Cabinet individual de Psihologie-Ciuperca Psihologie-Ciuperca M. Niculina STR. NICOLAE ONCESCU NR.4 , BLOC 100 SC.1 ET.2 AP. AP. 14
C.I. Colegiul Colegiul Psihologilor Psihologilor 10B0706 C.I.F. !6 10 !"!
RAPORT DE PSIHODIAGNOSTIC SI EVALUARE CLINICA (Tu Tulburare lburare de panica fara f ara agorafobie) I . Informatii despre client :
A. C. Are 28 de an, na!"na#!a!e r"$ana, #"%&e'!e n B&%&re'! $re&na %& '"!&#, )e!!a de 1 an ' 10 #&n , )ra!e#e ' arn! ( $a$a ' !a!a# *!re+. Are '!&d '&er"are e%"n"$%e. In re-en! e'!e n %"n%ed& en!r& %re'!erea %"#&#&. II. Obiectivul Psihodiagnosticului Psihodiagnosticului si Evaluarii :
P'"da+n"'!%&# ' E*a#&area are %a '%" den!)%area '!ar#"r '"#"+%e de 'ana!a!e ' /"a#a ' a $e%an'$e#"r '"#"+%e de e!"a!"+ene-a ' 'an"+ene-a . Dna A .C. , 'a re-en!a! #a %a/ne!&# '"#"+% en!r& e*a#&are ' n!er*en!e '"#"+%a #a re%"$andarea $ed%&#& de )a$#e, d&a n&$er"a'e %"n!r"a#e $ed%a#e($ed% de )a$#e, end"%rn"#"+e, %ard"#"+e ' $a $&#!e $ed%a$en!e ad$n'!ra!e )ara e)e%! n de%&r' de 8 #&n de -#e. Acuze principale
aar!a /r&'%a de a$e!e#, #'a de aer, 'en-a!e de #e'n, d&rer n e!,!ran'ra! re%, d&rer a/d"$na#e ,a#!a! n'"!!e de )r%a n!en'a, )r%a de $"ar!e . Evaluarea psihologica 'a rea#-a! rn n!er$ed&# In!er*&#& %#n% '!r&%!&ra! (SCID
I, In!er*&#& %#n% '!r&%!&ra! SCID II”(pentru tulburările clinice de personalitate
de pe axa II a DSM) S%a#e#e End#er de E*a#&are 3&#!d$en'"na#a a Ane!a! (E3AS, S%a#a de 'e*er!a!e a T&#/&rar de an%a, S%a#a de a!!&dn ' %"n*n+er (ABSII, Ce'!"nar&# +and&r#"r a&!"$a!e, S%a#a Ha$#!"n de e*a#&are a ane!a!, Ce'!"nar&#
1
de a%%e!are ne%"nd!"na!a a r"re er'"ane.(USA5, Ce'!"nar 67P5, Ce'!"nar&#
'%e$e#"r %"+n!*e (S5S9. Istoricul tulburarii prezente.
