Clincal Vignettes:
Clinical Vignette 1
Mrs A is a Turkish woman who came to this country 12 years ago with her husband. They came here because they thought this country would provide better opportunities and health care for their children. They have 4 children, aged 14,11, 8 and 6. The oldest, a boy, remained with his grandparents for two years while the parents settled here and then he came to join them.
Mrs A speaks no English and it is necessary to work with an interpreter. Her children are in English schools, but Turkish is spoken at home. She does not work. She has no immediate family here, although several of her husband's relatives are here. Her husband does some occasional work in a Turkish restaurant.
Mrs A has been complaining of aches and pains, which makes her feel miserable and they keep her in bed for days at a time. She is tearful and her mood seems low. The pains have been thoroughly investigated and no physical cause has been found. The GP prescribed anti-depressants but she continues to be incapacitated by her problems. The GP wondered whether a psychological approach could contribute to her management.
Questions:
- How would you think about Mrs. A's difficulties?
- What areas would you want to explore and know more about?
- What might be some of the hypotheses that you would want to test in the course of an assessment?
- What might be some of the difficulties working with an interpreter?
Clinical Vignette 2
John is a 75 year old man who has recently had his leg amputated. He used to be very independent and cheerful, but has recently lost a lot of weight and become depressed. He has a tendency to become agitated and confused. His wife died two years ago, but he is visited regularly by his two daughters and several friends. His GP referred him to you because he is not responding to anti-depressant medication and the GP is worried that John's self-neglect may lead to further physical complications.
Questions:
- What are the psychological factors and issues in this case?
- How would the role of the psychologist differ from the roles of other health care professionals?
- What if John had been from a different ethnic background? Would this change how you proceed?
Clinical Vignette 3
Jack is a 20 year old man with a mild to moderate learning disability. He was recently aggressive towards a man in a shop when he was accused of stealing a newspaper. When Jack's keyworker tried to talk to him about the incident, Jack became very aggressive. Jack has moved into supported living accommodation a few weeks prior. In a separate incident, Jack was caught exposing himself to a third party. Staff have asked for your advice on what should be done and how they should deal with Jack.
Clinical Vignette 4:
Adult mental health
A GP has referred a 53 year old man to the psychology department. The man lives on his own and is a chartered accountant who has been self employed for a number of years. The man has regularly consulted his GP over the last 3 years complaining of lethargy, lack of motivation and problems with sleeping.
Child
A mother and father with two young children aged 4 and 6 are referred to the psychology department. The youngest child has a long history of difficulties getting to sleep and settling at night.
Psychiatric Rehabilitation
A 46 yr old woman living in a hostel for people with long term psychiatric problems is referred by the hostel staff because she has become increasingly withdrawn and irritable when approached over the last 3 months. The referral is precipitated by an aggressive and violent argument with another resident.
Learning disabilities
A 23 year old woman living in a group home for people with learning disabilities is referred to your community team. During the last month her grandmother has died. The staff at the group home have contacted the psychologist because they are unsure what they should do.
Questions:
- Who might you arrange to see following this referral?
- What might their feelings be?
- What sort of information would you want to find out about? From whom?
- What do you think might be going on? Do you have any hypotheses
- What might an intervention by a psychologist involve?
Research Vignettes
Research Vignette 1
We have noticed that a disproportionate number of our initial DNA's are from people living on a particular estate. This estate is quite a deprived area, and we hypothesised that this DNA rate is because of difficulty in affording the bus fare. Design a small study to test this hypothesis. This question comes from the Surrey course. 20 minutes were given to think and/or write about it before the interview.
Questions:
- why a particular procedure had been chosen
- what practical factors need to be considered
- consent
- ethics
- how many people to include
- how to analyse the data.
Research Vignette 2
A researcher wants to discover what factors contribute to the development of PTSD symptoms.
Method: There has been an explosion in a factory. The noise was heard throughout the sites. Six people were seriously injured.A questionnaire was given to all workers on the site. It aimed to discover whether any of the workers were suffering from the symptoms of PTSD (eg excess anxiety, nightmares, flashbacks, avoidance). They were also given a personality inventory which assessed neuroticism, and a demographic information questionnaire.
Results: 22 questionnaires were given out. 100 returned. Of these 19 were from women and 81 were from men. 15 were returned by managers/administration staff, 85 by labourers. On average, those people who reported PTSD were also significantly more likely to report neurotic symptoms.There seemed to be a relationship between the likelihood of suffering from PTSD symptoms and employment level:
|
PTSD |
Non-PTSD |
Managers |
10 |
5 |
Labourers |
40 |
45 |
Questions:
- How could you interpret these results?
