and was absent for several years. The client stated that her mother was an alcoholic. Her mother would contact the children by phone, but physically did not have contact with them during this time. Her mother later returned to the family when the client was 16 years old, and she is currently living back home with her husband, Roger, and son, Brian. During the time that her mother was away, Cecilia reported that her father had to raise the children on his own. Cecilia remembered him being very “hurt” when her mother left.
Current Family Relationships: Cecilia lives with her husband of six years and their three children. Her husband adopted her daughter from her previous relationship, and they have two additional children together. Her husband has a small roofing business and puts in many long hours. Cecilia is home with their children all day long. Cecilia, her husband, and children attend family barbecues, picnics, parties, and other activities together. They also occasionally spend time with other couples and their children. She reported that they rarely spend time alone as a couple. Cecilia states that she would like to do this more often. When they did have time at home together, there were usually friends present, and this posed a problem for her. When friends were around she stated that her husband tended to drink more, and this made her feel anxious.
Medical and Psychiatric History: Cecilia reported that she had never sought psychological help prior to now. She did not feel that she was depressed at any other time in her life.
Medically, she reported having heavy menstrual flows lasting as long as nine days. She had been on birth control pills before her unplanned pregnancy. She states that she got pregnant while on the pill. She said that she must be in the “1% group that it doesn’t work for”. She reported no other medical conditions that she was experiencing at this time.
Social Supports and Patterns of Relationships: Cecilia said her husband recognized that she had a problem, and that he was supportive of her seeking treatment. She stated that he wanted to help her, but he did not know what to do. She added that she talked to him about her depression, but she did not feel that he understood what she was going through.
According to her, he did want her to get help and was accepting of her receiving counselling. She reported that he was willing to participate if need be. She stated that she was concerned that her depression may cause problems in their marriage if she does not get “out of it” soon. She said that she worried that he will get tired of her being this way if it continued to last for an extended period
Borderline personality – a case study [Thomas]
The patient is a 23-year-old single white male who presented for the first time to his local mental health centre. He was a recent college graduate who had just moved to the area to begin work in a small accounting firm. His chief complaint was insomnia of five years duration. He stated that the insomnia was due to feelings of guilt and anxiety; the reasons for these feelings he could not identify. There was no history of any previous psychiatric contact.
He began psychotherapy with a clinically experienced psychologist. Within two months he was hospitalized for nearly a three-month period after having grown increasingly depressed and suicidal and having begun to cut himself with a razor. He was diagnosed as having Major Depression and Borderline Personality Disorder.
Following the hospitalization, he continued with depressive symptoms, began drinking heavily, was intermittently anorexic and bulimic, continued cutting himself superficially and once made a suicidal gesture. Over the next ten months he was hospitalized on two more occasions and was treated with therapeutic doses of a variety of psychotropic medications, including tricyclic and MAOr antidepressants, lithium and both high and low potency neuroleptics. He began to limit his self-destructive activity and started to reveal information about his past in outpatient therapy. However, he soon experienced renewed insomnia and one day related to his therapist that the previous night he had gone for a walk to test out a fantasy he had been having. He approached an attractive young woman walking in a dark, isolated area and asked her for directions. The fantasy was that he would distract her attention with a question, knock her unconscious and then proceed to severely mutilate her body, particularly her sexual organs, with the razor blade that was in his pocket. However, after an exchange of words lasting ten seconds, he and the woman parted. The patient revealed that he had had this fantasy for some time and felt increasingly compelled to act out on it, to make it a reality.
He was distraught that he had gone this far in bringing the fantasy to life but felt as though he would be unable to control the forces that drove him to perform these acts. He was immediately hospitalized, and it was at that point that this writer was introduced to the patient, as it was felt that his previous therapist, a woman, was at too great a risk to her own safety to continue working with him. His initial response to the change in therapists was one of feeling rejected, abandoned and filled with a sense of rage. The patient was a man of intense appearance, with a face that revealed internal torment. He was highly anxious and rarely made eye contact. Somewhat disarming was the fact that he spoke with a quiet and articulate voice. He revealed a very unusual pattern of mostly well healed, generally superficial scars, each measuring about eight inches in length, which were present in clusters on his forearms, shoulders, chest, abdomen and legs, and which were caused by self-induced lacerations made by razor blades or paper clips. He had been cutting himself, it turned out, since age 13. He stated that at times he hated to see the wounds heal and disappear, for he felt the wounds had an identity and life of their own, and their disappearance was their response to his not paying enough attention to them (by keeping them open and bleeding) and represented their abandonment of him. He related that his self-lacerating was done not in a brief and slashing moment of anger, but with well-defined purpose, attention and care. There was a ritual to it. He would cut himself on days when he felt initial hopefulness followed by self-doubt, disappointment, sense of failure, depression, guilt, abandonment and loneliness. This would progress to a sense of fear and panic, a sense that he was peering out at the world from a belljar, a sense that the walls of rooms, buildings and other inanimate objects such as laundry were becoming personified, and with menacing, hostile intentions, were creeping up on him to overwhelm him. He would then begin to feel as though he were losing control, losing his mind and even his body-that his body was disintegrating and disappearing into the universe. This caused increasing panic and a sense that he had to recapture himself by some means to prevent himself from disappearing. The organizing and unifying act that he came upon was that of slowly etching a long linear cut in to his skin. It would bring his body and mind back together. It would give him himself again. He described looking forward to cutting himself with a sense of anticipation. The act of cutting was filled with excitement, and it was followed by a release of tension and sense of relief, calm, fulfillment and satisfaction.
