Watch Pakula, A.J., Barish, K., Gerrity, W.C., Starger, M. (Producers) & Pakula, A.J. (Director). 1983. Sophie’s Choice [Motion Picture]. United States: Universal Pictures.

And answer the questions

With the exception of the first question, you should answer questions as though you are referring to someone who is living today using the current DSM (DSM 5), methods of treatment, etc.

Generally, none of your responses should require more than 1 – 2 pages of text.  The maximum page limit for this exam is 7 pages and the minimum is 4.  Given this limitation, please answer the questions directly; there is no need to make your exam resemble an essay with an introduction, summary, etc.

Please follow the format of the exam when responding to questions.  Number your responses to correspond to the questions.  Do not combine the questions or your responses.  You do not need to cut and paste or retype questions. 

APA format is required and graded as part of this assignment.  I will pay particular attention to margins, text size, line spacing, font, proper format and use of citations and reference page.  Trauma is a writing intensive course; you will lose points for failure to use APA style.  MLA is NOT an acceptable substitute for APA style.

You are expected to use your notes, handouts, DSM and course texts freely.  Please see your syllabus for limitations on the use of the web.  Don’t forget to use proper citations. 

With the exception of our classroom discussion, this is an independent assignment; do not collaborate with other past or current students as you complete this exam.

Scoring Breakdown: Each question is worth 20 – 25 points (as indicated). This portion of your exam makes up 25 percent of your course grade.  Extra credit earned on homework assignments will be added to the score for this exam.

PSYC. 413, PSYCHOLOGY OF TRAUMA

June 16, 2014

Re:       Request for Consultation Regarding Sophie Zawistowski

            Med. Rec. No: 0012157

Dear Mr./Ms. _____________________ (insert your name),

I am contacting you to request a consultation regarding a patient, Ms. Sophie Zawistowski.  Sophie was hospitalized two days ago on the inpatient psychiatric unit here at Mercy Hospital.  The hospitalization is in response to an apparent double suicide attempt involving Sophie and her long term boyfriend, Nathan Landau.  As you may know, the pair ingested a vile of sodium cyanide that was taken from Nathan’s place of work, Pfizer Pharmaceuticals.  Each drank approximately half the contents of the vile; the amount was sufficient to induce severe respiratory suppression that greatly resembled death.  Upon examination, however, the paramedics were able to detect an extremely weak pulse and shallow breathing.  Both received medical treatment and are fortunate as it appears that neither suffered brain damage or any other long term physiological effects from the suicide attempt. 

Sophie arrived on our psychiatric unit two days ago.  For safety reasons, Nathan was sent to a different psychiatric facility following our initial assessment.  To date, Sophie’s presentation in the hospital has been guarded and reflects the sort of “layered” presentation that is typical among victims of trauma.  I understand that you are quite familiar with Sophie’s history and current relationships; I am hoping that you will be able to provide much needed input as I plan treatment.  I am enclosing multiaxial assessments for Sophie and Nathan for your review and consideration.  My questions are presented on the pages that follow the current discussion.  I anxiously await your reply. 

Sincerely,

Sophie’s Multiaxial Assessment:

I.    Alcohol Use Disorder, Moderate

      Other Specified Trauma and Stress-Related Disorder

II.  Dependent Personality Disorder

III. None Known

IV. Domestic violence, lack of primary support, lack of secondary support, Holocaust

      survivor

V.  40, current; 71, highest; 10, lowest

                                                Nathan’s Multiaxial Assessment

I.    Alcohol Use Disorder, Mild

      Unspecified Cocaine-Related Disorder

      Unspecified Benzodiazepine-Related Disorder

II.  Narcissistic PD

III. None Known

IV. Domestic violence (perp.), primary support, lack of secondary support

V:  15, current; 55, highest; 15, lowest

Personal History Childhood and Early Adulthood

          I.     Please consider Sophie’s historical context.  Please discuss some of the historical barriers to Sophie being able to receive effective treatment for her psychiatric difficulties.  (10 points  Key concepts:  History/In Search of Ourselves, Psychological perspectives/Theories, DSM)

NOTE FOR ALL OF THE REMAINING QUESTIONS PLEASE RESPOND AS THOUGH WE ARE DISCUSSING SOMEONE WHO IS LIVING TODAY AND HAS ACCESS TO MODERN TREATMENTS.

        II.     I.          As you know, social support is an important variable in determining both risk for the development of mental illness and in recovery from such illness (Resick, 2001; Perry, 2006).  Sophie’s primary sources of social support are her boyfriend, Nathan and her friend, Stingo.  Should Sophie be encouraged to continue these relationships?  Why or why not?  Are there any risks associated with your recommendation?  If so, please identify and discuss such risks. (10 points  Key concept:  Critical thinking, Social Support, Psychopathology, Stress vs Traumatic Stress)

      III.     Please consider our discussion regarding stress appraisals.  Sophie experienced chronic stress throughout her childhood and traumatic stress starting during her early adulthood.  How did this history or stress impact Sophie’s stress appraisals as she progressed from childhood through the current hospitalization? (20 points Key concepts:  Cognitive appraisals of stress, Impact of chronic stress, Impact of traumatic stress )

Current Risk and Protective Factors: 

Treatment Planning:

      IV.     In what manner might we consider Sophie’s psychiatric difficulties a product of maladaptive learning in behavioral realms?  Please make sure to focus on EACH of Sophie’s official diagnoses (the ones provided by Dr. Woodard) and include discussion of relevant classical and operant conditioning terms in your discussion.  (20 points Key concepts:  Learning theory/Operant Conditioning/Classical Conditioning)

        V.     Prolonged traumatic experiences create physiological shifts that disrupt the normal homeostatic functioning of the nervous system (Resick, 2001; Perry, 2006).  Sophie’s experiences in the concentration camp are sources of prolonged trauma that likely caused her PTSD – type symptoms as well as other behavioral symptoms.  What sort(s) of neurological and related physiological and behavioral dysfunction should I consider in planning treatment for Sophie?  In what manner are these variables contributing to Sophie’s difficulties? (20 points Key concepts:  Perry’s Neurosequential Model, Fight-or-Flight/Hypothalamic-Pituitary-Adrenal Axis, Amygdala-Hippocampus)

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