Manual Ncm 117 Lab (1)

MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca, Cagayan

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Website: www.mcnp.edu.phE-Mail Address: adminoffice@mcnp.edu.ph
COLLEGE OF NURSING
PERIOD: PRELIM
Self-Awareness Worksheet
Self-Awareness Worksheet
- Self-Awareness happens through reflection. You can have numerous experiences in your life,
but still lack self-awareness. You need to take the time to step outside of your experiences
and reflect on them.
- The key areas for self-awareness include our personality traits, personal values, emotions,
habits, and the psychological needs that motivate our behaviors
- Self-awareness and/or Self Discovery is about knowing and understanding:

your beliefs and principles
What you value and what is important to you
 what motivates you
your own emotions
your thinking patterns
your tendencies to react to certain situations
 what you want out of life
ACTIVITY:
1. Each student shall accomplish the “Self-assessment” work sheet and must submit it via LMS
2. The class will be divided into 3 groups and then the instructor will facilitate the sharing.
3. The students will be given a case analysis to assess how they would react with such situation
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SELF-AWARENESS CHECKLIST
Who am I?
I. Talents
a. What are your greatest talents or skills?
b. Which of your talents or skills gives you the greatest sense of pride or satisfaction?
c. Which of your talents or skills gives you the greatest sense of pride or satisfaction?
d. Which of your talents or skills gives you the greatest sense of pride or satisfaction?
II. TRAITS AND QUALITIES

a. What are your five greatest strengths?
1. _______________
2. _______________
3. _______________
4. _______________
5. _______________
b. What do you feel are your two biggest weaknesses?

1. _______________
2. _______________
c. What are your best qualities/characteristics?

1. _______________
2. _______________
d. What are your best qualities/characteristics?

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e. What qualities do you wish you had?
f. What qualities or traits do you most admire in others?
g. What behaviors, traits, or qualities do you want other people to admire in you?
III. VALUES
a. What are ten (10) things that are really important to you?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
b. What are the three most important things to you?

1.
2.
3.
c. Do you spend enough time on/with the things you most value? Why or why not?
d. What are the values that you hold most near to your heart?
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IV. PERCEPTION
a. How is the “public you” different from the “private you”?
b. What makes it hard to be yourself with others?
c. How are you trying to please others with the way you live your life?
d. What do you want people to think and say about you?
e. How do your behaviors and actions support what they think or say?
f. What do you least want people to think about you?
g. Is it more important to be like by others or to be yourself? Why?
h. Who are the people who allow you to feel fully yourself?
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i. What places allow you to feel fully yourself?
j. What activities allow you to feel fully yourself?
k. How do you want people to remember you when you are gone?
V. ACCOMPLISHMENTS
a. What three things are you most proud of in your life to date?
1.
2.
3.
b. What do you hope to achieve in life?
c. If you were to receive an award, what would you want that award to represent? Why?
d. If you could accomplish only one thing during the rest of your life, what would it be?
e. What do you believe you are here to accomplish or contribute to the world?
VI. REFLECTION
a. List three (3) things that you are:
1.
2.
3.
b. List three (3) things that you are not:
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1.
2.
3.
c. What is something that represents you? (e.g. song, animal, flower, poem, symbol, jewelry,
etc…) why?
d. What do you like best about yourself?
e. What do you like least about yourself?
f. What three things would you like to change most about yourself?
1.
2.
3.
g. Who are two people you most admire?

1.
2.
h. What do you admire about them?
i. What are five things you love to do?

1.
2.
3.
4.
5.
j. What matters to you most in my life?

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k. What makes you happy?
l. What are three things you believe you need in order to have a great life?
1.
2.
3.
m. Why are those things important to you?
n. What do you stand for (Principles)?
o. How do you want to impact the lives of others?
Finish the sentence

I do my best when...
I struggle when…
I am comfortable when…
I feel stress when…
I am courageous when...
One of the most important things I learned was...
I missed a great opportunity when...
One of my favorite memories is…
My toughest decisions involve...
Being myself is hard because…
I can be myself when…
I wish I was more….
I wish I could…
I wish I would regularly….
I wish I had…
I wish I knew…
I wish I felt…
I wish I saw…
I wish I thought…
Life should be about…
I am going to make my life about…
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Activity 2: JOHARI’S WINDOW
1. A participant selects a set number of adjectives from a list they feel best describe
themselves
2. The participant then selects, from the same set of adjectives, the characteristics that best
describe another person
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PERIOD: PRELIM
MENTAL STATUS EXAM
NAME: _________________________________________________________
Directions:
1. Read and analyze the given case scenarios.
2. Accomplish the checklist below based on the information given about the
patients
3. Put a check mark () for each sign/symptom manifested by the clients
based on the corresponding day of visit.
4. Students will get 1 point for each correct answer.
5. The total score shall be computed as follows:
#of correct answers – no. of incorrect/missed items = FINAL SCORE
6. Do not put anything under TOTAL column
Diagnostic category and time point
Schizophrenia Bipolar disorder

OCD (Ben)
(Karthik) (Robbin)
MSE component 1 2 3 1 2 3 1 2 3 TOTAL
SIGN OR SYMPTOM/
CRITERIA
Appearance, Behavior
and Cooperation
Grooming and hygiene

(abnormal)
Eye contact (abnormal)
Psychomotor retardation /
bradykinesia
Psychomotor activation /
akathisia
Physical proximity /
distance (abnormal)
Stereotypies or
mannerisms
Tics
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Tremor
Speech
Slowed/delayed
Prolonged latency to
response
Prosody (decreased)
Pressured
Thought Process A: Coherence
Circumstantial / tangential
Loosening of associations
Neologism
Word salad
Thought Process B: Speed
Mutism
Thought blocking
Racing thoughts
Flight of ideas
Thought Content A: Delusions
Paranoid
Of reference
Somatic
Grandiose
Of control
Thought Content B: Obsessions
Contamination /
environmental concerns
Somatic / illness
Aggressive / sexual /
forbidden thoughts / loss of
control
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Pathological doubting
Thought Content C: Compulsions
Cleaning / washing
Checking / seeking
reassurance
Ordering / organizing
Saving / Hoarding
Affect and Mood
Constricted range of affect,

flat
Anhedonic
Expansive range of affect,

wide
Inappropriate and/or labile

affect
Euphoric / hypomanic /
manic
Perceptions
Auditory hallucination
Visual hallucination /
illusion / misperception
Tactile hallucination
Responding to internal
stimuli
Suicidality
Suicidal ideation (active or

passive)
Homicidal ideation
Total
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CASE SCENARIOS
Karthik (Schizophrenia)
Name of Case: Karthik

Diagnosis: Chronic Schizophrenia Scenario
Activity: Mental status exam (MSE) video-based assessment tool
Initial visit (DAY 1): Karthik suffers from chronic schizophrenia, but currently is experiencing
minimal symptoms. He complains of a ‘noisy neighbor’ and asks the doctor to decrease his
medication, complaining that it makes him too tired. But states that “he is doing good overall.” It is
not readily apparent that there is anything substantially wrong with him – this could be a routine
concern over a neighbor.
DAY 2 (3 months later): Karthik states that “things are not as good as I would have hoped.” He has
a lot of “racing thoughts and can’t focus on anything.” He states that about a month ago he thought
someone was following him, but that he “is okay now.” Later in the conversation, he endorses
suspicion that his noisy neighbor is following him. These various symptoms (racing thoughts, lack of
concentration etc.) make the patient wonder if he should not have made medication changes after
all.
DAY 3 (4 months after initial visit): Karthik states that “everything has gotten worse since last
time.” He fears that his neighbor is poisoning his water supply (by accessing the water pipes in the
utility room of the building). The voices of his neighbor, and others, have gotten louder and are
bothering him more often (“all day and all night’’). These voices are telling him to jump off the roof.
He also complains of an inability to fall asleep and chronic shaking of his hand. Karthik regrets
lowering his medication.
Criteria/ Area Assessed Actual Findings
Patient appearance (e.g., DAY 1: groomed and well-dressed (jeans, white v-neck
disheveled, hospital gown, undershirt, black collared jacket).
business casual, casual) DAY 2: Slightly disheveled (messy hair, worn out grey t-shirt,
jeans)
DAY 3: Disheveled (messy hair, unwashed clothes, wearing a
hat and sunglasses, or headphones
Affect (e.g., pleasant, DAY 1: Flat with minimal facial movements, tense and tired but
cooperative) cooperative
DAY 2: Tense and avoids eye contact, slightly suspicious
DAY 3: Tense with poor eye contact and akathisia
Family group (e.g., who is family, Lives alone in a small apartment. He is the youngest of four (2
who they live with) brothers, one sister). Attends twice-a-month dinners with his
siblings and mother (who he is close with).
Education Sophomore in college