In considering this patient, there are two questions to be addressed: What was behind this bizarre thinking and what would the treatment be? The latter question was approached first. He was clinically depressed. Additionally, although his thought process was intact, and he consistently denied any hallucinations, he was highly anxious and agitated and his thought content was highly disordered with marked bizarre delusions of a paranoid quality. He also was consumed by grotesquely violent homicidal fantasies. Laboratory workup revealed no organic basis for his psychiatric symptoms.
The developmental and family dynamics were intriguing contributors to his psychopathology. In brief, the patient’s mother was highly labile emotionally. He found her threatening and overwhelming. She inspired fee lings of guilt and unworthiness in the patient, yet she was also dependent on him and discouraged his separation, growth and independence. His father was emotionally distant and detached; an academician who died in a motor vehicle accident when the patient was 12. The patient idealized him, yet he never really grieved his loss and felt guilty for this. This patient described himself as being a loner as a child. He had one trusted friend who was several years older than the patient. When the patient was 13 and his friend was 15, the friend one day took the patient by surprise and violently raped him. It was following this event that the patient first began to have the fantasy of the sexual slaying and soon after began to cut himself. When the patient was 16, he went to a party and was coerced by friends to have sex with a girl his same age. Like his only previous sexual contact, he found this experience degrading and humiliating. He never had another sexual encounter. The patient was an honours student in college and worked as a fast food attendant to pay for his college tuition. On occasion he fantasized about taking hostages at work, killing them and being killed himself by police. He occasionally used marijuana, cocaine and alcohol. He lived at his family home throughout college. It was only upon leaving home for the first time when he began work as an accountant that the chronic anxiety he experienced mounted into a sense of panic, the fantasies of torture became obsessional, the cutting ritual became compulsive and he began to fear losing all control. In assessing the relationship of the significant events in the patient’s history to his clinical presentation, it is clear that the patient started from a developmental base of fear of his mother and absence of an emotionally fulfilling relationship with his father, with consequent difficulty in being able to trust and form attachments to others. When this trust and attachment was at last established with his childhood friend, it was betrayed in the brutal violation of rape. Ever since that violation, the patient felt not only rage towards his friend, but also a sense of guilt, a feeling that somehow, he was responsible for the event. These were similar to the feelings of guilt which his mother had engendered; that he must somehow be responsible for her hostile behaviour towards him. Also, during the period of his life when the rape occurred, the patient was entering puberty and feeling a sexual attraction towards females. But he had received a Catholic upbringing and had taken from it a lesson about the evils of sexual desire. This, combined with his experience of sexual assault, established in him the belief that sex was cruel, evil and dirty.
Schizophrenia Case Study
Case Study Analysis of Sally
Sally is a young girl suffering from schizophrenia. Schizophrenia is a psychotic disorder, or a group of disorders represented by a severe impairment of individual thought process, and behaviour (TheFreeDictionary, 2012). According to Meyer, Chapman, and Weaver (2009) it may be more accurate to refer to schizophrenia as a family of disorders rather than a singular disorder. (p. 90). Untreated patients suffering from schizophrenia are normally unable to filter various sensory stimuli, and exhibit enhanced perception of color, sound, and other environmental factors. In most cases, a patient suffering from schizophrenia will gradually withdraw from personal interactions, and loose the ability to care for his or her individual basic needs (TheFreeDictionary, 2012). Schizophrenia is one of the top ten illnesses resulting in long-term disability, and accounts estimate that approximately 1% of the world population is affected by the illness (TheFreeDictionary, 2012). The following analysis is designed to provide and analysis of the patients history, and events that resulted in her hospitalization. The analysis will provide the specifics of the patients biological, behavioral, cognitive, and emotional components that factor into her illness. Schizophrenia Schizophrenia includes three different subtype, and two over subtypes. The main subtypes include the classifications of paranoid, disorganized, and catatonic, and each of these subtypes displays unique characteristics or symptoms (Hansell, & Damour, 2008). Patients suffering from paranoid schizophrenia will usually display symptoms of hallucinations or delusions. Patients suffering from disorganized schizophrenia are subject to an inappropriate effect, and disorganized speech patterns. Patients suffering from catatonic schizophrenia display symptoms of strange or bizarre sensory motor function (Hansell, & Damour, 2008). Individuals who display symptoms of schizophrenia but lack any symptoms of the three primary classifications are likely to be diagnosed into one of two alternate classifications: residual or undifferentiated schizophrenia (Hansell, & Damour, 2008). Symptoms of schizophrenia are classified into two primary categories. These two categories relate to positive and negative symptoms. Patients displaying positive symptoms exhibit pathological excesses including hallucinations, irrational thinking, and irrational behaviors, whereas patients displaying negative symptoms will exhibit pathological deficits including withdrawal and isolation from social interactions, and poverty of speech capabilities ((Hansell, & Damour, 2008). Schizophrenia is a complex illness that affects both men and women on an equal level. The illness usually starts around the age of ten, or in young adulthood. However, cases of childhood-onset schizophrenia indicate that the illness can start as young as five years of age. This is a rarer case of schizophrenia that can difficult to diagnose in relation to other childhood developmental problems (PubMedHealth, 2012). While researchers have yet to discover the cause of schizophrenia, many suspect genetics to be a major contributor (PubMedHealth, 2012).
