menatl health - training the trainer programme sri lanka - role play - kamha.org

8/8/2019 Menatl Health - Training the Trainer Programme Sri Lanka - Role Play - KAMHA.ORG

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TRAINING THE TRAINERS

MENTAL HEALTH TRAINING PROGRAMME

SRI- LANKA

Role Plays

National Institute of Mental Health Angoda Teaching Hospital

ROLE PLAYS FOR MENTAL HEALTH TRAINING PROGRAMME


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1. INVOLUNTARY ADMISSION

Role play to practice negotiating transfer to hospital for assessment and admission whenpatient does not want to go

Patient Name: ChitranganiAge: 26 yearsOccupation: ClerkMarital Status: MarriedTotal No. of children: 2

Medical History

Has had several episodes of acute mental disturbances leading to self harm, harm toothers and destruction to property. Most of these episodes are managed by joint effortof the local PHC staff and the local traditional healers.

Reason for Encounter

Current spell is severe and patient has been violent and destructive to property.

Reactions of the Patient

Held by relatives

Struggling to get free

Irritability

Anger

Acting out Chanting traditional songs and dancing to rhythm

Health Worker

You are the Health Worker in a Division in Kalutara?

Chitrangani has just been brought to you while acutely disturbed.

Please assume you have assessed mental state, suicidal risk and risk of violence to others,and have ascertained that she is a serious risk to herself and others.

Now interact with her and her relative in order to negotiate short (and longer) term

management plan including admission to the nearest mental health unit in first instance (towhich patient does not agree)


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2. COMMUNICATION SKILLS

(Role play to practice eliciting personal information courteously but speedily)

Instructions to Health Workers

In groups of twos, gather some general information about your partner, so that youcan introduce your partner to your class.

3. PSYCHOSOCIALSUPPORT (role play to give patient support)PatientName: SimonAge: 46 yearsOccupation: FarmerMarital Status: MarriedTotal No. of children: 3

Medical History

No major medical illness.

Reason for Encounter

Spells of life-stock thefts have been going on in his area. His life-stock in various partsof the division has been serially stolen. Last week he lost his last and prime stock from thehome yard, and his two sons were killed by the raiders.

Currently the family is undergoing a difficult spell due to lack of resources.

Reactions of the Patient

Visibly distressed

Irritability

Anger

Acting out Dissociation

Chanting traditional songs and moving slowly to rhythm

Patient: Simon

Health Worker

You are the Health Worker in a Division in Hambantota.

Simon has come to you to seek your assistance.

Please interact with him in order to clarify his problems, give him psychosocial supportand negotiate a management plan.


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4. BREAKING BAD NEWS

PatientName: CarolineAge: 35 yearsMarital status: Married with 4 children (3 sons, 1 daughter)

Occupation: Fish vendorResidence: Batticoloa

Social History:

You have been an average business lady for over the last five years. Your four (4)children are all in School and your husband is in the fish transport business.

While waiting for your regular fish supply at the Lagoon landing point at about 10 a.m,news have reached the site to the effect that a road traffic accident has occurred in thegeneral area of your husbands operations. The actual details of the accident arescanty. However, a man seems to have been seriously injured and has been taken tohospital near the site of the accident.

You decide to drop all your business activities and head to hospital for more news.

Different Reactions of the Wife

Shock and Denial

Wailing and Shouting and singing

Rolling on the floor and generally uncontrollably

Pulling on her hair and tearing her clothes.

Calling on others to assist

Health Worker

You are a health worker attached to the hospital receiving an RTA at around 10 a.m

today. Mr. Jude arrived in a comatosed state and has since died. Mrs Caroline has just arrived to enquire on her husbands state.

Break the bad news of her husbands death, using communication and supportiveskills, and offer further support as necessary.


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5. ANTIDEPRESSANT SIDE EFFECTS(role play to practice explaining and discussing management of side effects with patient)

Personal Details

Nandani (Patient)

40 years old

Housewife

Mother of 4 Children

Sanath (Husband)

45 years old

Husband

Father of the 4 teenagers

A Primary School teacher in a near home school

Medical History of patient

You are newly diagnosed with severe depression and have been put on anti-depressants in order to treat your depression.

