WK3 SOCW 6090 By Day 7
Submit 2- to 3, in which you complete both parts outlined below:
Part I: Diagnostic Summ and MSE
Provide a diagnostic summ of the client, Carl. Include:
Identifying Data/Client demographics
Chief complaint/Presenting Problem
Past psychiatric illness
Substance use history
Past medical history
Mental Status Ex (Be professional and concise for all nine areas)
Behavior or psychomotor activity
Attitudes toward the interviewer or examiner
Affect and mood
Speech and thought
Orientation and consciousness
Memory and intelligence
Reliability, judgment, and insight
Part II: Analysis of MSE
After completing Part I, provide an analysis and demonstrate critical thought (supported by references) in your response to the following:
Identify any areas in your MSE that require follow-up data collection.
Explain how using the cross-cutting measure would add to the information gathered.
Do Carl’s answers add to your ability to diagnose him in any specific way? Why or why not?
Would you discuss a possible diagnosis with Carl at this point in time? Why?
Support Part II with citations/references. The DSM 5 and case study do not need to be cited. Utilize the other course readings to support your response. Mental Status Examination for Carl (Transcript)
So in this section, we’re going to watch a mental status examination with a young man named Carl. This is a general check in. He was referred because of some odd ideation and bizarre behaviors. So his vocationalinstructors and educators were a little bit concerned.
JOHN SOMMERS-FLANAGAN: A traditional mental status examination includes about nine domains. And the first three– appearance, behavior or psychomotor activity, and attitudes toward the interviewer orexaminer– are always just inferred. In other words, you just observe the clients and then you make some inferences about those three categories. The remaining six categories are usually assessed in a little bit more of adirect way. And these other six categories include affect and mood together, speech and thought together, perceptual disturbances, orientation and consciousness, memory and intelligence, as well as reliability,judgment, and insight.
RITA SOMMERS-FLANAGAN: As I look at that list, it seems to me that the client’s speech is something more inferred or observed.
JOHN SOMMERS-FLANAGAN: I think you’re right. It’s usually inferred or observed more indirectly also. Although in the upcoming interview, I accidentally forgot to ask one of the speech assessment items, which isto ask Carl to repeat after me– no ifs, ands, or buts.
RITA SOMMERS-FLANAGAN: So, well, no ifs, ands, or buts, let’s watch a little section of Carl. Carl is a 19-year-old young man who is a student at Trapper Creek Job Corps. He has a lot of adjustment struggles andeccentricities.
And you’ll notice that he also has some tick-like mannerisms. We both met with Carl in earlier sessions. And we’ve talked about those mannerisms. So in this tape you won’t here us inquiring about those.
JOHN SOMMERS-FLANAGAN: As you get ready to watch this mental status examination interview with Carl, it might be a good idea to pull out a piece of paper and jot down a few notes in each of the nine domainsas you observe the interview.
JOHN SOMMERS-FLANAGAN: Well, Carl, thank you for coming in. And what I would like to do with you today is just a very standard interview that is sort of a way for me to get to know how your brain isworking. And so what I’m going to do is I’m going to ask you some questions.
But first I just want to start off by sort of asking some very easy questions. And then some of the questions will get harder as we go. And so, does that sound OK to you?
CARL: Yeah, that sounds OK.
JOHN SOMMERS-FLANAGAN: First one is state your full name.
CARL: I’ve actually had quite a few different names growing up. You want my current name?
JOHN SOMMERS-FLANAGAN: Whatever you would like.
CARL: Carl Dunn.
JOHN SOMMERS-FLANAGAN: OK. You said you’ve had quite a few different names growing up.
CARL: Yes, actually, my mother changed her name. I don’t know whether or not she legally changed them or anything. But she always changed our last name depending on what guy or girl she was dating at the time.
And I was CJ once. I tried to be Todd the second time, but the name just kind of sounded ridiculous. I’ve got Warren, Jr., Raccoon because of the rings around my eyes.
JOHN SOMMERS-FLANAGAN: What’s your favorite name for yourself?
CARL: Just Carl Dunn.
JOHN SOMMERS-FLANAGAN: Carl Dunn, OK.
CARL: I don’t really have a favorite name for myself, I just pick whichever one sticks better.
JOHN SOMMERS-FLANAGAN: OK. Well, I’ll just stick with Carl if that’s OK.
JOHN SOMMERS-FLANAGAN: And what is today’s date, Carl?
CARL: 3-29-2012, I believe.