Dn re#a!ar#e %#en!e ree'e %a r"/#e$e#e e a& de/&!a! d&a " er"ada $a '!re'an!a, n %are #a "/"'ea#a %a&-a!a d&a n"! ned"r$!e dn %a&-a %"#&#& (a*ea %"# de 10 #&n 'a ada&+a! '!re'&# r"*"%a! de n%er%area de a' %"n'!r& " #"%&n!a . In &r$a %& &n an , "!ara'!e de %"$&n a%"rd %& '"!&# 'a %"n'!r&a'%a " %a'a #a %a!e*a '!ra- de arn! e , n!r&%a! 'a!&# #"%&/# n re-en! #e e'!e n'&)%en! (#"%&e'% n!r" %a$era $re&na %& %"#&#, n #&' '&n! !"! !$&# deran:a! de %"$"r!a$en!&# !a!a#& *!re+ , %are "/'n&e'!e 'a /ea ' #a )e%are /e!e 'e $an)e'!a a+re'*. ;a% $r&$&! n /an%a , %&$ara $a!era#e en!r& %a'a , n%e %"n'!r&%!a, dar $a!era#e#e '&n! )&ra!e . C&$ara a#!e $a!era#e, dar n%e 'a r$ea'%a a$enn!ar !e#e)"n%e, %a da%a *"r n%er%a 'a %"n'!r&a'%a n %"n!n&are #e *"r ) )&ra!e ' a%e#ea . Pr$&# a!a% de an%a # )a%e #a 4 #&n de #a !e#e)"ane#e de a$enn!are ,%and a*ea $re'a %a 'e !er$na'e !"!&# ' n& $a '&n! $"!*e de n+r:"rare. N"a!ea , )ara &n $"!* aaren!, 'a !re-! %& " )r%a n!en'a , %& a#!a!, #'a de aer, !ran'ra!, !re$&ra!&r ' a a*&! 'en-a!a %a *a $&r . A", #a n!er*a#e de " #&na a!a%&r#e a& re*en! %& " n!en'!a!e $a $%a , &#!$&# a!a% 'a $an)e'!a! a+re'* , ar !ea$a de a 'e ree!a , a )a%&!" 'a %eara a:&!"r. Istoric medical
C#en!a a '"#%!a! $a $&#!e %"n!r"a#e $ed%a#e ($ed% de )a$#e, end"%rn"#"+e, %ard"#"+e n &r$a %ar"ra a r$! %"n)r$area )a!&#& %a n& are " r"/#e$a $ed%a#a ' 'a re%"$anda! %"n'&#!area &n& '"#"+ ' a &n& 'a!r& . Istoric psihiatric:
N& a &r$a! n%"da!a " $ed%a!e an"#!%a . In &r$a %& 9 #&n 'a re%"$anda! S!$"#"!"n ' La"!an# , e %are a re)&-a! 'a #e a, 'erand %a *a !re%e )ara $ed%a$en!e. Antecedente heredo- colaterale
Dn re#a!ar#e e ree'e %a $a$a a a*&! a!a%&r de an%a , e %are #ea re-"#*a! %& +re& d&a nde#&n+ !ra!a$en!e an"#!%e.
Istoric personal
Pana #a 4< an #"%&e'!e %& $a$a ' !a!a# 'a& n!r" a!$"')era ne%"n)#%!&a#a . D&a a%ea'!a *ar'!a, !a!a# ' +a'e'!e " a$an!a , " a#&n+a e $a$a dn %a'a ' "re'!e %"#&#. 3a$a *!re+a " a+re'a )-% ' *er/a# n #'a !a!a#&,&ne"r a:&n+and 'a d"ar$a rn *e%n, ana e'!e n%redn!a!a #e+a# $a$e . S&)era %a n&' "a!e *edea !a!a#, %are , da!"r!a ,,n!r+an!e= 'e ndear!ea-a de ea. Se %"n'"#ea-a %& *-!a #a '&r"r#e a%e'!&a, %are '&)er'era a%e#a' !ra!a$en! %a ' ea. La '%"a#a 'e '!rad&e'!e ,,'a )e %ea $a /&na=, )nd ndr&$a!a de /&n%a , ,," )e$ee "rd"na!a, "r+an-a!a=, %are " nde$na 'a n*e!e,,'a a:&n+a %ne*a n *a!a=, 'a ' er!e $a$a *!re+a ' e !a!a# 'a& ' 'a ar"e rn %"$"r!a$en!&# 'a& . I rer"'ea-a /&n% %a era rea r"!e%!"are, %"n!r"#a )e%are +e'!, )e%are $'%are, n'&)#a nen%rederea n "a$en ,,'a n& a:&n+ %a $a%a!a %are !"!dea&na a )"'! rea %red&#a=. A/'"#*en!a de ASE 'e %a'a!"re'!e %& &n %"#e+ de )a%&#!a!e , %ar&a n& %"n!e'!a n%"da!a de%-#e ,,%a 'a n& a:&n+a %a $a$a=. III. De'%rerea '&%%n!a a %" $"nen!e#"r '"#"+%e N*e# S&/e%!*>E$"!"na#(n%#&'* Sa!')a%!a>Ca#!a!ea *e! Ce 'a e*a#&a! D'"-!a an"a'a
C& %e 'a e*a#&a!