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Level of health literacy Adherent to his medication and doctor visits. Like many
patients suffering from psychosis, his insight into his condition
varies.
Employment, if any - present and Been employed in a work-study program at a natural foods
past, noting any current stresses store for the last year.
Home/homeless - type of Lives in an apartment (rented)

dwelling, number of stories,
owned or rented
Financial situation- any current Does not complain of any current financial stressors
stresses
Insurance Status (e.g.,
un/under/insured, public/private, Not specified
HMO/PPO)
Habits (i.e., diet, exercise, Not specified
caffeine, smoking, alcohol, drugs)
Activities (i.e., hobbies, sports, Karthik has acquaintances at work, where he is well liked, but
clubs, friends) has had no close friends or romantic attachments. He is
content keeping up with his siblings and mother.
Typical day - what is the usual Spends a lot of time at work and at his apartment. Does not
daily routine have many friends, but is close with his family. Keeps his days
pretty simple/routine in order to stay grounded in reality. Lately,
has been increasingly confused, experiencing perceptual
disturbances.
CASE INFORMATION
Chief Concern: The patient’s primary DAY 1: “I am doing okay. Things are going pretty well.”
reason for seeking medical care often (He suffers from chronic schizophrenia, but currently is
stated in his/own words. experiencing minimal symptoms. He complains of a
‘noisy neighbor’ and asks the doctor to decrease his
medication, complaining that it makes him too tired.
But states that “he is doing good overall.”)
DAY 2: “Things are not as good as I would have
hoped. Things are worse than last time. I wonder if I
should have not changed my medication after all.”
(He has a lot of “racing thoughts and can’t focus on
anything.” He states that about a month ago he
thought someone was following him, but that he “is
okay now.” Later in the conversation, he endorses
suspicion that his noisy neighbor is following him and
wants to evict him from the building. These various
symptoms (racing thoughts, lack of concentration etc.)
make the patient wonder if he should not have made
medication changes after all.)
DAY 3: “Everything has gotten worse since last time. I
think I should come down on my medication.”
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(Karthik worries that his neighbor is trying to poison
him. The voices he hears are becoming more intense
and frequent. They are telling him to jump off the roof
and are disturbing him. He regrets lowering his
medication.)
Additional Concerns: Other, if any, DAY 1: His main request is to decrease the dosage of
concerns the patient has today (i.e., his medication, complaining that it makes him too tired.
symptoms, requests, expectations, etc.) He also mentions having a noisy neighbor, but does
that will become part of set agenda. not ask for any help regarding that problem. Other than
those complaints, he is experiencing minimal
symptoms and feels that he is doing well.
DAY 2: He complains of racing thoughts and a lack of
concentration. He is concerned that his noisy neighbor
is following him and wants to evict him from the
building. He wonders if he should not have made a
medication change.
DAY 3: Karthik worries that his neighbor is trying to
poison him. The voices he hears are becoming more
intense and frequent. They are telling him to jump off
the roof and are disturbing him. He regrets lowering his
medication.
THE PATIENT STORY: The conversation between Karthik and his doctor takes
place at an outpatient clinic over three
visits/appointments. During his first visit (baseline,
DAY 1), Karthik present with ‘minimal symptoms’; he is
cooperative and in a good mood. During the second
visit, three months later (DAY 2), Karthik experiences
an exacerbation of his disease, presenting as anxious
and suspicious (i.e.: ‘medium symptoms’). He has
subtle paranoid thoughts, not immediately apparent,
and no hallucinations. He is trying to hide his thoughts
and feelings and shares only part of what he is going
through. His third visit takes place a month later (DAY
3), with Karthik experiencing ‘severe symptoms’,
including overtly paranoid thoughts and hallucinations.
First Visit (baseline, DAY 1): Karthik arrives at his

doctor’s office and states that he is “doing pretty well.”
He is looking forward to having his bi-monthly dinner
with his family, but prefers “to avoid other people.”
Karthik is happy with his current job at the health store:
“I don’t have to interact with too many people. I can
just make sure everything is on the shelf.” He does
complain of a noisy neighbor, who he “hears at all
hours of the night.” He endorses having “mood swings
here and there,” but states that it is mainly due to his
“annoying neighbor.” Karthik feels “good overall,” but
does request to have the dosage of his medication
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lowered. “It makes me so tired. It slows me down
during the day and I want to be at my best.” Overall,
Karthik displays a bit of a flat affect, his facial
movements are minimal and his blinking is reduced in
frequency, making his gaze seem like he is staring.
He also twirls his hair occasionally (slight mannerism).
Karthik is oriented to time and place, has insight into
his situation and has fair judgement.
DAY 2: Karthik arrives at his doctor’s office, 3 months

after their initial visit, and states that “things are not as
good as [he] would have hoped. They are worse than
last time.” He is disheveled (messy hair and dirty shirt),
displaying minimal eye contact, and psychomotor
retardation (his movements are slower than the first
visit). He complains of racing thoughts and an inability
to concentrate, which started “about a month ago.”
Karthik endorses suspicion that his neighbor is
following him around and trying to evict him from the
building: “My neighbor is still very annoying. I heard
him through the wall and I think he is trying to get rid of
me. I think he might be following me around.” The
therapist asks him why he thinks his neighbor is
following him and responds by saying that he saw his
neighbor standing over the staircase of their apartment
building, staring at him. He also endorses seeing his
neighbor at the store he works at, “right down the aisle
staring at me.” Moreover, Karthik thinks the neighbor is
spreading rumors about him. “He was talking to my
neighbor Marc and then the next day, Marc looked at
me like I did something wrong to him.” The therapist
than asks him again, “so you think he is following
you?” He responds, “it just makes sense.” Throughout
the conversation, Karthik has a prolonged latency to
response, decreased prosody and a general
delayed/slowed speech. During this visit, he expresses
paranoid delusions (i.e.: neighbor following him) and
ideas of reference (neighbor talking about him to other
tenants). Seeing his neighbor at his store and hearing
his neighbor through his walls can suggest auditory
and visual hallucinations. He is oriented to time and
place, but lacks insight into his situation.
DAY 3: Karthik arrives at his doctor’s office one month
after their last visit and states that “everything has
gotten worse since last time.” He arrives disheveled,
with messy hair and dirty clothing, wearing a wool hat
and sunglasses. When he is asked to take his
sunglasses off he responds, “are we alone here?” He
then looks around the room, as if he is suspicious of
his surroundings and is internally preoccupied. He
displays bradykinesia (slowness of movements;
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latency to respond to questions) as well as akathisia
(involuntary movements, restlessness, discomfort in
his chair (i.e.: in being in ‘his own skin). Shortly after
he endorses fear that his neighbor is trying to poison
his water supply (by accessing the water pipes in the
utility room of the building). Throughout the
conversation he displays loose associations and
tangential speech, as well as at least one neologism:
“The utility room where the water pipes are is the
‘pupility’ room, not the popularity room.” Moreover,
Karthik’s auditory hallucinations become more frequent
and more disturbing. “Sometimes I can hear a lot of
them talking, sometimes all the way down in the
basement.” He begins to develop suicidal ideation,
hearing voices telling him to kill himself. “I’m hearing
voices all day. Sometimes they tell me to jump off the
roof, but I don’t do that.” His delusions of paranoia and
delusions of reference strengthen as well (he is now
fully convinced that his neighbor wants to kill him).
Karthik’s symptoms have become severe; he is no
longer in touch with reality.
Robbin (Bipolar Disorder)
Name of Case: Robbin

Diagnosis: Bipolar Disorder Scenario
Chief Complaint:
Initial Visit: Her partner Lucas left her a few weeks ago and she has been feeling tired and gloomy since.
She usually sleeps 16 hours a day and having trouble going to work due to a lack of motivation.
DAY 2: (a few weeks later): Robbin feels that she is doing better and going to work, but feels like she “is just
going through the motions.” She is sleeping less but still feels tired all the time. She also feels guilty that she is
not doing enough for her daughter Carla. “I am not doing what I am supposed to be doing as a parent and it is
not fair to her.” Robbin is worried that her inability to be happy makes her a bad mother. She also manifests
passive suicidal ideation, stating that she would not go through with it because of her daughter, but that she
has had “thoughts.”
DAY 3: Robbin has no current complaints, stating that she “feels great.” She is in a rush to get back to work
and wants the doctor to hurry up and finish the patient visit.

