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Introduction

Clinical psychology is aimed at the study, diagnosis or treatment of psychological problems

or disorders or inappropriate behavior. It then becomes a demanding discipline for the professional

who, using his or her knowledge and interdisciplinary work, can address, accompany and intervene

in the problem for the patient's well-being.

Each pathological case requires a judicious study because the patient's situation needs to be

approached from their reality. The job of the psychology professional is to recognize this

particularity of the individual and his or her family environment. If necessary, an interdisciplinary

group will be required to work as a team and establish the appropriate treatment in terms of

therapies, tasks, methodologies, strategies and medications.

The present work is aimed at making a report on a psychopathological case from clinical

evaluation, starting from an interview, determining the contextualization of the case, the etiology

based on the DSM-V; posing a hypothesis based on the background, application of tests and ending

with a diagnosis and treatment proposal.

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UNIVERSITY CORPORATION GOD'S MINUTE

PATHOLOGY PSYCHOLOGICAL REPORT
SUICIDAL IDEATION
PATIENT IDENTIFICATION DATA
SURNAMES AND NAMES) AGE REPORT DATE
María Camila Casas Botero 17 years March 6, 2020
BIRTHDATE ID ADDRESS AND TELEPHONE
February 27, 2003 1,023,548,259 from Block 10, house 08. La Pradera
Pereira - Risaralda Pereira – Risaralda neighborhood. Dosquebradas -
Risaralda.

REASON FOR EVALUATION

During the interview, the patient reported that when he finished his high school studies he felt sad
because his parents did not have the financial means to attend university, which is why he attempted
suicide by taking several headache pills, which caused him It causes severe stomach pain, after
which the guilt of having carried out this behavior appears, and he does not comment on this
situation to any member of the family.

At 18 months, after entering university studies, the patient felt overwhelmed with academic
responsibilities and attempted suicide by consuming poison, a situation that caused poisoning and
hospitalization for a week with referral to psychology and psychiatry.

In the session, the patient states: “I am worried about keeping the scholarship”, I was referred for
university welfare “I was not used to this type of life” “I did poorly in a subject “I feel stressed”, “it
has been hard for me”. ", "I understand but when they give me the exam I can't do it."

His mother present at the interview reports: “I am worried because every time he has a nervous
breakdown, he always says that he is useless, he is defrauding his parents, that he wants to make an
attempt on his life, he cries and screams uncontrollably. ¨.

CONTEXTUALIZATION OF THE CASE

The alteration of the patient's mood manifests itself with a frequency of 3-4 times a week, in
situations of loss, when she does not obtain good grades she feels helpless. Expressing cognitions
such as “I am useless,” you believe you are not achieving your goals. Recently, being exposed to a
situation of significant loss (the loss of calculus partials) provokes emotions such as anger and
sadness. The anger becomes more intense when he sees that he has no control over the situation, he
says: “I study and I don't see results.”

She has had a low tolerance for frustration since she was a child, with a tendency toward
Impulsive and poorly measured, without taking into consideration the consequences that such
behaviors may have. One of the behaviors he performs is breaking objects when he does not
achieve good results, when carrying out his tasks and academic activities.

The patient's depression responses manifest in situations in which she obtains negative evaluations
regarding the academic area, and occur at three levels or channels: cognitive, physiological and
behavioral.
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The mother says that the patient has always wanted to be the best student, and she has excelled
during all her years of study. He expresses his concern about the patient's condition, which he has
been observing since he finished his high school studies. One of the situations that were a cause for
concern was the few financial resources that were available to enter their university; Faced with this
situation, the mother reports that her mood is negatively affected. Then, when taking the state tests,
due to the results obtained, she is worthy of a full scholarship to study engineering at a private
university.

Obtaining low grades for the first time triggers the symptoms of recurrent thoughts of death or
suicidal ideation and plans or attempts that are reaffirmed by isolating oneself, presenting
conciliation insomnia and irritability when one does not achieve what one wants. The patient also
experiences symptoms that include changes in appetite, psychomotor activity sleep, lack of energy,
feelings of guilt, disability, difficulty thinking, concentrating or making decisions. He frequently
presents with easy crying, irritability, sadness, ruminations about worries about maintaining the
scholarship, and complaints of pain (headaches or joint, abdominal or other pain) and sleep
insomnia.

Symptoms last most of the day, every day for several consecutive weeks. The episode is
accompanied by significant clinical discomfort or deterioration in social, academic, and other
important areas of the patient's activity.

