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Copy of We Need To Talk About Kevin

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Alyson MIller

on 23 March 2014

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Transcript of Copy of We Need To Talk About Kevin

Alyson Miller
Angelica Williams
Courtney Aikens
Diane Labis

Kevin Khatchadourian
Male

17 years old

Situation:

Currently in a juvenile detention center for a killing spree at his high school.

History of Present Illness (HPI)
Family History of Illness
Parents are drinkers
Mother has postpartum depression
Over hears parents discussing separation
Coping Mechanisms
DSM-5 Diagnosis & Criteria
DSM-V: Axis 1-5
Cultural Assessment:
General Appearance & Motor Behavior
Mood & Affect
Quiet

Reluctant to talk

Amused with mom's frustration

Blunted affect






Thought Process & Content
Sensorium & Intellectual Processes
Judgement & Insight
Self-Concept
Roles & Relationships
Student, Son, Brother

Targeted sister

Troubled relationship with mother since infancy

No peer relationships seen

Disruptive behavior towards mother


Physiologic & Self-Care Considerations
Physical aggression involving the bow and arrow

Plays with food and low appetite



Family Role
Father didn't believe that Kevin had a problem, just thought he was being a typical boy

Mother took Kevin the doctor and insisted that he wasn't normal

Mother took anger out on Kevin






Expected Outcomes
Client will not harm others or damage property.

Client will be compliant with medication and other treatments.

Client will learn effective problem-solving and coping skills.

Client will use appropriate language and behaviors when interacting with others.

Client will improve relationship with mother.




Nursing Interventions
Decrease violence and increase complaince with treatment

Limit setting and institute time-out

Provide a routine schedule

Promote social interaction

Provide client and family education

Recommend family therapy & cognitive-behavioral therapy


Community Resources
Poor compliance
Impulsivity
Rigid irritable behavior
Cruelty to animals
Destructive behavior
Lying
Manipulative
Refused to speak until age 3
Potty trained at age 6

N/A
Bow and arrow

Nail biting
Assessment
Consistently break the rules with no regard for consequences

Never take the blame for actions he has taken

Poor judgement
Alert and oriented with intact memory

Very smart


Ineffective Coping

Few or no meaningful peer relationships
Inability to empathize with others
Inability to give and receive affection
Low self-esteem, masked by "tough" act
Age 3
Age 6
Age 15
Age 16
Age 17
312.81 Conduct Disorder, Child Onset Type
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past six months:


Aggression to people and/or animals
1. Often bullies, threatens or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.

Destruction of property
1. Has deliberately destroyed others' property (other than by fire setting).


Serious violations of rules
A. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Specify severity:
Severe: many conduct problems in excess of those required to make the diagnosis, or conduct problems cause considerable harm to others.

Eva Khatchadourian
Female

Late 30's to early 40's

Situation:
Emotionally unstable mother who is trying to come to terms with the loss of family members and the consequences of her son's actions.
Family History of Present Illness

N/A
Coping Mechanisms
Drinking


Very meticulous

Organized thinking

Destructive

Lack of conscience



Flashbacks
Auditory hallucinations
Trouble sleeping
Easily agitated
Violent tendencies
Isolated
Disorganized
Fatigue
Kevin
Eva
Kevin
Eva
Drinking
Kevin
Eva
DSM-5 Diagnosis & Criteria
Diagnostic Criteria: Posttraumatic Stress Disorder 309.81 (F43.10)

A. Exposure to actual or threatened death, serious injury, or sexual violence
A3. Learning that the traumatic event(s) occurred to a close family member or friend, the events must have been violent or accidental.
DSM-V Axis 1-5
309.81 (F43.10) Posttraumatic Stress Disorder
Broad affect

