Sunday, May 8, 2005

psychological evaluation

here it is, for your amusement

name: rainbow warrior
age: 31
date of birth: 2/23/74
sex: male
education: 14
occupation: student
handedness: right
date tested: 5/2/05
tested by: doc

reason for referral

this patient was referred for psychological counsultation by his psychiatrist, dr. shrink, to evaluate current levels of cognitive and emotional functioning. he has a long term history of depression and psychiatric treatment, although only recently coming under dr. shrink's care.

background information

mr. warrior is a 31 year old, white, right handed male who lives in ft. worth, texas. he has about completed two years of college, currently attending tcc. he plans to attend ut-arlington in the fall. current gpa is 3.2 and there is no history of school failure or specific learning disabilities. he reports prior sat scores of 1450. the patient has been married for five years and they have three children. their marriage is stressed with him not working, financial concerns, and three young children.

acording to mr. warrior, he has had long term problems with depression. he was first seen by a psychiatrist at age 10 because of depression and underachievement. he was not hyperactive as a child, but he has always had some trouble with authority figures, anger management, and inability to complete projectsion. he has never hed a job for more than six months, often because of chronic tardiness. the patient was hospitalized in plano in 1998 after a relationship broke up and he was hospitalized at all saints in 2003. [i call those my siestas in the nut hut.] he has had suicidal ideation in the past, but none recently.

mr. warrior's prior medical history includes hernia repair as a child and a tonsillectomy in 2002. neurologically, he denies any history of loss of consciousness, siezures, or infections diseases of the nervous system. a ct of the head done several years ago was reportedly normal. psychiatric history is as reported above. family hisory is positive for his mother being treated for depression. the patient indicates that he has not used alcohol in 11 years and he is still somewhat active in a.a. current medications include zoloft 50 mg qd and depakote 1000 mg qd.

tests administered and behavioral observations

wechsler abbreviated scale of intelligence
rorscach inkblot test
minnesota multiphasic personality inventory-2
clinical interview

mr. warrior was seen at the examiner's office on 5/2/05. he arrived by himself, seeming somewhat disheveled in his appearance. no gross physical defects were apparent. he is alert and fully oriented. speech scans normally. he was generally cooperative with the examiner and rapport was adequately established. the patient is capable of a full range of affect which is easily mobilized. reported mood is stable at the present time, and he denies neuronegative changes typically associated with depression. thoughts appear goal directed and associtations tight; i see no overt evidence for hallucinatory or delusional processes.

in approaching individual tasks, the patient's effort and motivation appeared good. the following data give an accurate reflection of his current levels of psychological functioning.

test results

iq & mental flexibility:

verbal tests - scaled scores
vocabulary - 16
similarities - 14

performance tests - scaled scores
block design - 12
matrix reasoning - 13

verbal iq = 127
performance iq = 111
full scale iq = 122

on the wasi, this patient obtained a verbal iq of 127 (superior), a performance iq of 111 (high average), and a full scale iq of 122. these data place him overall in the superior range of intelligence, with the fsiq falling at the 93rd %tile for his age group. i see nothing to suggest declines from estimated premorbid levels of functioning. the 16 point discrepancy between verbal and performance scores is suspicious, and this degree of discrepancy occured in only 10-15% of the standardization sample. the data suggest that he is more adept at tasks relying on previous education and experience rather than those requiring adaptation and flexibility when faced with novel situations. while it is clear this his verbal skills are relatively stronger, perceptual organization abilities are still falling in the high average range and he is quite functional in these areas.

emotional:

mmpi-2 validity scales indicate that this patient consistently responded to the items. he is openly acknoweding distress and asking for assistance with his problems. this is an over-reported profile and it is difficult to know the motivation for such. oftentimes, this reflects a cry for help, althought deliberate attempts to look worse than is the actual case cannot be ruled out. this profile needs to be viewed with some caution. high points suggest an individual who is chronically worried, tense, agitated. they are socially uncomfortable and have poor social skills and judgement. they have difficulty in forming close interpersonal relationships and usually are withdrawn, isolated, and introverted. these characteristics exacerbate their obsessive ruminations. he is reporting a good deal of paranoid thinking, and the presence of delusions should be ruled out on a clinical basis. this patient reports feeling depressed and lacks the energy to deal with problems of everyday life. he endorses the items "lately i have thought a lot about killing myself." and "no one knows it but i have tried to kill myself.". these patients feel that others do not understand them, and they tend to withdraw into fantasy and daydreaming while under stress. they usually have problems in getting along with authority figures and tend to be impulsive in their behavior. they show a low tolorance for frustration, and outbursts of temper are common. these are usually rebelliouis, nonconforming types of individuals.

rorschach data suggest an individual who does have some organized resources for coping with stressful situations, and he is prone toward ideational delay when placed in coping situations. at the present time, he appears to be withdrawing from or avoiding emotional eliciting stimuli. overall reality operations appear to be intact, although there are important times when he appears to disregard perceptual accuracy. this occurs most frequently with responses that reflect negativism and oppositional features. again, the issue of paranoid features should be evaluated on a clinical basis. he appears to be well aware of others, and possibly preoccupied with them. this may reflect low self-esteem and worry about what others think of him, or it may be part of a more general paranoid process. the data are not consistent with a psychotic process such as paranoid schizophrenia, and they more likely represent chronic personality features.

diagnostic impression:
296.33 major depression
r/o 301.0 paranoid personality disorder

summary

this 31 year old male reports a long history of treatment for depression, underachievement, and difficulty in keeping employment. he is currently a student at tcc with plans to attend uta, and law school after his degree. the patient is married with three young children, and his inability to keep a job and him remaining a student has caused financial problems and difficulties in his marriage.

current test data place him in the superior range of intelligence and he appears to have the cognitive capabilities to succeed in college. from an intellectual standpoint, he should be able to handle law school without much difficulty. emotionally, this patient appears to have chronic problems with depression, poor self-esteem, and lack of self-confidence. his mood disorder appears relatively stable with medication, and this may not be his primary problem at the moment. the data suggest a chronic personality disorder with strong paranoid features. i would describe this man as a bohemian type of personality who generally sees himself as different from others. he is "thin skinned" and sensitive to criticism from others, yet he is opinionated and intolorant of differing viewpoints from his own. there is a clear paranoid trend to his thinking and he will generally be suspicious of the motives of others. he will externalize blame for his problems and project responsibility for his own negative feels.

from a treatment perspective, this patient's depression appears fairly well controlled with current medications and these should be monitored periodically by dr. shrink. he should be referred for family or marital therapy as i suspect that his marriage is under a great deal of pressure. the personality disorder is going to be difficult to treat without long-term therapy, and it may make more sense to have therapy geared toward real life problems which he and his wife are experiencing.

[signed]
dr. phd
clinical neuropsychologist

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