Rhonda

RhondaMorgan Brewton, Sarah Durham, Chris Matzye, Hillary Olivier, Becca Price, & Lauren TumeyRHONDA46 year old Caucasian woman living in DenverOnly child and lives at home with her parents (ages 73)PhD in comparative literature and has taught at several universitiesReferred to local hospital for 90 days outpatient treatment (Psychiatric Day Treatment Program) to include OT services 3x a week.Rhonda is on SSI disability, and the hospital does not take her Medicaid insurance; her parents are paying out of pocket

Rhonda's HISTORYFirst became ill when a graduate student at Stanford, age 22Spent 3 months in mental hospital where she was diagnosed with depressionAfter leaving hospital, Rhonda had difficulty holding down a jobShe hit a period of drug and alcohol abuse( the alcohol temporarily killing the depression)After being pulled over for drinking and driving, Rhonda joined AA and has been sober for 10 years now. A few years later Rhonda began having additional symptomsHallucinations and delusionsVisualized dogs and cats that had been run over but not yet dead, and I had to work my way through them with my car I was certain I was being watched

Rhonda's HISTORYWhen symptoms continued, Rhonda saw a psychiatrist where she was put on thiothexineSymptoms gradually residedAfter finishing PhD, she went to teach at a university in South Dakota, but results were disastrousSymptoms, paranoia and delusions, returned after teaching one yearShe was put into local hospital for 5 weeksgrateful that I no longer had to stand in front of the students who terrified meRhonda withdrew from her job and returned to Denver to live at home with her parents.

Current Status Medication: Clozapine Main side effects: Weight gain, dizzinessQuestions strange thoughtsUnable to hold intricate conversations Doesnt seem to care about anything Anxiety triggers confusion Insight: I know the voices are wrong; I am not evil and I am not to blame for my illness, but I still feel guilty and depressed anyway.Rhonda would like to live on her own, but cannot afford it.Occupational competence scaleSection of the OPHI assessmentRhonda scored a 2 on all items of occupational competence scale2= some occupational dysfunctionAdditional evaluator notesclient has difficulty adjusting to stressclient has been persistent over time, but has difficulty sustaining effortclient states depression and cognitive issues have hindered her ability to participate in leisure activitiesclient has difficulty maintaining work routine, however she has been sober for 10 years and has adapted several adaptive coping strategies6Results of leisure checklistHer top 5 activities were:AA meetings, 12 step work; editing newsletter maybeNeedleworkGet a catGardenWriting(although this is also work)

5 activities she would like to do in near future:Go to a fairMake a friendTeach part-time( not leisure, but I want to work)Cant think of anything else7OBM: occupational Adaptation(oa)Rhonda is hyperstableRhonda uses existing modeRhonda uses primary energy

Our goal is for Rhonda to become more adaptive in her social skills and stress managementAs Rhonda becomes more adaptive, she will become more functionalFocus on Rhondas barriers to adaptation

OBM: occupational Adaptation(oa)9Frame of Reference: CBTCognitive Behavioral Therapy CBT is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors.By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping.Client is encouraged to challenge irrational beliefs and thoughts (delusions).Rhonda's GOALSIn order to improve productivity, client will learn stress management techniques in OT and report having used them at least once a week by the end of the 90 days/discharge.

Diaphragmatic Breathing & YogaStress can be a major trigger for people with schizophrenia, which can lead to relapse and rehospitalization.Rhondas anxiety and stress keep her from performing meaningful occupations of teaching and forming friendships. Incorporating stress management techniques into therapy and having the client determine ways to use them during different situations can help the client be able to generate adaptive responses to stressful situations in order to function more independently.If she is unable to generate times or situations where she can use these techniques, we will help her create a schedule and give her possible ideas. We will also give her resources for additional yoga classes and encourage her to use her strategies to attend these classes and socialize with others.Diaphragmatic breathing & YogaQuestions to ask during treatment (Motivational interviewing and CBT):When can you use diaphragmatic breathing?What time of day can you use yoga to decrease your stress?What situations would you find these strategies most effective?How can yoga direct you away from irrational thoughts (delusions)?What are the benefits of implementing diaphragmatic breathing or yoga into your daily routine? What are the costs of implementing diaphragmatic breathing or yoga into your daily routine?

nEEDLEWORKTo encourage rhythmic, repetitive motion to decrease stress.

Questions to ask during activity:How has your stress level changed during this activity?Where can you use this activity?How could you use this activity to interact with others?

NeedleworkBehavioral Activation Worksheet Record keeping and journaling depression, pleasure, and achievement levels before and after performing needle working activities.

Rhondas GoalIn order to improve social participation, client will have meaningful and personal interactions with friend for at least 10 minutes 3 times a week by the end of 90 days/discharge.

Role playingSkill- starting conversation with new personIntroduce self to person, HIChose topic to talk about or ask question Judge whether the other person is listening or wants to talk Know when is the appropriate time and place to begin conversationScenario examples: sitting at lunch with another person, volunteering with new person, meeting someone new at AA)How to know if a person is interested in conversation:Interpret tone of voiceAffectGestures 17Role playingStrategy to enhance role play=REBT self help form Questions to ask during activity:Think about a situation or conversation where you felt overwhelmed. How could you have used these skills to better handle the situation?How will you use these skills to initiate a conversation?How do you feel these skills will help you form friendships?What will be the most difficult part of interacting with others?

NAMIThe nations largest non profit grass roots mental health education advocacy and support organization dedicated to mental illnessThere are discussion groups and message boards for all 50 statesInformation about specific mental illnessesState chaptersPeer-to-Peer Support Groupshttps://www.nami.org19HUD Housing ProgramU.S. Department of Housing and Urban DevelopmentEstablishes to provide decent and safe rental housing for eligible low-income families, elderly, and persons with disabilitiesEligibility:Annual gross incomeU.S. citizen or eligible immigration statusIf meeting these requirements, public housing would then check references to make sure you will be a good tenantRhonda would benefit from HUD housing because it is a cheaper alternative for her to live independently