Patient appearance (e.g., Initial Visit: Slightly disheveled and dressed too casually (grey
disheveled, hospital gown, business sweatshirt with her hood on, jeans, and a scarf).
casual, casual) DAY 2: Groomed and well-dressed (grey long sleeve Henley and blue
jeans).
DAY 3: Abnormal appearance (wearing a lot of makeup, a bright
multi-colored button- down shirt, a tie, and colorful plastic hair clips in
her hair)
Affect (e.g., pleasant, cooperative) INITIAL VISIT: Flat, with psychomotor retardation, but pleasant and
cooperative
DAY 2: Constricted range of affect and anhedonic, but pleasant and
cooperative
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DAY 3: Labile with an expansive affect (irritable, euphoric, and
sexually inappropriate).
Family group (e.g., who is family, Her partner (Lucas) recently left. She lives with her daughter Carla
who they live with) (age 16).
Education Law School Graduate

Level of health literacy Adherent to her medication and doctor visits. Like many patients
suffering from bipolar disorder, her insight into her condition varies.
Employment, if any - present and Works as a public attorney and is generally successful, but missed a
past, noting any current stresses few days due to fatigue/anhedonia.
Home/homeless - type of dwelling, Not specified

number of stories, owned or rented
Financial situation- any current None
stresses
HMO/PPO)
Habits (i.e., diet, exercise, caffeine, Not specified
smoking, alcohol, drugs)
Activities (i.e., hobbies, sports, clubs, Robbin has been too tired and depressed to attend social gatherings
friends) or to partake in her hobbies. She is very close with her daughter, but
can rely on her too much at times.
Typical day - what is the usual daily Robbin works as an attorney at a law firm. After work, she comes
routine home and tries to spend time with her daughter. Lately she feels as
though she is “just going through the motions.” She goes to work
most of the time, but spends most of her free time in bed sleeping.
CASE INFORMATION
Chief Concern: The patient’s primary reason INITIAL VISIT: “I’m doing okay, tired.”
for seeking medical care often stated in (Her partner Lucas left her a few weeks ago and she has
his/own words. been feeling tired and sad since. She endorses sleeping up
to 16 hours a day and having trouble going to work due to a
lack of motivation).
DAY 2: “I’m doing better. I’m going to work, but just feel like I
am going through the motions”
(Robbin has enough energy to go to work, but still “feels
tired all the time.” She is also worried about her daughter
Carla. “I am not doing what I am supposed to be doing as a
parent and it is not fair to her.”)
DAY 3: “I’m doing great! Let’s go, I gotta get out of here,
let’s get out of here!”
(Robbin has no current complaints, stating that she feels
great. She is in a rush to get back to work and wants the
doctor to hurry up and finish the patient visit.)
Additional Concerns: Other, if any, concerns INITIAL VISIT: Robbin feels sad and tired and wants to find
the patient has today (i.e., symptoms, a way to feel better. She has trouble going to work, lacking
requests, expectations, etc.) that will become motivation to get out of bed, and asks the doctor for help.
part of set agenda. DAY 2: Robbin has enough energy to go to work, but finds
that most things are no longer enjoyable. “I am just going
through the motions.” “I’m doing what I need to do, but it is
just not fun anymore.” She is worried that her inability to be
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happy makes her a bad mother. Robbin also endorses
passive suicidal ideation, stating that she would not go
through with it because of her daughter, but that she has
had “thoughts.”
DAY 3: Robbin’s only current complaint is that she needs
her current visit to wrap up because she needs to get back
to work. She has a lot of things to do and cannot be
bothered.
THE PATIENT STORY: The conversation between Robbin and her doctor takes
place at an outpatient clinic over three visits/appointments.
During her first visit (baseline, INITIAL VISIT), Robbin
presents mainly with ‘depressive symptoms’; she is
anhedonic, sad, and lacks motivation. She is prescribed an
SSRI and beings treatment. During the second visit, a few
weeks later (DAY 2), Robbin has a bit more energy, but
continues feeling anhedonic and sad. She now endorses
passive suicidal ideation. Her third visit takes place a few
weeks after her second visit (DAY 3), with Robbin
experiencing ‘manic symptoms’, including racing thoughts,
lack of need for sleep, and grandiosity.
First Visit (baseline, INITIAL VISIT): Robbin arrives at her

doctor’s office and is not engaging with her therapist; she is
slightly disheveled, wearing sweatpants and a hood over her
head, and is lacking eye contact). The therapist asks her
how she is feeling a few times before she finally responds,
stating that she is “constantly tired and sad,” sleeping 12 to
16 hours a day. When asked about what is making her sad,
she states her partner, Lucas, left a few weeks ago (i.e.:
they split up). Throughout the conversation she continues to
state that she is tired, displaying psychomotor retardation,
anhedonia, and a slow/delayed speech. She rarely expands
on the therapist’s questions, answering with a few words
each time. Robbin endorses missing work the last few days,
due to a lack of motivation and “feeling tired.” The therapist
then asks her if she has “any thoughts of harming herself.”
She denies any suicidality, stating that she “just misses her
[Lucas].” The therapist asks Robbin about her daughter:
“She is at home. She cooks for me and cuddles me in bed.”
The conversation abruptly ends here. Throughout the visit,
Robbin displays a constricted/flat affect, rarely opening up.
While it is not stated explicitly in the video, Robbin begins
taking an SSRI (Zoloft) after this visit.
DAY 2: Robbin arrives at her doctor’s office a few weeks

after their initial visit, and states that “[she’s] better and
going to work.” The therapist then asks, “you are going to
work, but how do you feel?” Robbin responds, “I am going
through the motions. I’m tired. I’m not sleeping as much as I
was, but I’m still tired.” While Robbin seems a bit distressed,
she is no longer disheveled, she is making good eye
contact, and seems to be a bit more conversational (i.e.: no
psychomotor retardation). Robbin then expands on what is
bothering her: “I am worried about Carla. I’m not doing what
I am supposed to be doing as a parent. It is not fair to her.
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I’m just not right. I feel off. I miss having fun with my
daughter.” Robbin once again displays anhedonia and a
flat/constricted affect. Although she is going to work, she
worries that she will be fired. “They know about my
condition, but I am not sure how long they will put up with it.”
Later in the conversation she brings up her daughter again:
“I need to be mom and I don’t feel like mom.” The therapist
follows up by asking if “she has had any thoughts of hurting
herself.” “No, because of Carla. But I have thought a few
times of not being here because there is nothing here for
me.” Robbin is endorsing passive suicidal ideation, but has
her daughter as a protective factor. She goes on to say “It is
not fun. I’m saying that a lot. I just feel flat.” It has been a
few weeks since starting the SSRI, and while Robbin has
more energy to go work, she also seems to have more
energy to think more deeply about what has been bothering
her. Unlike her first visit (before the SSRI), she feels guilty
about being a bad mother and endorses suicidal ideation.
While the SSRI is making her more functional, it is also
putting her at greater risk of harming herself (i.e.: she has
the physical energy to do so).
DAY 3: Robbin arrives at her doctor’s office a few weeks

after their last visit and states emphatically that she “is
feeling great!” She is abnormally dressed (wearing a lot of
makeup, a bright multi-colored button-down shirt, a tie, and
colorful plastic hair clips in her hair). She also displays
abnormal eye contact, staring intensely at the therapist
throughout the conversation. After stating that she is doing
great, she right away gets agitated. “Yeah, yeah, let’s go! I
gotta get out of here. Let’s get out of here.” Throughout the
conversation she displays akathisia/psychomotor activation,
hoping to quickly finish the visit and head back to work. She
is very euphoric/manic and displays grandiose delusions:
“I’m a very important person. If you look up the word
attorney in the dictionary it shows my face and says the
most awesome attorney on the planet.” The therapist then
asks her if “she is going to go to work looking like that.” She
responds, “of course, I look fantastic. You know how great I
look!” Immediately after this response, Robbin gets agitated
and shouts “you’re aggravating me now because you asked
me this before!” Robbin’s mood is very labile throughout the
conversation, going from euphoric to agitated. She also
displays pressured speech, loosening of associations, and a
tangential/circumstantial thought process. During the
conversation she randomly interjects with off topic
comments: “Do you know GE has the best appliances. I use
ammonia on the floor, not the store bought stuff. It makes
the floors pristine.” Robbin also endorses a decreased need
for sleep and distractibility. “Sleep? Who needs sleep when
you are the #1 attorney in the world….oh yeah and the
cabinets.” As the conversation continues, Robbin begins to
be sexually inappropriate towards the therapist and gets too
physically close to him (abnormal physical proximity).
“You’re very nosy! But you’re really cute too, more cute than
nosy.” At this point, she is out of her chair and in his face.
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The therapist kindly asks her to go back to her seat, stating
that “this is not appropriate.” Robbin listens and sits back
down, but then continues with her mood lability,
distractibility, and sexual inappropriateness: “You’re pissing
me off, but you’re awfully cute in those cute littles shoes.
What are you doing tonight? Take me out for a drink and I’ll
forget all the things you are not doing right Doc!... I need to
make steak tonight.” It seems as though the SSRI caused
Robbin to switch into mania. The therapist needs to decide
what he will do next (i.e.: stop the SSRI, possible
hospitalization).
Attitude (what does the patient think is the INITIAL VISIT: Robbin feels sad, depressed, and tired since
problem, and how does he/she feel about it) her partner left. She seems to attribute some of the way she
feels towards this external stressor, but she does not open
up/express much during the visit.
DAY 2: Unlike in her initial visit, Robbin seems a bit more
curious and contemplative regarding the issues that are
causing her depression. While she is still sad over her
partner leaving, she also wonders if she is a good mom and
how her depression is affecting her daughter. She is also
more expressive about her anhedonia, stating that she is
“just going through the motions.” She even endorses
passive suicidal ideation during this visit. It seems as though
Robbin is more aware of her depressed feelings and where
they may be coming from.
DAY 3: Robbin’s only current complaint is that she needs
her current visit to wrap up because she needs to get back
to work. She has a lot of things to do and cannot be
bothered. From a clinician’s point of view, she has switched
into mania (possibly due to the SSRIs), which began after
her last visit (a few weeks ago). She does endorse racing
thoughts and a decreased need for sleep, but thinks she is
“doing great.”
Ben (Obsessive Compulsive Disorder)
Name of Case: Ben

