Last Day Psychology Pictures

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George Case Study

 By the time he was admitted to the hospital, George Lawler was talking a mile a minute. He harangued the other patients and ward staff, declaring that he was the coach of the U.S. Olympic track team and offering to hold tryouts for the other patients in the hospital. His movements were rapid and somewhat erratic as he paced the halls of the ward and explored every room. At the slightest provocation, he flew into a rage. When an attendant blocked his entrance to the nursing station, he threatened to report her to the president of the Olympic committee.

He had not slept for 3 nights. His face was covered with a stubbly growth of beard, and his hair was scattered in various directions. His eyes were sunken and bloodshot, but they still gleamed with an intense excitement.

             His life had taken a drastic change over the past 2 weeks. George was 35 years old, married, and the father of two young children. He worked at a small junior college where he taught physical education and coached both the men’s and women’s track teams. Until his breakdown, the teams had been having an outstanding season. They were undefeated in dual competition and heavy favorites to win the conference championship. The campus was following their accomplishments closely because it had been many years since one of the school teams had won a championship. In fact, track was the only sport in which the school had a winning record that season.

             This was not the first time that George had experienced psychological problems.  His first serious episode had occurred during his junior year in college. It did not seem to be triggered by any particular incident; in fact, things had been going well. George was playing defensive back on the university football team.

He was in good academic standing and fairly popular with the other students.

Nevertheless, during the spring semester, George found that he was losing interest in everything. It was not surprising that he did not look forward to classes or studying. He had never been an outstanding student. But he noticed that he no longer enjoyed going out with his friends. They said he seemed depressed all the time. George said he just did not care anymore. He began avoiding his girlfriend, and when they were together, he found fault with almost everything she did. Most of his time was spent in his apartment in front of the television. It did not seem to matter what program he watched because his concentration was seriously impaired. He kept the TV on as a kind of distraction, not as entertainment.

            When he did not show up for spring football practice, the coach called him to his office for a long talk. George told his coach that he did not have the energy to play football. In fact, he did not feel he could make it through the easiest set of drills. He did not care about the team or about his future in sports. Recognizing that George’s problem was more than a simple lack of motivation, the coach persuaded him to visit a friend of his—a psychiatrist at the student health clinic.

George began taking antidepressant medication and attending individual counseling sessions. Within several weeks, he was back to his normal level of functioning, and treatment was discontinued.

             George had also experienced periods of unusual ambition and energy. As a student, he had frequently spent several days cramming for exams at the end of a semester. Many of his friends took amphetamines to stay awake, but George seemed able to summon endless, internal reserves of energy. In retrospect, these periods seemed to be hypomanic episodes (i.e., periods of increased energy that are not sufficiently severe to qualify as full-blown mania). At the time, these episodes went relatively unnoticed. George’s temporary tendency toward excess verbosity, his lack of need for sleep, and his ambitious goals did not seem pathological. In fact, his energetic intervals were productive, and his behavioral excesses were probably adaptive in the competitive university environment.

             There had been two subsequent episodes of depression with symptoms that were similar to those of the first episode. The most recent incident had occurred

8 months prior to his current hospitalization. It was September, 2 weeks after the start of the fall semester. George had been worried about his job and the team all summer. Who would replace his star sprinter who had transferred to the state university? Would his high jumper get hurt during the football season? Could they improve on last year’s winning record? Over the past month, these concerns had become constant and consuming. George was having trouble getting to sleep; he was also waking up in the middle of the night for no apparent reason.

He felt tired all the time. His wife and children noticed that he was always brooding and seemed preoccupied. Then came the bad news. First, the athletic department told him that he would not get an increase in travel funds, which he had expected. Then he learned that one of his assistant coaches was taking a leave of absence to finish working on her degree. Neither of these events would have a drastic effect on the upcoming season, but George took them to be disasters.

            His mood changed from one of tension and anxiety to severe depression.

