therapeutic interview

8/3/2019 therapeutic interview

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THERAPEUTICINTERVIEWLasiste and Lopez

02 November 2011


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THE CASEGeneral Data. Clinical History. Diagnosis.


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GENERAL DATA

RM

45-year-old male

Married

Roman Catholic

Pasig

Admitted 28 October 2011.


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CHIEF COMPLAINT

Blood-tinged stools and increased bowelmovement


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HISTORY OF PRESENT ILLNESS

4 months PTA

Noted onset ofblood-tingedstools, increasedfrequence ofbowelmovement. (-)

consult, meds.

14 weeks PTA

Consulted atlocal clinic,managed asamebiasis. Noimprovement

after 1 week ofmeds.

13 weeks PTA

Consulted aprivate hospital.Advisedendoscopy.


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HISTORY OF PRESENT ILLNESS

2 weeks PTA

Endoscopyshowed rectalmass, 20 cm fromanal verge.

1 1/2 weeks PTA

Biopsy of massshowedadenocarcinoma,well-differentiated.

Admission

For further workup(staging) andpossible surgicalmanagement.


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PAST MEDICAL ILLNESSES

s/p appendectomy

Noted by patient to be worst illness until

diagnosis of cancer

No known co-morbids


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PERSONAL/SOCIAL HISTORY

10-pack year smoker

Occasional alcoholic beverage drinker

Denies illicit drug use

Diet

Meat and fish

Low fiber intake


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PERSONAL/SOCIAL HISTORY

Operates a family business (bakery)

Panadero

Married, with 3 children

Aged 22, 17, 11

Maintains good communication withrelatives and neighbors.


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DIAGNOSIS

Rectal adenocarcinoma, well-differentiated


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PSYCH REFERRAL

Patient was referred for psychiatriccounselling, given the treatment options

available.


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THERAPEUTIC INTERVIEWInsight to Illness. Functional Capacity. Interpersonal

Relationships. Support System. Outlook on Life.


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INSIGHT TO ILLNESS

Diagnosis of rectal cancer

Patient believes his cancer is still in its early

stages and is amenable to treatment. Also expressed fears and sadness but

emphasizes that he tries not to focus onnegative thoughts.

Welcomes any mode of treatment.

If he had adequate resources, he wouldhave opted for immediate surgery at aprivate institution.


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INSIGHT TO ILLNESS

When asked about could havecontributed to his disease:

Patient maintains it could have happenedto anyone.

Admits that smoking, diet could have

contributed to it.

Attempts to educate his children to changetheir habits.


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FUNCTIONAL CAPACITY

BEFORE

Daily gym

workouts/jogging

Attends to family

business

Able to pursue

leisure activities(card games)

AFTER

No avenue for

physical activitiesin the hospital

Easy fatigability

Unable to manage

family business


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INTERPERSONAL RELATIONSHIPS

Patient claims thathe is:

Outgoing

Talkative

Close with family

and friends

After having beendiagnosed, people

have told him that: Nabawasan yung

kulit ko.

Mas matamlay

daw ako.


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INTERPERSONAL RELATIONSHIPS

However, despite illness, patientmaintained that there was:

No change in how he treated family andfriends.

Was not irritable, not prone to angry outbursts.

No change in how he was treated either.

Did not notice pity. Received words of support and

encouragement instead, which heappreciated.


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SUPPORT SYSTEM Family

Words of encouragement

Care and understanding Relatives

Financial support

Encouragement

Friends Company

For sharing experiences


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SUPPORT SYSTEM

Religion

Plays a role: patient is a practicing Catholic

Did not notice intensification of religious

practice/more significant role of faith.


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OUTLOOK ON LIFE

On the overall, given:

His support system

His optimism in his health

RM believes that he can survive thisordeal.


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PSYCHIATRIC DIAGNOSIS

Axis I: Normal reaction to illness

Axis II: Deferred

Axis III: Rectal adenocarcinoma, well-differentiated

Axis IV: Financial constraints

Axis V: GAF 81-90


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THERAPEUTICINTERVIEWLasiste and Lopez

02 November 2011

therapeutic interview

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