CASES FOR DIAGNOSTIC AND ASSESSMENT EXERCISES


ABNORMAL BEHAVIOUR AND PSYCHOLOGICAL TESTING


 


The following are the cases to be considered for the assessment task related to diagnosis and evaluation of test material. 


 


Please note that students should complete the TWO diagnoses and give brief responses to questions related to the TWO cases where test material is provided. 


 


 


CASES FOR DIAGNOSTIC EXERCISES

 


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.


 


 


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. 


 


 


CASES FOR QUESTIONS BASED ON TESTING

 


1.      Child/adolescent assessment


Ruth, aged 13 years 4 months, is Australian-born with no obvious perceptual or physical disabilities. She has no siblings and her parents are divorced.  She was brought to a psychologist by her father within days of a court order that removed her from the care of her mother in Queensland into the custody of her father in NSW.  He wanted advice about her psychological and educational stage of development. The psychologist gave a battery of intelligence, personality and clinical adjustment/maladjustment measures.  Results of selected tests are given below.


 


Intelligence was measured by the Kaufman Brief Intelligence Test (K-BIT) designed for people over the age of 4 years.  It has two subtests: 1) vocabulary (expressive vocabulary and definitions) and 2) matrices (measuring ability to solve new problems, understand relationships among pictures and designs, and to reason by analogy).


 


Ruth’s scores on the K-BIT are as follows:


Subtest                        Score     90% confidence interval             % rank Vocabulary                              124                  117-131                                   95

Matrices                                  124                  117-131                                   95


Composite                               127                  121-133                                   96


 


 


A self-report personality inventory, the Behaviour Assessment System for Children, Self-Report of Personality – Adolescent (BASC, SRP-A) was also administered.  This measure was repeated at a subsequent assessment when Ruth was aged 14 years 11 months.  Between the two assessments Ruth lived with her father and attended a new school. Scores (T scores) of selected subtests at both administrations are given below.  At each administration validity indexes suggested that the scores could be treated as valid indicators.  High scores on the subscales (T scores of 60 or above) can represent negative or undesirable characteristics.  Significant differences in T scores between the two administrations are indicated by *


 


BASC-SRP subscale          Age 13-4             Age 14-11 School maladjustment composite                   62                                47* Attitude to school                                           50                                38*

Attitude to teachers                                        69                                43*


Sensation seeking                                            60                                63


 


Clinical maladjustment composite                  53                                51


Social stress                                                     59                                60


Anxiety                                                           52                                58


Depression                                                      46                                43


Sense of inadequacy                                       65                                42*


 


Considering these results, and information provided above about the K-BIT and BASC answer the following questions:


 


a)                  What could you conclude about Ruth’s ability from the K-BIT test?


 


b)                  What are the limitations of the estimate of her ability?


 


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?


 


d)                 What could you conclude about Ruth’s clinical maladjustment from the clinical subscales at the first administration?


 


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?


 


f)                   What could you conclude about Ruth’s clinical maladjustment from the second administration?


 


g)                  In a couple of sentences write what you could conclude overall from the BASC and K-BIT results, considering both administrations.


 


h)                  In a paragraph outline any limitations of your conclusions: in what ways would you qualify your conclusions in any report to the father?


 


 


2.      Adult personality assessment


 


Margaret, aged 22, referred herself for assessment and therapy.  Presenting symptoms were depression, anxiety with panic attacks and guilt about past sexual conduct.  She is the second of four children.  Margaret described her mother as ‘loving but weak’ and prone to severe episodes of anxiety and depression.  Her father, according to Margaret, is an obsessive, emotionally unstable man who verbally abused his children.  There is a history of psychological problems in her mother’s family: Margaret’s grandmother was diagnosed as suffering from schizophrenia and her grandfather frequently attempted suicide.  Six years ago her father moved out of home and he now lives with another woman.  Margaret left home at the age of 18 and is now studying at university, supported by part-time work and Austudy.  At the age of 21 she met a young man and quickly entered a sexual relationship.  During the six-month relationship she felt guilty and worthless.  Feelings of depression and anxiety increased when he terminated the relationship.  Recently she met a young man she describes as ‘mature and caring’.  However, she is anxious about commitment to him and fears being hurt by his rejection.


 


Tests were administered to clarify the diagnosis and support treatment choices.


 


Assessments included the Beck Depression Inventory (BDI-II) and the Millon Clinical Multiaxial Inventory (MCMI-II).  Results are shown below:


 


BDI-II             Total score 40.  Items scored at highest levels (3) relate to sadness, pessimism, punishment feelings, self-dislike, indecisiveness, and loss of energy.


 


MCMI             Note that clinically significant scores exceed 85.  Margaret’s validity scale scores indicate average levels of self-disclosure, high levels of self-criticism and moderately high levels of responding in a socially desirable manner.


 


Personality patterns

Schizoid                      0


Avoidant                     64


Dependent                  79


Histrionic                    119


Narcissistic                  78


Antisocial                    64


Aggressive                  72


Compulsive                 52


Passive aggressive       88


Self-defeating             77


Schizotypal                 49


Borderline                   79


Paranoid                      68


 


Clinical syndromes

Anxiety                       118


Somatoform                100


Hypomania                  113


Dysthymia                   104


Alcohol                       59


Drugs                          66


Psychotic thinking      59


Psychotic depression   71


Psychotic delusions     54


 


Respond to the following questions.


 


a)      What would you conclude from the BDI about Margaret’s level of depression?


 


b)      Considering the MCMI data as well as the BDI what could you conclude about a possible mood disorder?


 


c)      From the MCMI data what would you conclude about other possible clinical syndromes?


 


d)     Are any personality disorders suggested by the MCMI data? 


 


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?


 


f)       What other kinds of tests would you consider administering or what other information would you seek to clarify the diagnosis and why?


 


 



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