You are about to start this treatment. You request whether the drugs have anyadverse effects on your health.

Husband

You are accompanying your wife to the Health Centre where she reports for the firsttime with severe depression. She is assessed and put on tablets to treat herdepression. You are concerned about the effects of these drugs on your wife.

Health Worker

You have just visited Nandani, the patient at her home. She was found to bemoderately depressed and was started on antidepressants (amitryptiline/Fluoxetine)by the MOMH yesterday.

You are expected to review her weekly as she lives nearby and has the adequatefamily/domestic support to monitor her progress.

Please discuss with patient and husband the following issues

Side effects of antidepressants

How to adjust time of medicine so sedation occurs at night rather than in day

When to expect antidepressant effects to start

Supervision of medication, and prevention of overdose


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6. ANTI PSYCHOTIC SIDE EFFECTS(role play to practice discussion of antidepressant side effects)

PatientName: SirisomaAge: 45 years old

Marital status: HusbandOccupation: Father of 2 teenagers

You are about to start this treatment. You request whether the drugs have any adverseeffects on your health.

WifeName: MallikaAge: 45 years oldMarital status: HousewifeOccupation: Mother of the 2 teenagers

You are accompanying your husband to the Health Centre where he reports for the first timewith acute psychosis. He is assessed and put on tablets to treat his acute psychosis. Youare concerned about the effects of these drugs on your husband.

Health WorkerYou have visited Sirisoma, the patient, and found him to have acute psychosis.The MOMH has decided to start him on an antipsychotic and requests you to review himweekly or PRN as he lives nearby and has the adequate domestic support to monitor hisprogress.

Discuss with patient and wife the following issues.a) effects of medicationb) side effects of medication, and when to consult in case further mediation needed to

manage side effectsc) supervision of medicationd) importance of compliancee) importance of regular review


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8a. DEPRESSIVE DISORDER(role play to practice assessment and management)

PatientName: Mr. WariyapolaAge: 60 yearsMarital Status: Married for 30 years

Children: Five children aged between 18 and 35 yearsOne boy and four girlsEmployment: Now jobless after being retired six months ago as an accountant.Residence: Matale

Social History

Used to work as an accountant in Ministry of Health Headquarters

30 years. You have moved to your rural home after retirement.

You are married to a primary school teacher who is currently supporting the

entire family.

Your wife is always quarrelling with you for finding you at home doing nothing but

listening to the radio. The children (3 unmarried and unemployed), whose standard ofliving has dropped ,have no respect for you and keep on asking you why you are notgoing to work.

You have no friends in the village and even your relatives hardly visit you any more.

You have been unable to pay house expenses . For the last two weeks you havebeen telling your wife that you are preparing to take a long journey. Your wife did nottake the hint and just wished you a safe journey.

Medical History

No previous major illness. After retirement you have been visiting local clinicswith complaints of difficulty in sleep, body aches, a burning sensation in head, and lack

of appetite. Recently you have been thinking about killing yourself.

Reason for encounter

Your wife has brought you to the clinic for trying to commit suicide.

Presentation of Patient

depressive and tired

slow in movement and answering questions

no longer interested in life

low-esteem

feeling of worthlessness

feeling hopeless

feeling helpless

has multiple body pains

Instructions for Health Worker

this patient comes to you for the first time.

take history

assess mental state and suicidal risk


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negotiate a bio-psycho-social management plan based on home care.?? Do we omithome care given the high risk factors


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8b. DEPRESSION(discussion of case below and preparation of a management plan)

PatientName: JosephAge: 56 yearsOccupation: Retired Railways Clerk (currently a shopkeeper)

Marital Status: Married, has 3 childrenResidence: Amparai

Summary

An average shopkeeper in local village in a location in Amparai.

Over the last three weeks, he has not been feeling well.

Started by sleeping too much. He was slowed down in his personal and shop keepingactivities.

