| 1 |
Maria, a 59-year-old female patient, has four children (two were murdered and one was released from prison for drug trafficking in 2013), and four grandchildren of her only daughter, each from a different father. Also, in 2013, she became a widow and lost her mother. He does not work. Her home has been locked by the civil defense after a hill collapse. She receives a rent allowance. |
| She comes to the medical center complaining of sadness, anxiety and insomnia. She cries during the appointment and says: “it’s a lot to worry about, I can’t sleep and I think I have a memory problem, I don’t want to think about anything, I don’t want to worry.” She talks about the fact that she is irritated with her daughter because she is not rigorous with her children, so she is afraid they will quit studying and get involved with ‘wrong things;’ she speaks of the death of her mother and her husband - “”he was my support”” - and that she cannot sleep, she is worried about the intense shootings near her house. She also complains of severe abdominal pain, tenesmus (desire to evacuate, but without success) and rectal bleeding. Previous diagnosis of renal lithiasis Suspected diagnosis of anorectal cancer. |
| She asks for a medicine to relax her mind. |
| ✓ How would you receive that request? What referral would you provide? |
| 2 |
João, a 19-year-old male patient, a student, comes to the appointment scheduled by his parents, who have noticed changes in his behavior. Lately, João has become more isolated at home, he does not want to meet his friends, he misses his university classes and feels restless. He has no prior history of mental disorder, he denies drug use and has no clinical complaints. |
| He started a law school program some months ago after much dedication. |
| The patient does not recognize this change in his behavior. He just says that the classes ‘confuses his mind, but it is because of the high amount of information.’ |
| The health professional who received João, after providing care, says that he will refer him to a treatment with a specialized mental health service to help him overcome the problem, but the patient reacts and says that he is not crazy and does not need a treatment. |
| ✓ What would you do if you were the health professional who received João? |
| 3 |
Rafael, a 40-year-old male patient, without family or work bonds, lives alone in a rented room from a boarding house. His income is from the government benefit that corresponds to a minimum wage. |
| He receives regular monitoring from a mental health network and regular clinical follow-up. He has been diagnosed with psychosis and systemic arterial hypertension. He follows the medication treatment prescribed by his physicians and a weekly follow-up with a psychologist. |
| He is a patient who, when he is in a more acute psychotic crisis, feels threatened when people look at him on the street, and then he wants to react and protect himself or goes to the psychiatric emergency service and want to be hospitalized, claiming that the cannot live in the society, because they want to harm him. |
| In these moments of crisis, he often visits different health services in his municipality asking for ‘further care’ to be ‘more protected.’ |
| ✓ Suppose Rafael has arrived at the medical center where your work and he asks for health care to feel more protected. What would you do? What would say to him? |
| 4 |
Ivete, a 37-year-old female patient, lives with her mother. She uses drugs and she is psychotic. She has three children who are always on the street, receiving care from neighbors and relatives. |
| She arrives at the health center asking for advice because her child has diarrhea and she does not know what to do. The professional who receives her feels the situation is more complex than diarrhea and identifies Ivete’s symptomatology. |
| At the service, Ivete reported drug use, for her it was for fun, although she recognized that it brought negative consequences for her life and her children, including financial problems, as she had left her job as a supermarket cashier, and since then, she had no income and no free pass. After established a bond with the health professional, she reported that it was the first time she was able to talk about her problem without fear of being judged. The professional provides guidance regarding her child’s care, requests that she returns with the boy for evaluation the next day and sends her to Caps AD. She says she had already been referred to this place, but she had never showed up. The professional explains the need for referral and insists that she should go. Ivete does not return with the child and does not follow the guidance of the professional. |
| ✓ Would you do anything different? Talk about this situation and the actions the professional suggested for Ivete’s care. |