Over several days, George became more and more lethargic until he was almost completely unresponsive. His speech was slow and, when he did say more than a word or two, he spoke in a dull monotone. Refusing to get out of bed, he alternated between long hours of sleep and staring vacuously at the ceiling. He called the athletic director and quit his job, pointing to minor incidents as evidence of his own incompetence. He believed, for example, that the assistant coach had quit because of a brief argument that he had had with her 6 months earlier. In fact, they had a positive relationship, and she had always planned to return to school at one time or another. She was leaving earlier than she had expected for personal reasons. George seemed to be blaming himself for everything. He apologized profusely to his wife and children for failing them as a husband and father. His despair seemed genuine. Suicide appeared to be the only reasonable solution. He threatened to end it all if his family would only leave him alone.

             George’s wife, Cheryl, called the psychiatrist who had treated him during his last episode (2 years earlier) and arranged a special appointment. The psychiatrist decided to prescribe lithium carbonate, a drug that is used to treat manic episodes but that is also an effective antidepressant.  Although George had never been hospitalized for a manic episode, the psychiatrist suggested that his past history of “maniclike” behavior (increased energy, sleeplessness, inflated self-esteem, and so on) and his positive family history for this disorder (his uncle Ralph) were both consistent with the diagnosis. The lithium seemed to be effective. Three weeks later, George was back at work. Maintenance doses of lithium were prescribed in an attempt to reduce the frequency and severity of future mood swings.

             His first fully developed manic period began suddenly near the end of the next spring track season. The team was having a good year, and a few team members had turned in remarkable individual performances. Two days before the conference meet, Cheryl noticed that George was behaving strangely. There was a driven quality about his preparation for the meet. He was working much longer hours and demanding more from the athletes. When he was home, he talked endlessly about the team, bragging about its chances for national recognition and planning intricate strategies for particularly important events. Cheryl was worried about this change in George’s behavior, but she attributed it to the pressures of his job and assured herself that he would return to normal when the season was over.

             George was clearly losing control over his own behavior. The following incident, which occurred on the day of the conference meet, illustrates the dramatic quality of his disturbance. While the men’s team was dressing in the locker room prior to taking the field, George paced rapidly up and down the aisles, gesturing emphatically and talking at length about specific events and the virtues of winning. When the men were all in uniform, George gathered them around his own locker. Without Cheryl’s knowledge, he had removed a ceremonial sword from their fireplace mantel and brought it with him that morning. He drew the sword from his locker and leaped up on a bench in the midst of the men. Swinging the sword above his head, he began chanting the school’s fight song. The athletes joined in, and he led them out onto the field screaming and shaking their fists in the air. A reporter for the school newspaper later described the incident as the most inspirational pregame performance he had ever seen in a locker room. Without question, the team was driven to an exceptional emotional peak, and it did go on to win the meet by a huge margin. In fact, George was later given the school’s annual coaching award. His behavior prior to the meet was specifically cited as an example of his outstanding leadership qualities. Unfortunately, the action was also another manifestation of psychopathology and a signal of further problems that would soon follow.

             George did not return home after the meet. He stayed in his office, working straight through the night in preparation for the regional meet. Cheryl was finally able to locate him by phoning his friend who worked in the office next door.

She and his colleagues tried to persuade him to slow down, but he would not listen. The next morning George was approached by a reporter from the school newspaper. Here, George thought, was the perfect opportunity to expound on his ability as a coach and to publicize his exciting plans for future competition. The interview turned into a grandiose tirade, with George rambling uninterrupted for

3 hours. The reporter could neither interrupt nor extract himself from this unexpected and embarrassing situation.

             The interview turned into a professional disaster for George. Among other things, George boasted that he was going to send the star high jumper from the women’s team to the NCAA national meet in Oregon. He planned to go along as her chaperone and said that he would pay for their trip out of the proceeds of a recent community fund-raising drive. This announcement was startling in two regards. First, the money in question had been raised with the athletic department’s assurance that it would be used to improve the college’s track facilities and to sponsor running clinics for local children. George did not have the authority to redirect the funds. His announcement was certain to anger the business leaders who had organized the drive. Second, the prospect of a married male coach chaperoning a female athlete, who also happened to be quite attractive, promised to raise a minor scandal in their small, conservative community.

