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Name: ______
ECD 560 – Research and Assessment in Counseling
ASSESSMENT EXAM
I. DSM Diagnosis: ( 50 Points)
Provide a complete Multiaxial Diagnosis for each Brief Case Study. Remember to include the Code # as well as any specifiers. For Axis V, Make sure you indicate the timing of the score, (At Intake, At Termination, etc.)
Case Study #1:
A 29-year-old car salesman was referred by his girlfriend, a psychiatric nurse, who suspected he had a Mood Disorder, even though the patient was reluctant to admit that he might be a "moody" person. According to him, since age 14 he has experienced repeated alternating cycles that he terms "good times and bad times." During a "bad" period, usually lasting 4–7 days, he oversleeps 10–14 hours daily and lacks energy, confidence, and motivation—"just vegetating," as he puts it. Often he abruptly shifts, characteristically upon waking up in the morning, to a 3-day to 4-day stretch of overconfidence, heightened social awareness, promiscuity, and sharpened thinking ("Things would flash in my mind"). At such times he indulges in alcohol to enhance the experience, but also to help him sleep. Occasionally the "good" periods last 7–10 days but culminate in irritable and hostile outbursts, which often herald the transition back to another period of "bad" days. He admits to frequent use of marijuana, which he claims helps him "adjust" to daily routines.
In school, A's and B's alternated with C's and D's, with the result that the patient was considered a bright student whose performance was mediocre overall because of "unstable motivation." As a car salesman his performance has also been uneven, with "good days" canceling out the "bad days"; yet even during his "good days," he is sometimes argumentative with customers and loses sales that appeared sure. Although considered a charming man in many social circles, he alienates friends when he is hostile and irritable. He typically accumulates social obligations during the "bad" days and takes care of them all at once on the first day of a "good" period.
Axis I: ______
______
Axis II: ______
Axis III: ______
Axis IV: ______
Axis V: ______
Case Study #2
Dorothea Cabot, a 42-year-old socialite, has never had any mental problems before. A new performance hall is to be formally opened with the world premiere of a new ballet; Dorothea, because of her position on the cultural council, has assumed the responsibility for coordinating that event. However, construction problems, including strikes, have made it uncertain whether finishing details will meet the deadline. The set designer has been volatile, threatening to walk out on the project unless the materials meet his meticulous specifications. Dorothea has had to calm this volatile man while attempting to coax disputing groups to negotiate. She has also had increased responsibilities at home as her nanny has had to leave to visit a sick relative.
In the midst of these difficulties, her best friend has been decapitated in a tragic auto crash. Dorothea herself is an only child, and her best friend had been very close to her since grade school. People have often commented that the two women were like sisters.
Immediately following the funeral, Dorothea becomes increasingly tense and jittery and able to sleep only 2–3 hours a night. Two days later she happens to see a woman driving a car just like the one her friend had driven. She is puzzled, and after a few hours she becomes convinced that her friend is alive and that the accident had been staged, along with the funeral, as part of a plot. Somehow the plot is directed toward deceiving her, and she senses that she is in great danger and must solve the mystery to escape alive. She begins to distrust everyone except her husband and to believe that the phone is tapped and that the rooms are "bugged." She pleads with her husband to help save her life. She begins to hear a high-pitched, undulating sound, which she fears is an ultrasound beam aimed at her. She is in a state of sheer panic, gripping her husband's arm in terror, as he brings her to the emergency room the next morning.
Axis I: ______
______
Axis II: ______
Axis III: ______
Axis IV: ______
Axis V: ______
Case Study #3
Emily is a 7-year-old girl who was brought to an outpatient mental health clinic for children by her mother because of difficulties with peer relationships. A recent telephone call from Emily's second-grade teacher convinced her mother that it was necessary to seek professional help for Emily. The teacher was becoming increasingly concerned about Emily's reluctance to interact with the other children in the class. During recess, Emily stands off to the side of the playground with her head down, looking extremely uncomfortable. In the classroom she never initiates conversation with the other children and has great difficulty responding even when approached by another child. It is now 6 months into the school year, and Emily's extreme discomfort around her peers has not improved at all. Indeed, she does not have a single friend in the classroom.
Emily's discomfort in interacting with peers dates back to kindergarten. Her teachers in kindergarten and first grade had commented on her report card that she was very withdrawn and nervous with the other children. However, her second-grade teacher was the first to take an active role in trying to get Emily the help she needed.
Emily's mother had tried repeatedly to get Emily involved with other children in the neighborhood. In fact, she would take Emily by the hand and lead her to neighbors' homes where there were children of the same age to try and make friends for her child. Unfortunately, when she did this, Emily would start to shake or cry and would not be able to say a word to the neighbor's child. Emily has never been asked to attend a birthday party for another child.
Her behavior at home is quite different. Emily is warm and outgoing with her family, in marked contrast to the withdrawn and anxious child observed by her teachers and peers.
Axis I: ______
______
Axis II: ______
Axis III: ______
Axis IV: ______
Axis V: ______
Case Study # 4
A 41-year-old man was referred to a community mental health center's activities program for help in improving his social skills. He had a lifelong pattern of social isolation, with no real friends, and spent long hours worrying that his angry thoughts about his older brother would cause his brother harm. He had previously worked as a clerk in civil service, but had lost his job because of poor attendance and low productivity.