Clinical Diagnosis: Obsessive Compulsive Disorder (OCD) Scenario
Chief Complaint: At his initial visit (INITIAL VISIT): Ben is concerned that he will get ill due to environmental,
food, and household contaminants. He also fears that others will have accidents unless things are in the right
place (fears traffic signals are not up-to-date). Reports that the degree of occupation with the thoughts during
the day is ‘relatively low’ and that ‘it’s all under control”
Second visit Day 2 : Ben is becoming more preoccupied with the possible health issues caused from the
food/beverage contaminants. He is spending a lot of his time researching these contaminants and it is causing
him to be late to work. He begins to develop somatic obsessions, worried that he has kidney and liver failure
from the chemicals in commercial foods. He does not feel balanced or in control. He hopes the therapist can
refer him for a physical workup.
Third visit Day 3: Ben endorses feeling even less stable and in control than in his previous visit. He has
avoided going to work out of fear of saying something inappropriate and has missed deadlines due to
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compulsive cleaning of his office. Ben is suffering from stomach pain and is now convinced that he has a
tumor in his stomach. He asks the therapist to refer him for an MRI or PET scan, convinced that he has a
malignant tumor. Moreover, he is afraid that his wife never loved him and believes that her lack of love,
combined with the contaminants, have caused this tumor.

Patient appearance (e.g., INITIAL VISIT and DAY 2: Business casual (dress pants and button-
disheveled, hospital gown, business down)
casual, casual) DAY 3: Casual (Khaki pants and long -sleeve shirt)
Affect (e.g., pleasant, cooperative) Euthymic, pleasant and cooperative
Family group (e.g., who is family, Lives with his wife Laura and two children (Ben Jr., 14 Sarah; 8)
who they live with)
Level of health literacy Knowledgeable about his psychiatric condition and adherent to
medication and routine visits
Employment Works as an engineer, often at different construction sites. He is in
charge of making sure that all the building codes are up to date. He
worries that the buildings he is working in are unsafe (constantly
checking the building codes). He also misses various deadlines at his
job due to his inability to get his work done (spending his time
compulsively cleaning his office). In addition, he is worried of
offending female coworkers by “saying something inappropriate,”
which makes him avoidant at the office.
Home/homeless - type of dwelling, Not specified

number of stories, owned or rented
Financial situation- any current No current financial stressors
stresses
HMO/PPO)
Habits (i.e., diet, exercise, caffeine,
smoking, alcohol, drugs) Very aware of ‘anything I put in my body’; reads food labels carefully
Activities (i.e., hobbies, sports, clubs,
friends) Not specified
Typical day - what is the usual daily
routine Conscientious and timely worker, but his increasing preoccupations
have more recently made him arrive late on more than on occasion:
very unusual for him, and a further source of embarrassment and
anxiety.
CASE INFORMATION
Chief Concern: The patient’s primary reason INITIAL VISIT: “I am feeling good lately. Everything is under
for seeking medical care often stated in control. I am just here for a routine visit.”
his/own words. (He has a history of OCD, but currently has minimal
concerns regarding his level of functioning. He watches
what he eats and stays away from certain chemicals, fearing
that they could lead to cancer or Alzheimer’s, but he has
been this meticulous for many years.)
DAY 2: “I don’t feel so good. I definitely had a relapse. I
don’t feel balanced. A lot of my worries have gotten worse. I
am having trouble controlling everything.”
(He is worried about the contaminants in his seltzer/food
and believes that it is has caused him kidney damage. He
also has been second guessing himself at work because he
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feels the buildings are not safe/up to code.)
DAY 3: “Everything has gotten worse. I don’t feel stable. I
don’t feel like I have control. I have not been able to go to
work lately. I have a tumor inside my stomach, I need an
MRI or PET scan”
(He is now convinced that he has developed a tumor in his
stomach from all the contaminants. He also worries that his
wife never loved him and just settled for him. He is
beginning to avoid going to work altogether).
Additional Concerns: Other, if any, concerns INITIAL VISIT: He has concerns regarding environmental,
the patient has today (i.e., symptoms, food, and household contaminants but states that his degree
requests, expectations, etc.) that will become of occupation is ‘relatively low.’ He is concerned that the
part of set agenda. traffic lights on his way to work are ‘screwed up’, so he waits
a few extra seconds at the traffic before proceeding. These
thoughts/concerns are not interfering with his daily
responsibilities and he feels stable.
DAY 2: He is worried about the contaminants in his
seltzer/food and believes that it is has caused him kidney
damage. He is feeling bloated, nauseous, and complains of
burning when he urinates. He asks the therapist to refer him
for further work up. He also has been second guessing
himself at work because he feels the buildings are not
safe/up to code.
DAY 3: He is now convinced that he has developed a tumor
in his stomach from all the contaminants. He also worries
that his wife never loved him and just settled for him. He is
beginning to avoid going to work altogether. His main
request is for the therapist to refer him for a PET or ‘whole-
body CT’ scan.
THE PATIENT STORY: The conversations between Ben and his doctor take place at
an outpatient clinic over three visits/appointments. During
his first visit (baseline, INITIAL VISIT), Ben presents with
‘minimal symptoms’ and is not too concerned regarding his
level of functioning. His second visit takes places three
months later (DAY 2), where Ben experiences an
exacerbation of his disorder; he presents as anxious and
worried (i.e.: ‘medium symptoms’). The third visit takes place
one month later (DAY 3), with Ben displaying ‘severe
symptoms’, including somatic delusions.
First Visit (baseline, INITIAL VISIT): Ben arrives at his

doctor’s office and begins by sharing some good news
regarding a possible promotion at work. He seems a bit
nervous about the increase in responsibility, but overall
states that the promotion would be a “good thing.” When
asked about his current symptoms, Ben states that he feels
stable: “My hands are good. I’m not chaffed, I’m not raw. I
have it pretty under control.” He does endorse a few
symptoms which he describes as “the usual stuff.” These
include being careful with what he eats, such as avoiding
phthalates, since “they can cause cancer and are linked to
Alzheimer’s.” He also states that the traffic lights on his way
to work are “totally screwed up” and that “it is an accident
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waiting to happen.” Therefore, in order to avoid getting into
an accident, he waits “an extra 10 seconds once the light
turns green” before proceeding. But he describes these
symptoms/actions as the “usual stuff, nothing [he] can’t deal
with.” In addition, he seems content with his marriage,
stating that things with his wife are going well. He mentions
that his son just turned 14, which is the age when he first
experienced his symptoms. He endorses “watching [his son]
more intently,” looking for symptoms, but states that “so far
he is a normal 14-year-old boy.” Ben does display neck and
eye tics throughout the conversation (excessively blinking
and tilting his head towards his shoulders), but all his other
previous symptoms seem to be under control (i.e.:
excessive handwashing etc.). Even his concerns regarding
his diet and the traffic lights, while present, have not affected
his day to day functioning (i.e.: he still goes to work and is
succeeding). Overall, Ben is pleasant and cooperative
throughout the interview, displays minimal symptoms, and
seems content at work and at home.
Second Visit (DAY 2): Ben arrives for a second visit 3

months later. When asked how he is doing he states “not so
good, I definitely had a relapse. I don’t feel balanced. A lot of
my worries have gotten worse. I’m having trouble controlling
everything.” He is then asked what he is trying to control and
states that he recently found out that the seltzer he has
been drinking daily is contaminated with chemicals that can
“cause kidney failure and possibly cancer.” He seems
convinced that he suffered some kidney damage from this
contamination, “I just know it has affected my kidney and
liver. I have to pee more often and it burns. I need a work
up.” Here, Ben is displaying pathological obsessions
regarding contamination (i.e.: chemicals in the seltzer) and
somatic illness (kidney failure). Although he fears being ill,
he is not certain that he is sick; he is still displaying some
self-questioning and doubt about his physical symptoms,
these are still obsessions and have not yet turned into overt
delusions. As the conversation progresses, Ben endorses
spending an excessive amount of time online, researching
the ill effects of the chemicals he ingested, which was
causing him to be late for work. In addition, when he does
get to work, he constantly checks the buildings he is going
into, believing that they are not up to code. “I am constantly
second-guessing going into the buildings. I do not feel safe
in them.” Ben’s compulsive checking of these buildings, as
well as his internet searches regarding the chemicals, are
affecting his day-to-day functioning and are no longer just
obsessions. Overall, Ben seems agitated and anxious
throughout the visit. He displays akathisia, uneasily sitting in
his chair, and has neck and eye tics throughout the
conversation. While he is not displaying any delusions or
psychotic features, his obsessions have turned into
pathological doubting and led to compulsions in the form of
repeated checking, organizing, and ordering and reordering.
His symptoms are affecting his ability to function and are
causing him a lot of anxiety and distress.
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Third Visit (DAY 3): Ben comes for an appointment one

