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{"id":7735,"date":"2020-08-20T01:09:22","date_gmt":"2020-08-20T01:09:22","guid":{"rendered":"https:\/\/nursingwritersbureau.com\/?p=7735"},"modified":"2020-08-20T01:09:22","modified_gmt":"2020-08-20T01:09:22","slug":"psychological-assessment-i-a18","status":"publish","type":"post","link":"https:\/\/nursingwritersbureau.com\/psychological-assessment-i-a18\/","title":{"rendered":"Psychological Assessment I-A18"},"content":{"rendered":"Assignment 18 complete on Frank…. Frank’s information below:<\/p>\n
A description of the content for each of the main sections of your report follows:<\/p>\n
Identification and Referral<\/u><\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Client\u2019s name, age, marital status, ethnicity, gender.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Describe the setting, including where the testing took place, how the \u00a0client travelled there (or if you went to the client\u2019s home), if he or \u00a0she was on time and accompanied by anyone.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Reason for testing at this time, including the referral source (can be a \u00a0self-referral or a fictitious referrer) and the information sought by \u00a0the referrer.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Presenting problems and symptoms.<\/p>\n
There \u00a0should be one or more referral questions to be answered by your \u00a0assessment.\u00a0 These questions will be answered in your \u201cRecommendations\u201d \u00a0section and the answers should flow logically from your findings.\u00a0\u00a0 Some \u00a0common referral questions for psychological testing include:<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mental health diagnosis and treatment or management recommendations.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Disability determination \u2013 whether the client is able to work and limitations.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vocational\/educational assessment \u2013 what kind of work would be a good fit for the client\u2019s abilities.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Learning disability assessment \u2013 is a learning disability present and \u00a0what sort of limitations and accommodations are appropriate.<\/p>\n
History<\/u><\/p>\n
Preface your history by indicating the source (such as client\u2019s report or family report) and whether you feel it is reliable.<\/p>\n
Family History.<\/u>\u00a0 Include information about current family, current living situation and family of origin.<\/p>\n
Educational and Vocational History<\/u>.\u00a0 \u00a0Level of education completed, high school and college grades, any \u00a0history of special education, expulsions and suspensions, occupation and \u00a0jobs held, last worked, reason for any dismissals, longest time at the \u00a0same job, vocational aspirations if relevant.<\/p>\n
Medical and Mental Health History<\/u>.\u00a0 \u00a0The non-psychiatric section should include reports of medical diagnoses \u00a0and symptoms, current medications, surgeries and overnight \u00a0hospitalizations, and head injuries.\u00a0 The mental health section should \u00a0include psychiatric hospitalizations, outpatient mental health \u00a0treatment, substance abuse treatment, history of psychotropic medication \u00a0prescriptions, and suicide attempts.\u00a0 When applicable, indicate that \u00a0there was \u201cno reported history of \u2026\u201d to show that you inquired about the \u00a0areas above.<\/p>\n
Antisocial Behavior\/Substance Abuse<\/u>.\u00a0 \u00a0Age, charge, and outcome of any arrests or other legal problems.\u00a0 \u00a0Current and past use of alcohol and other recreational drugs, 12-step \u00a0group attendance.<\/p>\n
Daily Functioning<\/u><\/p>\n
Client\u2019s \u00a0mode of travel (car, bus, family rides) and ability (short trips by \u00a0car, uses the bus but needs help to get to a new location, etc.).\u00a0 \u00a0Client\u2019s daily living skills, including ability to groom, bathe, dress, \u00a0do household chores, and manage money.\u00a0 Include a general description of \u00a0the client\u2019s daily activities including job, recreational, and social \u00a0activities.<\/p>\n
Review of Records<\/u><\/p>\n
Include \u00a0a brief summary of educational or medical records if available (or \u00a0indicate that no records were available when the report was completed).\u00a0 \u00a0Diagnoses and test scores are often particularly helpful, as they \u00a0provide a baseline for comparison.\u00a0 Records reviewed should include \u00a0report dates, institution name, and the name of the physician or other \u00a0professional.<\/p>\n
Mental Status and Behavioral Observations<\/u><\/p>\n
Use \u00a0the Mental Status Exam form as a guide for your interview.\u00a0 This \u00a0section can be written or dictated directly from this form.<\/p>\n
