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A Case of Biopsychosocial Assessment

Research · March 2016

DOI: 10.13140/RG.2.1.4984.2325

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 Subject: Discussion post-week 06
A Case of Biopsychosocial Institution: Online University of Liverpool
Programme: Master of Mental Health & Clinical
Assessment Psychology
Date: August 2015
Place: Kilifi, Kenya

Key Words Abstract

Fear/ anxiety; Mr Berret was referred for treatment by Mrs Skin, a human resource manager of a
SB-syndrome; large cleaning service company. She mentioned that Mr Berret experienced recent
social- and professional interaction problems with both supervisors and colleagues.
Biopsychosocial;
Over a period of three months Mr Berret became unmanageable as a team member
Marginalization; due to hostilities between colleagues. Currently, Mr Berret has received a non-
Disability; active status and is on unpaid leave for three months but the company covers all
History; expenses for treatment.

Presentation of Complaint can pick up a pencil but chooses to write poorly

Mrs Skin reported that Mr Berret became more
and more introvert, distant in awareness and
extremely confused- and chaotic over a period of
three months. During the first two weeks, Mr
Berret would “vanish” from the work floor, only
to appear some time later in resuming his
activities with colleagues. The two weeks after,
Mr Berret would simply refuse to abide to a
work schedule by changing the company activity
chart and only accept tasks that were related to
one specific floor of a building that was under
contract by the company. The situation
completely deteriorated over the forthcoming
months wherein he refused to take the elevator
and ignored several company regulations,
including washing uniforms at home. Mrs Skin
put Mr Berret on non-active after security
reported that Mr. Berret managed to enter the
building with a duplicate of his own during off
days.
Demographic data
Mr Berret is 34 years old and single. He has no
girlfriend or children of his own and lives with
his grandfather in a two bedroom apartment. His
grandfather is supported by an old age pension
but – according to Mr Berret - seems in good
mental- and physical condition. Mr Berret was
diagnosed with hemiplegic cerebral palsy which
affected the right side of his body. He walks
with a slight limp, but has no difficulty in
climbing stairs or walking distances. He has
some limitations in the use of his right hand; he
with his left hand. He has some articulation
difficulties, although he can be understood. He
wears glasses for near-sightedness. His hearing
is normal. Mr Berret takes no medications and
was not earlier diagnosed for mental illnesses.
Demeanor and personal appearance
Mr Berret is of average height and build. Upon
his first visit, he wore clean company work
clothes, was well-shaven, representative and
well groomed. He carried a copy of an old- and
worn daily newspaper that was folded under his
arm. He smiled nervously, made brief eye
contact but did not extend his left hand when
introductions were exchanged. “It smells funny
here,” he whispered. During this first meeting,
he seemed friendly but openly scrutinized the
room with slight suspicion. When asked for
routine personal data, he took out his wallet and
retrieved an old folded piece of paper with his
details.
Client history
Mr Berret was raised by his grandfather and has
no siblings. Upon asking whether his parents
were still alive, he looked distant in my eyes and
simply answered, “They are not here. That is
how it is.” He has two elder cousins that live in
the city but never saw them. Mr Berret
completed high school and worked for the
company since he was sixteen years old. Upon
asking why he thinks he is having problems at
work, Mr Berret gave me the old newspaper and
murmured “Read this. Then you know
everything.” The article Mr Berret was referring
to reported on an incident that happened three
months ago where a 30 year old woman died
overnight after an asthma attack. Ms X was
accidentally left being locked in one of the
storage rooms without any medication. “You
know, I always bring flowers to her desk and
talk to her. I wanted to ask her to marry me. I
don’t want the others near her. Her desk
becomes the same when I clean that floor. I give
it flowers and put her picture frames back where
she liked them.” When I asked why he decided
not to use the elevator, he hesitated but finally
whispered with great concern “You know, there
is a problem with that building. That is why she
died. I have problems breathing as well you
know and look; I have rashes all over my body!”
He rolled up his sleeve and showed me the red
rashes that were opened up by his scratching. He
continued in the same whispering but sharp tone
“And I always have a splitting headache. I get
dizzy. Just by seeing or thinking of that building.
Even now, I tell you the truth!”
Client goals
Upon closing the first session, Mr Berret turned
very serious and asked “Can you please make
sure I keep my job when I promise to tell you
everything, everything I know about that
building? You see, I have to buy things for my
grandfather and need to be there for her!”
Diagnosis and Biopsychosocial treatment
Mr Berret is diagnosed with a mixed anxiety
depressive disorder. Mr Berret suffers from
depression under the loss of ms X and