JOHN SOMMERS-FLANAGAN: OK. All right. What day of the week is it?
CARL: No, it’s 3-20, and I don’t remember what day it is. OK, what?
JOHN SOMMERS-FLANAGAN: What day of the week is it?
CARL: OK, it’s Thursday.
JOHN SOMMERS-FLANAGAN: Thursday, OK. And can you tell me what season of the year it is?
CARL: It seems to be spring, going from winter into spring. But judged by the weather, it’s still kind of wintery. There’s a lot of snow.
JOHN SOMMERS-FLANAGAN: So we’re going from winter into spring.
JOHN SOMMERS-FLANAGAN: Yeah. Which one do you think we’re in?
CARL: Here spring, but back at Job Corps, winter.
JOHN SOMMERS-FLANAGAN: OK. And what is the name of the town or city where you are living now?
JOHN SOMMERS-FLANAGAN: Darby. OK. OK. Now this is a hard question. Do you know who the governor of Montana is?
JOHN SOMMERS-FLANAGAN: No, OK. So my next question is going to be a test of your memory. Is that OK if we do that?
JOHN SOMMERS-FLANAGAN: So I’m going to say three things. And all you need to do is when I’m finished saying them, you repeat them back.
JOHN SOMMERS-FLANAGAN: OK. So the three things are cup, newspaper, banana.
JOHN SOMMERS-FLANAGAN: What are the three things?
CARL: Cup, newspaper, banana.
JOHN SOMMERS-FLANAGAN: OK. All right, good work. Now this one is a little bit harder. You ready for something a little bit more of a mental challenge? I’d like you to begin with the number 100 and then countbackwards by sevens. So it’s like 100–
CARL: Oh yeah. 100, 93, 86, 79, 72, 65, 58, 51, 44.
JOHN SOMMERS-FLANAGAN: You can stop, good work. That seemed pretty easy for you.
CARL: It was pretty easy. I used to be able to multiply double digit numbers.
JOHN SOMMERS-FLANAGAN: Yeah, so you’re pretty good with math. You’re pretty good with numbers.
CARL: Yeah, I used to be a lot better reading. In the second grade, I knew words that none of the college teachers I used to visit knew. And I was able to read beyond a college level and in a couple other languages. Andthen I forgot all that. But that’s another story.
JOHN SOMMERS-FLANAGAN: Sure. So try this one. Spell the word “world” backwards.
JOHN SOMMERS-FLANAGAN: OK. Now who is currently the president of the United States?
CARL: I believe it’s still Obama.
JOHN SOMMERS-FLANAGAN: OK. Do you know who was president before Obama?
CARL: Bush, I believe.
JOHN SOMMERS-FLANAGAN: OK, do you know who was president before Bush?
CARL: No, I don’t remember who it was before Bush. I mean, I know who it is. I just don’t remember the name.
JOHN SOMMERS-FLANAGAN: OK. Can you describe the person?
CARL: A Christian white guy.
JOHN SOMMERS-FLANAGAN: OK.
CARL: I’ll know him when I see him.
JOHN SOMMERS-FLANAGAN: OK.
CARL: Then before that was Bush.
JOHN SOMMERS-FLANAGAN: OK, so before the Christian white guy there was Bush. And then–
CARL: Another Christian white guy. OK, I’ll remember the faces. If I see a face of the president, I’ll be able to recognize it.
JOHN SOMMERS-FLANAGAN: You can recognize–
CARL: I don’t really know that much about the presidents.
JOHN SOMMERS-FLANAGAN: Do who was before the first Bush?
CARL: His father.
JOHN SOMMERS-FLANAGAN: OK.
CARL: Before Bush, it was his father Bush. Before him was the other Christian white guy.
JOHN SOMMERS-FLANAGAN: OK.
CARL: Why is it that all the presidents up until Obama were Christian white males?
JOHN SOMMERS-FLANAGAN: I don’t know.
CARL: You don’t know.
JOHN SOMMERS-FLANAGAN: Why do you think?
CARL: Because people are naturally judgmental, and there are a lot of racist people out there. Everything’s always going to be fair. It’s always going to have something to do with looks, religion, and ethnic nationalbackground, stuff like that. Christianity and stuff like that just happens to be one of the more powerful religions. So coming from that aspect, lots of people are compelled by their religious beliefs to do a lot of things. Itwould all make sense that the government in general would look for white Christian males.
JOHN SOMMERS-FLANAGAN: OK. Sounds good. Now I’m going to ask you some questions that are a little different, questions about feelings. OK.
