Intervención desde el modelo cognitivo conductual en un caso de trastorno bipolar I con síntomas psicóticos en comorbilidad con abuso de cannabis: estudio de caso en un adulto joven
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Fecha
2023
Autores
Trejo Herrera, Kathleen Yulieth
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias Jurídicas y Sociales
Facultad de Ciencias Jurídicas y Sociales
Resumen
La salud mental hoy en día ha tenido un notable incremento lo cual ha ocasionado una afectación a nivel mundial, entendiéndose estas como un desequilibrio clínicamente significativo que comprende la desregulación emocional, problemas conductuales y una alteración cognitiva generando discapacidad funcional en otras áreas importantes. En el presente estudio de caso se evaluó la presencia de estas dos patologías agudas, se analizaron las características del trastorno bipolar I con síntomas psicóticos en comorbilidad con el trastorno de abuso de cannabis, esto con el fin de poder caracterizar de forma directa al paciente. Se llevaron a cabo 12 sesiones, en las cuales se recolecto el motivo inicial de consulta, identificación de problemáticas, se recabó información de la historia personal, generando así un proceso de evaluación, diseño e intervención del plan terapéutico desde el modelo cognitivo conductual. Se
aplicaron las pruebas de Hypomania checklist (HCL-32), Mood Disorder Questionnaire (MDQ) versión en español, Esquemas mal adaptativos de Yung, Escala de evaluación del cambio (URICA), y Escala pronóstica para la esquizofrenia de Stauss y Carpenter. Dentro del proceso de intervención se implementaron técnicas cognitivas como la psicoeducación, técnica de control, auto registro, técnica control de pensamiento, registro de pensamientos disfuncionales, registro de emociones, termómetro del ánimo, entrenamiento para recibir críticas, técnicas de relajación progresiva y profunda, prueba de realidad, debate socrático, reestructuración cognitiva, técnica de la flecha ascendente y entrenamiento en técnicas de uso del tiempo libre al igual que en habilidades sociales con modelado de conducta. Dentro de los resultados del proceso de intervención, se logró identificar la comorbilidad existente entre los diagnósticos identificados en el paciente: Trastorno Bipolar I con síntomas psicóticos en comorbilidad con el trastorno de abuso de cannabis. Se regulo el estado de ánimo elevado, disminuyo el contenido delirante, se redujeron las respuestas de ansiedad, se modificaron las creencias disfuncionales a unas más adaptativas y las distorsiones cognitivas asociadas al consumo de sustancias psicoactivas, a su vez se aumentó la conciencia sobre el diagnóstico y daño del consumo. D.A.L.A logro mejorar el vínculo con su figura paterna a lo largo de las sesiones y adquirió herramientas en pro a la regulación emocional. Se logra egreso del paciente al finalizar el proceso terapéutico. Estos hallazgos ponen en evidencia la importancia de llevar a cabo procesos de intervención psicológica desde el ejercicio práctico que ha sido basado en la evidencia para el tratamiento de diversas problemáticas de la salud mental con una carga de disfuncionalidad. En este sentido, se aspira que el siguiente estudio de caso sirva de ayuda y soporte para otros profesionales de la salud mental en el ejercicio de su profesión.
Mental health today has had a notable increase which has caused a worldwide impact, understood as a clinically significant imbalance that includes emotional dysregulation, behavioral problems and a cognitive alteration generating functional disability in other important areas. In the present case study, the presence of these two acute pathologies was evaluated, the characteristics of bipolar I disorder with psychotic symptoms in comorbidity with cannabis abuse disorder were analyzed, in order to be able to directly characterize the patient. 12 sessions were carried out, in which the initial reason for consultation was collected, identification of problems, information from personal history was collected, thus generating a process of evaluation, design and intervention of the therapeutic plan from the cognitive behavioral model. The Hypomania checklist (HCL-32), Mood Disorder Questionnaire (MDQ) Spanish version, Yung's maladaptive schemas, Change Assessment Scale (URICA), and Stauss and Carpenter's Schizophrenia Prognostic Scale were applied. Within the intervention process, cognitive techniques were implemented such as psychoeducation, control technique, self-registration, thought control technique, registration of dysfunctional thoughts, registration of emotions, mood thermometer, training to receive criticism, progressive and deep relaxation techniques, reality testing, Socratic debate, cognitive restructuring, upward arrow technique and training in techniques for using free time as well as social skills with behavioral modeling. Within the results of the intervention process, it was possible to identify the existing comorbidity between the diagnoses identified in the patient: Bipolar I Disorder with psychotic symptoms in comorbidity with the cannabis abuse disorder. Elevated mood was regulated, delusional content decreased, anxiety responses were reduced, dysfunctional beliefs were modified to more adaptive ones and cognitive distortions associated with the consumption of psychoactive substances, and awareness of the diagnosis was increased. and harm from consumption. D.A.L.A managed to improve the bond with her father figure throughout the sessions and acquired tools for emotional regulation. The patient is discharged at the end of the therapeutic process. These findings highlight the importance of carrying out psychological intervention processes from practical exercise that has been based on evidence for the treatment of various mental health problems with a burden of dysfunctionality. In this sense, it is hoped that the following case study will serve as help and support for other mental health professionals in the exercise of their profession.
Mental health today has had a notable increase which has caused a worldwide impact, understood as a clinically significant imbalance that includes emotional dysregulation, behavioral problems and a cognitive alteration generating functional disability in other important areas. In the present case study, the presence of these two acute pathologies was evaluated, the characteristics of bipolar I disorder with psychotic symptoms in comorbidity with cannabis abuse disorder were analyzed, in order to be able to directly characterize the patient. 12 sessions were carried out, in which the initial reason for consultation was collected, identification of problems, information from personal history was collected, thus generating a process of evaluation, design and intervention of the therapeutic plan from the cognitive behavioral model. The Hypomania checklist (HCL-32), Mood Disorder Questionnaire (MDQ) Spanish version, Yung's maladaptive schemas, Change Assessment Scale (URICA), and Stauss and Carpenter's Schizophrenia Prognostic Scale were applied. Within the intervention process, cognitive techniques were implemented such as psychoeducation, control technique, self-registration, thought control technique, registration of dysfunctional thoughts, registration of emotions, mood thermometer, training to receive criticism, progressive and deep relaxation techniques, reality testing, Socratic debate, cognitive restructuring, upward arrow technique and training in techniques for using free time as well as social skills with behavioral modeling. Within the results of the intervention process, it was possible to identify the existing comorbidity between the diagnoses identified in the patient: Bipolar I Disorder with psychotic symptoms in comorbidity with the cannabis abuse disorder. Elevated mood was regulated, delusional content decreased, anxiety responses were reduced, dysfunctional beliefs were modified to more adaptive ones and cognitive distortions associated with the consumption of psychoactive substances, and awareness of the diagnosis was increased. and harm from consumption. D.A.L.A managed to improve the bond with her father figure throughout the sessions and acquired tools for emotional regulation. The patient is discharged at the end of the therapeutic process. These findings highlight the importance of carrying out psychological intervention processes from practical exercise that has been based on evidence for the treatment of various mental health problems with a burden of dysfunctionality. In this sense, it is hoped that the following case study will serve as help and support for other mental health professionals in the exercise of their profession.
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Palabras clave
Trastorno Bipolar I, Salud mental, Modelo cognitivo conductual, Abuso de cannabis, Síntomas psicóticos, Intervención psicológica, Estudio de caso, Bipolar I Disorder, Mental health, Cognitive Behavioral Model, Cannabis abuse, Psychotic symptoms, Psychological intervention, Case study