            Recognizing the sensitive nature of these plans, the reporter asked George if he might want to reconsider his brash announcement. George replied—asking the reporter to quote him—that it was not every year that he had the opportunity to take a free trip with a pretty girl, and he was not about to pass it up. He added that this might blossom into a genuine romance.

             The article appeared, along with a picture of George, on the front page of the school paper the next morning. His disheveled appearance and outrageous remarks raised an instant furor in the athletic department and the school administration.

The head of the department finally located George in his office making a series of long-distance calls. The director demanded an explanation and immediately found himself in the midst of an ear-shattering shouting match. George claimed that he had just been named head coach of the Olympic track team. He was now calling potential assistant coaches and athletes around the country to organize tryouts for the following month. Any interference, he claimed, would be attributed to foreign countries that were reluctant to compete against a team led by a coach with such a distinguished record.

             The department head realized that George was not kidding and that he could not reason with him. He returned to his own office and phoned Cheryl. When she arrived, they were unable to convince George that he needed help. They eventually realized that their only option was to call the police, who then took George to a psychiatric hospital. Following an intake evaluation, George was committed for 3 days of observation. Because he did not recognize the severity of his problems and refused to cooperate with his family and the hospital staff, it was necessary to follow an involuntary commitment procedure. The commitment order was signed by a judge on the following day, after a hospital psychiatrist testified in court that George might be dangerous to himself or others.

 Social History

             In most respects, George’s childhood was unremarkable. He grew up in a small, Midwestern town where his father taught history and coached the high school football team. He had one older brother and two younger sisters. All of the children were fair-to-average students and very athletic. George loved all sports and excelled at most. When he accepted a football scholarship to the state university, everyone expected him to go on to play professional ball.

             He was always popular with his peers. They looked to him for leadership, and he seemed to enjoy the role. He and his friends were mischievous but were never serious discipline problems. Although some of his friends began drinking alcohol during high school, George always refused to join them. His father had been a heavy drinker, and he did not want to follow the same path. After several years of problem drinking, George’s father had joined Alcoholics Anonymous and remained sober. Everyone agreed that the change in his behavior was remarkable.

            George’s uncle (his mother’s brother) had also experienced serious adjustment problems. This uncle was several years older than George’s mother, and the principal incidents occurred before George was born. George was therefore uncertain of the details, but he had been told that his uncle was hospitalized twice following periods of rather wild behavior. A later search of hospital records confirmed that these had, in fact, been maniclike episodes. Although the uncle had been assigned a diagnosis of “acute schizophrenic reaction,” contemporary diagnostic criteria would certainly have required a similar diagnosis to George.

Janet Case Study

        Janet called the mental-health center to ask if someone could help her 5-year-old son, Adam. He had been having trouble sleeping for the past several weeks, and

Janet was becoming concerned about his health. Adam refused to go to sleep at his regular bedtime and also woke up at irregular intervals throughout the night. Whenever he woke up, Adam would come downstairs to be with Janet.

Her initial reaction had been sympathetic, but as the cycle came to repeat itself night after night, Janet’s tolerance grew thin, and she became more argumentative.

She found herself engaged in repeated battles that usually ended when she agreed to let him sleep in her room. Janet felt guilty about giving in to a 5-year-old’s demands, but it seemed like the only way they would ever get any sleep.

The family physician was unable to identify a physical explanation for Adam’s problem; he suggested that Janet contact a psychologist. This advice led Janet to inquire about the mental-health center’s series of parent-training groups.

             Applicants for the groups were routinely screened during an individual intake interview. The therapist began by asking several questions about Janet and her family. Janet was 30 years old and had been divorced from her husband, David, for a little more than a year. Adam was the youngest of Janet’s three children;

Jennifer was 10, and Claire was 8. Janet had resumed her college education on a part-time basis when Adam was 2 years old. She had hoped to finish her bachelor’s degree at the end of the next semester and enter law school in the fall. Unfortunately, she had withdrawn from classes 1 month prior to her appointment at the mental-health center. Her current plans were indefinite. She spent almost all of her time at home with Adam.