S%"r&r
S%a#e#e End#er de E*a#&are
E3AS T P;<
3&#!d$en'"na#? a
E3AS PES<4
Ane!?@ (E3AS
E3ASPP; < E3ASPR6 < SAST SE<4 SASTADP2 SASTES SASPAD < SASPES 9 SASPA <
!
S%a#a Ha$#!"n de e*a#&are a
90
ane!a! S%a#a de 'e*er!a!e a T&#/&rar
14
de an%a Trar e$"!"na#e
S%a#a de a!!&dn ' %"n*n+er
129
(ABS II A%%e!area ne%"nd!"na!a a r"re
Ce'!"nar&# de a%%e!are
er'"ane
ne%"nd!"na!a a r"re
8
er'"ane.(USA5
!ivel cognitiv Ce 'a e*a#&a!
C& %e 'a e*a#&a!
S%"r&r A!en!e d$n&a!a, d)%&#!a! de %"n%en!rare (n&
A!en!a ' %"n%en!rarea
In!er*&
$a "a!e #e%!&ra n% $a%ar " re*'!a
Caa%!a!ea de *er/a#-are
In!er*&
Er$are *er/a#a d)%#a
+andrea
In!er*&
Gand&r a&!"$a!e=a$ 'a )a% n)ar%!=,=a$ 'a #e'n=, Fa$ 'a $"r=
Ce'!"nar&# +and&r#"r
49
a&!"$a!e
N*e# %"$"r!a$en!a# Ce 'a e*a#&a!
C& %e 'a e*a#&a!
C"$"r!a$en!&#
In!er*&# %#n%
S%"r&r e*!area n!era%!&n %& )"'! re!en ' %&n"'%&! n& d"ar$e 'n+&ra, de !ea$a 'a n& a/a %ne 'a ")ere &n r$ a:&!"r n %a- de a!a% de a!a% de an%a
#
N*e# '")-"#"+%
Ce 'a e*a#&a!
C& %e 'a e*a#&a!
S$!"$e )-"#"+%e a#!a!, !a%arde,
In!er*&
!re$&ra!&r, !ran'ra!, 'en-a!e de '&)"%are, d&rer n e!, +rea!a ' d&rer a/d"$na#e, 'en-a! de a$e!ea#a ' #e'n, d)%&#!a! re'ra!"r, )r'"ane .
N*e# de er'"na#!a!e ' 3e%an'$e De)en'*e > Ada!are Ce 'a e*a#&a!
C& %e 'a e*a#&a!
er'"na#!a!ea
Ce'!"nar 67P5
S%"r&r S%a#a Ca&!are $&#'*a de 'en-a! 41 "cala An#ietate $ %% &peste media populatiei)
S%a#a A+re'*!a!e 4 ('&/ $eda "&#a!e "cala Activitate $ '( &sub media populatiei)
S%a#a S"%a/#!a!e 1
Ce'!"nar&# '%e$e#"r
Der*are e$"!. (ra+
%"+n!*e (S5S9
A/and"n14 (ra+8 Nen%redere>A/&- 1 (ra+ 11 I-"#are '"%a#a 12(/are$ 8 De)e%!>r&'ne (/are$ E'e% 1 (ra+ 8 Deenden!a 18(ra+ V&#nera/#!a!e #a ra& ' /"a#a 1 (ra+ Pr"!e%!"n'$>E+" n)an!#1<( S&/:&+area 1< (ra+ 8
$
A&!"'a%r)%& 22 (ra+ 18 In/!e e$"!"na#a 1 (ra+ 10 S!andarde nerea#'!e 14 ( ra+ 1 Re*end%are> Grand"$ane21 (14 A&!"%"n!r"# 1 (ra+ 12 Ca&!area ar"/ar << ( /are$ 9< Ne+a!*'$ >Pa'*!a!e 99( 21 Pena#-area 99 (ra+ 9
N*e# de re#a!"nare n!erer'"na#a (n%#&'* de %&#&, )a$#e, +r& e!%. Ce 'a e*a#&a! Ca#!a!ea re#a!#"r
C& %e 'a e*a#&a! Ana$ne-a %#n%a
n!erer'"na#e
S%"r&r Re#a!ea-a %a '"!&# e'!e deran:a! de '!area e , %erand& 'a' re'"#*e r"/#e$e#e, en!r& %a e# are 2 :"/&r, $&n%e'!e de'!&#, n& $a )a%e /ne 'a '&na ' r"/#e$e#e e. Re#a! %"n)#%!&a#e %& !a!a# *!re+, re% %& )ra!e#e , ar"a!e %& $a$a.
