The Todd Family - Psych Week 2

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Contents

Background Information

The family includes Mr. and Mrs. Todd and their two children Mary and Bobby.

Mr. Todd is presently on disability as a result of a back injury suffered in a motor vehicle accident. He was employed in the building trades as a labourer. Mr. and Mrs. Todd separated some time ago when Mr. Todd left Mrs. Todd. He left the marriage because Mrs. Todd was not able to control Bobby’s behavior. Mr. Todd was physically assaultive to his wife and to Bobby. He is verbally abusive to all of the family members. He has a very limited ability to be reflective. Mr. Todd was raised in a home where his father was a rigid disciplinarian and regularly used spanking with a leather belt to discipline the children. The children often had bruises from the discipline. Mr. Todd’s father died several years ago and his mother is still living in the house where Mr. Todd was raised as a child. Mr. Todd moved into his mother’s home when he left his wife. Since living with his mother, Mr. Todd has taken over his mother’s finances. He has purchased a new car from her savings. He has had her sign over title to her house and her bank accounts to him. Mr. Todd’s siblings do not know about these financial transactions. Mr. Todd’s sisters visit their mother regularly and note that she has become very withdrawn since Mr. Todd moved into the home. She has become very unkempt and has a poor appetite. She spends much of the day sitting in her bedroom rather than tending her garden and knitting mittens for her church mission circle.

Mrs. Todd is a homemaker and has not worked outside of the home since she was married. She felt things were going well in their marriage prior to and for awhile after the birth of their first child, Mary. Mary was a cuddly infant and a happy child. Mrs. Todd described her as easy to raise. The Todd’s marriage started to deteriorate after the birth of Mary because Mrs. Todd no longer devoted all of her time to anticipating or complying with her husband’s requests. She was isolated from social supports including her family of origin. Her mother warned her against marrying her husband, whom she called "That Idiot". As Mrs. Todd’s marriage deteriorated, she started drinking. She became pregnant with Bobby. Bobby was very different from Mary in infancy. He was constantly irritable and would not settle at night. He looked different from his elder sister, having an unusually small head. Mrs. Todd became more despondent and her drinking increased. She was driving the car when the family was in a major accident. This accident resulted in the back injury that has prevented Mr. Todd from working. Mrs. Todd did not want to drive, as she was concerned about her alcohol consumption that evening. When she agreed to drive, she wanted to delay their departure until she was more sober but Mr. Todd insisted that they leave immediately. She was not physically injured in the accident. She has been treated for depression with medication and individual psychotherapy for a long time without any improvement. Family therapy was recommended as an adjunct to her therapy.

Mary, who has a long history of anxiety manifested by psychosomatic pain and phobias, moved out of the family home several years ago at the encouragement of a high school guidance counselor. She completed high school while living in a group home. She attended college and is employed. She resides in her own apartment but maintains a close relationship with her mother. She was in the car at the time of the accident but did not have serious physical injuries. She was wearing her seatbelt. She had some additional phobias after the accident and symptoms of post-traumatic stress disorder.

Bobby, an adolescent, resides with his mother. He was a sickly infant, appeared physically different than Mary at birth, and had a very difficult temperament. He had several fractures as a result of climbing trees. The family first sought help in relationship to Bobby when Bobby was 5 years old. During the assessment, he was diagnosed with fetal alcohol syndrome and attention deficit disorder. Stimulant medication was prescribed but was not very effective. Bobby was not wearing his seat belt when the family was in the car accident. He was thrown out of the car and sustained a head injury. He has residual brain damage. Following the accident he his functioning at school deteriorated and he quit school. He become involved with street drugs and has convictions related to theft as a Young Offender. He has spent time in jail.

Learning Issues

Disease

Discussion of disease topics this week should be limited to definitions and descriptions. Specific details of diagnosis and treatments for various psychiatric disorders are a major focus in 2nd year

Briefly define/describe/summarize affective disorders

Generalized anxiety disorders

DSM-IV-TR Diagnostic criteria for 300.02 Generalized Anxiety Disorder

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The person finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

  1. restlessness or feeling keyed up or on edge
  2. being easily fatigued
  3. difficulty concentrating or mind going blank
  4. irritability
  5. muscle tension
  6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. F. The disturbance is 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., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

Personality disorders

What is Fetal Alcohol Syndrome?

What is Post-Traumatic Stress Disorder?

What is Attention Deficit Disorder?

What is 'Mental Retardation'?

Illness

Are behaviours learned or inherited?

How are children encouraged to learn a variety of emotional responses?

What makes a disorder "life-long" and which disorders fall into this category?

What kinds of effects does alcoholism have in a family?

Discuss factors involved in abuse. What distinguishes an abuser, a victim?

How much should a physician involve others family members in the treatment of a single family member?

Person

What roles are necessary in a family?

Discuss roles and conflict resolution within the family

  • Always must keep in mind the Patterson Cycle of Coercion
  • Parents must present solid rules, not chaotic rule structures

How is 'parenting' learned?

  • Though an accreditation program administered by the government, without which individuals may not be licensed/accredited to have children

What is the role of a sibling to a "problem child"?

  • Could be coerced, as with sibling collusion

Context

What are the roles, qualifications and limitations of a psychologist vs. a psychiatrist vs. a psychotherapist?

Should psychologists be licensed to prescribe medications?

  • There has been good success with trained military psychologists
  • Psychologists in New Mexico *are* trained to prescribe medications
  • Coverage of the issue seems to depend on whether or not the person covering is a psychologist (approve) or a psychiatrist (disapprove)

How does the Children's Aid Society protect children? What is the law?

How are children "removed" by social services?

Discuss the background to and the recent Supreme Court decision in regard to spanking

  • More resources are below
  • Basically, the supreme court decided that it was outside its jurisdiction to try to dictate what people could do to their children in private
  • The court made a distinction between parents and teachers that had heretofore not existed
  • The government was very anxious not to be put in a situation where it was prosecuting loads of parents for hitting their childrens' bottoms
  • The decision makes it such that it is illegal to hit the children with objects, or give them blows on the face n shit.
  • The decision also states that the beating should be trifling

Discuss cultural/minority differences with respect to mental disorder prevalence/treatment differences/etc?

Discuss the depiction of families and family functioning by the media

What is a group home? Who goes there? What are the pros and cons of a group home?

Resources

Spanking

Prescribing psychologists

Parenting

Sibling Collusion and Problem Behavior in Early Adolescence: Toward a Process Model for Family Mutuality

Fetal Alcohol Syndrome