Simulation 6 Flashcards
(36 cards)
A 56 year old daughter brings in her 80-year-old mother, Marjorie, with a chief complaint of “cluttering and hoarding” to the point of
dysfunction. The problem was brought to a head when the mother recently fell in the home and injured her knee. After a brief hospital visit, rehabilitative physical therapy was ordered, and a physical therapist was sent to the home, in company with the daughter, to prepare for the patient’s discharge. To their dismay, the home was filled, virtually floor to ceiling with an amazing array of “stuff”—boxes of magazines, bins of clothing, piles of old newspapers, a variety of household items, cooking paraphernalia, health items, etc., still in their original unopened boxes; file cabinets filled with mail, advertisements, clippings, photocopies, bills, and other paperwork of a great variety; etc. The clutter extended throughout the home, and was significant enough that none of the three bedrooms could be entered, the bathroom was barely accessible (the bathtub was filled with things), the kitchen was unusable, and the living room had no negotiable space beyond that immediately around a recliner (in which the client clearly slept) and a television surrounded by boxes of second-hand video cassettes and some DVD movies. In the backyard were five metal sheds, all full, which had been erected by a son who had hoped each time to off-load some things and help the client become more functional. The daughter took her mother home during the rehabilitative period, but now is uncertain what to do to ensure her mother’s safety.
A 56 year old daughter brings in her 80-year-old mother, Marjorie, with a chief complaint of “cluttering and hoarding” to the point of
dysfunction. The problem was brought to a head when the mother recently fell in the home and injured her knee. After a brief hospital visit, rehabilitative physical therapy was ordered, and a physical therapist was sent to the home, in company with the daughter, to prepare for the patient’s discharge. To their dismay, the home was filled, virtually floor to ceiling with an amazing array of “stuff”—boxes of magazines, bins of clothing, piles of old newspapers, a variety of household items, cooking paraphernalia, health items, etc., still in their original unopened boxes; file cabinets filled with mail, advertisements, clippings, photocopies, bills, and other paperwork of a great variety; etc. The clutter extended throughout the home, and was significant enough that none of the three bedrooms could be entered, the bathroom was barely accessible (the bathtub was filled with things), the kitchen was unusable, and the living room had no negotiable space beyond that immediately around a recliner (in which the client clearly slept) and a television surrounded by boxes of second-hand video cassettes and some DVD movies. In the backyard were five metal sheds, all full, which had been erected by a son who had hoped each time to off-load some things and help the client become more functional. The daughter took her mother home during the rehabilitative period, but now is uncertain what to do to ensure her mother’s safety.
What is the chief complaint of Marjorie?
Cluttering and hoarding to the point of dysfunction
This issue was exacerbated by a recent fall that injured her knee.
What items filled Marjorie’s home?
An array of items including:
* Boxes of magazines
* Bins of clothing
* Piles of old newspapers
* Household items
* Cooking paraphernalia
* Health items still in unopened boxes
* File cabinets filled with paperwork
What was the condition of Marjorie’s home?
Cluttered to the point that:
* None of the three bedrooms could be entered
* The bathroom was barely accessible
* The kitchen was unusable
* The living room had limited space
What did the daughter express uncertainty about?
How to ensure her mother’s safety after the rehabilitative period
What is an appropriate initial question to ask Marjorie?
Do you know why you’ve been brought to see me today?
Which question was indicated for understanding Marjorie’s concerns?
Can you tell me about your greatest concern today?
What did Marjorie think about her living situation?
She believes she can take care of herself and has been living alone since her husband died.
What is the significance of city fire hazard ordinances?
They limit what can be stored in a home, which Marjorie was unaware of.
What was Marjorie’s response to the question about her safety in the home?
She felt her home was just as safe as anyone else’s.
What is the most likely diagnosis for Marjorie?
Hoarding Disorder (F42.3)
What traits might Marjorie exhibit related to Obsessive-Compulsive Personality Disorder?
Traits of being highly focused on order, tasks, lists, and details.
What did Marjorie’s adult children note about their mother’s behavior towards help?
She is always concerned that they will do something wrong or mess up the ‘order’ of things.
Fill in the blank: Hoarding Disorder can be classified as with ______, poor insight, or absent insight.
good insight
What did Marjorie refuse to consider regarding her possessions?
She did not feel she could donate or discard anything.
True or False: Marjorie’s symptoms align closely with Generalized Anxiety Disorder.
False
What kind of support did the daughter seek for Marjorie?
Help to ensure her mother’s safety after rehabilitation.
What was a key factor in Marjorie’s home situation?
The clutter was significant enough to limit access to essential areas of the home.
What did the adult children describe about Marjorie’s childhood behavior?
She was very rigid with rules and had no tolerance for deviation.
What is a potential secondary diagnosis for Marjorie?
Problems of Adjustment to Life-Cycle Transitions (Z60.0)
What is the diagnosis code for obsessive-compulsive personality disorder?
F42.3
What diagnosis may be given due to multiple aging issues impacting a client’s life?
Problems of Adjustment to Life-Cycle Transitions (Z60.0)
How should multiple mental health diagnoses be ranked?
As ‘primary,’ ‘secondary,’ and ‘tertiary’
What are the goals of Cognitive Behavioral Therapy (CBT) for hoarding disorder?
Decrease clutter via enhanced decision-making and organizational skills, and strengthen resistance to urges to collect and save.
