877025

Client’s Name: Daniel Arson

Date of Birth: 08/24/96

Date of Assessment: 07/4/2018

Home Street Address: Main street, 345, CN

Telephone #: 345-504-2412

Service Coordinator: Beck Guinevere

Referred by: Dept. of Psychiatry

IDENTIFICATION AND REFERRAL:

Daniel is a 22-year-old Canadian man. He drove himself to the examiner’s office. He reported that he previously received Department of Psychiatry services to assist him in resolving issues related to severe anxiety. Daniel has a history of depression and anxiety since few years. He told that he is feeling stressed and exhausted all of the time, sleeping badly, having frequent headaches and persistent worries about his work situation. He is being re-assessed because the company he is working in want his current mental health status on which he would be allowed to continue his job or not.

HISTORY:

The history was provided by Daniel.

Family History

Daniel is unmarried. He lives with his younger brother age 17. He reported that his parents were separated when he was 13-years old. Since than he is taking care of his brother. He insisted that his father used to beat him at a very young age because he supported his mother. His father was drug addict and died two years ago. Daniel’s mother died five years ago. Daniel was born in Ottawa and has always lived in Montreal.

Educational and Vocational History

Daniel obtained a Bachelor’s Degree in Marketing and Finance, he is currently working in a well reputable company of the city. Daniel started working at a very young age to support his brother also. Prior to this job he worked in a General store as accountant and also gave tuitions 3 years back while he was studying.

Medical and Mental Health History

Daniel reported that he has been diagnosed with Depression and Anxiety from past three years. He currently takes medication Citalopram (SSRI antidepressant) with quetiapine a mood stabilizer to boost the effect of antidepressant alone.

With regards to mental health treatment, He first started medication for anxiety given by his physician back in 2015. By the end of 2015 he went to Dept. of Psychiatry because he was easily stressed over small issues and there his treatment started. He saw various mental health professionals, psychologist and psychiatrists. He never attempted suicide but suicidal thoughts were there in the beginning.

Antisocial Behaviors/Substance Abuse

He reported that he drank occasionally, alcohol has never created problem for him. He has no history of drug abuse of illicit intake of drug. No antisocial behaviors were found as he has always been a sensible citizen.

Daily Functioning

Daniel is able to conduct his daily functioning normally like taking bath and groom, he is able to dress and cook, he had no recent accidents, and he is also able to keep track of his money. Describing his daily working abilities he is able work but is losing attention and interest in work, he is stressing about redundancies from workplace.

MENTAL STATUS:

General Appearance

Daniel’s hygiene and grooming were good. He walked with a normal gait. He was well dressed. He appeared his stated age.

Attitude and General Behavior

Daniel was anxious but cooperative throughout the assessment. He responded well to instructions and appeared to try her hardest on the tasks presented. Over all he was stressing over small stuff.

Mood and Affect

Daniel demonstrated a broad range of affect. When asked to describe his mood, he said that he has felt a little upset dealing with the fear of losing job. He regularly wakes up early and feel morning sickness and headache. He is facing trouble in sleep. He stated that his appetite is decreased. He stated that he has little interest and pleasure in daily activities these days. He denied feelings of worthlessness. He is facing concentration difficulties. He denied any suicidal thoughts or intent. He reported that is feeling depressed from last few months.

Stream of Mental Activity

Daniel responded in a coherent and relevant fashion. The rate and rhythm of his speech was normal. His speech was clear and 100% intelligible.

Sensorium and Orientation

Daniel was alert and aware of his surroundings. He correctly stated the current date, the current day of the week, and the city of his residence.

Memory

Daniel correctly recalled his birth date, the name of the current president, and the name of the previous president. He registered three objects after one trial and recalled two of the three objects after a few minutes. He repeated eight digits forward and six digits reversed.

Fund of Information

Daniel fund of information was within normal limits. For instance, He was able to name the capital of US.

Concentration and Attention

Denial demonstrated adequate ability to attend to instructions and adequate task persistence. He counted backwards from 20 to 1 in 6 seconds with no errors.

Perceptual Distortions

Daniel did not appear to be responding to internal stimuli. He denied any history of auditory or visual hallucinations.

Judgment/Insight

Daniel’s judgment and understanding of social conventions was intact. When asked how he would respond if his neighbor’s house were on fire, he said, “I’ll care the fire department and make sure no one is in there.” He has adequate insight into his current condition. He realizes the need for psychotropic medication.

TESTS ADMINISTERED:

Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV)

Wide Range Achievement Test, Revision 4 (WRAT-4)

Minnesota Multiphasic Personality Inventory, II (MMPI-II).