month after his last visit. On initial appearance, it is apparent
that his akathisia is worse than before (he is anxiously
moving his right foot up and down and is nervously wringing
his hands). In addition, his grooming and hygiene are
inappropriate (messy hair, wrinkled shirt, etc.) and he is
displaying more prominent neck and eye tics. He states that
he is not feeling good; “Everything has gotten worse. I don’t
feel stable and I don’t feel like I have control.” He further
explains that he has not been able to go to work lately, after
missing deadlines due to his constant compulsive cleaning
of his desk and computer. Moreover, he is afraid of
interacting with female coworkers out of fear that he will say
something inappropriate (an obsession in the form of
sexual/forbidden thoughts). Ben’s current symptoms/actions
seem to be affecting his marriage as well. He endorses
“driving [his wife] crazy” and begins to wonder if she was
ever in love with him. “She did not want to kiss me on the
first date. She probably never loved me and just settled for
me.” As the conversation continues, Ben’s speech becomes
pressured as he complains of having bloating and nausea,
due to a tumor in his stomach. He asks the therapist to
schedule further workup (PET scan, ‘whole-body CT scan’).
The therapist follows this statement by asking if these
symptoms may be from the anxiety he is experiencing. Ben
denies any possibility that it is from anxiety and is fully
convinced that he has a tumor. “This is above and beyond
anxiety. It is a tumor and it is probably malignant.” He
believes that the tumor was caused by the contaminated
beverage and his insecurities with his wife, stating that “they
are probably connected.” Ben’s
contamination/environmental obsessions as well as his
somatic obsessions have turned into somatic delusions (i.e.:
he is not merely worried; he is certain that he has a tumor).
Overall, Ben’s symptoms have become very severe. He can
longer function at work and he is beginning to frustrate his
wife/family. His obsessions are turning into delusions and he
is fully preoccupied with these thoughts.
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PERIOD: MIDTERM
Establishing Therapeutic Nurse-Patient Relationship
Activity: Recorded NPI with Process Recording
Case scenario 1:
Susan B, a 35-year-old woman came to the hospital for an out-patient breast biopsy. The nurse
noticed that while Susan waits in the room with her husband, she obviously appears nervous –
staring unblinking at the wall, tapping her feet and wringing a tissue in her hand. The nurse is
aware that the patient is a known case of Generalized Anxiety Disorder and is being treated with
benzodiazepines.
Case Scenario 2:
Marietta was a 43-year-old married security guard who came for a consultation at CVMC –
Department of Behavioral Medicine with a long history of depression. She described being depressed
for a month since she began a new job. She had concerns that her new boss thought her work was
poor and slow, and that she was not friendly. She had no energy or enthusiasm at home. Instead of
playing with her children or talking to her husband, she watched TV for hours, overate and slept
long hours. She gained six pounds in just three weeks, which made her feel even worse about
herself. She cried many times through the week, which she reported as a sign that “the depression
was back.” She also thought often of death but had never attempted suicide.
Case Scenario 3:
Mr. K is a 39 year old single (never married, no children) male who experienced his first symptoms
of mental illness in 2010, 11 years ago. He was living in the province at the time and sought
treatment at his local hospital. At this time he reported having feelings of déjà vu experiences off
and on for the past two years and these experiences were intensifying. He received some
medications (Haloperidol) in the emergency room but was not admitted. He had completed college
and had worked full-time ever since. Back then, Mr. K was employed full-time in an occupation that
required him to travel from different provinces. Mr. K reported that he smoked marijuana once per
week and drank alcohol occasionally. In June of 2021, at the age of 30, Mr. K was hospitalized for 6
days in his home town. At this time he was experiencing delusions, paranoia and isolation. Examples
of his delusions included the following:
 beliefs that the television was sending him messages;
 belief that mythological creatures were trying to entice him to battle;
 belief that a celebrity on TV wanted to marry him;
 Misinterpretation of numbers to indicate that he was GOD.
Guidelines:
1. Each student will submit a recorded video of the Nurse-patient interaction

2. The video must contain the three phases of the NPR
3. The student must consistently apply therapeutic communication throughout the NPI
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4. The student must come with their own script based on the given scenario
5. Identify the priority nursing diagnosis based on the given scenario
6. The video must be at least 6 mins in duration
7. The NPI must be transcribed using the format for process recording
Date and Time of NPI: Case Scenario

Patient’s Response Nurse’s Response Therapeu Analysis and
tic Evaluation
Verbal Non- Verbal Non- Commun
Respons verbal Response verbal ication
e respons respon Techniqu
e se e
Ex: open “Ok lang.” (nods, Giving This is the
“Magandan posture smiles a recognition Orientation Phase so
it is important that I
g araw Mr. , little but • Offering
establish rapport and
J, ako po walking avoids self a trusting
si , eye •Rapport relationship with my
nurse smiling contact) building client.
James, at ) •Giv
ako ing Greeting the client
info by name shows that
makakasam
you acknowledge the
a nyo sa rma patient as an
araw na tion individual, and by
responding proves
ito. that he knows his
kamust own name and is
oriented with what’s
a ka?”
happening at the
( moment. I feel that
my Patient
responded rather
shyly
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NPR – Process recording
1. Appearance and setting

a. 3 – includes full description of appearance and setting/environment (client’s
details; description of environment, position of the nurse and client, presence of
other people and distractions)
b. 2 – provides some description of the above
c. 1 – very limited information
2. Professional Goal
a. 3- clearly stated and defined; priority nursing diagnosis is relevant, timely and
mutually agreed upon
b. 2- goal is clearly stated and defined; nursing diagnosis is not considered as
priority
c. 1 – goal is not stated and defined; nursing diagnosis is irrelevant
3. Content and completeness

a. 3 – all phases of the NPI including tasks are complete and approprite
b. 2 – phases are somehow complete with some missing tasks
c. 1 – incomplete phases and tasks are not inappropriate
4. Therapeutic Communication (Patient)

a. 3- records both verbal and non-verbal communication; direct quotes are used for
all statements; has at least 10 interchanges recorded from the client for each
phase of the NPI
b. 2 – records verbal and non-verbal response; has at least 5-7 interchanges
c. 1 – omits behavioral communication with less than 5 interchanges
5. Therapeutic Communication (Nurse)

a. 3- records both verbal and non-verbal communication; direct quotes are used for
all statements; has at least 10 interchanges recorded from the client for each
phase of the NPI
b. 2 – records verbal and non-verbal response; has at least 5-7 interchanges
c. 1 – omits behavioral communication with less than 5 interchanges
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6. Self-awareness
a. 3- records thoughts and feelings for each interchange
b. 2- records thoughts and feeling for 80% or greater
c. 1 – records thoughts and feelings for less than 80 %
7. Nurse’s Self-evaluation
a. 3 – for each interchange, the student identifies communication skills or blocks
used. Identifies correct therapeutic communication technique and its
corresponding rationale
b. 2 – Omits the above for 1-2 interchanges
c. 1 – does not provide appropriate communication strategy
Rubric for Video Demonstration
Category 4 - exemplary 3 proficient 2 partially 1 incomplete