CARL: Feelings, feelings, yes.
JOHN SOMMERS-FLANAGAN: And my first question about that is how are you feeling right now?
CARL: Calm, that’s about it.
JOHN SOMMERS-FLANAGAN: OK. So you’re feeling calm. If you were to rate your mood, zero is the worst possible mood. It’s like you’re so down and depressed that you’re just going to kill yourself. It’s over. And10 is the happiest you could possibly feel. You’re so happy maybe– I don’t know what you do when you’re really happy– but maybe you’re dancing, and singing, and you’re just super happy. On that scale of zero to 10,how would you rate your mood right now?
CARL: Right down the middle.
JOHN SOMMERS-FLANAGAN: You’re about a five, you think? Down the middle?
CARL: Well, I had a pretty good day. But yesterday was pretty crappy. And I’ve got some stressful things on my mind. So it’s about a five.
JOHN SOMMERS-FLANAGAN: So you’re about a five.
CARL: Yeah, it’s right there in the middle.
JOHN SOMMERS-FLANAGAN: OK. Now if you were to say the worst mood you’ve had for the last three months.
JOHN SOMMERS-FLANAGAN: You know, Rita, many professionals I think are a little reluctant to do something as structured and evaluative as a mental status examination for fear that it might adversely affect thereport or the therapeutic relationship. One thing that I found, and maybe it’s just because I’m a little bit weird, is that I actually find that using that kind of structure and the assessment parts of the mental statusexamination can be framed in a way that engages the clients and I think at least doesn’t adversely affect the relationship. And I think I try to frame questions as they might be difficult. And I try to respond empathicallywhen clients have trouble or struggle with the questions.
RITA SOMMERS-FLANAGAN: I think you do put people at ease. I like how you kind of ask permission. You tell them it’s going to be a hard question.
But even with all of that reassurance, you can feel the anxiety that comes up in Carl when he can’t get something right. And then he says, he was able to multiply double digit numbers in second grade. But really, thereis always that urge to ask about the past, to explore. And mental status exams are about the functioning of the client in the present.
JOHN SOMMERS-FLANAGAN: So even Carl’s defensiveness that we saw, and maybe his exaggeration, and his use of humor, that’s all data that the mental status examiner or the clinical interviewer can use to makestatements within those nine different domains. In particular, I think at the very least, we know Carl is a creative young man.
RITA SOMMERS-FLANAGAN: Yes, we do. And one thing that has always been a little confusing for me in mental status exams is affect and mood. So the strategies for assessing those are important.
Remember that affect is something that you infer, that you observe. And mood is something that you actually ask about. And you ask about the mood now with some rating form. And then you can also ask about moodthe past three months, the highest, the lowest, do an average with that.
JOHN SOMMERS-FLANAGAN: And you get a chance to compare where the client is now with previous highs and lows. In this next section–
RITA SOMMERS-FLANAGAN: Yeah, let’s watch another one.
JOHN SOMMERS-FLANAGAN: OK, in this next section, I start off by doing an assessment of Carl’s intermediate memory. And one thing I think that we’ll discover is he has an excellent intermediate memory. Healso shows that he has a pretty darn good sense of humor.
RITA SOMMERS-FLANAGAN: All right.
JOHN SOMMERS-FLANAGAN: Now I’ve got kind of a tricky question for you. You ready?
CARL: Does this question do back flips? Then it’s not very tricky, is it?
JOHN SOMMERS-FLANAGAN: All right, I guess not.
JOHN SOMMERS-FLANAGAN: Remember a few minutes ago I asked you to remember three things that I said? Can you remember what those three things are?
CARL: Cup, banana, and newspaper.
JOHN SOMMERS-FLANAGAN: OK. You’ve got them.
CARL: Well, it was cup, newspaper, banana, in that order. But still.
JOHN SOMMERS-FLANAGAN: You got all three anyway. You even remember the order they came in.
CARL: Of course, of course, I’m smarter than your average Job Corps kid, which is about average.
JOHN SOMMERS-FLANAGAN: OK. All right, now I have some questions. Those were questions about your feelings and emotions. And now have some questions that are more about your thinking, OK?
And then we might come back to feeling a little bit too. But tell me, let’s see. Do you ever get any thoughts stuck in your head, they just kind of go over, and over, and over?
CARL: I’ve got millions of those. Which one do you want?
JOHN SOMMERS-FLANAGAN: What would be a typical that gets stuck in your head?