impairment of his physical health. In addition,
Mr Berret is further diagnosed with obsessive-
compulsive disorder (OCD) due to distressing
recurrent obsessional ruminations and impulses
with rituals that impede social- and occupational
functioning (Baldwin, 2005).
On a closing note, there is significant reason to
suspect a presence of the sick building syndrome
and company management need to be informed
(Svanström, 1999). Through the five-factor
theory of personality, I assessed Mr Berret his
personality construct through: Extraversion,
Agreeableness, Conscientiousness, Neuroticism,
and Openness (McCrae & Costa, 1999, 140).
Treatment 01: Reductionism and psycho-
analytic therapy
Upon this first session we can conclude that Mr
Berret seems to cope with intellectual
disabilities and is experiencing ‘unwanted
thoughts‘ with a ‘vague awareness’ of the
problem. Due to cognitive limitations and
barriers of communication, a non-prescriptive
therapy is suggested by utilization of the Stiles
(2006) pan-theoretical model where clients are
given the opportunity to articulate their
experiences and assimilate at the ‘problem
statement’ level: Research found that the Stiles
(2006) psychodynamic model has been
particularly effective, especially by
psychotherapy treatment in adults with
intellectual disability (Newman and Beail, 2002,
2005).
Treatment 02: Oppressive compulsive
disorder (OCD)
Mr Berret is additionally suffering from
oppressive compulsive disorder (OCD) since he
lost ms X prior to his intention to ask her to
agree to a marital bond: He is experiencing
delusions and believes that he can talk to ms X
when he is sitting at her desk: He brings flowers
and arranges her desk to have the ‘right setting’
for his spiritual communication in order to
apologize to her (Nicholas, 2003). Exposure
therapy seems to be the best psychotherapeutic
intervention since cognitive therapy would bring
limitations on success due to Mr Berret his
intellectual disability (Exposure therapy, 2015).
Treatment 03: Sick building syndrome
(SBS)
There seems to be reason to further investigate
the possibility of exposure to the sick building
syndrome (SBS) since Mr Berret experiences
headache, breathing problems and rashes: He
claims that he thinks that the building is ‘sick’
and blames it for the death of his girlfriend. It
would be obligatory to inform the management
of the company to investigate Physical status,
ventilation, moisture tests, laboratory tests, x-
rays and other examinations are as a rule
normal: The sick building syndrome is a
combined bio-medical and psychosocial
pathology (Svanström, 1999).
Treatment plan
Since Mr Berret is diagnosed with multiple
disorders, a treatment plan should be carefully
planned. In our opinion, the treatment plan for
MR Berret should uphold a three-phase
intervention strategy.
Intervention phase 01(1-2 weeks): Due to the
fact that Br Berret does not seem to be aware of
his depressive- and compulsive behavior, he is
required to understand the nature of treatment.
The first and most crucial step is to undertake a
motivational interview through the concept of
self–determination theory (SDT) (Miller &
Rollnick, 2002, 25)
Intervention phase 02(4-8 weeks): Consecutive
to the motivational interview and upon
satisfactory completion, a ‘problem statement’
therapy should be taken in order for Mr Berret to
understand assimilation of the problem that
creates stress in his social- and occupational life
(Stiles, 2006): Due to the fact that Mr Berret
maintains compulsive mental- and physical
rituals, a request to company management
should be made in order for Mr Berret to
continue to ‘see’ ms X in order to avoid pharma-
treatment through Selective serotonin reuptake
inhibitors (SSRIs) (Baldwin, 2005). In the
occurrence of refusal to grant Mr Berret ‘visiting
hours’ to ms X, well founded argumentation
should be considered (a) Currently on leave and/
or (b) The management is ‘treating’ the building
for its sickness.
Intervention phase 03(10-20 weeks):
Although custom views by practitioners concern
that pharma-treatment for OCD might negatively
influence the positive impact of psychological
treatment, we believe that this is most likely
unfounded but do consent that a start-up
monitoring is essential (Lader and Bond, 1998).
We therefore suggest a combined treatment of
Pharma intervention and behavior therapy: We
believe that significant research supports acute
treatment of OCD through SSRI intervention
that is combined with cognitive- and exposure
therapies would accelerate the recovery process
of Mr Berret without a prolonging of distress
(Kobak et al., 1998).
Intervention phase 04(3-12 months): With
immediate effect and parallel to intervention
phase 01, Mr Berret needs to undertake a
medical examination to understand the nature of
his mental- and physical complaints: In addition,
the management of the company needs to
address a possible SBS identification and
collaborate on an intervention method where
personnel will be interviewed/ screened, plans of
buildings scrutinized, ventilation- and moisture
tests undertaken and hygiene laboratory tests
executed.
Social environmental concerns: Mr. Berret his
apartment should be visited and contact should
be made with his grandfather or relatives to see
whether he has anyone he can trust.

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