IV. C"n%#&- (S&$ar-area n)"r$a!#"r n !er$n '"#"+% In &r$a P'"da+n"'!%&#& ' E*a#&ar )"r$&#a$ &r$a!"are#e %"n%#&- '"#"+%e Interviul clinic structurat &"I* +I) a
den!)%a! &r$a!"are#e a'e%!e
a!a%&r de an%a re%&ren!e !ea$a n #e+a!&ra %& $#%a!#e a!a%&#& re"%&are er''!en!a n #e+a!&ra %& )a!&# de a n& a*ea a!a%&r &#!er"are
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'$!"$e a#e a!a%&#& de an%a %e 'a& de-*"#!a! /r&'% ' a& a!n' a"+e&# n10 $n&!e a#!a!, !re$"r, '%&r!are a re'ra!e, 'en-a!e de '&)"%are, d'%"$)"r! re%"rda#, 'en-a!e de a$e!ea#a, )r%a de erdere a %"n!r"#&#&, )r%a de $"ar!e. Interviul clinic structurat ,"I* II”(pentru tulburările clinice de personalitate de pe axa II a DSM)- n& a e*den@a! " !&#/&rare de er'"na#!a!e,
n!r&%J! !r?'?!&r#e de er'"na#!a!e n& n!r&ne'% ra+&# ne%e'ar en!r& da+n"'!% S%a#e#e
End#er de E*a#&are 3&#!d$en'"na#? a Ane!?@ (E3AS nd%a
'%"r&r e'!e $ede #a '%a#e#e E3AS T P; (Per%"# ;-%< , E3AS PES (E*a#&are '"%a#a<4 , E3ASPP; ( '%"r < , E3ASPR6 (r&!na -#n%a '%"r <, SASTSE('earare de %e dra+<4,SASTADP(a'e%!e er'"na#e de're 'ne &n"r re!en2, SASTES (e*a#&are '"%a#a,SASPAD (de-*a#&re er'"na#a<, SASPES (E*a#&are '"%a#a9, SASPA (er%e!a a$enn!ar< S%a#a Ha$#!"n de e*a#&are a ane!a! nd%a " ane!a!e 'e*era. S%a#a de 'e*er!a!e a T&#/&rar de an%a nd%a re-en!a &ne !&#/&rar de an%a nre+'!rand &n '%"r 'e$n)%a!* 14
S%a#a de a!!&dn ' %"n*n+er II( ABS II are '%"r 129, ' nd%a !"#eran!a
'%a-&!a #a )r&'!rare ('%"r 9, +andre %a!a'!r")%a ('%"r 9< %redn!e ra!"na#e de !KK!re/&e= ('%"r 94 a&!"dere%ere> e*a#&are +#"/a#a ('%"r 1 . Ce'!"nar&# de a%%e!are ne%"nd!"na!a a r"re er'"ane.(USA5 rn '%"r&# de 8 nd%a " er'"ana %& a%%e!are ne%"nd!"na!a a r"re er'"ane '%a-&!a. Ce'!"nar&# +and&r#"r a&!"$a!e ('%"r 49 nd%a " er'"ana %& &n n*e# rd%a! a# +and&r#"r a&!"$a!e d')&n%!"na#e >ra!"na#e Ce'!"nar&# de er'"na#!a!e 67P5 rn re-en!a '%"r&#& $are #a '%a#a de ane!a!e nd%a " er'"ana %are ' )a%e +r: en!r& "r%e, 'e '&ara )re%*en! , n& are n%redere n %aa%!a!#e r"r '%"r&# $% #a '%a#a A%!*!a!e nd%a " er'"ana #'!a de ener+e , %are re)era $&n%#e de r&!na.