            Janet and the children lived in a large, comfortable house that she had received as part of her divorce settlement. Finances were a major concern to Janet, but she managed to make ends meet through the combination of student loans, a grant-in-aid from the university, and child-support payments from

David. David lived in a nearby town with a younger woman whom he had married shortly after the divorce. He visited Janet and the children once or twice every month and took the children to spend weekends with him once a month.

            Having collected the necessary background information, the therapist asked for a description of Adam’s sleep difficulties. This discussion covered the sequence of a typical evening’s events. It was clear during this discussion that

Janet felt completely overwhelmed. At several points during the interview, Janet was on the verge of tears. Her eyes were watery, and her voice broke as they discussed her response to David’s occasional visits. The therapist, therefore, suggested that they put off a further analysis of Adam’s problems and spend some time discussing Janet’s situation in a broader perspective.

            Janet’s mood had been depressed since her husband had asked for a divorce.

She felt sad, discouraged, and lonely. This feeling had become even more severe just prior to her withdrawal from classes at the university (1 year after David’s departure). When David left, she remembered feeling “down in the dumps,” but she could usually cheer herself up by playing with the children or going for a walk. Now she was nearing desperation. She cried frequently and for long periods of time. Nothing seemed to cheer her up. She had lost interest in her friends, and the children seemed to be more of a burden than ever. Her depression was somewhat worse in the morning, when it seemed that she would never be able to make it through the day.

            Janet was preoccupied with her divorce from David and spent hours each day brooding about the events that led to their separation. These worries interfered considerably with her ability to concentrate and seemed directly related to her withdrawal from the university. She had been totally unable to study assigned readings or concentrate on lectures. Withdrawing from school precipitated further problems. She was no longer eligible for student aid and would have to begin paying back her loans within a few months. In short, one problem led to another, and her attitude became increasingly pessimistic.

             Janet blamed herself for the divorce, although she also harbored considerable resentment toward David and his new wife. She believed that her return to school had placed additional strain on an already problematic relationship, and she wondered whether she had acted selfishly. The therapist noted that Janet’s reasoning about her marriage often seemed vague and illogical. She argued that she had been a poor marital partner and cited several examples of her own misconduct.

These included events and circumstances that struck the therapist as being very common and perhaps expected differences between men and women.

For example, Janet spent more money than he did on clothes, did not share his enthusiasm for sports, and frequently tried to engage David in discussions about his personal habits that annoyed her and the imperfections of their relationship.

Of course, one could easily argue that David had not been sufficiently concerned about his own appearance (spending too little effort on his own wardrobe), that he had been too preoccupied with sports, and that he had avoided her sincere efforts to work on their marital difficulties. But Janet blamed herself. Rather than viewing these things as simple differences in their interests and personalities,

Janet saw them as evidence of her own failures. She blew these matters totally out of proportion until they appeared to her to be terrible sins. Janet also generalized from her marriage to other relationships in her life. If her first marriage had failed, how could she ever expect to develop a satisfactory relationship with another man?             Furthermore, Janet had begun to question her value as a friend and parent. The collapse of her marriage seemed to affect the manner in which she viewed all of her social relationships. The future looked bleak from her current perspective, but she had not given up all hope. Her interest in solving Adam’s problem, for example, was an encouraging sign. Although she was not optimistic about the chances of success, she was willing to try to become a more effective parent.

 Social History

            Janet was reserved socially when she was a child. She tended to have one or two special friends with whom she spent much of her time outside of school, but she felt awkward and self-conscious in larger groups of children. This friendship pattern persisted throughout high school. She was interested in boys and dated intermittently until her junior year in high school, when she began to date one boy on a regular basis. She and her boyfriend spent all of their time together. Janet remembered that the other kids teased them about acting as if they were married.

Unfortunately, she and her boyfriend broke up during Janet’s first year in college.

 Janet met David a few weeks afterward, and they were married the following summer. Janet later wondered whether she had rushed into her relationship with David primarily to avoid the vacuum created by her previous boyfriend’s sudden exit. Whatever her motivation might have been, her marriage was followed shortly by her first pregnancy, which precipitated her withdrawal from the university. For the next seven years, Janet was occupied as a full-time mother and homemaker.