Seemed to have no drive for any matter in his life. Was not interacting much withcustomers and started having difficulties with giving correct change.

Last week, he did not participate in shop keeping activities. He just lay in bed, hardly

ate or drank anything. Has been slow in speech and activity. He says he hears voices of people unknown to him calling him a sinner who will surelyburn in hell. They also tell him to hang himself.

Also he feels that his body organs e.g. the heart and brain are not working at all. Hebelieves they are rotten. He is tired most of the time. He feels sad. Has no plan forfuture. He is hopeless and helpless. He does not see why he should continue with life,as it is such a big bother. He wants to die and rest forever.

Instructions to groups

In your groups, please discuss

a) differential diagnosisb) investigationsc) management plan


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9. SOMATIZATION DISORDER( ?Would expect this man to be referred to the specialist for clarification of diagnosis as thehistory is also suggestive of a depressive disorder)(role play of assessment and negotiating a management plan)

PatientName: Mr. AsithaAge: 36 yearsMarital Status: Married for 12 yearsChildren: Three children aged between 3 and 9 years

One boy and two girlsEmployment: TraderResidence: Kataragama

Medical History

Long standing history of body pains which shift from place to place. Feels sharp

electric like discharges passing from one end of the body to another. Has frequentattacks of numbness on all limbs. The top of the head has burning sensations fromtime to time. Is frequently constipated. Gets frequent attacks of hot and cold spells.Frequently gets burning sensation when he passes urine. This has been going on forthe last 4 years. He has seen various clinicians but has not been well assisted. Mostinvestigations have been unrevealing. Most of the times is treated for clinical malaria.Recently he has been thinking about killing himself.


Wife has brought him to the PHC for trying to commit suicide.

Different Reactions of the Patient Has multiple body pains

Low-esteem

Feeling of worthlessness

Feeling hopeless

Feeling helpless

Health Workera) this patient comes to you for the first timeb) take historyc) assess mental state

d) what investigations, if any, would you do?e) make bio-psycho-social management plan


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10a. ANXIETY - GENERALISED ANXIETY DISORDER(Role play of assessment and management)

PatientName: Miss JenniferAge: 18 yearsMarital Status: Single

Employment: Advanced level student:Residence: Jaffna

Social History

A/Level student awaiting final examinations. Parents are university graduates whodemand that daughter does well in the final examination so as to acquire universityeducation. After getting the results of the mock examination, daughter is afraid she willnot do well enough in finals. Recently she has fallen in love with the chemistry teacher,She is unable to concentrate on studies, and is worried she might be pregnant.

Medical History

Dysmenorrhoea, treated in the school clinic.

Reason for the Encounter

After getting the mock examination results, student started sweating, having chestpains, trembling, feeling tense and nervous.

Patient

Feeling dizzy

Fast pounding heart

Restlessness

Poor concentration

Wide open eyes

Health Worker

this patient comes to you for the first time

please take history

assess mental state

make bio-psycho-social management plan


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10b. ANXIETY (case vignette for discussion)

PatientName: RenukaAge: 35 years

Marital Status: Married, has2 children (1 boy, 1 girl)Occupation: Pradeshiya sabha representative

A highly organised woman who has little patience with people who are slovenly and donot keep time.

Recently, she has developed more stringent behavior. She feels uncomfortable if shewears any piece of clothing twice without washing it. She is over concerned about theuse of her utensils at home.

Over the last month, she has been having panic attacks (i.e. shortness of breath,

dizziness, trembling, shaking, sweating, palpitations, numbness, flushing, chills, chestdiscomfort, fear of going crazy or dying) whenever she was confronted with a situationof addressing a meeting or the usual political crowds. She has since avoided publicappearances in order to stem these attacks. She now is seeking help from the healthcentre.

Please discuss

diagnosis

management


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10 c Post Traumatic Stress Disorder(role play)

PatientName: Mohamed HameedAge: 43 years

Occupation: TraderMarital Status: Married 4 childrenResidence: Batticoloa

History

Was in Colombo to collect supplies 3 months ago. You traveled back home in aregular bus to Batticloa.