- What are the strengths and weaknesses of this research?
- How could this research be improved?
Research Vignette 3
You are working in a busy community mental health team. Your supervisor suspects that older clients are less likely to attend appointments.
Design a study to test whether or not this is the case.
Research Vignette 4
A researcher is interested in whether certain variables (optimisim, social network size and income) are related to levels of well-being in carers of relatives with Alzheimer's disease. How should s/he go about designing a study to answer this question? Pay attention to issues of:
Questions:
- Sampling/participants
- Selection of measures
- Formulating a hypothesis
- Design
- Analysis
- Interpretation
- Ethical Issues
From the Oxford Course:
Work with People with learning disabilities
Joanna is a 22 year old woman who has been assessed as having a moderate to severe learning disability and who has very limited language. She recently moved to a staffed residential unit- her parents felt unable to continue meeting Joanna's needs. Staff notice that she has fewer self-care skills than they would have expected. However, she becomes quite agitated when they try to implement any training programmes, especially when her parents have visited for the day. The staff ask if you have any ideas.
Adult mental health
Alan is a 40 year old man who has a long life history of serious mental health problems. He recently separated from his wife under very difficult circumstances, and has been living in council-run bed and breakfast accommodation. Alan's psychiatrist tells you he has not attended out-patient sessions for some time. His social worker has contacted you to see if you have any ideas, because Alan has been behaving ‘oddly'. He often stays-up late at night and disturbs other residents by shouting; at other times he refuses to answer the door to anyone.
Work with older people
Emily is a 73 year old woman who, until recently, lived with her 82 year old brother in a rather run down council estate. They have no living relatives. This winter there were problems with the heating, and her brother was admitted to hospital with pneumonia, and died. When Emily came to visit her brother, ward staff nitced that she seemed disorientated, but when they enquired about her welfare and conditions at home, she became very angry. She also refused to talk to the social worker who had originally been allocated to her brother. The team are quite worried about her, and the social worker contacts you to see if you have any ideas.
Work with children
At his previous school, Harry's teacher thought of him as a bright and engaging 11 year old, but since starting at his new school he has been having an increasing number of days off with minor ailments. When asked by the teachers, Harry's mother says that she hasn't noticed anything herself, but does reveal that she is pregnant following a long period of treatment at a local hospital. The teachers ask if you have any ideas.
Questions:
- What psychological factors or issues would you consider important in thinking about the case?
- What, in your view, would distinguish the approach of the clinical psychologist from that of other professionals and carers involved in the case?
Mai Su's Vignette:
Mai Su is a 14 year old girl who was diagnosed with mild learning disability as an eight year old child following her arrival in the UK from Vietnam . She has managed throughout her school life in the local government schools but has always needed some learning support. She has been a hard worker and maintained reasonable grades although being in the bottom set for all subjects. Mai Su has two younger sisters. Mai Su's parents have become increasingly worried about their daughter, as she has gradually eaten less and less over the past year. The school has noticed that she has lost of weight and has been finding it difficult to concentrate at school and her grades have been falling.
When her parents took Mai Su to the GP they insisted that physical tests were conducted and refused to accept that her problems may be psychological in nature. However, Mai Su has continued to lose weight and is now dangerously low in her body weight. She has often been too tired to attend school and in desperation her parents have agreed to her seeing a Psychologist. Little is known about the circumstances in which the family moved from Vietnam to the UK , but they were granted refugee status. English is her second language and is not spoken in the home.
Maria's Vignette:
Maria is a 72 year old woman with a five year history of depression, which onset following the death of her husband to whom she had been married for fifty years. She has had two in-patient admissions for treatment of her depression, but has not had psychological intervention. She has never responded to medication, but her mood improved after both admissions following a course of ECT. Maria had been a housewife throughout her married life and had raised six children. All but one of her children live abroad and are very successful. Her youngest daughter lives near by and has never married. She is a successful career woman. Maria feels that she does not receive much support from this daughter. Maria has a number of regrets about her life and now wishes that she had developed a more independent lifestyle earlier in her life. She also has numerous physical problems, including osteoporosis, which limits her activities. Her mood has been gradually worsening again over the past six months and she wants someone to talk to about her problems.
Questions:
- What are the specific clinical issues which may need to be addressed?
- What implications may these have for case management?
- What difficulties are likely to be encountered in working with this client?