Personality assessment inventory (PAI)

WHODAS 2.0

TEST RESULTS:

WAIS-IV

Verbal Comprehension Perceptual Reasoning

Similarities (7) Block Design (12)

Vocabulary (9) Matrix Reasoning (11)

Information (10) Visual Puzzles (8)

Comprehension (12) Picture Completion (8)

Figure Weights (12)

Working Memory Processing Speed

Digit Span (16) Symbol Search (12)

Arithmetic (11) Coding (8)

Letter Number Sequencing (11)

Index %ile

Verbal Comprehension 93 50

Perceptual Reasoning 109 79

Working Memory 115 82

Processing Speed 99 43

Full Scale 103 67

The Wechsler Adult Intelligence Scale is an IQ test designed to measure intelligence and cognitive ability in adults and older adolescents. The WISC-IV has 15 subtests, 10 of which are core subtests that are usually used to measure the four index scores and Full Scale IQ. The results are interpreted by the score obtained on each subtest which indicates the level of intelligence of the individual.

On the WAIS-IV, Daniel obtained a Full Scale IQ of 103. This score is in the Average Range of Intelligence and exceeds 67 out of 100 persons his age.

Daniel’s Verbal Comprehension Index which includes Similarities he was presented with two words and asked how they are alike. The test is designed to assess verbal reasoning and the development of concepts. Vocabulary The individual was presented with words and is asked to define them. The test was developed to measure word knowledge and verbal concept formation. Comprehension The individual was asked questions about social and other situations, such as: Why should children not be allowed to work in factories? The test was developed to measure an individual’s ability to understand complex questions and formulate answers. There are two supplementary subtests that can be used to measure the Verbal Comprehension Index: Information, the individual was given a series of general knowledge questions, such as: How far is it from London to Paris? The test was developed to measure an individual’s ability to acquire, retain and retrieve information. Word Reasoning, the individual was given a series of clues and has to say what the common concept is. The test was developed to measure verbal reasoning. Verbal Comprehension Index of Daniel is 93 which exceeds 50 out of 100 persons of his age and is in the Average range. Advantages reflects word knowledge, fund of general information, understanding of social conventions, and abstract verbal reasoning are within an average range.

His Perceptual Reasoning Index includes Block Design; he was asked to copy a pattern using colored blocks. The item is designed to assess an individual’s ability to understand complex visual information. Picture Concepts, the individual was shown three rows of pictures and has to choose one picture from each row that share a common characteristic. The test was developed to assess person’s ability to categorize items. Matrix Reasoning, he was presented with a matrix of abstract pictures in which there is one picture missing. He has then to choose which of a number of possible options the missing picture is. The test was developed non-verbal problem solving. There is one supplementary subtest that can be used to measure the Perceptual Reasoning Index: Picture Completion The individual was shown a picture in which there was a significant part missing, such as a man cutting down a tree using an axe without a head, and he was required to say what is missing. The test was developed to measure visual understanding and organisation. Daniel’s Perceptual Reasoning Index (109) exceeds 79 out of 100 persons his age and is in the High Average range. This reflects relatively strong nonverbal reasoning abilities. Which is significantly higher than his Verbal Comprehension Index (93), reflecting greater facility with tasks requiring nonverbal reasoning and performance than with tasks requiring words. Both the score lies in average range. Daniel performed relatively well on PRI it was examined during the administration that he was doing these activities more interestingly than VCI.

Daniels’s Working Memory Index includes, Digit Span There are two parts to this subtest. In the first part (digits forward) the individual read a series of numbers and was required to say them back to the examiner. In the second part (digits reversed) he again read a series of numbers but this time he was required to say them back to the examiner in reverse order. The test was developed to measure verbal short-term memory, and attention. Letter-Number Sequencing he read a series of letters and numbers and was required to repeat them back with the letters in alphabetical order and the numbers in numerical order. The test was designed to measure an individual’s ability to hold verbal information in memory while he manipulates it. There is one supplementary subtest that can be used to measure the Working Memory Index: Arithmetic This consisted of a series of mental arithmetic questions such as: If Jo has 12 buns, he then eats 3 and gives 4 away how many does he have left? The test was designed to measure a number of mental tasks including the ability to hold information in memory while it is being manipulated. Working Memory Index of Daniel is 115 which exceeds 82 out of 100 persons his age and is in the High Average range and is a relative strength. This reflects strong auditory attention and concentration. Daniel’s Matrix Reasoning is a significant strength which reflects strong nonverbal abstract problem solving.

Daniel’s Processing Speed Index which includes Coding The individual was presented with a key in which the numbers 1 to 9 are each paired with a different symbol; his task was then to use this key to put in the appropriate symbols for a list of numbers between 1 and 9. The test was designed to measure speed of processing but it also is affected by other cognitive abilities such as learning, short-term memory and concentration. Symbol Search The individual has to look at two target symbols and then examine a group of symbols to see if the target symbols are repeated. The test is designed to measure processing speed but is also affected by other cognitive abilities such as visual motor coordination and concentration. There is one supplementary subtest that can be used to measure the Processing Speed Index: Cancellation The individual has to looks at a random sequence of pictures and is required to cross out target pictures. In addition to processing speed it is probably affected by other factors such as attention, and visual neglect. All ten core subtests are used to measure Full Scale IQ. Processing Speed Index of Daniel is 99 which exceeds 43 out of 100 persons of his age and is in the Average range. This reflects average psychomotor speed and immediate visual memory.