proficient
Concept and Has a clear Has a fairly clear There is no clear Limited effort
completeness of picture of what picture of what focus in each of spent; focus is
phases they are trying to they are trying the phases; goals not defined and
achieve. There is to achieve. are not clearly irrelevant;
an adequate Provided defined; incomplete
description of the description on incomplete phases with no
phases of NPI. most of the phases with descriptions
All phases are phases some description provided
present
Content and the content has There is a clear The content does The video lacks
organization clear statement statement of the not clearly content and
of the purpose of purpose; most present the focus. The
the video of the details are purpose of the overall message
presentation; logical and video; some is irrelevant and
there is a variety persuasive; messages and inappropriate
of supporting most messages information are
information in are relevant and vague and
the video accurate irrelevant
presented;
messages are
well conveyed
and appropriate
to the scenario
Quality The presentation Video is Video lacks 1 or Video lacks most
is complete and complete. The 2 elements. of the elements
had all required transition is Transition needs required.
elements. The somehow further Transition is poor
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video transition is smooth improvement
smooth.
timeliness The video was Video was The video was The video was
submitted on submitted a day submitted 2 days submitted 3 days
time after the set after the after the
deadline deadline deadline
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Date and Time of NPI:
Patient’s Response Nurse’s Response Therapeu Analysis and
tic Evaluation
Verbal Non- Verbal Non- Commun
Respons verbal Response verbal ication
e respons respon Techniqu
e se e
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SEMI-FINAL WORKSHEET
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TOPIC: PSYCHOTHERAPY
General Instructions:
1. Divide the class into 4 groups.
2. Each group must select one case from the scenarios given
3. The group should must plan for appropriate psychotherapies for the patient
4. Accomplish a session design (see attached document for sample template)
5. Students must present how they will be able to apply the identified psychotherapies
Scenario 1: A CASE OF AGORAPHOBIA
Patient E. L had intense fear of falling and dying, along with fears of losing consciousness; not
to be found in time; and might be buried alive. She had been home bound for the last 17 years.
She had a fear that something bad will happen, if she will go out of her apartment. She stayed
mostly in her bed, and did not even allow her husband to leave the apartment. She believed,
that she might get hurt or buried alive if she leaves the safety of her bed. She also believed that
she might not be found in time, should something bad happen to her. The patient was quite
fearful of dying, thinking she may go to hell, although she could not describe anything that would
make her deserve that fate. When her brother died in 2002, she managed to go to the hospital
but did not want to go to his room to see him. Her niece reported that in the 1990s, when the
patient’s husband was working, she couldn’t tolerate being home alone. It was unclear if the
patient met the criteria for Panic disorder; however, her niece also reported she may sometimes
have panic like symptoms. These include shortness of breath; tightness in her chest; palpitation;
sweaty hands; tremors and sudden jolts of fear of dying. Her brother would pick her up and she
would stay all day with his family until her husband returned from work to pick her up at the
same time every day. Over the years, her condition worsened to a point where she even
refused to step out of her apartment. As the time progressed, so did her agoraphobia,
eventually forcing her to be confined to the corners of her bed. She was then provided with
services such as a bedpan and sponge baths.
In 2015, during the month of July, Mrs. E. L called her husband, who was in the next room, like
any other day. But this time she did not get a response from him. She immediately started
having bad thoughts and ideas of what could have happened to him; so she called the police.
This all took place from her bed. Instead of going to check up on his whereabouts in their own
home, the agoraphobia took a drastic turn, which clouded her rational decision-making in the
most critical time.
The safety of her husband was jeopardized, yet she still could not leave her cloister of safety
and comfort. Mrs. E. L denied feelings of depression, hopelessness and worthlessness. She
also denied loss of concentration. She had no leisure activities and simply lied in bed. She did
not listen to the radio or watch TV. She denied symptoms of mania or psychosis and also
denied suicidal or homicidal ideation.
Case scenario 2: A CASE OF SCHIZOPHRENIA

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Mr. K is a 39 year old single (never married, no children) male who experienced his first
symptoms of mental illness in 2010, 11 years ago. He was living in the province at the time and
sought treatment at his local hospital. At this time he reported having feelings of déjà vu
experiences off and on for the past two years and these experiences were intensifying. He
received some medications (Haloperidol) in the emergency room but was not admitted. He had
completed college and had worked full-time ever since. Back then, Mr. K was employed full-
time in an occupation that required him to travel from different provinces. Mr. K reported that
he smoked marijuana once per week and drank alcohol occasionally. In June of 2012, at the
age of 30, Mr. K was hospitalized for 6 days in his home town. At this time he was experiencing
delusions, paranoia and isolation. Examples of his delusions included the following:
 beliefs that the television was sending him messages;
 belief that mythological creatures were trying to entice him to battle;
 belief that a celebrity on TV wanted to marry him;
 misinterpretation of numbers to indicate that he was GOD.
Again he received medication but stopped it once he felt better. Mr. K contends that he was
never instructed to get the medication refilled once he left the hospital. He was again
hospitalized for one week in January of 2013. Records indicate that upon admission, he
reported feeling down, depressed, and crying a lot and that he believed he was not himself. He
also expressed beliefs that he had been in the military but that he was not sure. In actuality, he
had been a part of the Philippine Army for approximately 4 months but was discharged due to
reported feelings of suicide. At the hospital he reported that his thoughts seemed jumbled.
Records indicate that he was treated with Risperdal and diagnosed with Schizophrenia. Again,
he took the medication until the prescription ended but did not seek a renewal.
In April 2013, at the age of 30, Mr. K was travelling and had stopped to get some dinner at a
restaurant. He reported feeling very paranoid as if someone was going to harm him. He stated
that he believed some of the people in the restaurant looked like devils and were possessed by
demons. Mr. K went back to his vehicle and secured a knife for protection. He reentered the
restaurant and sat down to have dinner. Another patron approached him and began a casual
conversation. At this time Mr. K responded by pulling the knife and stabbing the bystander to
death. Mr. K left the restaurant but stopped to talk to the cashier on his way out the door as if
nothing out of the ordinary had transpired. He was arrested a short time later. After Mr. K’s
arrest he spent time at CVMC for restoration to competency. After receiving medications, he
was able to be restored and he was also evaluated for a second opinion sanity evaluation
requested by his public Attorney. In December, 2013 he was found Not Guilty by Reason of
Insanity and subsequently committed to the custody of the commissioner to begin the
privileging process. Mr. K’s initial progress in the hospital was slow and was laden with
numerous medication changes in order to maximize his treatment efficacy.
Psychiatric treatment was complicated with the medical problem of brittle diabetes. Additionally,
once Mr. K was stabilized and was able to fully appreciate the gravity of the fact that he had
committed murder, he was despondent, isolated and overwhelming remorseful thus requiring
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further medication adjustments. He began to work with a therapist to address the guilt and
shame that he felt due to his actions. Slowly, Mr. K began to make progress and by November,
2017 he was able to receive approval from the Forensic Review Panel for Unescorted
Community Visits (up to 8 hours) to a day program. Although Mr. K’s psychiatric stability
remained constant, his insulin levels were unpredictable and often dangerous. At one point his
passes for unescorted community were held for two months in order to regain control of his
medications for his diabetes. However, by March, 2018 Mr. K was ready to request 48 hour
overnight passes. Until that time, he had continued to do well psychiatrically and was especially
vigilant of his blood sugar levels and has learned to administer his own insulin and other
medications such as Haloperidol, Fluphenazine Decanoate IM injections, Chlorpromazine,
Setraline, Biperiden and Cogentin tabs
Case Scenario 3: A CASE OF MAJOR DEPRESSIVE DISORDER
Marietta was a 43-year-old married security guard who came for a consultation at CVMC –
Department of Behavioral Medicine with a long history of depression. She described being
depressed for a month since she began a new job. She had concerns that her new boss thought
her work was poor and slow, and that she was not friendly. She had no energy or enthusiasm
at home. Instead of playing with her children or talking to her husband, she watched TV for
hours, overate and slept long hours. She gained six pounds in just three weeks, which made
her feel even worse about herself. She cried many times through the week, which she reported
as a sign that “the depression was back.” She also thought often of death but had never
attempted suicide.
Marietta said her memory about her history of depression was a little fuzzy, so she brought in
her husband, who had known her since college. They agreed that she had first become
depressed in her teens and that she had had at least five different periods of depression as an
adult. These episodes involved depressed mood, lack of energy, deep feelings of guilt, loss of
interest in sex and some thoughts that life wasn’t worth living. Marietta also sometimes had
periods of “too much” energy, irritability and racing thoughts. These episodes of excess energy
could last hours, days or a couple of weeks.
Marietta’s husband also described times when Marietta seemed excited, happy, and self-
confident — “like a different person.” She would talk fast, seem full of energy and good cheer,
do all the daily chores and start (and often finish) new projects. She would need little sleep and
still be up the next day.
Because of her periods of low mood and thoughts of death, she had seen mental health care
providers since her mid-teen years. Psychotherapy had given some help. Marietta said that it
“worked okay” — until she had another depressive episode. She could then not attend sessions
and would just quit. She had tried three antidepressants. Each gave short-term relief from the
depression, followed by a relapse. An aunt and grandfather had been in the hospital for mania,
although Marietta was quick to point out that she was “not at all like them.”
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Marietta was diagnosed with bipolar II disorder and as having a current depressive episode. Her
husband’s information about her moments of hypomania helped in making the diagnosis.
 Lithium
 Risperidone
 Prozac
CASE SCENARIO 4: A CASE OF SCHIZOPHRENIA
PSJ was a 21 year-old male who was brought to the emergency room of CVMC by the security
guard of MCNP from which he had been suspended for several months. A professor had called
and reported that PSJ had walked into his classroom, accused him of taking his payment for his
tuition fee and refused to leave.
Although PSJ had much academic success as a teenager, his behavior had become increasingly
odd during the past year. He quit seeing his friends and no longer seemed to care about his
appearance or social pursuits.
He began wearing the same clothes each day and seldom bathed. He lived with several family
members but rarely spoke to any of them. When he did talk to them, he said he had found
clues that his college was just a front for an organized conspiracy and rebellion.
He had been suspended from college because of recurrent tardiness and abseentism. His sister
said that she had often seen him mumbling quietly to himself and at times he seemed to be
talking to people who were not there. He would emerge from his room and ask his family to be
quiet even when they were not making any noise.
PSJ began talking about conspiracy and rebellion so often which prompted his father and sister
to bring him for consultation.
Upon assessment, PSJ was found to be a poorly groomed young man who seemed inattentive
and preoccupied. His family said that they had never known him to use drugs or alcohol, and
his drug screening results were negative. He did not want to eat the meal offered by the
hospital staff and voiced concern that they might be trying to hide drugs in his food.
His father and sister told the staff that PSJ great-grandmother had a serious illness and had
lived for 30 years in a hospital, which they believed was a mental hospital.
PSJ’s mother left the family when he was very young. She has been out of touch with them,
and they thought she might have been treated for mental health problems.
PSJ agreed to sign himself into the psychiatric unit for treatment. His story reflects a common
case, in which a high-functioning young adult goes through a major decline in day-to-day skills.
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Although family and friends may feel this is a loss of the person they knew, the illness can be
treated and a good outcome is possible.
Significant verbalizations:
“May naririnig akong mga boses”- auditory
“Palagi nila akong pinupuntahan. Sabi nila may digmaan na magaganap”- delusions
“Hindi ako makatulog”- insomia
“Hirap akong makakain at baka may lason ang mga ulam”- paranoia
Medications:
Typical/conventional : EPS: extrapyramidal symptoms,
Dystonia: a movement disorder that causes the muscles to contract involuntarily
- Haloperidol 1 mg OD
- Fluphenazine Decanoate 50 mg IM once a month
- Benztropin Mesylate
- Clozapin
SAMPLE SESSION DESIGN