CLINICAL DESCRIPTION OF THE CASE

According to the DSMV, the proposed criteria are:

TO. The individual has made a suicide attempt in the last 24 months.
Note: A suicide attempt is a sequence of behaviors initiated by the individual himself, who at the
moment of initiating them hopes that the set of actions will lead to his own death. The “onset
moment” is the moment at which a behavior in which the suicide method was applied took place.

b. The act does not meet criteria for non-suicidal self-injury, that is, it does not involve self-injury
directed at the body surface that is performed to alleviate a negative feeling/cognitive state or to
achieve a positive mood.

c. The diagnosis does not apply to suicidal ideation or preparatory acts.

d. The act did not begin during delirium or a state of confusion.

AND. The act was not carried out solely for a political or religious purpose.

Specify if:
Current: No more than 12 months have passed since the last attempt.
In initial remission: 12-24 months have passed since the last attempt.

Specifiers:

Suicidal behavior is often categorized by the violence of the method used. Overdoses with legal or
illegal substances are usually considered non-violent methods, while rushing, gunshot wounds, and
other methods are considered violent. Another dimension to classify it is the medical consequences
of the behavior, with high-lethality attempts being defined as those that require medical
hospitalization that exceeds a visit to the emergency department. An additional dimension to
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consider would be the degree of planning versus the impulsivity of the attempt, a characteristic that
could have consequences for the medical prognosis of a suicide attempt.
If the suicidal behavior occurred 12-24 months before the evaluation, the condition is considered to
be in initial remission. Individuals remain at increased risk for subsequent suicide attempts and
death in the 24 months following a suicide attempt, with the 12-24 month period after the behavior
occurring specified as "initial remission." .

Diagnostic features:

The fundamental manifestation of suicidal behavior disorder is a suicide attempt. A suicide attempt
is a behavior that the individual has carried out with at least some intention to die. The behavior
may or may not result in serious injuries or medical consequences. There are several factors that can
influence the medical consequences of a suicide attempt, such as poor planning, lack of knowledge
about the lethality of the chosen method, poor intentionality or ambivalence, or the casual
intervention of other people after it has begun. suicidal behavior. These factors should not be
considered when assigning the diagnosis.

Determining the degree of intent can be challenging. Individuals may not recognize their intention,
especially in situations where doing so may result in hospitalization or cause suffering to their loved
ones. Some risk markers include the degree of planning, which involves choosing a time and place
that minimizes the likelihood of rescue or disruption, the individual's mental state at the time of the
behavior, with acute agitation being of particular concern with a recent discharge. from an inpatient
unit or recent discontinuation of a mood stabilizer, such as lithium, or an antipsychotic, such as
clozapine, in the case of schizophrenia. Some examples of environmental triggers include recently
learning of a potentially life-threatening medical diagnosis, such as cancer, experiencing the sudden
and unexpected loss of a close relative or partner, losing a job, or being evicted from one's home. In
contrast, characteristics such as talking to others about future events or being willing to sign a "non-
suicide pact" would be the least reliable predictors.

For the criteria to be met, the individual must have made at least one suicide attempt. Suicide
attempts can involve behaviors in which, after the suicide attempt began, the subject changed his or
her mind or another person intervened. For example, an individual may intend to ingest a certain
amount of medicine or poison, but stops or is stopped before ingesting the full amount. If another
person dissuades the individual or the individual changes his or her mind before initiating the
behavior, the diagnosis should not be made. The act must not meet the criteria for non-suicidal self-
harm, that is, it must not involve repeated self-harm episodes (at least five times in the last 12
months that are performed to alleviate a negative feeling/cognitive state or to achieve a state of
positive mood. The act must not have been initiated during delirium or a state of confusion. If the
individual was deliberately intoxicated before initiating the behavior to decrease anticipatory
anxiety or minimize interference with the planned behavior, the diagnosis should be made.

Development and course:

Suicidal behavior can occur at any time throughout life, but is rarely seen in children under 5 years
of age. In prepubertal children, the behavior will often consist of a behavior (e.g. e.g., sitting in a
corner) that a parent has forbidden them due to the risk of suffering an accident. Approximately 25-
30% of people who attempt suicide will make more attempts in the future. There is significant
variability in the frequency, method, and lethality of attempts. However, this is not different from
what is observed in other diseases, such as major depressive disorder, in which the frequency of
episodes, the subtype of episodes, and the dysfunction associated with a given episode can vary
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significantly.