WRAT-4

Subtest Standard Score Percentile

Word Reading 93 49

Sentence Comprehension 98 30

Spelling 89 50

Math Computation 95 80

Reading Composite 96 30

On the WRAT-4, Daniel earned a Standard Score of 89 on Spelling, which is in the below Average range and is in the 50th percentile. Reading Composite is a combination of Word Reading and Sentence Comprehension.

Daniel’s Reading Composite of 96 is in the Average range and is in the 30th percentile. Daniel’s Word Reading Standard Score of 93 is in the Average range and is in the 49th percentile. This score reflects average sight reading abilities. Daniel’s Sentence Comprehension of 98 is in the Average range and is in the 30th percentile.

This score reflects low average reading comprehension. He earned a Standard Score of 89 on Spelling, which is in the below Average range and is in the 50th percentile. His Math Computation skills of 95 were in Average range and is in the 80th percentile.

Daniel was able to add, subtract, multiply and divide whole numbers, decimals, and fractions. He was able to solve algebraic equations. he was able to work with percentages.

MMPI-2

Scale	Score You did not display these as T scores as I requested.
L (Lie- Scale)	6
F (Infrequency-Scale)	9
K (Correction Scale)	17
1-Hs	17
2-D	31
3-Hy	25
4-Pd	26
5-Mf	24
6-Pa	60
7-Pt	35
8-Sc	31
9-Ma	15
0-Si	30

MMPI-2, The Minnesota Multiphasic Personality Inventory (MMPI) is a psychological test that assesses personality traits and psychopathology. It is primarily intended to test people who are suspected of having mental health or other clinical issues. The MMPI-2 is designed with 10 clinical scales which assess 10 major categories of abnormal human behavior, and four validity scales, which assess the person’s general test-taking attitude and whether they answered the items on the test in a truthful and accurate manner. Interpretation is based on interpretation of the scales which have a mean of 50 and a standard deviation of 10. T scores above 65 are considered significant.

Daniel’s responses to the items indicated that on this test administration, he might have felt the need to present as having strong moral character or to deny having any weaknesses. Despite this tendency to present himself in a positive light, his responses can be considered a good reflection of his current state and the current protocol can be considered valid.

Daniel’s score on the L (Lie-scale), F (infrequency scale) and K (correction scale) lies in average and normal range suggesting that his profile is interpretableaccura. Average scores were seen on MMPI-II scale 1 and 3. Scale 1 reflects concern about bodily function. Daniel’s scores suggest that he does not tends to have multiple vague physical complaints and but tend to convert emotional distress into physical symptoms like headache. Daniel’s scores on Scale 3 indicates that he might be interpersonally demanding and tend to maintain shallow relationships.

The average scale on 1 and 3 generally reflects an individual who is conforming and conventional. Such individuals value being seen positively by others. Daniel may be emotionally over controlled and express anger and other negative feelings in indirect ways.

Scale 2 measures depression. This scale was slightly above average range, suggesting that Daniel’s depressive symptoms are currently not well controlled and he might need psychological help. During the evaluation interview Daniel was shy, unassertive, and socially distant. He found it difficult to talk about her problems. The Minnesota Report confirmed Daniel’s current high level of distress and symptoms of anxiety, and provides descriptive narratives based on elevation from her three profiles (i.e., Clinical and Supplementary Scales, Content Scales, and PSY-5 Scales).

In addition to being very introverted and distant from others (apparent from her Si elevation on the Clinical Scales and INTR from the PSY-5 profile), Daniel’s narrative highlights other interpersonal difficulties based on elevations on NEGE from the PSY-5 and CYN from the Content Scales profiles.

I requested previously that you present information an all the scales.

“For the purposes of this course please describe the performance on all scales, not only significant elevations. It is as important sometimes to show the areas where a client functions within “normal limits” as it is to describe areas of concern. Think of it as strength-based thinking.”

DIAGNOSTIC IMPRESSIONS:

296.35 (F33.41) Major Depression, recurrent, in partial remission due to medication.

SUMMARY AND RECOMMENDATIONS:

Daniel is a 22-year-old Canadian man who is being assessed to determine his current mental status ad her ability to remain stable. He has a history of depression and anxiety including no psychiatric hospitalization. At present, her depression appears to be well controlled by medication. He reported functioning not well at his job and maintaining an non active social life. He currently appears to maintain not good emotional stability with the assistance of medication. The results from the WAIS reflected intelligence in the average range, nonverbal abilities are better developed than verbal abilities, and relative strengths with nonverbal task as well as auditory attention and concentration. Daniel’s academic testing reflects low average spelling and site reading, average reading comprehension and average math skills.

The results from the MMPI indicate that Daniel may struggle with some physical complaints like headache, have some difficulty with interpersonal relationships with colleagues, and his depressive symptoms are not in normal range indicating that they may be in remission but not fully controlled. Considering that he is currently not emotionally stable, and stressing over things due to anxiety needed support. The results from reports a number of difficulties consistent with a significant depressive experience.

He is likely to be plagued by thoughts of worthlessness, hopelessness, and personal failure. He admits openly to feelings of sadness, a loss of interest in normal activities, and a loss of sense of pleasure in things that were previously enjoyed.

Thank you for referring this very interesting man for assessment.