YK
Psychological Assessment Report (Confidential Information) NAME: YK DOB: 04/15/1979 Age: 23 Gender: Male Test Administrator: Advanced Assessment Student Dates/Tests Administered: 01/2 01/23/ 3/20 2003 03 Cli Clinica nicall Inte Interv rviiew Minnesota Multiphasic Personality Inventory –2 (MMPI-2 Short Form) 1/30 1/30/0 /03 3 Wide Wide Rang Range e Achi Achiev evem emen entt Test Test-3 -3 Read Readin ing g Subt Subtes estt (WRA (WRATT-3 3 Read Readin ing) g) Millon Clinical Multiaxial Inventory (MCMI-III) Sentence Completion Test (SCT) 2/6/2003 Bender-Gestalt Test of Visual-Motor Integration (BGVMT) House-Tree-Person (HTP) Wechsler Adult Intelligence Scale – Third Edition (WAIS-III) 2/11/2003 Rorschach Thematic Apperception Test (TAT) Personality Assessment Inventory (PAI)
Reason for Referral YK was referred for psychological assessment to clarify his current symptomotology. However, this report was prepared for a class assignment to fulfill the course requirement for an Advanced Psychological Assessment course at Pepperdine University.
Background Information The following information was obtained during a clinical interview and a review of the patient’s chart. YK is a twenty three-year-old Korean-American male who was transferred to XXX Hospital on 1/09/2003. He was initially brought into the Psychiatric Emergency Room on 1/08/2003 after his family became concerned about his behavior, which included banging on his mother’s car, threatening to harm his mother, and burning himself with cigarettes. He was determined to be a danger to self and others and was admitted to the inpatient ward. He stated to hospital staff that he thought the local
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elementary school children were making fun of his sister and him. He was noted to be preoccupied with the other tenants at his apartment complex, stating that they are trying to run his family from their home. He is diagnosed with Schizoaffective Disorder. He is presently taking Neurontin, Pindolol, Naltrexone, Geodon, and Depakote. His medication management has been challenging and he has previously taken Zyprexa, Ativan, and Haldol during this hospitalization. He is presently being h eld in the hospital under conservatorship and is awaiting placement at a residential facility.
YK was born in Korea and moved to the United States when he was four years old. He said that he does not think there were any complications during his birth and that he met all developmental milestones at appropriate ages. He denied any significant medical history but stated that his father passed away due to emphysema in 2001. He currently lives with his ten-year-old sister and his mother in a Section 8 housing complex. He reported that his sister is his best friend and that he has played a father-like role in her life. He stated that he graduated high school and has been attending a California State University since 1998 with a criminal justice major. He stated that he wants to be released from the hospital because he needs to attend his classes. YK stated that he would like to return to his mother’s home but if she will not let him, he would live with friends. He stated that if he could not live with friends he would go to a homeless shelter.
YK stated that he began using drugs in junior high school. He stated that marijuana is his drug of choice but that he recently quit as his New Year’s resolution. He stated that he has also taken ecstasy seven times, and used hallucinogenic mushrooms twice. He stated that he began using crack cocaine when he was fourteen years old. He said that he initially used it about one time per week, but that he progressively used it more and more until he was using it every other day. He stated that he last used crack cocaine one
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and half years ago. He stated that it was not difficult for him to quit. YK also stated that he is a member of a gang, but that he is now considered an older member and does not have to behave in the manner that he used to. He stated that younger members look up to him for advice. He stated that when he was younger he was more actively involved in gang activity. YK was very vague about his gang activity, and repeatedly brought the discussion back to his newer and more socially acceptable behavior and role in the gang.
YK stated that he has been hospitalized twice in the past. His first hospitalization was in 2001, following his father’s death. His last hospitalization was in January 2002, when he broke his mother’s nose because he thought she was the devil. He stated that he wanted to go out for New Year’s Eve but his mother did not want him to. He stated that his mother’s face looked evil to him so he hit her. He admitted that he had smoked marijuana immediately before this incident. Due to the timing of the present and last hospitalization, he stated that he believes that he has difficulty during the winter months, especially around New Year’s. YK does not appear to comply with medication recommendations, and does not follow-up with treatment between hospitalizations. Regarding his current hospitalization, YK stated that he was brought to the hospital because his mother noticed he was acting weird. He stated that he was hearing the voices of the children from the elementary school next to his house yelling gang abbreviations at him. He said that he knows that the children were not really yelling because his sister told him that they were not.