Diagnostic aspects related to culture:

Suicidal behavior varies in frequency and form in different cultures. Cultural differences may be
due to the availability of methods (e.g. g., pesticide poisoning in developing countries, gunshot
wounds in the southwestern United States) or the presence of culturally specific syndromes (e.g.,
(e.g., nervous breakdowns, which in some Latino groups can lead to behaviors that resemble suicide
attempts, or can facilitate suicide attempts).

Diagnostic markers:

Abnormalities in laboratory tests often appear as a consequence of the suicide attempt. Suicidal
behavior resulting in blood loss may be accompanied by anemia, hypotension, or shock. Overdoses
can lead to coma or obtundation and associated abnormalities in laboratory tests, such as electrolyte
imbalances.

Functional consequences of suicidal behavior disorder:

Medical conditions may appear (e.g. e.g., lacerations or skeletal trauma, cardiopulmonary
instability, inhalation of vomit and asphyxiation, liver failure consequent to the use of paracetamol)
as a consequence of suicidal behavior.

Comorbidity:

Suicidal behavior can occur in the context of several mental disorders, most commonly bipolar
disorder, major depressive disorder, schizophrenia, schizoaffective disorder, anxiety disorders
(especially catastrophic panic disorders and PTSD flashbacks), substance use disorders (especially
alcohol use disorders), borderline personality disorder, antisocial personality disorder, eating
disorders, and adjustment disorders. It rarely appears in individuals without perceptible pathology,
unless it is performed due to a painful medical condition with the intention of drawing attention to
their martyrdom for political or religious reasons or in couples who make a suicide pact, both cases
being excluded from this. diagnosis, or when third-party informants want to hide the nature of the
behavior.

Risk factor's:
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CPG Prevention of suicidal behavior

POSSIBLE HYPOTHESES
To establish the possible hypotheses, it is necessary to know the history of the adolescent and the
biological or social learning situations that influenced the development of the pathology.

Personal history: During his childhood and adolescence he lived with his parents and younger
sister, on whom he depends for his support.

In his childhood, at the age of five, he was a victim of bullying by his peers, due to his thick build.
She was characterized as a shy girl isolated from the rest of the group.

The mother reports that, during pregnancy, she experienced strong emotional discomfort because
her parents constantly reproached her for getting pregnant before marriage. Faced with this
situation, he cried constantly and became depressed.

Family history: The teenager comes from a nuclear family, made up of a 43-year-old mother, a
housewife. The young woman describes her as a person who listens, to whom she tells all her
things. The 50-year-old father, the young woman describes him as an unaffectionate father, a distant
relationship. Her 15-year-old sister considers her her best friend and with whom they have good
communication.

She highlights the sacrifice they make in her parents to cover both her and her sister's college and
housing expenses.

Socio-affective history: The patient presents difficulties in interpersonal relationships, she is

characterized by little sociability, shyness and isolation. During his life he has focused on the
academic area, relegating his social area, he does not share time with his friends, he does not
integrate with them, he does not engage in leisure activities. Due to the little interaction with others,
it is difficult to establish new friendships and conversations with strangers.

Academic history: Since he began his school studies, he has stood out for having excellent
academic performance, always occupying first place. By taking the state tests, she obtains a high
score that makes her worthy of a full scholarship at the university.
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Currently, he is studying the first semester of civil engineering. During this semester he has had a
poor performance in the calculus subject, in the other subjects he has obtained good grades.

EVALUATION PROCESSES

1. Interview: It was carried out in two moments, the first with the adolescent alone after informed
consent signed by the mother and the second moment with the mother to know the family context
that surrounds the patient.

2. Evaluation instruments: Carried out under authorization (Informed consent of the minor's
mother)

Beck Hopelessness Scale (BHS). It is an instrument created to evaluate a system of cognitive

schemes based on the negative expectation of the future in the medium and long term. The scale has
presented good reliability data and obtains positive results regarding its validity, by clearly
differentiating between potentially suicidal subjects and those who are not.

The BHS Hopelessness Scale is made up of 20 statements definable as true or false. The evaluation
is carried out with a correction key that allows adding the points that coincide with the protocol that
receive one point. Answers that are not answered or answered in both directions receive a score of
zero and the sum of the raw scores can range between 0 and 20.
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3. Results:

The patient presented 14 points that are equivalent to a severe risk of committing suicide.