On the way, the bus was ambushed by gunmen, all tyres were shot flat, you were allbeaten, robbed and left stranded for 24 hours without food, water and cover.Eventually a military convoy found you and rescued you to Batticoloa.

You lost most of your investment in your trade goods. You have been re-experiencing

this episode for the last 3 months.

Symptoms

Reliving the event both in the day time and in dreams at night

Dissociation during the 1st one month

Avoidance of any reminders of the event

Emotionally numb lately

Sympathetic hyper arousal persists

Health Worker

take historyconduct mental state examinationplan management


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11a. SLEEP PROBLEMS WITH UNDERLYING SOMATISING DEPRESSION(role play of assessment and management)

PatientName: Mrs. HemalathaAge: 46 years

Marital Status: MarriedChildren: three grown up children.Employment: House wifeResidence: Moneragala, own village house

Medical History

Long standing history of disturbed sleep. Has difficulties in initiating and maintainingsleep. Wakes up in the middle of the night and does not fall asleep easily. Keepstossing in bed. while fully awake, gets the occasional wink early in the morning. Eventhis is not refreshing. Over the last one month, she is getting muddled in thought and isfunctioning poorly in doing regular chores.


Your husband has brought you to the clinic for this problem.

Symptoms

Multiple body pains

Low-esteem

Sad

Irritable

Feeling worthless, hopeless and helpless

Health worker

conduct mental state examination

make diagnosis

negotiate management plan


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12. EATING DISORDER-NOT YET AVAILABLE


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13. FEMALE SEXUAL AROUSAL DISORDERS -ANORGASMIAPatientName: Mrs. TecklaAge: 37 yearsMarital Status: Married with 3 children: all girls

Employment: House wife (self employed)Residence: Modera

Medical HistoryYou have been undergoing treatment-using tablets for 4 years to control your diabetes.

Reason for The EncounterYour sexual life is currently frustrating, as you are no longer able to achieve orgasm. Youhave come to the local clinic with complaints of dissatisfaction with your sexual life andfeeling generally irritable for the last 6 months.

PresentationHesitant in answering questionsTrying to find out the possible cause of your problemAsking whether the problem is treatableFeeling shy

Health WorkerMrs Teckla comes to you seeing assistance.

a) conduct history and mental stateb) what physical examination and investigations would you doc) negotiate management plan


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15. ALCOHOL ABUSE(role play assessment and management)

Please construct a case scenario yourselves, and demonstrate

Patient

Name:Age:Marital Status:Employment:Residence:

Social History

Medical History

Reason for The Encounter

Further Information

Reaction of the Patient

Health Worker


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16. DRUG ABUSE (role play assessment and management)(role play assessment and management)

Please construct a case scenario yourselves, and demonstrate

establishment of weekly quantity, frequency and type of substances physical, psychological and social problems

negotiate a management plan

PatientName:Age:Marital Status:Employment:Residence:

Social History

Medical History

Reason for The Encounter

Further Information

Reaction of the Patient

Health Worker


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17. CASE FORMULATIONDiscussion of diagnosis, differential diagnosis, investigations, causes and management

(Answers on next page!)

Description:Mr. Hassan is a twenty-three year-old unmarried self-employed. He was admitted as anemergency one week ago after being taken to the casualty department by his neighbours. Hehad shown increasingly disturbed behaviour in the last three months, with persecutorydelusions of being followed by the CIA, and believed that they were using laser beams tocontrol his actions. He had heard voices discussing plans to kill him, and on the day ofadmission had destroyed most of his possessions whilst apparently searching for a videocamera, which he thought, had been planted in his room. He had started to becomewithdrawn socially four years previously, in his final year at high school. He has been anabove average student. He had cared for himself adequately but showed little motivation orinterest in social activities. Apparently he has been taking some drugs secretly on regularbasis.