Behavioral Observations
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YK was appropriately groomed for testing. He was dressed in his own clothes and appeared overweight. He appeared his stated age. No gross motor abnormalities were observed. His speech was normal in rate, volume, and prosody, and no word finding difficulties or oddities in pronunciation were noted. His mood was euthymic, and his affect was congruent to his mood. YK was alert and oriented to person, place, time, and situation throughout the testing. His thought process was linear, and he did not appear to be responding to internal stimuli. The content of his thoughts was somewhat paranoid. He stated he felt like he was being singled out by having to take these tests. He was somewhat guarded with the examiner but responded appropriately with further explanation of the reason for assessment and prompting by the examiner. Although he acknowledged previous auditory hallucinations, he denied any current hallucinations. He denied suicidal or homicidal ideation. During the second day of testing, YK had five cigarette burns on his arm, which he stated he had purposefully done the previous day. He said that it felt good and that it relieved some of his anxiety. He said that the marks were a symbol for “Fuck all bitches and whores.”
YK appeared to attend to parts of the assessment in a very cautious and thoughtful manner; however, at other times he seemed to rush through the tests and to put forth less effort. For example, he rushed through the HTP, completing it in less than five minutes. On the SCT he left numerous items blank. He appeared very interested but hesitant about the TAT and Rorschach. He stated his curiosity about what each of these tests could possibly indicate about him. On the final card of the TAT, which is blank, he laughed and said, “Is this a joke?” He stated that he did not enjoy the MMPI-2 and stated that he was unable to complete the entire test; however, he agreed to complete the items necessary for the MMPI-2 Short form. He was resistant to taking the PAI and MCMI-III, but agreed to do so with encouragement and assurance that he would not be
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asked to complete any further tests with a similar format. Although the assessment appears to be reflective of YK’s cognitive and personality functioning in general, the results should be interpreted with caution.
Assessment Results Cognitive Functioning YK was administered the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), which is an individually administered test of a person’s cognitive ability across verbal and non-verbal modalities. On the WAIS-III, YK obtained a Full Scale IQ (FSIQ) score of 96, placing him in the Average Range of intellectual functioning. Due to the error that is inherent in any testing situation, the chances that the range of scores from 87 to 95 includes YK’s true IQ score are about 95 out of 100. His current performance indicates that he performed as well or better than 27% of all people in his age group that took the test as part of the WAIS-III standardization sample.
YK’s unique set of thinking and reasoning abilities make his overall intellectual functioning difficult to summarize by one single score on the WAIS-III. His Verbal IQ (VIQ) score was 98, which falls in the Average range of intellectual functioning (93-101, 95% confidence interval; 45th percentile). YK’s Performance IQ (PIQ) was 83, which falls in the Low Average range (77-91, 95% confidence interval; 13th percentile). The difference between YK’s VIQ and PIQ is statistically significant, meaning that if retested, YK would likely obtain a similar difference in his verbal and performance scores. YK expressed his intelligence better via verbal expression and comprehension than nonverbally, using pictures and concrete materials.
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YK’s difference in verbal versus non-verbal performance can also be seen by examining the scores he obtained on the Verbal Comprehension Index (VCI) and Perceptual Organization Index (POI), which excludes subtests that measure cognitive abilities such as working memory and processing speed, respectively. YK’s VCI was 101, which falls in the Average range (95-107, 95% confidence interval; 53rd percentile). YK’s POI was 89 (83-97, 95% confidence interval; 23rd percentile). The difference between YK’s VCI and POI was again statistically significant. Thus, whether we consider YK’s performance on “purer” measures of verbal and non-verbal abilities (i.e. VCI and POI) or not, he tends to express his intelligence better via verbal means. The difference between YK’s VIQ and PIQ (as well as VCI and POI) indicate that to obtain a clearer picture of his cognitive abilities, it is appropriate to examine the specific components of the WAIS-III, rather than relying on his FSIQ.