             When Adam was 2 years old and able to attend a day-care center, Janet decided to resume her college education. Her relationship with David became increasingly strained. They had even less time than usual to spend with each other.

David resented his increased household responsibilities. Janet was no longer able to prepare meals for the family every night of the week, so David had to learn to cook. He also had to share the cleaning and drive the children to many of their lessons and social activities. A more balanced and stable relationship would have been able to withstand the stress associated with these changes, but Janet and

David were unable to adjust. Instead of working to improve their communications, they bickered continuously. The final blow came when David met another woman to whom he was attracted and who offered him an alternative to the escalating hostility with Janet. He asked for a divorce and moved to an apartment.

 Janet was shaken by David’s departure, despite the fact that they had not been happy together. Fortunately, she did have a few friends to whom she could turn for support. The most important one was a neighbor who had children of approximately the same ages as Janet’s daughters. There were also two couples with whom she and David had socialized. They were all helpful for the first few weeks, but she quickly lost contact with the couples. It was awkward to get together as a threesome, and Janet had never been close enough with the women to preserve their relationships on an individual basis. That left the neighbor as her sole adviser and confidante, the only person with whom Janet felt she could discuss her feelings openly.

             For the next few months, Janet was able to continue her studies. With the children’s help, she managed the household chores and kept up with her work.

She even found time for some brief social activities. She agreed to go out on two blind dates arranged by people with whom she and David had been friends. These were generally unpleasant encounters; one of her dates was boring and unattractive, and the other was obnoxiously aggressive. After the latter experience, she discontinued the minimal efforts she had made to develop new friendships.

 As time wore on, Janet found herself brooding more and more about the divorce. She was gaining weight, and the children began to comment on her appearance. To make matters worse, Claire became sick just prior to Janet’s midterm exams. The added worry of Claire’s health and her concern about missed classes and lost studying time contributed substantially to a decline in Janet’s mood. She finally realized that she would have to withdraw from her classes to avoid receiving failing grades.

             By this point, 1 month prior to her appointment at the mental-health center, she had lost interest in most of her previous activities. Even casual reading had come to be a tedious chore. She did not have any hobbies because she never had enough time. She also found that her best friend, the neighbor, was becoming markedly aloof. When Janet called, she seldom talked for more than a few minutes before finding an excuse to hang up. Their contacts gradually diminished to an occasional wave across the street or a quick, polite conversation when they picked up their children from school. It seemed that her friend had grown tired of Janet’s company.

             This was Janet’s situation when she contacted the mental-health center. Her mood was depressed and anxious. She was preoccupied with financial concerns and her lack of social relationships. Adam’s sleeping problem, which had begun about a week after she withdrew from her classes, was the last straw. She felt that she could no longer control her difficult situation and recognized that she needed help.

ADD/ ADHD homework

Hey all,

So here is the homework for today/ tonight.

1.  Watch this clip
















If it is not loading here it is on Youtube 


2.  Go to this site and read this article

3.  Fill out the worksheet

4.  Take the ADD/ ADHD quiz on Socrative.com

Sorry for the chaos in class today, I honestly thought it would work.

See you tomorrow!

~ Ms. A

Anxiety Quiz

READ ALL STEPS BEFORE DOING WHAT THE STEPS TELL YOU TO DO

Step 1: Copy 73bbe7b4

Step 2: CLICK ME

Step 3: Paste 73bbe7b4 into "Room Name"

Step 4: Enter your real name (If Ms. A Sucks takes my quiz, then Ms. A Sucks will get your score while you will receive a "0")

Step 5: Take your time and enjoy my Thanksgiving gift :D
 
Now, go back and do what the steps tell you what to do.

(Am I being literal enough, Kevin?) :)

Anxiety Disorders Powerpoint

Hey all!

I made the executive decision to not upload the Anxiety Disorders PP since we have only covered OCD and OCPD.  We will cover the rest on Monday, and I will upload it then.

~ Ms. A

Freud Power Point

Freud Power Point