On mental state examination he appeared fully conscious, his clothes were untidy, and hewas suspicious in manner, and he paced the room. There was no spontaneous speech andhe appeared secretive when answering questions, but talk was coherent and relevant. Hismood was subjectively all right but he appeared tense and frightened and sweatedprofusely. He was secretive about the recent destruction of his possessions. During theinterview he appeared to be distracted, listening and talking to voices on several occasions,but denied this when asked. He was correctly oriented in time and place. He would notcooperate with formal tests of cognitive function but correctly identified and had learned thenames of the ward staff and gave an accurate account a recent visit from his parents. Hethought he was not ill but needed help- probably police protection and was willing to remainin hospital because he said he felt safer.

On physical examination he was thin, with evidence of self-neglect, but no other abnormality.


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Probable response for case formulation: Mr. Hassan

1. Differential Diagnosisa) Paranoid Schizophrenia: Characterized by the persistent delusions of persecution,

control and auditory hallucinations discussing the patient. The history prior to thissuggests the slow development of apathy, lack of motivation, social isolation and

gradual development of hallucinations. Drug abuse may be secondary toSchizophrenia.b) Psychotic disorder due to drug abuse (symptomatic schizophrenia). The symptoms

that have occurred in the last three months are consistent with the acute psychoses,which are associated with cannabis particularly following prolonged use. Thepossibility of other drug and alcohol effects must also be considered despite thepatients denial of abuse.

c) Psychosis secondary to other organic conditions.

2. Aetiology

Predisposing factors: Family history indicates that his maternal uncle is having

mental health problem (treated at Mathari Hospital), and one of his brothers hasshown social deterioration similar to the patients, so there may be a geneticpredisposition to schizophrenia. There is no evidence of perinatal or developmentalproblems or of personality problems before the last four years.

Precipitating factors: The social withdrawal and deterioration started in his finalyear at high school when he had the stress of impending Final Examinations followedby death of his father. The more recent deterioration followed within weeks of thebroken relationship with his girlfriend.

Maintaining factor: Cannabis use

3. Investigations

Medical records of the uncle and brother (if possible) Further history from his parents, particularly concerning his family history,childhood development, and pre-morbid personality, and from his neighbours about hisrecent state.

Psychological. Observation of his beliefs, perceptions and behaviour- includingpossible drug or alcohol ingestion. Examination of cognitive aspects of mental state. Itwill also be necessary to assess his insight into psychosis and drug abuse and hislikely compliance with management.

Physical investigations should include haematology,

Social. Observation of the extent of his social withdrawal on the ward and ofrelationships with his family, girlfriend, neighbours and workmates. Consider whether

there is evidence of high expressed emotion. When his mental state improves,assess his abilities and strengths in occupational and other settings in order to planaspects of rehabilitation, including self-care, occupation and recreation.

4. Treatment

Depending on the setting, if dispensary the patient should kept under observation for24 hours as he was willing to be admitted and accept treatment. If is at Health centerthe patient should be admitted as a voluntary patient.

Physical. Start drug treatment such as Chlorpromazine or Haloperidal on regularbasis, a dose which will have to be adjusted depending on response and possible


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unwanted effects. The client is likely to require long-term medication preferably withdepot injections to improve adherence. He will need counseling regarding the effectsof drug abuse and encouragement to remain abstinent.

Psychological and social. Initially he should be allowed to avoid pressures ofinvolvement in a group activities, but as psychotic symptoms settle down there shouldbe increasing emphasis on rehabilitation e.g. self-care and social activities. The patientand family members will need information on the condition and how they can

contribute to its management. Follow- up at OPD for depot medication is important.

5. Prognosis

Factors suggesting a poor outcome include insidious onset, prolonged duration, andnegative symptoms.

However, there are also some favourable factors- the lack of problems in his pre-morbid personality, his good educational record and work, and support from family.

If cannabis abuse has been an important cause and he becomes abstinent this willgreatly improve the outcome.