Verbal Comprehension and Knowledge: This area provides information about YK’s ability to learn, reason, and problem solve through the use of language and previously learned verbal information. As previously stated, YK obtained a score of 101 on the VCI, which falls in the Average Range (53rd percentile). This is an evenly developed area for YK and his VCI score is significantly higher than his scores on the other three indices (WMI, POI, and PSI) that make up the WAIS-III.
When required to give oral definitions of words, YK scored in the Average Range (Vocabulary, 63rd percentile). On the Similarities subtest, which required YK to respond orally to a series of word pairs by explaining how the words are alike, he performed in the 25th percentile. YK’s knowledge of general information is well developed, reflecting exposure to the information as well as alertness to the world around him (Information,
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75th percentile). Additionally, his performance on the Information subtest represents a relative strength for YK.
Although the Comprehension subtest is not used to formulate the VCI score, it will be discussed here as it is related to the Verbal Domain subtests previously mentioned. This subtest required YK to provide oral solutions to everyday problems and to explain the reasons for certain social conventions. On this subtest, YK scored in the average range (Comprehension, 50th percentile).
Attention and Memory: YK’s ability to focus and concentrate for immediate recall tasks that are numeric in nature falls in the Low Average Range (WMI=88, 82-95, 95th confidence interval, 21st percentile). The subtests that comprise the Working Memory Index require strong auditory attention and auditory short-term memory. There is variability in YK’s scores on the tests that comprise the WMI. Specifically, his ability to perform mathematical operations on numbers that are held in memory was a relative strength for YK (Arithmetic, 75th percentile). In contrast, repeating and reversing orally presented numbers were relative weaknesses for YK (Digit Span, 9th percentile). Similarly, when required to numerically and alphabetically sequence orally presented numbers and letters, he performed in the Low Average Range (Letter-Number Sequencing, 9th percentile).
Visual Processing and Perceptual Organization: This area provides information about YK’s ability to organize, analyze and synthesize visual information. As previously stated, YK obtained a score of 89 on the Perceptual Organizational Index (POI, 83-97, 95th confidence interval, 23rd percentile, Low Average Range). YK’s performance in this area appears to be evenly developed.
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Visual-Spatial Construction: Within this area, YK’s spatial-visualization ability in manipulating blocks to form a specified design appears to be a relative strength for him (Block Design, 63rd percentile). On this subtest, YK was required to use two-color cubes to copy geometric patterns. This task measured his ability to mentally organize visual information and analyze a whole into component parts. In addition, it measured deductive reasoning skills.
Fluid Reasoning: YK’s ability to reason, form concepts, and solve novel problems was measured on the Matrix Reasoning subtest. This subtest required YK to analyze a whole pattern and then identify solutions that either completed the pattern or adhered to a pattern that followed an unstated rule. On this subtest, YK performed in the Average Range (37th percentile).
Visual Processing: YK scored in the Low Average Range on a subtest measuring his ability to organize visual information into a meaningful sequence (Picture Arrangement, 9th percentile). This task required YK to rearrange sets of randomly ordered pictures into a logical story sequence. This is a visual sequencing task that reflects YK’s capacity to anticipate and plan in social contexts.
YK scored in the Borderline Range when required to identify the missing part in pictures of common objects and scenes (Picture Completion, 5th percentile). This subtest requires ability in visual discrimination and the ability to detect essential details and to differentiate them from nonessential details.
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YK scored in the Average Range on a task requiring perceptual organization and visualmotor coordination (Object Assembly, 25th percentile). On this subtest, YK was required to assemble puzzle pieces to form a meaningful whole.
Further information about YK’s perceptual-motor abilities can be obtained from YK’s performance on the Bender Gestalt Visual Motor Test (BGVMT). YK’s performance on the BGVMT indicated normal functioning in his perceptual-motor abilities and no signs of cognitive impairment.
Processing Speed: This area provides information about YK’s ability to perform cognitive tasks automatically, particularly when under pressure to maintain focused attention. YK obtained a score of 76 on the Processing Speed Index, which falls in the Extremely Low to Borderline Range (PSI, 70-88, 95th confidence interval, 5th percentile).
