WRITTEN DIAGNOSTIC AND TESTING EXERCISE
There has been underlying interests imposing incidence of personality disorders as found within individuals and for this particular report, certain diagnosis of DSM-IV is comprehensive upon assessing through case situations focusing on Rita and Alice as subjects. The prospect of DSM assessments is rather been situated into disciplinary silos of personality formation at demarcation of mental illness. The clinical usage of the DSM IV-TR will clarify the incidence and clinical assessment of Rita and Alice and when the patterns are identified as recurring destructive behaviors, they result in significant distress in social and personal areas of functioning that impacts the individual, as Rita and Alice situation does require diverse diagnosis like, structured case history as well as interviews from within assessment of the medical and psychology meeting criteria for effective diagnosis exercise and in process of conveying cases, there serves better action for interdisciplinary collaboration in studying personality disorders (in, American Psychiatric Association, 2000).
CASE ONE
RITA A.
Rita is a 15 year old high school student. Recently her parents have been awakened by her crying out in the night. This has happened about twice a week for a month. When they rush in to try to comfort her she seems unresponsive. She sits in the bed perspiring profusely, breathing rapidly, her pulse racing. After a few moments she relaxes and is more alert. She isn’t able to remember what so terrified her. Rita’s parents contacted a physician to try to ascertain what was causing this problem.
Rita is doing well in school and has a lot of friends who visit her house often. Her parents are warmly supportive of their children, and the family functions very well. The only thing Rita or her parents could think of that was outside the norm, as far as past behaviour or function, was that Rita had lost a good deal of weight during the past year. She had gone on a diet to lose 2-5 kilos but had actually reduced her weight from 58 to 48 kilos. Still, she is concerned that her waistline is too thick. Rita has not had her menstrual period in the last 8 months and her doctor diagnosed amenorrhea.
OUTLINES FOR DIAGNOSTIC SUMMARIES
CASE: Rita A
Axis I: Clinical disorders
Anxiety as well as stress disorder as reflected through a possible peer pressure
Amenorrhea as caused by having a diet that may lead to stress
Axis II: Personality disorder
Rita’s personality conforms to unresponsive actions, rapid breathing and pulse rising and often shows alertness and seems to forget which terrified her. Rita’s parents contacted a physician to try to ascertain what was causing this problem.
Axis III: General medical conditions
Rita had amenorrhea due to stress and anxiety which resulted to lost her menstrual period for 8 months and Rita had lost good deal of weight
Axis IV: Psychosocial and environmental problems
CHECK: SPECIFY:
Problems with primary support group: Rita was unresponsive to her parents
Problems related to the social environment: shows problem within the classroom
Educational problems: Rita is doing well in school but can be affected by having lose of weight and amenorrhea
Occupational problems:
Housing problems:
Economic problems:
Problems with health care access:
Interactive problems with legal system/crime:
Other psychosocial and environmental problems: the occurrence of possible peer pressure issues/problems
Axis V: Global assessment of functioning scale
Score: ……..3.2……. Time frame: 2-3 WEEKS
Justification and discussion (attach sheets)
DIAGNOSTIC OUTLINE FOR SAMPLE CASE: DID
Diagnostic criteria for DID
Examples from case
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring patterns of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person’s behaviour.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g.. blackouts or chaotic behaviour during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).
Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
There can be presence of anxiety related to stress and a possible indication of anorexia nervosa can be evident as she loses weight of about 10 lbs due to diet
Amenorrhea adhering severe stress as reflected more on the mind set and thinking towards others.
Rita has the ability to ignore real situations along her as she tries to forget what are specific instances that have terrified her to act differently in the past months
Anxiety disturbance is not merely on the primary support groups but can be within Rita’s social environment, school setting she belongs.