Date and Time Objective/s Psychotherapy Methodology
(Session day)
April 18, 2022  Teach patient  Milieu Therapy  Role Playing/ Return
8:00 am basic self-care Demonstration
activities (Brushing teeth, combing
Day 3 hair)
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WORKSHEEET:
Date and Time Objective/s Psychotherapy Methodology

(Session day)
 
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CRISIS INTERVENTION AND MANAGEMENT

Term: Final Period
ACTIVITY 1: SELF-REFLECTION AND JOURNALING
Instructions: Reflect on a life experience that involved significant joy, sadness, conflict, anger.
Situate the experience historically, personally and socially by asking yourself: What were the
circumstances?
A. What events preceded the experience? Utilize the life world existential—lived space, lived
body, lived time, and lived human relation—as guides to reflection.
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B. Begin to write the story. Try to be as clear and descriptive as you can. When you feel that
you have completed the story, put it down. Walk away from it for awhile. Then return to it and
reread it. Does it seem true to life? Do other memories surface as you revisit it? Add them if
they do.
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C. Reflect on the following and write a journal to summarize the following:

1. What themes emerged within your story? How do those themes speak to you of your
life experience?
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2. What did you become sensitive to within yourself through the process of reflecting
upon and writing this story?
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3. Why do you believe that you chose this particular story? Why did these memories
emerge? How do they speak to you of your life and of the significance of your experience to
whom you are today?
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ACTIVITY 2: CRITICAL THINKING
Give what is being asked. Explain each item comprehensively. If answers were taken from
articles or journals, please cite according and don’t forget to include your bibliographic
entries using the APA format. Please be reminded to include proper punctuation and the
use of subject- verb agreement.
Situation: Jomar a BSN Level 3 student voices concerns to his class adviser regarding his
father’s (43 years old) termination from work. For years long, his father has been drinking
heavily, and he seems to have a hard time coping with the situation. He expressed that he
wanted to leave school for good. His mother is currently experiencing neuromuscular
disorder and thought that Jomar should stop studying and should be taking care of her.
1. Enumerate and discuss the different crises present in the situation based from the
different viewpoints of each family member.
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2. Identify the areas of assessment and what questions to be included to

evaluate the individual’s needs and the needs of the family as a unit?
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3. Provide tentative goals that is fitted for this family.

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4. Identify appropriate agencies in your local areas that you think will be helpful for each
client and for the family as a whole
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5. Device an effective discharge plan for this family. Include the set-up of follow-up
visits, cooperation of family members, and type of service to be provided.
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APPENDICES
Rubrics
Self-awareness worksheet
CATEGORY 1 2 3 4
Worksheet Less than 1/2 of At least 1/2 of 3/4 of the The entire
completion the worksheet the worksheet worksheet was worksheet was
was completed. was completed. completed. completed.
(How much of
the worksheet
was completed?)
Accuracy Less than 1/2 of At least 1/2 of 3/4 of the The entire
the worksheet the worksheet worksheet was worksheet was
(How much of was done was done done correctly. done correctly.
the worksheet correctly. correctly.
was done right?)
Expression of Ideas expressed Output illustrates Output illustrates Output illustrates
Ideas are difficult to little thought or some thought a lot of thought
understand. preparation. and preparation. and preparation.
Following The worksheet The worksheet The worksheet

instructions was not done was done The worksheet was done
showing some was done showing lots of
work. showing most of work neatly and
Was the the work. easily followed.
assignment
completed
showing all
work?
Effort Minimal effort Some effort was Good effort was Outstanding
was given. The made, The made and the work, the
student should student just did student met my student should
The student try harder. enough work. expectations. be proud of their
worked at what effort!
level of their
ability?
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Oral Revalida
Category Excellent - 4 Very good - 3 Good - 2 Deficient 1

content Information given Information Information Does not give
is enough to the given is partially given is good enough
written work. related to the according to the information,
written work written work supporting
materials or
details
Vocabulary and Uses vocabulary Uses vocabulary Uses vocabulary Uses several
Comprehensibility that is that is that is somehow words that are
appropriate for appropriate for appropriate to not familiar to
the audience. the audience. the audience the students
Extends the Includes and but does not
audience defines some include or
vocabulary by words that define new or
defining words might be new to unfamiliar words
that might be the audience
new or unfamiliar
to the audience0
Clarity and Speaks clearly Speaks clearly Reads the Purely reads the
Spontaneity and distinctly; and distinctly information information.
demonstrates almost always; sometimes; There is a lot of
ease of comfort complete nearly There are hesitation and
with natural all thoughts with mostly complete pauses; the
pausing some pauses thoughts with student does
significant not complete
pauses as the thoughts
student
searches for
words to fill in
the idea
Appearance Student presents Presentation is Student displays Presentation is
the topic in a formal; body discomfort and informal;
formal way; language almost some inappropriate
shows confidence always show confidence while body language
when speaking; confidence; presenting; is noted; not
clothing is clothing is presenter is wearing uniform
appropriate somehow wearing
appropriate incomplete
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uniform
RUBRICS FOR SHORT ANSWER ESSAY

5 4 3 2 1 0
Excellent Very Good Fair Poor Non-
Good Complia
nt
Correctne Correct Answer Answer Answer Answer given (No
ss of answer is provided provided provided is incorrect, answer
Answer given is correctis similar is not and has no Provided
(right but concept clear relation to the )
terminolog incomplet with the topic or
y or e correct question being
concept) answer. asked.
Concise Explanatio Explanati Explanati Explanati Explanation is No
explanati n is on is on is on is incorrect. answer
on supported correct correct missing Provided
with but is not but the
appropriat supporte supportin significan
e d with g t
concepts. appropria concepts informati
te is not on.
concept. applicabl
e.
Sentence Answer is Answer is Answer Answer is Sentences are No
compositi presented presented does not too long incomprehensi answer
on briefly briefly follow and lacks ble. Provided
with but with the significan
correct grammati format t
grammar cal provided. informati
and errors. on.
punctuatio
ns.
RUBRICS FOR CASE STUDY/CRITICAL THINKING ACTIVITIES
DESCRIPTORS Excellent Very good Good Fair Poor

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SCORES 5 4 3 2 1
AREAS
ISSUES Recognizes Recognizes Recognizes Mentions Does not

one or multiple one valid problems recognize the
more key problems in problems that lack main
problems the case significanc problem or
in the case. e mentions
Indicates problems
some that are not
issues are based on the
more facts of the
important case
than others
and
explains
why
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CONTENT AND Best and Important Some Failed to Applicable
ANALYSIS applicable points are important make any points are
points are presented points are important not
presented, while addressed, points and presented
no unnecessar but not analyze and paper is
unnecessar y contents fully the case full of
y contents. are left covered. scenario unnecessary
out. with it contents
Discusses Considers
issues.
facts in the Discusses facts in the Does not
case and facts in the case and Accurately have a clear
cites case and understand lists facts understandin
related cites s relevance in the case g of the facts
knowledge related of these but does in the case
from knowledge facts not
research from understan
and adds research d the
knowledge relevance
from of these
personal facts
experience
ACTIONS Proposed More than Action Action No actions

actions one proposed is proposed proposed
best deal reasonable feasible is not
with action feasible
issue/s
ORGANIZATIO Points are Made a Made some Failed to Points are

N AND LOGIC logical and point, but points but make the not logical
well- could not logical; point, do and are not
supported, present not related not use supported by
organized more to the case the the materials
and logically itself. concepts,
presented and more theories
by organized; and
evidence. supported principles
by
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evidences
RUBRICS FOR GROUP PRESENTATION