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Ce'!"nar&# '%e$e#"r %"+n!*e (S5S9 nd%a " er'"ana %are %"n'dera %a n& 'e ")era '&'!nerea e$"!"na#a ' r"!e%!a de %are are ne*"e dn ar!ea %e#"r#a#!, 'e %"n'dera n'e#a!a, &$#!a,$n!!a,d)er!a de %e#a#! de %are 'e -"#ea-a , 'e %"n'dera n%aa/#a 'a' nde#nea'%a re'"n'a/#!a!#e, are " )r%a ea+era!a de e*en$en!e 'a& %a!a'!r")e, e %are n& #e "a!e re*en. Pre-n!a $a!&r!a!e e$"!"na#a , 'e %"n%en!rea-a e a'e%!e#e ne+a!*e a#e *e!, $n$a#-and %e#e "-!*e ' are " !"#eran!a '%a-&!a #a )r&'!rare .
Profil psihologic
S&/e%!&# e'!e " er'"ana an"a'?, %are ' )a%e +r: en!r& "r%e, 'e '&ara )re%*en!, n& are n%redere n %aa%!a!#e r"r, e'!e #'!? de ener+e re)er? $&n%#e de r&!n?, en!r& %? 'ar%n#e n" 'a& a$/+&e r"*"a%? d'%"n)"r!, ar +Jnd&r#e ra@"na#e n #e+?!&r? %& a%e'!ea, da& " '!are ne ne'+&ran@?. Are " ne*"e ea+era!? de '&'@nere, re%&n"a!ere a!en@e dn ar!ea %e#"r#a#@, %& " 'en-a@e %"n'!an!? de ne&!n@?, a&!"dere%ere, %"n*n'? %? )?r? a:&!"r&# %e#"r ar"a@ n& "a!e nde#n re'"n'a/#!?@#e. De a%eea 'e '&&ne %"n!r"#&#& e%e'* a# a%e'!"ra, e'!e )a!? e%e'* e 'a!')a%erea ne*"#"r %e#"r dn :&r, n de!r$en!&# r"r#"r ne*" en!r& a $en@ne re#a@#e a ) '+&r? %? n& *a ) a/and"na!? #a ne*"e. Re#a@a e$"@"na#? de ar"ere ea+era!? )a@? de er'"ane#e re#e*an!e, $ed%? de-*"#!area r"re den!!?@ nd*d&a#e '"%a#e. Pen!r& a e*!a de-ar"/area %e#"r#a#@, n/? a%@&n#e, 'en!$en!e#e %"$&n%area, de 'e '$!e d)er!? de a%e!a e'!e %"n*n'? %? ar $er!a r*#e+ 'e%a#e. Are d)%&#!?@ de a 'e %"n!r"#a d'%#na n "/@nerea '%"&r#"r, %"n!r"# n'&)%en! a# e$"@#"r $&#'&r#"r, !"#eran@? '%?-&!? #a )r&'!rare, +Jndre %a!a'!r")%?, %redn@e ra@"na#e de !=!re/&e=d"rn@? e%e'*? de $en@nere a %"n)"r!&#&, de e*!are a '!&a@#"r ne#?%&!e. CJnd #&%r&r#e n& $er+ /ne, 'e %"n'der? 'n+&ra *n"*a!?, e ne$&#@&$!? %? n& a rea#-a! %J! ar ) !re/&!, 'e n)&re, de*ne n!"#eran!?, ner?/d?!"are &n!*? %& r"ra er'"an?.