General appearance<\/u>: \u00a0Particularly note unusual characteristics that may provide diagnostic \u00a0information \u2013 neglected hygiene, usual dress or tattoos, or physical \u00a0characteristics that may affect the person\u2019s social interactions and \u00a0abilities.<\/p>\n
Attitude & general behavior<\/u>: Describe the person\u2019s interaction with you and attitude toward being tested and interviewed.<\/p>\n
Mood and affect<\/u>: \u00a0Obtain a quote from the client regarding recent mood.\u00a0 Ask about any \u00a0history of depression and anxiety.\u00a0 Note the range of the client\u2019s \u00a0affect.\u00a0 Ask about sleep and appetite, and inquire further about \u00a0depressive or anxious symptoms if a particular disorder if suspected.\u00a0 \u00a0See the symptom guide at the bottom of the MSE form.\u00a0 For instance, if \u00a0PTSD were suspected, you would inquire about symptoms such as \u00a0nightmares, flashbacks, and startle response.<\/p>\n
Stream of mental activity<\/u>: \u00a0Most clients will be described as responding in a coherent and relevant \u00a0fashion and speaking at a normal pace with 100% intelligibility.\u00a0 Note \u00a0any deviations from this, including psychotic symptoms, slower or faster \u00a0than normal speech, and problems with speech intelligibility.\u00a0 Note \u00a0unusual speech content and inquire into delusional thinking (paranoid, \u00a0reference, control, grandiosity) if psychosis is suspected.<\/p>\n
Sensorium and orientation<\/u>: \u00a0You will describe most clients as alert and aware of their \u00a0surroundings; note any deviations from this.\u00a0 Orientation includes \u00a0awareness of elements such as person, place, time and situation.\u00a0 Do not \u00a0say the client was \u201coriented times three\u201d as the meaning of this is not \u00a0always consistent and clear.\u00a0 Do report the questions you asked and the \u00a0client\u2019s responses.\u00a0 For instance, \u201cThe client reported the current day \u00a0of the week as Saturday rather than Monday.\u201d<\/p>\n
Memory.<\/u>\u00a0 \u00a0Use simple tests to assess the client\u2019s long- and short-term memory and \u00a0report the results of those tests.\u00a0 A useful test of short-term memory \u00a0is to list three objects, have the client repeat them back, and then ask \u00a0the client to recall them after five minutes have passed.<\/p>\n
Fund of information<\/u>.\u00a0 \u00a0Two or three questions will give a rough index of the client\u2019s general \u00a0knowledge.\u00a0 Easy (mental retardation suspected): \u201cHow many legs on a \u00a0dog?\u201d or \u201cWhere is your nose?\u201d, Average: \u201cHow many days in a year?\u201d, \u00a0Above average: \u201cWhat is the boiling temperature of water?\u201d<\/p>\n
\u00a0Concentration and attention<\/u>: \u00a0Rate the client\u2019s ability to attend to instructions and task \u00a0persistence.\u00a0 Simple concentration tasks are counting backwards from 20 \u00a0or, for higher functioning clients, counting backwards from 100 by 7.\u00a0 \u00a0Note the time required and number of errors.\u00a0 If ADHD is suspected, use \u00a0the symptom guide at the bottom of the MSE form to inquire further about \u00a0symptoms.<\/p>\n
Perceptual distortions<\/u>: \u00a0Ask about any history of auditory or visual hallucinations and \u00a0determine if they were associated with drug use or mood (mania or \u00a0depression).\u00a0 If there were hallucinations, note their frequency, when \u00a0they last occurred, and their content.\u00a0 Note if the client appears to be \u00a0responding to hallucinations.<\/p>\n
Judgment & insight<\/u>.\u00a0 \u00a0Use a simple, standard question to test judgment, such as \u201cWhat would \u00a0you do if your neighbor\u2019s house were on fire?\u201d\u00a0 Also, note any history \u00a0that would indicate impaired judgment, such as arrests or job \u00a0dismissals.\u00a0 Insight is whether the client has an accurate understanding \u00a0of his or her mental health status.\u00a0 If there are mental health \u00a0problems, a client with good insight attributes symptoms to these \u00a0problems, and is aware of the need for treatment.\u00a0 For instance, a man \u00a0diagnosed as schizophrenic would demonstrate good insight if he \u00a0understands that his auditory hallucinations are caused by his illness \u00a0and that psychiatric medication would help.\u00a0 An alcoholic demonstrates \u00a0good insight if she admits her illness and recognizes the need to attend \u00a0AA or other treatment.<\/p>\n
Test Results<\/u><\/p>\n
When \u00a0discussing the WAIS-IV results, be sure to include a discussion of the \u00a0Full Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index \u00a0(VCI) and Perceptual Reasoning Index (PRI), Working Memory Index (WMI) \u00a0and Processing Speed Index. You will need to discuss the client’s \u00a0strengths and weaknesses with regard to subtest variability.<\/p>\n
Refer \u00a0to the WAIS-IV PowerPoint and the sample report as a guide.\u00a0 Start with \u00a0the FSIQ, indicate its percentile range and category (Low Average, \u00a0Superior, etc.).\u00a0 If a change in functioning is suspected due to head \u00a0injury or other problem, compare the FSIQ to estimated pre-morbid \u00a0functioning.<\/p>\n