CLINICAL DIAGNOSIS

It is concluded that the patient presents Suicidal Behavior Disorder, with severe risk of committing
suicide, according to criteria established in the DSMV, history specified in the interview,
psychological test and associated risk factors.

TREATMENT AND INTERVENTION OBJECTIVES

Psychotherapy is the first choice of treatment for Suicidal Behavior Disorder, and the most used is
of the cognitive-behavioral type. Pharmacotherapy is an option when there is no response to
psychotherapy in this pathology. The treatment is therefore considered multimodal (interventions at
the individual, family, group and pharmacological level) (Harrison, Beck & Buceta, 1984).

Cognitive therapy is a problem-solving process based on a learning experience. The patient, with
the help of the therapist, learns to discover and modify cognitive distortions and dysfunctional
ideas. The immediate goal, called "short-term therapy" in Cognitive Therapy, consists of modifying
the systematic predisposition of thinking and producing certain cognitive biases. The final goal,
called "long-term therapy," consists of modifying the underlying cognitive assumptions that would
make the subject vulnerable, preventing relapses. (Obst, 2008).

Cognitive Problem Area

Goals Treatment plan Sessions
Explanation of suicidal Use of psi coeducation 1-2
ideation in the reduction of
myths and false concepts.

Decreased thinking Cognitive restructuring

Suicidal in academic
situations.

Change irrational beliefs about Discussion of thoughts: “How 2-6

your incompetence.
Modify negative self-schemas
of incompetence and
defectiveness.
has your performance been in
the other subjects?”
"I am useless". "I'm ugly" 7
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Debate and discuss
attributions Cognitive restructuring of
errors in the patient: “I am misattributions and self-
useless” control.

Behavioral Problem Area

Goals Treatment plan Sessions

Increase the patient's pace of Programming of mastery and 3

daily activities, their sense of enjoyment activities.
Competition and its ability to Assignment of gradual tasks.
enjoy. Cognitive essay practice
role play

Teach effective strategy to General orientation towards

face their problems. problem
Define the problem: 6
Search for alternatives
solution
Evaluate the alternatives
Choose one of them and put it
into practice

Physiological Problem Area

Goals Treatment plan Sessions
Decreased physical reactions Progressive relaxation 4
of anxiety. training.

Reduce physiological anxiety

reactions when making Muscle relaxation 4
decisions and look for
problem-solving strategies.

Affective Problem Area

Goals Treatment plan Sessions
Records of subjective units Progressive relaxation and 7
that help you manage suicidal cognitive restructuring.
ideation Subjective labeling.

Ensure that the patient Bibliotherapy material. 3

differentiates assertive Training in assertive
behaviors from not achieving behaviors, and management of
her expectations. non-assertiveness.
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References
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Working group of the Clinical Practice Guideline for the Prevention and Treatment of

Suicidal Behavior. YO. Evaluation and Treatment. Clinical Practice Guideline for the Prevention

and Treatment of Suicidal Behavior. Quality Plan for the National Health System of the Ministry of

Health, Social Policy and Equality. Agency for the Avaliation of Health Technologies of Galicia

(avalia-t); 2010. Clinical Practice Guidelines in the SNS: Avalia-t 2010/02.

Ceballos G. A., Suarez C. and others (2015). Suicidal ideation, depression and self-esteem

in school adolescents from Santa Marta. DUAZARY. 12(1), 15- 22.Retrieved from Retrieved from:

http://revistas.unimagdalena.edu.co/index.php/duazary/article/view/1394/895

Fefegrad

Alvarez Z. M., & Marín C. TO. (2011). Depression and suicidal ideation in fesi students: a

pilot study. Electronic Journal of Psychology Iztacala. 14(4). Retrieved from: Retrieved from

http://www.revistas.unam.mx/index.php/repi/article/view/28911

Beck J. (1960). Cognitive therapy: basic concepts and deepening. Recovered from:

https://books.google.com.co/books?id=7EHjCgAAQBAJ&printsec=frontcover&dq=-

%09Beck+Judith+(1960).Cognitive+therapy:+physical+concepts+b%C3%A1and+depth

C3%B3n.&hl=es-

419&sa=X&ved=0ahUKEwjtncyzrpPdAhUFq1kKHUtQDEsQ6AEIJzAA#v=onepage&q&f=

False Beck
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