CARL: Well, I sometimes whenever something happens, I picture another event happening as a result of it that gets stuck in my head. Songs get stuck in my head. Voices get stuck in my head.
JOHN SOMMERS-FLANAGAN: Yeah.
CARL: They don’t really [UNINTELLIGIBLE], but they just kind of sit there. And they used to tell me to do things, but now I get into arguments with them on occasion.
JOHN SOMMERS-FLANAGAN: OK, so you have some songs that get stuck in your head and then some voices that get stuck in your head.
CARL: Well, yeah, I like to make up the voices, because it helps drown out the music. I mean, the voice thing is intentional. Because it helps get the songs, and the thoughts, and memories out of my head. So that’s kindof like a self-help right there.
JOHN SOMMERS-FLANAGAN: So one of the ways you get something that’s stuck in your head out of your head is maybe you sort of creative these voices in your head? And they kind–
CARL: It’s kind of like an invisible imaginary friend.
JOHN SOMMERS-FLANAGAN: OK. Do you have a consistent, invisible imaginary friend?
CARL: No, not really, because they’re not technically imaginary friends. They’re just little bodily voices that I made up in my head. They’re like a little thoughts that I created, like I find a way create a thought thatoverpowers all the other noises and stuff that I hear in my head. They kind of just [UNINTELLIGIBLE] these other voices that– it’s pretty much I’m using my imagination.
JOHN SOMMERS-FLANAGAN: Sure. This is just a different kind of question. Do you have any beliefs that other people think are strange or odd? Unusual beliefs?
CARL: Quite a few, actually.
JOHN SOMMERS-FLANAGAN: Well, give me an example. What would be an unusual belief?
CARL: Well, I really don’t care if anybody’s into bestiality. I mean, for starters, there are guys out there that are raping little kids, people out there getting violated 24-7. There are necrophiliacs. There are all this otherstuff. I mean, unless it’s like the most powerful out of the seven sins out there.
And animals, for instance, for that example, they’re pretty much born to mate. I mean, I really don’t care. The only reason why it’s considered a bad thing is because people just didn’t understand it back then, which isnothing really to understand. The only risk is that they find a new kind of STD.
JOHN SOMMERS-FLANAGAN: So one of your unusual beliefs might be that you don’t–
CARL: I really don’t care about bestiality. I don’t think–
JOHN SOMMERS-FLANAGAN: One way or another, It doesn’t matter to you much. Yeah.
JOHN SOMMERS-FLANAGAN: I have some more questions for you. Are you ready? Do you ever see or hear things that other people don’t see or hear?
CARL: Sometimes I see ghosts. But other people see them too.
JOHN SOMMERS-FLANAGAN: OK. And do you ever think that the radio or the television is speaking directly to you?
CARL: Right. I don’t think that the radio or the television’s speaking directly to me.
JOHN SOMMERS-FLANAGAN: That would be a no.
JOHN SOMMERS-FLANAGAN: Definitely not, OK.
CARL: I mean, unless the TV turned on and the guy said– and I just happen to be sitting in my room, by myself, in my house. Let’s say I have a house, in my house and watching TV. And the TV magically comes onand I’m single at the time, and the guy goes, are you lonely? A little.
Even a little lonely? Oh, yeah, yeah. Are you sitting underneath the covers with– I’m not going to get into that. I’m just saying, I’m probably not going to believe it unless some really weird stuff goes on.
JOHN SOMMERS-FLANAGAN: OK. So for the most part, you’re saying probably absolutely not.
CARL: I’m trying to watch my language here.
JOHN SOMMERS-FLANAGAN: Yeah. Has anyone ever tried to steal your thoughts or read your mind? I know that’s kind of an unusual question. It’s OK. Some people think that. And that’s just mostly why I’m asking.
CARL: People try to steal other thoughts or read their mind. So that’s original. Well, how do I answer this one?
JOHN SOMMERS-FLANAGAN: Yes or no.
CARL: I never thought that anybody was trying to steal or read my mind. But I used to have friends and family and stuff that were Wiccan. And I’ve met quite a few people–
JOHN SOMMERS-FLANAGAN: Speaking of knowledge, I’ve got a few more questions for you.
CARL: Yes, yes.
JOHN SOMMERS-FLANAGAN: And these are a little more knowledge based. So in what way is a pencil and a computer alike?
CARL: You write with them. You can transfer knowledge from one spot to another with it. Pretty much the only difference between a pencil and a computer is that the computer’s electrical and the pencil, you can’t storesmall bits of data on, except for …