Compare \u00a0the VCI to the PRI, and indicate if they are significantly different.\u00a0 \u00a0Briefly interpret this comparison.\u00a0 If they are not significantly \u00a0different you can say, \u201cThe VCI and PRI were not significantly different \u00a0from each other, reflecting about equal facility with tasks requiring \u00a0words as with tasks requiring non-verbal reasoning and performance.\u201d\u00a0 If \u00a0they are significantly different, indicate why you think this is.\u00a0 Is \u00a0it consistent with a suspected diagnosis?\u00a0 Does it reflect cultural \u00a0differences or a physical impairment?<\/p>\n
When \u00a0discussing the WRAT4 results, be sure to include a discussion of the \u00a0WRAT4 scores.\u00a0 Present the Standard Scores and Percentile ranks for each \u00a0subtest of the WRAT4 (Word Reading, Spelling, Sentence Comprehension, \u00a0Math Computation). You also want to talk about scores that are out of \u00a0the normal range and what that might suggest.\u00a0 It is helpful to give \u00a0examples of the client\u2019s abilities, particularly on Math Computation \u00a0(i.e., \u201cable to perform arithmetic operations with whole numbers, but \u00a0unable to work with decimals or fractions\u201d).\u00a0 If a WRAT4 subtest differs \u00a0significantly from IQ (at least 20 points lower), a diagnosis of \u00a0learning disorder is likely, unless you feel that the difference is \u00a0better explained by other factors.<\/p>\n
When \u00a0discussing the MMPI-2 results, be sure to include a discussion of the \u00a0validity scales (you can refer to your text for further guidance). Then \u00a0interpret\/discuss the clinical scales that are clinically significant, \u00a0which are a T-score of 65 or greater. Your text and the powerpoint of \u00a0the MMPI-2 (found under the course resources tab) list interpretive \u00a0paragraphs of such scores.<\/p>\n
When \u00a0discussing the MCMI-III results, be sure to include a discussion of the \u00a0validity scales, which can be assessed by noting the pattern of scores \u00a0of the validity indicators (you can refer to your text for further \u00a0guidance). Then interpret\/discuss the Personality Disorder Scales that \u00a0are clinically significant. Note that a BR score of 75-84 suggests the \u00a0syndrome or pattern is present, whereas scores of 85 or above indicate \u00a0that it is prominent. Next, interpret\/discuss the Clinical Syndrome \u00a0Scales. Your text lists interpretive paragraphs of such scores.<\/p>\n
Diagnostic Impressions<\/u><\/p>\n
Provide a complete DSM-5 diagnosis to include the WHODAS 2.0 (p. 747 on the DSM-5).<\/strong>\u00a0 \u00a0Your diagnoses should be clearly supported by the material you have \u00a0presented to this point.\u00a0 Your assessment is very likely the most \u00a0thorough psychodiagnostic procedure the client will ever undergo, so it \u00a0is important that you come to a decision and not expect that another \u00a0clinician will be better able to do this.<\/p>\nSummary\u00a0<\/u><\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0This section should not introduce any new information. It needs to \u00a0integrate and present an overall picture of the client, in regards to \u00a0the referral question.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Statement of overall level of functioning, symptoms present, and problems experienced<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 What is the level of cognitive functioning and capacities<\/p>\n
Recommendations<\/u><\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0The most significant and pressing problem should be listed first and \u00a0should be in the context of the referral question.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Do not make recommendations about issues that are outside the purview \u00a0of your training and competency.\u00a0 For instance, you would not recommend \u00a0an imaging study or a specific medication.\u00a0 You might recommend referral \u00a0to a neurologist or psychiatrist for evaluation and possible treatment.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Make recommendations that take practical and financial limitations into \u00a0account.\u00a0 It may be tempting to recommend \u201cfurther testing\u201d because you \u00a0feel unsure of your recommendations.\u00a0 But keep in mind that testing can \u00a0be expensive and time consuming.\u00a0 Additional testing should only be \u00a0recommended if it is for a specific purpose and is necessary for \u00a0important decision-making.<\/p>\n
As much as possible, your recommendations should take your test \u00a0findings into account and should answer questions that could not have \u00a0been answered before the assessment was done.\u00a0 You do not need to \u00a0suggest that the client see a physician because she reported occasional \u00a0headaches.<\/p>\n \n
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