On interview the patient was distant and somewhat distrustful. He described in elaborate and often irrelevant detail his rather uneventful and routine daily life. He told the interviewer that he had spent an hour and a half in a pet store deciding which of two brands of fish food to buy and explained their relative merits. For 2 days he had studied the washing instructions on a new pair of jeans—Did "Wash before wearing" mean that the jeans were to be washed before wearing the first time, or did they need, for some reason, to be washed each time before they were worn? He did not regard concerns such as these as senseless, though he acknowledged that the amount of time spent thinking about them might be excessive. He described how he often would buy several different brands of the same item, such as different kinds of can openers, and then would keep them in their original bags in his closet, expecting that at some future time he would find them useful. He was, however, usually very reluctant to spend money on things that he actually needed, although he had a substantial bank account. He could recite from memory his most recent monthly bank statement, including the amount of every check and the running balance as each check was written. He knew his balance on any particular day, but sometimes got anxious if he considered whether a certain check or deposit had actually cleared.
He asked the interviewer whether, if he joined the program, he would be required to participate in groups. He said that groups made him very nervous because he felt that if he revealed too much personal information, such as the amount of money that he had in the bank, people would take advantage of him or manipulate him for their own benefit.
Axis I: ______
______
Axis II: ______
Axis III: ______
Axis IV: ______
Axis V: ______
Case Study # 5
Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his twentieth hospitalization, by his mother because she is afraid of him. He is dressed in a ragged overcoat, bedroom slippers, and a baseball cap and wears several medals around his neck. His affect ranges from anger at his mother ("She feeds me shit...what comes out of other people's rectums") to a giggling, obsequious seductiveness toward the interviewer. His speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hip movements. His mother reports that he stopped taking his medication about a month ago and has since begun to hear voices and to look and act more bizarrely. When asked what he has been doing, he says "eating wires and lighting fires." His spontaneous speech is often incoherent and marked by frequent rhyming and clang associations.
Emilio was first hospitalized when he was 15. His development was apparently normal until the family moved from Puerto Rico when he was 9. He made no friends in his new neighborhood, dropped out of school in ninth grade because he felt victimized by the older boys, and began to hang out with homosexual male prostitutes. He has apparently never held a job for more than a few weeks. Living with his mother and sister, he became increasingly disorganized, wandering the apartment all night, talking and laughing to himself, refusing to bathe, eating very little, throwing things out of the window, and lighting fires in the apartment. He sometimes said a monster was after him or a white bird was flying over him trying to grab his hair. During each hospitalization he was quickly stabilized on antipsychotic medication, but after discharge he refused to continue taking medication, and within a few months he was either again psychotic, leading to readmission to a hospital, or else he disappeared for months at a time before turning up at his mother's house incoherent and unwashed. There is no evidence that he ever abused drugs or alcohol. His sister suspects that when he is relatively well, he finds older men to take care of him, and in this manner has made his way back and forth across the country without ever having a steady job.
Axis I: ______
______
Axis II: ______
Axis III: ______
Axis IV: ______
Axis V: ______
II. DSM Essay: (25 Points) (On the back of a page or on a separate sheet. Make sure to answer Part 1 & 2.)
Part 1. Write a brief essay describing which DSM diagnosis you would be least comfortable working with as a professional counselor. Identify the rationale behind your apprehension, how you feel about this hesitancy, and how you would handle the situation if a client with this disorder was on your caseload in the future.
Part 2. Write a brief essay describing which DSM diagnosis you would most like to have yourself. Identify the rationale behind your appeal for this disorder, how you feel about this awareness, and how your life would be different if you were experiencing this disorder.
III. Short Answer: (15 Points)
1. With the exception of the times when someone is a danger to themselves or someone else, what factor is often key to being able to reach a diagnosis in the DSM-IV?
2. Give at least 3 Points that explain the difference between Borderline Personality Disorder & Histrionic Personality Disorder.
3. Give at least 3 Points that explain the difference between Paranoid Schizophrenia & Disorganized Schizophrenia.
IV. Assessment Concepts (10 Points)
1. Looking at the diagnostic criteria for Mood Disorder due to General Medical Condition while making the clinical diagnosis of Major Depressive Disorder is an example of reviewing the ______.
2. AXIS V is where the clinician provides an assessment of how the client is doing overall. The scale is called the ______or abbreviated as ______.
3. The specifier ______can be used when there is a strong presumption that the full criteria will ultimately be met for a disorder, but not enough information is available initially to make a firm diagnosis.
4. True or False. Women are twice as likely to experience Body Dysmorphic Disorder than men.
5. When issuing an diagnosis of Obsessive Compulsive Disorder where the individual has little awareness of their compulsive behavior it is important to include the specifier: ______.
6. Three examples of differential diagnoses for Conversion Disorder are:
1) ______,
2) ______,
3) ______.
7. The addiction process begins when the individual first Uses a substance. This process then progresses to Misuse, ______, and finally, ______.
8. A disorder commonly diagnosed in childhood that is similar to Oppositional Defiant Disorder but includes a persistent pattern of more serious aggressive behavior that includes not respecting the rights to others or cruelty to animals is ______.
9. True or False. Factitious Disorder is more common in females than in males.
10. Among the Cultural features discussed about schizophrenia include that studies have indicated that ______and ______individuals are more often diagnosed with schizophrenia than other racial groups.