Patient History
The patients case study indicates that she has a history of eccentricity. Medical notations indicate that the patent’s mother was an avid smoker, consuming approximately two packs of cigarettes daily before and during pregnancy. Further notations include that the patients mother suffered from a very severe case of the flue during her fifth month of pregnancy. As a child, the patient showed signs of slower developmental skills, and was diagnosed as suffering from hyperactivity in early childhood. Records indicate that the patient experienced a turbulent home life because of ongoing conflicts between her parents that resulted in separation, and reconciliation. Because of her apparent developmental disabilities, her parents devoted time to the patient however; the patient did receive criticism from her father for her behavioral dysfunctions. As the patient matured, she displayed signs of being socially awkward and isolated from her peers, and in early adulthood started to display worsening symptoms like talking to herself, and displaying unusual behavior like stating at the floor for long periods. Her first documented schizophrenia episode requiring hospitalization occurred shortly after the additional symptoms started to be displayed. During her examination, the patient displayed signs of unresponsiveness, and waxy flexibility that allowed her limbs to be easily positioned (Meyer, Chapman, & Weaver, 2009). After the initial hospitalization, the patient was returned home to facilitate a quicker recovery. that was short lived because the patient failed to follow the prescribed treatment regimen which, resulted in a secondary episode shortly after her return to college. Further home-based treatments proved unsuccessful as the patient slowly declined, resulting in unresponsiveness, and displaying hebephrenic symptoms like unprovoked giggling, and rocking movements (Meyer, Chapman, & Weaver, 2009). The patients second hospitalization and treatments started to show positive results, and she was taken back to her home environment. She was able to obtain a part-time position at work, and maintain daily household chores. However, the patient failed to follow the prescribed treatment regimen. Following the death of her father, and additional stressors resulting from her mothers added dependency, the patient suffered from a third regression of the illness. Her third hospitalization resulted from local law officials discovering her walking in a local pond while incoherently mumbling to herself.
Components of the Schizophrenic Episodes
The primary component of the patients episodes appear to be related to stress as the primary factor. However, biological factors resulting from her mothers illness and smoking during pregnancy, and a genetic predisposition related to her grandfather’s eccentricity are viable underlying factors resulting in the patients illness. In addition to the primary stressor, and the underlying genetic and biological factors, it is possible that the emotions of the patient also contributed to her condition. Further documentation indicates that interfamilial expressed emotion, and communication deviance are probably contributors that appear to be operative in the patients case (Meyer, Chapman, & Weaver, 2009). The first of these factors, expressed emotion would be explained by the turbulent relationship, combined with her mothers over protective nature conflicting with her fathers over critical reactions to the patients behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors, communication deviance resulted from the patients inability to focus and maintain normal dialog with others (Meyer, Chapman, & Weaver, 2009). Cognitive factors are a viable consideration for this patients case. Meyer, Chapman, and Weaver (2009) suggest that prodomal pruning theory may be one example of a cognitive factor. Prodomal pruning theory suggests that the human brain deletes unnecessary synapses to allow the brain to function properly during the change from adolescence to adulthood (Meyer, Chapman, & Weaver, 2009). Behavior is another factor relating to the patients repeated hospitalization. The patient displayed behavior deficiencies in regard to compliance, to prescribed treatment regimens, and involvement in situations that could produce high level stressors in her life. Conclusion
Because illnesses like schizophrenia relate to various and different factors, each person effected by the illness will show differences in ability to function in a normal environment. The various classifications of schizophrenia, ability to receive treatments, and the consideration of various influences and base-line factors help researchers determine what classification a patient falls into. In this case, the patient displays symptoms of catatonic schizophrenia. She can function in environments that do not produce high levels of demand or stress on the individual. However, the underlying assumptions would indicate that the combination of outlined biological, emotional, cognitive, and behavioral were in-place, and waiting for the appropriate stressor to trigger her symptoms.R
RUBRIC