The tasks that comprise the PSI required YK to quickly scan and sequence simple visual information. On a speeded task that requires the ability to make paired associations and code abstract symbols quickly and accurately, YK performed in the 9th percentile (DigitSymbol Coding). Similarly, he performed in the 5th percentile on a task measuring visual discrimination of abstract visual stimuli (Symbol Search). On this task, YK was required to find the symbol that matched one of two target symbols in a row of many different symbols.
Emotional/Personality Functioning Validity of Measures: The Reading Subtest of the Wide Range Achievement Test was administered to ensure YK’s reading ability was sufficient to complete the MMPI-2, MCMI-III, and PAI. YK’s performance on the WRAT-3 Reading Subtest indicates that he
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reads at a High-School level. His score is consistent with his stated level of education and academic performance and is sufficient for reading the items on the MMPI-2, MCMIIII, and PAI.
Overall, YK’s test results appear to be valid; however, there is some concern about his tendency to show himself in a favorable light on the MCMI-III and the PAI (MCMI-III: Y, BR=89; PAI: PIM, T=61). His response pattern may be indicative of his need for approval or a lack of insight about psychological matters. This is consistent with his stated desire to be released from the hospital and return to his family. YK’s scores on the MCMI-III indices measuring willingness to make self-disclosures and selfdeprecating tendencies were within the normal range (X, BR=50; Z, BR=38, respectively). Additionally, he appears to have responded in a consistent manner (V=0). Similarly, YK appears to have responded consistently on the PAI (ICN, T=58). On this test, his response patterns indicate that he did not endorse many rare items that were infrequently endorsed in the standardization sample (INF, T=51). Further, YK does not seem to have tried to portray himself in a negative light (NIM, T=47). Due to his tendency to deny minor faults and present himself in a favorable light, YK’s MCMI-III and PAI need to be interpreted with caution, as they may not be a true indicator of the extent to which he actually experiences symptoms.
YK’s MMPI-2 profile suggests that he attended to the test in an appropriate and valid manner. YK’s score on the F Scale, made up of items that were endorsed by less than 10% of the MMPI-2 standardization sample, is elevated, indicating that he may experience severe pathology or may hold deviant social and political views (T=76). YK’s score on the L Scale (T=48) illustrates that he admitted to an appropriate amount of minor personal faults. YK’s score on the K Scale (T=49), which measures
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defensiveness, indicates that YK is utilizing an appropriate amount of self-disclosure and self-protection and is not being overly defensive. YK’s MMPI-2 may be a better reflection of his experiences; however, it is important to note that YK completed the MMPI-2 near the beginning of his hospitalization and that the PAI and MCMI-III were completed several weeks later. YK may have been more open to admitting to his symptoms when he first arrived at the hospital and was in a distressed state; however, as he is recompensating, he seems to be denying symptoms that may still be present. This phenomenon is common in psychiatric inpatients. Treatment effects and changes in YK’s mood may also account for differences in his performance on these three tests. Further, it cannot be inferred that he is no longer functioning in the manner reflected on his MMPI-2 profile; it can only be stated that he was no longer showing it on his MCMI-III and PAI.
YK’s responses to the Rorschach provided data that is interpretively useful. He did not reject any cards and gave a total of 21 responses. This is within the normal range of responses. His Lambda score is also within the normal range (L=0.75).
On the TAT, Rorschach, HTP, and Sentence Completion tests, YK stated his concerns about what the tests could possibly tell about him. Consistent with his concerns, he appeared to attend to these tests in a less thoughtful manner. He hurried through the HTP, completing it in less than five minutes and drawing a stick figure for the person. On the Rorschach and TAT, he provided very little spontaneous information and had to be prompted several times on the TAT to provide the required information. YK left eighteen of the sixty-four items on the Sentence Completion Test blank. The blank items appear to be deliberate rather than random as they covered general themes about personal weaknesses such as shame and guilt. Although this does not invalidate his
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other responses, it is indicative of a response style that is guarded. n general, it appears that YK approached the tests in a manner that allowed him to deny minor faults and avoid some questions dealing with personal weakness. YK’s defensiveness should be considered when examining the remainder of this assessment.