CRITERIA STANDARDS
1. Organizatio Extremely Generally, Somewhat Poor or
n well well organized. nonexistent
(15 points) organized. organized. (4-7.9 organization
(8-11.9 points) .
(12 -15
points) Introduces the (0-3.9
points)
Introduces the purpose of the points)
Introduces the purpose of the presentation. Does not
purpose of the presentation Includes some clearly
presentation clearly. transitions to introduce the
clearly and Include connect key purpose of the
creatively. transitions to points but presentation.
Effectively connect key there is Uses
includes points but difficulty in ineffective
smooth, clever better following transitions
transitions transitions presentation. that rarely
which are from idea to Student jumps connect
succinct but not idea are around topics. points; cannot
choppy in order noted. Most Several points understand
to connect key information are confusing. presentation
points. Student presented in Ends with a because there
presents logical summary or is no
information in sequence; A conclusion; sequence for
logical, few minor little evidence information.
interesting points may be of evaluating Presentation is
sequence which confusing. content based choppy and
audience can Ends with a on Evidence. disjointed; no
follow. Ends summary of apparent
with an main points logical order
accurate showing some of
conclusion evaluation of presentation
showing the evidence -- Ends
thoughtful, presented. without a
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strong summary or
evaluation of conclusion.
the evidence
presented.
2. Content (12 -15 (8-11.9 (4-7.9 (0-3.9
(15 points) points) points) points) points)
Speaker For the most Explanations No reference
provides an part, of concepts is made to
accurate and explanations and/or literature or
complete of concepts theories are theory. Thesis
explanation of and theories inaccurate or not clear;
key concepts are accurate incomplete. information
and theories, and complete. There is a included that
drawing upon Presents great deal of does not
relevant evidence of information support thesis
literature. valid research that is not in any way.
Provides with multiple connected to Shows little
evidence of sources. the evidence of
extensive and Combines presentation the
valid research existing ideas thesis. combination
with multiple to form new Combines of ideas.
and varied insights. No existing ideas. Information
sources. significant Enough errors included is
Combines and errors are are made to sufficiently
evaluates made; a few distract a inaccurate
existing ideas inconsistencie knowledgeable that the
to form new s or errors in listener, but listener
insights. information. -- some cannot
Information Level of information is depend on the
completely presentation is accurate. presentation
accurate; all generally Portions of as a source of
names and appropriate. presentation accurate
facts were are too information.
precise and elementary or Presentation
explicit. Level too consistently is
of presentation sophisticated too
is appropriate for audience. elementary or
for the too
audience. sophisticated
for the
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audience.
3. References (12 -15 (8-11.9 (4-7.9 (0-3.9

(15 points) points) points) points) points)
Utilized more Solicited more Utilized more Utilized less
than ten types than eight than five types than 5
of updated types of of resources resources but
resources to updated but some are some or all
make project resources to outdated. are outdated.
effective. enhance Format of the Bibliography is
Format of the project. bibliography missing or
bibliography Format of the generally format of the
follows the bibliography follows the bibliography
guidelines very follows the guidelines does not
accurately and guidelines though some follow the
without errors. accurately errors are guidelines.
though minor present.
errors are
present.
4. (12 -15 (8-11.9 (4-7.9 (0-3.9
Communica points) points) points) points)
tion aids Graphics are While graphics Occasional use Student uses
(15 points) designed to relate and aid of graphics excessive
reinforce presentation that rarely graphics, no
presentation thesis, these support graphics, or
and maximize media are not presentation; graphics that
audience as varied and visual aids are so poorly
understanding; not as well were not prepared that
use of media is connected to colorful or they detract
varied and presentation clear Choppy, from the
appropriate thesis. Font time wasting presentation.
with media not size is use of Font is too
being added appropriate multimedia; small to be
simply for the for reading. lacks smooth easily seen
sake of use. Appropriate transition from
Visual aids information is one medium to
were colorful prepared. another. Font
and large Some material is too small to
enough to be is not be easily seen.
seen by supported by Communicatio
everybody. visual aids n aids are
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Details are poorly
minimized so prepared or
that main used
points stand inappropriately
out. . Too much
information is
included.
Unimportant
material is
highlighted.
5. Delivery (15 – 20) (10 – 14.9) (5 – 9.9) (0 – 4.9)
(20 points) Within allotted Within Within minutes Too long or
time. Involved minutes of of allotted too short or
the audience in allotted time. time. Some more minutes
the Presented related facts above or
presentation; facts with but went off below the
held the some topic and lost allotted time.
audience's interesting the audience. Incoherent;
attention "twists"; held Some eye audience lost
throughout. the audience's contact, but interest.
Maintains eye attention most not maintained Student reads
contact; seldom of the time. and at least all or most of
returning to Student half the time report with no
notes; maintains eye reads most of eye contact.
presentation is contact most report. Presenter is
like a planned of the time Audience obviously
conversation. but frequently occasionally anxious and
Poised, clear returns to has trouble cannot be
articulation; notes. Clear hearing the heard or
proper volume; articulation presentation; monotone
steady rate; but not as seems with little or
enthusiasm; polished; uncomfortable. no expression.
confidence; slightly Student Student
speaker is uncomfortable incorrectly mumbles,
clearly at times Most pronounces incorrectly
comfortable in can hear terms. Selects pronounces
front of the presentation. words terms
group. Correct, Student inappropriate incorrectly.
precise pronounces for context; Selects words
pronunciation most words uses incorrect inappropriate
of terms. correctly. grammar. for context;
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Selects rich and Selects words Presentation Uses incorrect
varied words appropriate has three grammar.
for context and for context misspellings Student's
uses correct and uses and/or presentation
grammar. correct grammatical has four or
Presentation grammar. errors. Can more spelling
has no Presentation follow the errors and/or
misspellings or has no more presentation, grammatical
grammatical than two but some errors. Cannot
errors. misspellings grammatical focus on the
Sentences are and/or errors and use ideas
complete and grammatical of slang are presented.
grammatical, errors. For the evident. Some Because of
and they flow most part, sentences are difficulties
together easily. sentences are incomplete/ with grammar
Words are complete and halting, and/or and
chosen for their grammatical, vocabulary is appropriate
precise and they flow somewhat vocabulary.
meaning. together limited or
easily. With a inappropriate.
few
exceptions,
words are
chosen for
their precise
meaning
6. Handling (15 – 20) (10 – 14.9) (5 – 9.9) (0 – 4.9)
questions Encourages Encourages Reluctantly Avoids or
(20 points) audience audience interacts with discourages
interaction. interaction. audience. active
Calls on Demonstrates Demonstrates audience
classmates by knowledge of some participation.
name. the topic by knowledge of Demonstrates
Demonstrates responding basic incomplete
extensive accurately and questions by knowledge of
knowledge of appropriately responding the topic by
the topic by addressing accurately to responding
responding questions. At questions. inaccurately
confidently, ease with and
precisely and answers to all inappropriatel
appropriately to questions but y to
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all audience fails to questions.
questions. elaborate.
Comments
Grade: /100

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

- Self-awareness and/or Self Discovery is about knowing and understanding:

II. TRAITS AND QUALITIES

b. What do you feel are your two biggest weaknesses?

c. What are your best qualities/characteristics?

d. What are your best qualities/characteristics?

e. What qualities do you wish you had?

f. What qualities or traits do you most admire in others?

b. What are the three most important things to you?

b. What makes it hard to be yourself with others?

d. What do you want people to think and say about you?

f. What do you least want people to think about you?

g. Is it more important to be like by others or to be yourself? Why?

i. What places allow you to feel fully yourself?

j. What activities allow you to feel fully yourself?

b. What do you hope to achieve in life?

d. What do you like best about yourself?

e. What do you like least about yourself?

g. Who are two people you most admire?

h. What do you admire about them?

i. What are five things you love to do?

j. What matters to you most in my life?

k. What makes you happy?

m. Why are those things important to you?

n. What do you stand for (Principles)?

o. How do you want to impact the lives of others?

Finish the sentence

Activity 2: JOHARI’S WINDOW

Diagnostic category and time point

Schizophrenia Bipolar disorder

MSE component 1 2 3 1 2 3 1 2 3 TOTAL

Grooming and hygiene

Eye contact (abnormal)

Thought Process A: Coherence

Thought Process B: Speed

Thought Content A: Delusions

Thought Content B: Obsessions

Thought Content C: Compulsions

Affect and Mood

Constricted range of affect,

Expansive range of affect,

Inappropriate and/or labile

Suicidal ideation (active or

Name of Case: Karthik

Education Sophomore in college

Home/homeless - type of Lives in an apartment (rented)

First Visit (baseline, DAY 1): Karthik arrives at his

DAY 2: Karthik arrives at his doctor’s office, 3 months

Robbin (Bipolar Disorder)

Name of Case: Robbin

Criteria/ Area Assessed Actual Findings

Education Law School Graduate

Home/homeless - type of dwelling, Not specified

First Visit (baseline, INITIAL VISIT): Robbin arrives at her

DAY 2: Robbin arrives at her doctor’s office a few weeks

DAY 3: Robbin arrives at her doctor’s office a few weeks

Ben (Obsessive Compulsive Disorder)

Name of Case: Ben

Criteria/ Area Assessed Actual Findings

Home/homeless - type of dwelling, Not specified

First Visit (baseline, INITIAL VISIT): Ben arrives at his

Second Visit (DAY 2): Ben arrives for a second visit 3

Third Visit (DAY 3): Ben comes for an appointment one