Anorexia Nervosa that are in profound dietary problems as she can have eagerness to change her self due to peer pressure
Amenorrhea as a most common domain for having severe anxiety and stress for a particular event that have happened in Rita’s life
MENTAL STATUS INTERVIEW OUTLINE
1. Preliminary identification
Name: Rita A
Age: 15
A high school student
Rita lives together with her supportive parents
The appearance was aloof to receive care and attention
Lacks tangible expression and emotion and shows certain degree of alertness at times
2. Development of rapport
Private session with the physician, one on one interaction and interim counseling
3. Chief complaint
Data concerning the following should be gathered:
Behaviour: unresponsive, relaxed and alert behavior
Affect: self conscious and timid may be seen
Somatic: no menstrual flow for 8 months time
Interpersonal: good parental and familial relationship, as well as with peers at school
Perception: there is feelings of depersonalization or derealization
Thought processes: self distraction as caused by losing weight and diet
Cognition: fare mind set and knowledge skill
Judgment: misunderstanding of accepted values as a teenager, too tight on judging intermittent situations, problems within social groups
4. History of present disorder
Crying at night showing changes into Rita’s physical attributes, Reduction of the body weight was evident as Rita is on diet
5. Medical and family history
Not indicated but can somehow caused by family problems if there is any
6. What will happen next
Since, Rita is having Amenorrhea it is advisable for her and her family to seek more medical support and help probably the best option is to seek an OB-Gyne to evaluate on the situation and suggest useful options to resolve the problem and maybe Rita can enroll into teen counseling session as there can be found within the community if asked
CASE TWO
ALICE C.
Alice, at age 50, showed unfounded jealousy toward her husband as the first noticeable symptom of disease. Soon thereafter she began displaying an increasing loss of memory and, at times, could not find her way around her own house. She would carry objects around and hide them, or she would think someone was trying to kill her and begin screaming loudly. After five years of increasing degeneration her husband decided that she should be evaluated and placed her in a hospital.
In the hospital Alice appeared utterly perplexed. She was totally disoriented to time and place. At times she didn’t recognize her doctor and assumed he was just a visitor. At other times she accused him of wanting to cut into her or of wanting to have sex with her. Periodically she became totally delirious, dragging her bedding around, screaming for her husband and daughter, and appearing to have auditory hallucinations.
When examined by a neurological consultant Alice seemed confused and uncomprehending. She could not remember any one of six objects after an interval of ten minutes, even when prompted. Her speech was well articulated, but vague and circuitous. She could not complete even the simplest mathematical calculation and had difficulty in finding similarities between related objects. She could not remember the names of common objects or what year it was.
A neurological examination showed normal cranial and peripheral nerve function. All laboratory studies were normal. However, a computerized tomography (CT) scan showed marked cortical atrophy. Shortly after her consultation she began to lost weight, took to bed, and developed contractures. Six months later she died of pneumonia.
OUTLINES FOR DIAGNOSTIC SUMMARIES
CASE: Alice C.
Axis I: Clinical disorders
Dementia as caused by loss of memory
Axis II: Personality disorders
Alice displays loss of memory as well as increased degeneration
Alice was totally delirious, dragging her bedding around, screaming for her husband and daughter and appearing to have auditory hallucinations
Axis III: General medical conditions
A neurological examination showed normal cranial and peripheral nerve function. However, a computerized tomography (CT) scan showed marked cortical atrophy. Died due to pneumonia
Axis IV: Psychosocial and environmental problems
CHECK: SPECIFY:
Problems with primary support group: In the hospital Alice appeared utterly perplexed. She was totally disoriented to time and place. At times she didn’t recognize her doctor and assumed he was just a visitor.
Problems related to the social environment:
Educational problems:
Occupational problems:
Housing problems:
Soon thereafter she began displaying an increasing loss of memory and, at times, could not find her way around her own house. She would carry objects around and hide them, or she would think someone was trying to kill her and begin screaming loudly.
Economic problems:
Problems with health care access:
Interactive problems with legal system/crime:
Other psychosocial and environmental problems:
At other times she accused him of wanting to cut into her or of wanting to have sex with her. Periodically she became totally delirious, dragging her bedding around, screaming for her husband and daughter, and appearing to have auditory hallucinations.
Axis V: Global assessment of functioning scale
Score: …….4.40…….. Time frame: 2 MONTHS
Justification and discussion (attach sheets)
APPENDIX C DIAGNOSTIC OUTLINE FOR SAMPLE CASE: DID
Diagnostic criteria for DID
Examples from case
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring patterns of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person’s behaviour.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g.. blackouts or chaotic behaviour during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).
Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
No recognition of the doctor, the feeling of being a visitor, thinking that environment is too violent for her as she screams and hallucinates
Auditory hallucinations and delirious actions take control of Alice
Inability to remember series of things and events, loss of memory and right cognition is present, does not have the ability to recall names and important information
The severe disturbance is not been in composed of a substantial events into Alice life but can be directly to increase degeneration and the lack of self trust and attachment to herself
MENTAL STATUS INTERVIEW OUTLINE
1. Preliminary identification
Name: Alice C
Age: 50
Living with husband and daughter
Alice appearance was pale and shivers from moment to moment
2. Development of rapport
Provide comfort and acceptance to Alice within proper application of communication
3. Chief complaint
Data concerning the following should be gathered:
Behaviour: unfounded jealousy toward her husband, screams, didn’t recognize her doctor and accused the doctor of wanting to have sex with her totally delirious and appearing to have auditory hallucinations. She could not remember any one of six objects after an interval of ten minutes, even when prompted. Her speech was well articulated, but vague and circuitous. She could not complete even the simplest mathematical calculation and had difficulty in finding similarities between related objects. She could not remember the names of common objects or what year it was.
Affect: showing of possible dementia disease
Somatic: neurological examination and computerized tomography (CT) scan
Interpersonal: belongs to a ideal family with husband and daughter
Perception: delusions, hallucinations
Thought processes: incompatible speech
Cognition: severe loss of memory
Judgment: unrealistic judgment
4. History of present disorder
Unfounded jealousy towards her husband as the first symptom of the disease, long term disorders leading to Alice death due to pneumonia, proper assessment given with the aid of a physician
5. Medical and family history
No prior medical intervention aside, CT scan and neurological exam and Alice husband decided to enter her in hospital for immediate care
6. What will happen next
Provide enough care assistance as well as support for Alice family, to her husband and daughter for her death as grieving needs attention
_________________
American Psychiatric Association (2000), DSM IV-TR: Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Arlington, VA
Retrieved information from: http://allpsych.com/disorders/dsm.html
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ANSWERS TO THE CASE QUESTIONS
Ruth’s Case
a) What could you conclude about Ruth’s ability from the K-BIT test?
I can conclude that Ruth’s ability as based on the K-BIT test imposes a very good intelligence marking from within the test sub-sets as the test results shows a 95 percent rank from a score of 124 in vocabulary and matrices set and a composite score of 127 from within a 90 percent confidence interval thus, it shows that Ruth is very good in such vocabulary domain and also comprehends well to solving problems and has good reasoning skills.
b) What are the limitations of the estimate of her ability?
The limitations with regards to the estimate of Ruth’s ability can be that there can be possibility that she may lack verbal as well as non-verbal abilities that may pertain to speech and communication in both oral and written presentation but, only a small percentage of lapses can incur.
c) What could you conclude about Ruth’s capacity to adjust to school from the first administration of the BASC-SRP subscales relating to school maladjustment?
Ruth’s capacity to adjust to school from such school maladjustment composite from such BASC-SRP subscales on first administration indicate that there is enough incidence of maladjustment at all as there shows a T score 62 showing a negative or undesirable characteristics when she was aged 13 and up. It can be that family problems on the first administration have been present and evident in Ruth’s life as a student.
d) What could you conclude about Ruth’s clinical maladjustment from the clinical subscales at the first administration?
Thus, on Ruth’s clinical maladjustment from the clinical subscales at the first administration entail that there may be certain occurrence of problem formation as there can be presence of such positive characteristics although Ruth was in circumstance of her parents having divorced as the composite score shows 53 mark outcome
e) What could you conclude about Ruth’s capacity to adjust to school from the second administration of the BASC-SRP subscales relating to school maladjustment?
Ruth’s capacity to adjust to school from such school maladjustment composite from the BASC-SRP subscales on second administration do indicate that there can be presence of school maladjustment as the score reached to 47 mark which Ruth has been affected by the situation of her parents as well as the fact that she transfer to new school imposes high risk to cope up any form of maladjustment mostly to the immediate environment she belongs,.
f) What could you conclude about Ruth’s clinical maladjustment from the second administration?
Then, for Ruth’s clinical maladjustment recognition from clinical subscales in the second administration is still evident even though some indicators of the composite may indicate negative characteristics pointing to school stress in particular and even under problems within family there is still positive characteristics shown into Ruth’s attitude towards school and in general.
g) In a couple of sentences write what you could conclude overall from the BASC and K-BIT results, considering both administrations.