Constantly frustrated

Depressed

Exhausted


Kevin
Eva
Kevin
Eva
Kevin
Eva
General Appearance & Motor Behavior
Disheveled




Kevin
Eva
Appeared older than she was

Tense/anxious
Disorganized

Thought something was wrong with Kevin

Intrusive, persistent thoughts about experience with auditory hallucinations




Kevin
Eva
Mother, wife, employee

Caretaker

Poor communication with husband



Kevin
Eva
Kevin
Eva
Kevin
Eva
Kevin
Eva
Kevin
Eva
Educate client about PTSD

Teach stress management and relaxation techniques

Set limitations and consequences for substance use

Encourage client to talk about experience

Family therapy


Oriented to reality except when experiencing a flashback

Intrusive thoughts can make it hard to concentrate
Insisted something was wrong with Kevin

Poor judgement

Poor insight until the end of the movie


Low self-esteem

Saw herself as hopeless
Client will begin the grieving process.

Client will deminstrate an increased ability to cope with stress.

Client will eliminate substance use.

Client will verbalize knowledge of illness, treatment plan, or safe use of medications.

Client will openly and directly express feelings in nondestructive ways.

Client will build a better relationship with son.


N/A
Posttrauma Syndrome
(Eva & Kevin)
(Eva)
Flashbacks
Auditory hallucinations
Depression
Anger, frustration, irritability
Low self-esteem
Decreased concentration
Substance use
Difficulty with interpersonal relationships, marital problems, and divorce


Mother and wife

Inaffective mother (aggressive)

Shows favoritism


Figure 1. We need to talk about Kevin title (2012).
Figure 2. Kevin, age 3; Refusing to roll ball back to his mother (2013).
Figure 3. Kevin, age 6; Crouched on table after vadalizing his mothers special room (2013).
Figure 4. Kevin, age 15; Practing shooting skills with his bow and arrow (2013).
Figure 5. Kevin, age 16; Biting his nails in jail (2012).
Figure 6. Kevin, age 17; In jail and unsure of himself (2012).
He thinks very highly of himself
Eating and sleeping problems due to stress and anxiety

Uses alcohol while taking medications (medication is not known)
Sidran Traumatic Stress Education and Advocacy
“helps people understand, recover from, and treat:
• traumatic stress (including PTSD)
• dissociative disorders, and
• co-occurring issues, such as addictions, self injury, and suicidality. “
- Offers projects that help support survivors of complex trauma holistically; ex.
the Spirituality and Victims Services Initiative in urban Eastern Baltimore
Sheppard Pratt Health Systems
A “…non-profit behavioral health organization that provides a full range of services in a variety of settings to meet the needs of children, adolescents, adults and older adults.” – Mission statement
- Locally based but has many treatment centers located in the state and some out of state community resource centers as well
- Offers a variety of treatment options: both inpatient and outpatient
National Alliance on Mental Health: Maryland Chapter
- Aims to improve the lives of those with mental health disorders
- Operates at national, state and local levels
- Have programs like peer-led education and support programs – teachers/facilitators have “been there” so they can use their experiences to help those people with mental illness or to help educate the family members of those with mental illness
- Provides brochures and other educational material to help actual members with mental health problems and/or their family members
Calvert County Health Department: Calvert County Mental Health Clinic County Jail Program
- Identifies and delivers appropriate mental health services to individuals in the criminal justice system that are diagnosed with severe persistent mental illness.
- Provides training for staff to promote sensitivity, recognize and be aware of incarcerated individuals who suffer from mental illness.
- Services available: Diagnostic Evaluation; Individual Therapy; Group Therapy; Case Management Services
Axis 1:
Axis 2:
Axis 3:
Axis 4:
Axis 5:
Axis 1:
Axis 2:
Axis 3:
Axis 4:
Axis 5:
N/A
N/A
Death of husband and daughter, son in jail for commiting multiple counts of murder
GAF Scale:
312.81 (F91.1) Conduct Disorder, Child Onset Type
N/A
N/A
Over hears parents discussing separation
GAF Scale:
Full transcript