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18. EARLY RELAPSE OF PSYCHOSIS(Role play of relapse prevention by prompt action on EARLY WARNING SYMPTOMS)

PatientName: Nimal JayanthaAge: 40 years old

Marital Status: Married, 3 childrenEmployment: Community Development OfficerResidence: Lives alone at work station

Health Worker: Matara Malani, 40 years old

Medical HistoryYou are a known to suffer from Paranoid Schizophrenia over the last five (5) years.The condition is currently well controlled by monthly injections which you normally get at thehealth centre after arranging for these to be so administered through the District MentalHealth Unit.From previous experience, you have noted that if you miss the monthly injection, you usuallybecome restless, irritable, argumentative and have poor concentration at work andaccomplish less. At house where your only company is a day house boy, you are evenworse. Your house keeping is poor, you do not have a clear grasp of what is happening athome.You start having vague noises in your ears and sometimes you feel you are in danger eventhough you do not know the actual source. Sleep becomes a problem and at times you haveto go to the canteen for a drink to find sleep. But the beer there tastes liked it has beendoctored and you are sure that records show that you have missed the injections of the last 2months.

You report to the nearest PHC and after a physical and mental assessment, you are injectedand released home with your neighbour to monitor progress.In three days time, you have settled down and are back to willing to go back to work.


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19. BIPOLAR DISORDER MANIA(role play)

PatientName: Jaya shanthaAge: 48 years

Marital Status: Married, has 3 children,Employment: Casual labourer .Residence: Domestic Home in Ambalangoda

Medical HistoryYou have a 5 years history of attacks of manic and depressive episodes, which alternate.Initially these were once a year, then twice a year and now (this year) you have had 4 of them(2 manic, 2 depressive). You are not very good at drug compliance. Drugs are also notreadily available in the PHC.

Social HistoryYou are married to a supportive wife and children. You used to work for a building contractorin your Province but now you have shifted home where you do subsistence farming andcasual jobs in the area.You used to take alcohol, smoke tobacco and sniff some. Your children are all at home, havenot done well academically due to lack of school fees.They are currently employed as casuals in the catchment area. The wife is mainly ahousewife.

Symptoms

Slovenly attired

Hyper active (Psychomotor)

Pressured speech/increased flow, disinhibited Mood Elevated/irritated

Flight of ideas

Grandiose delusions

Perceptual disorders (Hallucinations, depersonalized, derealization)

Cognition, orientation-poor

Judgment - poor

Insight - Lacking

Other Over generous with own property.

Health Workera) You are a health worker in the local PHC in Jayashanthas catchmentarea. J is brought to you by two of his sons.b) Proceed to take adequate history, do an examination and make plansto adequately address his problems with in the area of catchment.


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19. EPILEPSY (? Omit)(Role play of management of fit)

PatientName: Fatuma Ali

Age: 36 yearsMarital Status: Divorced - has 3 children (1 son, 2 daughters)Employment: Trader in textilesResidence: In a Manyata 100 kilometers from Isiolo Town

Medical History

A known epileptic (Generalized seizure type) for the last 5 years.

Husband divorced you after you became epileptic.

Fits have been investigated at District Hospital and you have been on Phenobarbitonetablets 60 mg twice daily.

You collect your drugs from your PHC. You have missed collections once due to lack

of supply caused by heavy rains and floods in your area. You are off drugs over the last 3 weeks.

Fits have become frequent and severer every time they occur.

Symptoms

Seated on a bench in the PHC waiting room

Feeling dizzy, nauseated, with abdominal discomfort

Loud Scream

Falls off the wooden bench on to the earth floor

Becomes stiff, breathless, bites tongue

Starts thrashings

Frothing from the mouth

Passes urine

Passes stool

Stops thrashings

Becomes still

Goes into deep sleep

Wakes up

Movements are automatic (Occupation related)

Poor level of awareness (disorientated STP)

Has headache

Has muscle pains all over.

Health WorkerYou are the Health Worker in a PHC in a division in Isiolo District of Kenya. Fatuma Ali has

just had a Grand Mal type of a fit in the waiting room in your PHC.a) Proceed to manage the fit as necessary.


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20. DEMENTIA(Role play of supporting the carer)

PatientName: Aisha AliAge: 56 yearsMarital Status: Married

Employment: Housed wifeResidence: In Kadugannawa

Medical History

Husband is aged 67 years and has been in poor mental health over the last four years.