Both from the BASC and K-BIT outcomes upon considerations of the two different test administrations therefore, it can be that the K-BIT do recognize such intelligence measure from knowing the capability to solve problems and can’t affected by certain experience and education domain along with levels of knowledge. Showing that intelligence is changing phenomenon that may need diverse approach for assessment. Thus, Ruth performance at school can be more complicated from psychological operations and are better to convert and use information, the test is highly reliable and has great validity. Aside, BASC-SRP is a good measure as utilize to evaluate Ruth’s perceptions and feelings about school from within composition of her own behaviour and there implies how Ruth adopts to the environment directly as manifested from within actual process in which she is connected to the rationality of herself and her composed attitude as individual.
h) In a paragraph outline any limitations of your conclusions: in what ways would you qualify your conclusions in any report to the father?
My conclusions is only limited to what is free or given into the situation for further assessment of Ruth’s case and that the two tests does really help to understand better from within sides and that Ruth is still a normal student that can be affected by familial issues but has tendencies to easily cope with those situations, points of recovery and counseling can still be okay under certain instances. The two tests administered were effective upon showing certain categorical level of Ruth’s behaviour from such interpretative reliability aspect and stance.
Margaret’s Case
a) What would you conclude from the BDI about Margaret’s level of depression?
The BDI provide measure of severity of symptom rather than diagnosis integration as it can be inappropriate to ascertain diagnosis of depression solely on basis of inventory. Margaret’s level of depression is in high mark from the BDI scoring 40 at highest level as such factors can affect her depression state such as sadness, punishment feelings and self-dislike. Thus, it can be due to the past experiences she had encountered.
b) Considering the MCMI data as well as the BDI what could you conclude about a possible mood disorder?
Yes, there can be a possible mood disorder can be seen from such BDI and MCMI assessments as there have been indicative assumptions that Margaret can show signs of such like, having fear to commit into a relationship after a failed relationship and what type of family orientation she has can be serve as a main factor for the disorder to come in. Thus, clinical scores exceed the maximum score even if average outcomes were shown on the scale rank.
c) From the MCMI data what would you conclude about other possible clinical syndromes?
There can be clinical syndromes possible if based from the MCMI data, I can conclude that such scores present valid points for other existing clinical syndromes that are not indicated upon testing Margaret from within such category as there can be such twenty two personality disorders and clinical syndromes used for Margaret who is undergoing psychiatric assessment upon developing treatment approach that takes account in patient’s personality style and coping behavior and guiding treatment decisions based on Margaret’s personality pattern.
d) Are any personality disorders suggested by the MCMI data?
There can be such other personality disorders in suggestion linking to the MCMI data such as stress disorders as well as disturbance of conduct and antisocial personality disorders as the test are being support by the Diagnostics and Statistical Manual approach as based on the MCMI norms and standard set up such as subjects representing various DSM-III and DSM-III-R diagnoses.
e) How does your provisional diagnosis fit with the case history material? That is, can you see the roots or early signs of some issues in the case material?
The provisional diagnosis fit with case history material in such a way that family history of medical and or mental heath can be a consideration in indicating types of disorders seen within the individual and that personality disorders are known in such areas and domains that needs attention for proper action. There are early signs known within Margaret’s situation as such she has family background of family having roots of mental disorder, having history of psychological problem in the mother side as her grandmother has been diagnosed of schizophrenia and her grandfather did attempted suicide many times.
f) What other kinds of tests would you consider administering or what other information would you seek to clarify the diagnosis and why?
The other tests as showed below are possible to administer that are connected to Margaret’s case can be the following:
- Advanced Multidimensional Personality Matrix (Abridged, Personality Profile)
- Depression Test
- Anger Test
- Mental Toughness (Hardiness) Test
- Risk Taking Test
- Self-Esteem Test
- Optimism/Pessimism Test
- Values Profile
In, Psychological Tests Lists
At: http://www.psychtests.com/tests/alltests.html
For other information wished to clarify for diagnosis can be the evidence of interim tests outcomes serving as proof of the scores attained from within the two assessment tool as administered accordingly.
Credit:ivythesis.typepad.com
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