1. The Effect of Culture and Comorbidities on Patient Care
Jesse Chavarria, M.S.
January 19th, 2017

2. The Effect of Culture and Comorbidities on Patient Care
Discussant
Dr. Lindsay Brauer

3. YM
Sex: Female Age: 61 Race: Chinese (immigrated in 1973) First intake: 3/16/15 Transfer: 7/27/16 Number of sessions: 42(8) Seeking treatment for: Depression Anxiety Obsessive Compulsive Disorder

4. Y.M.
Initial Intake
Panic Disorder with Agoraphobia in partial remission
Frequent panic attacks
Wouldn’t leave room/house
Generalized Anxiety Disorder
“nervous” at all times
Easily fatigued, tense, problems with concentration
Major Depressive Disorder
Low appetite, poor sleep, low energy, anhedonia
Obsessive Compulsive Disorder
Denied intrusive thoughts
Compulsive checking and manipulation of locks and stove
2-3 minutes per day
-Panic: first began 27 years ago after her children contracted salmonella
-reappeared in 1997 after contracting hep B
- occasional symptoms currently, but far less impairing
-GAD: has increased and become problematic since a laparoscopic cholecystectomy
-Lorazepam for anxiety (first presscribed 27 years ago)
-Sertraline for OCD/Depression (100mg/ daily)

5. Y.M. 1st Therapist OCD MDD Showering 2-3 times per day
Washing hands until red/chapped
Spend whole day cleaning
Refuse to handle eggs, trash, or leave home
Excessive concerns about germs and contaminating others
MDD
Continued to endorse previously mentioned depressive symptoms.
5-weeks later
OCD
Therapy consisted of Exposure and response prevention.
-Little gains due to a lack of commitment/buy in
MDD
Behavioral Activation
-Some gains made

6. Y.M. 2nd Therapist Sessions conducted in Cantonese
Focus on OCD symptoms
Distracted self by watching TV
Focused heavily on ERP
Colon Cancer diagnosis
Processed diagnosis
Began to focus on Depression Sx
-Pt reported that she did not enjoy the added stress of homework assignment
-Distraction was causing disturbances in pt’s sleep schedule and mood.

7. Y.M. Current Therapist Sessions conducted in English GAD
Constant fear of cancer recurrence
Avoid meat, only eat vegetables
Very invested in Chinese herbal remedies despite
Conflict with physicians and family
Concern of terrorist attack when children travelled
Focused primarily on MDD
Behavioral Activation (BA)
Buy-in accelerated due to work done by previous therapist
Sleep Hygiene
very skeptical
Poor insight
Treatment terminated due to insurance change

8. Y.M. Behavioral Activation
Set of techniques in which patients monitor and notice the connection between mood and daily activities (Lewinsohn, Biglan, & Zeiss, 1976)
As efficacious as Cognitive Therapy during acute treatment (Jacobson et al., 1996)
BA effects as enduring as CT and Anti-Depressant medications over at 2-year follow-up (Dobson et al., 2008)

9. The Effect of Culture and Comorbidities on Patient Care
Discussant Questions

10. Audience Questions
What effect does speaking the pt’s preferred language have on rapport?
How do you navigate issues of culture with regards to untested medications?
How do you deal with pseudoscience and movement (by some) towards the rejection of science (i.e., vaccine deniers)?
What effect will possible changes to the ACA have on patient care?
What role will we as psychologists/psychiatrists play in this? Is it our ethical responsibility to find care alternative care providers?