Insidiously progressive mental loss has bee noted.

Started as difficulty in remembering where he had placed most of his normal useitems.

Then was unable to dress properly. Currently he wonders away from home and doesnot return unless brought back by well wishers in the village. He does not remembermost of the names of his immediate family.

He at times forgets to feed self. Aisha, his wife has been taking care of her husband,Yusuf Ali, during all this happenings. She also has been ensuring that he comes forroutine reviews at the PHC. Today she seems rather distressed.

Different Reactions of Patient

Tearful

Feeling weak,dizzy, nauseated, with general fatigue

Has muscle pains all over

Health WorkerYou are the Health Worker. Aisha Ali has just brought her demented husband for a routine

review.

b) Proceed to assess her current needs and plan for their management.


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21. DELIRIUM(Role play of diagnosis and management plan)

PatientName: Mutu BandaAge: 42 YearsMarital Status: Married, two children (2 sons)

Employment: Casual LabourerResidence: Badulla

Medical History

You work with an NGO in you Division that is involved in Domestic violence.

One week ago you were marooned in a village that was surrounded by floodwater andcould not get out of the site for 2 days. After you were free to wade out of the village,you went back home.

You have been not sleeping and becoming restless and your friends have brought youto the health centre for management.

Reaction of the PatientOver active, agitated

Incoherent mumbling speech

Severely disorientated in space, time and person

Anxious, irritable mood

Muddled thought and perplexed

Visual and somatic illusions, hallucinations

Poor immediate and recent memory

No insight

Health WorkerYou are a Health Worker in a PHC. M is brought to you by his friends, wife and son.a. Interact with them to ascertain Mutus medical condition and proceed to make plans for

his management.


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22. CHILDHOOD OR ADOLSECENT EMOTIONAL DISORDER(Role play please construct a scenario and demonstrate health worker interaction with childand parent )


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23. CHILDHOOD DISORDERS CONDUCT DISORDER(role play)

PatientName: KusumSex: Male

Age: 10 yearsOccupation: Pupil (Class 4)

Medical History

You are a pupil in a primary school, standard 4.

Your relationship with your friends has been tumultuous ever since you came to std 1.There have been periods of fistfights, wrestling and use of weapons. You seem tostart most of the scuffles you are involved in.

At ten your body has many scars. You seem to always have a wound somewhere onyour body. You regularly smoke. Occasionally you drink the local brew. These arefunded by regular thefts. You regularly run away from school on account of conflicts

with other pupils.

Reasons for this Encounter

Your parents have brought you to the PHC because they found you confused after yousmoked some ganja.

Symptoms

Aggressive towards people

Destructive to property, setting fires and breaking things

Deceitful, stealing

Serious rule violations, lying

Running away from home and school Smoking cigs, smoking ganja and drinking local brew

Frequent fights with injuries

Health WorkerYou are the Health worker. His parents have brought Kasund into your centre.

a. Please interact with the 3 in order to find out Kasuns problem and make a plan ofmanagement, and demonstrate the following skills

social and communication skills training

anger control

Goal Setting, Self monitoring and planning

parent training in how to deal with the child

plan booster sessions to prevent relapses

collaboration with schools when needed


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24. MENTAL RETARDATION(role play)

PatientName: NuwanAge: 18 yearsMarital Status: SingleOccupation: NilResidence: Kaduwela

Medical HistoryYou are severely mentally retarded currently you live with your parents and you are one oftheir 4 sons. Your sibs also assist in your care.

Symptoms

Unable to live alone

Verbal communication is impaired but possible especially with family members whoare familiar with your peculiar mode of communication.

Left school in nursery as was unable to be socialized in school life.

Can conduct simple domestic tasks

Can read some words eg. Stop, Go, No, Yes, Men, Women.

Sometimes becomes irritated and aggressive

Of late has been masturbating openly within the house

Health Workera) Interact with this patient who is currently brought to your PHC in order to understand

her condition and make plans for her management.

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