%
Are " )r%? ea+era!? de %a!a'!r")e %are 'e "! n!?$#a "r%Jnd e %are n& #e "a!e re*en, re%&$ de /"# de !&#/&r?r e$"@"na#e. E'!e 'e!a!? e a'e%!e#e ne+a!*e a#e *e@, e %are #e %"n!&rea-? e%e'*, #e '&/#na-?, $a$-ea-?, $n$a#-Jnd e*en$en!e#e 'a& a'e%!e#e "-!*e, "!$'!e, 'a& #?%&!e.
Psihodiagnostic A#a I-Tulburare de panica fara agorafobie . Factori predispozanti '%e$e %"+n!*e d')&n%!"na#e , red'"-!a de a '$!
ane!a!e n d)er!e $re:&rar , !endn!a de a )a%e e*a#&ar a/'"#&!'!e ' r+de a#e e*en$en!e#"r er%e&!e. Factori declansatori '!re'&# r"*"%a! de r"/#e$e n #e+a!&ra %& $ed&# '"%a#
( n%er%area de a' %"n'!r& " #"%&n!a, $r&$&!&r#e de #a /an%a , )&r!&# $a!era#e#"r, !e#e)"ane#e de a$enn!are ' +r&&# de '&"r! .(re%a'a!"rrea $a$e, r"/#e$e#e %& !a!a# *!re+. ;a%!"r de $en!nere r"/#e$e#e %& !a!a# *!re+, nd)eren!a '"!&#&. Pen!r& a )a%e )a!a %"n)#%!&#& e$"!"na# ,)"#"'e'!e %a $e%an'$ de aarare a#!r&'$&# (ded%area )a!a de ne*"#e %"#&#&. Aa II n% &n da+n"'!% Aa III n% &n da+n"'!% Aa IVPr"/#e$e '"'"%a#e ' de $ed& r"/#e$e %& +r&&# de '&"r! r"/#e$e n #e+a!&ra %& $ed&# '"%a# . Aa V EG; 0 (d)%&#!?@ n )&n%@"narea '"%a#? r")e'"na#?.
*iagnostic diferential
A!a%&r#e de an%a n& '&n! da!"ra!e e)e%!e#"r )-"#"+%e dre%!e a#e &ne '&/'!an!e, &ne %"nd! $ed%a#e +enera#e 'a& a#!e !&#/&rar $en!a#e. ecomandari:
1 %"n'&#!a!e 'a!r%a en!r& '!a/#rea $ed%a!e %"re'&n-a!"are 2. In!er*en!e '"#"+%a, a*and %a "/e%!*e
"
red&%erea +rad&#& de d'"nan!a %"+n!*a ' a)e%!*a rn e#%area ane!a! ' a!a%&r#"r de an%a $"d)%area %"+n!#"r ne+a!*e ' a +and&r#"r a&!"$a!e ne+a!*e, re%&$ ' a &n"r %"$"r!a$en!e ' $"d&r de +andre.( "rrea n!erre!ar#"r %a!a'!r")-an!e a#e &n"r '$!"$e '"$a!%e ' "/'n&rea 'a !"#ere-e '$!"$e#e %"n'dera!e neer%&#"a'e. )&rn-area &n"r n'!r&$en!e ' '!ra!e+ de #&!a $"!r*a a!a%&r#"r de an%a a$e#"rarea $a+n de 'ne ' %re'!erea n%reder n 'ne . %"n'#ere )a$#a#a en!r& a %"n'!en!-a )a$#a de r"/#e$e#e %& %are 'e %"n)r&n!a %#en!a ' a 'e %"n'!!& n!r&n '&"r! a)e%!* a# a%e'!ea , re%&$ ' a a%"rda 'r:n&# ne%e'ar )a$#e %are 'e %"n)r&n!a %& a%ea'!a r"/#e$a . N%&#na C&er%?, '"#"+ %#n%an 'e%a#'!
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