Case Studies in Abnormal Psychology by Kenneth N. Levy & Kristen M. Kelly & William J. Ray

Author:Kenneth N. Levy & Kristen M. Kelly & William J. Ray
Language: eng
Format: epub
Published: 2017-12-20T04:38:18.047642+00:00

Diagnosis and Case Formulation

The mental status examination (MSE) is an important part of the diagnostic assessment and provides a standardized way of observing and describing the patient’s current state of mind. It is important to have a baseline assessment of the patient and to monitor the patient’s mental status for any changes that might suggest important issues to attend to. Monitoring the mental status of a patient is useful for identifying the occurrences of psychotic, manic, or depressive episodes, or suicidal or homicidal risk. The domains of the MSE include appearance, attitude, behavior, mood, affect, speech, thought processes, thought content, perception, cognition, insight, and judgment. In terms of mental status, Ms. Porter arrived for her initial sessions on time, dressed professionally and consistent with her level and type of employment. She appeared kempt although a bit frazzled after what she reported was a long day. She was slightly taller than average for a woman and appeared of normal weight. She appeared slightly younger than her chronological age. Although her attitude was generally cooperative, she was distressed and easily irritated. Initially, she was extremely pleasant and outgoing. Her mood appeared upbeat. However, her mood would quickly shift with the content of what she was discussing. At times she was tearful and other times smiling, making subtle jokes, or even laughing. Although her affect was generally consistent with the content, either happy or sad, at times her affect was incongruent with what she was talking about; most notably, she would often giggle or have a slight laugh when discussing some distressing events. Her speech was normal in terms of rate, rhythm, and volume, although she sometimes became pressured in her speech. Her thought content was logical, but at times she went on slight tangents. She was oriented to person, place, and time.

During the initial evaluation, Ms. Porter complained of being very unhappy and appeared in a lot of distress. She was very activated, talking quickly, somewhat perturbed and even agitated at times about perceived failures on other people’s part to attend to or understand her. She was upset with her parents, siblings, ex-husband, children, and previous therapist. The author hypothesized that Ms. Porter’s pattern of being dissatisfied with others, including her previous therapists, would also likely happen with him. Sure enough, even in the very first session, he perceived that Ms. Porter was annoyed with him at times for not allaying her distress and/or for not being sympathetic enough. The author felt that the patient wanted him to wave a magic wand and cure all her ills in one quick swoosh, and anything short of that was disappointing. The patient also seemed to be “fishing” to get the therapist to agree to her many grievances about having been mistreated by others. The therapist attempted to be sympathetic and concerned for Ms. Porter; however, anything short of a strong acknowledgement by the therapist of the injustice suffered by Ms. Porter appeared to annoy her. The patient reported worrying about a host of concerns, including her work situation, child care, and meeting an appropriate romantic partner.

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