Symptoms: YK’s clinical picture has changed since he was admitted to the hospital on 01/09/2003. YK initially presented with paranoid ideation, auditory hallucinations, and aggressive outbursts. Since he has been hospitalized, these symptoms have decreased, as he presently denies any auditory hallucinations, and has not been observed to engage in any aggressive behaviors. The presence of paranoid thinking was evident on YK’s MMPI (Pa, T=72), which was given shortly after YK was admitted to the hospital. Paranoid thinking was not apparent on YK’s PAI and MCMI-III (PAR, T=51; P, BR=24; SS, BR=4). Despite this, some paranoid thinking appears to remain, as evidenced by YK feeling singled out in having to complete the assessment battery. Such paranoid ideation may also account for the large number of omitted items on his SCT.
YK also appears to experience some anxiety and compulsivity (MCMI-III: A, BR=80; 7, BR=67), which is consistent with his statement that he burned five circles in his arm with a cigarette to relieve his anxiety. In addition, his responses on the Rorschach are indicative of the presence of high levels of situation related stress, which may be exceeding or making strong demands on his capacity for control and causing anxiety (D< AdjD). Despite this, high levels of anxiety were not reflected on his MMPI-2 or his PAI (7, T=49; ANX, T=42), which were taken prior to and after the MCMI-III, respectively. This discrepancy could be due to differences inherent in the tests or could be indicative of YK’s building anxiety during the MCMI-III as it was taken the day before he was to attend his conservatorship hearing.
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Of considerable concern is YK’s propensity for self-harm. As previously stated, he intentionally burned a cigarette in his forearm five times. On the PAI, he also indicated that, “When I am upset, I typically do something to hurt myself,” as “Slightly True” for him. It is important to note that on the SCT, YK wrote, “I think suicide (mercy killing) should be legal.” Despite this, YK denied any suicidal ideation during the assessment procedures and on direct assessment questions.
Additionally, YK endorsed several items that are indicative of d rug use and addiction, indicating that he may exhibit dangerous behaviors with substance use (MCMI-III: T, BR= 75; PAI: DRG, T=70). This is consistent with his self-reported substance use history. Although YK states that he stopped using substances on New Year’s Day, he was admitted to the hospital only nine days later; thus, no extended and continuous period of sobriety during which YK could readily have access to drugs has been achieved. YK also had elevated scores on scales measuring problematic, illegal, or socially unacceptable behavior (MMPI-2: Pd, T=69; MCMI-III: 6A, BR=67; PAI: ANT, T=59). Again, this is consistent with YK’s gang involvement, early substance use, and adolescent behavioral problems. It is unclear if YK remains actively involved in gang activities or if he is minimizing his involvement.
Interpersonal Functioning: YK likely experiences a limited capacity to form close relationships (MMPI-2, 6-4 code type; Rorschach, T=0). Although he may be interested in being around other people, he may also feel threatened and discomforted in social situations (MMPI-2, Si, T=51; Rorschach, H+(H)+Hd+(Hd)=6, Pure H=2). His projective drawings on the HTP may support this finding, indicating that he might have difficulty relating to other people (stick figure drawing). This is perhaps worsened by his tendency to misperceive interpersonal interactions (Rorschach, X-%=.24, FQx-=5). Because of his
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discomfort, he may not engage in interpersonal relationships with others (Rorschach, COP=0, AG=0). Further, others may view him as being distant. He endorsed items such as “When I have a choice, I prefer to do things alone,” and “I take great care to keep my life a private matter so no one can take advantage of me,” (MCMI-III Noteworthy Responses).
Despite his tendency to keep people at a distance, YK may be dependent on others and easily hurt when others fail to meet his expectations, which may perpetuate the cycle of YK feeling threatened in interpersonal situations and his subsequent avoidance (Rorschach, Food=1). This interpersonal style can also be seen on the SCT, which indicates that he appears to value and be dependent on his family but feels that they treat him like a child. For example, YK wrote the following response (in italics) “When I am away from my family, I feel empty inside.” He also wrote, “My family treats me like a child and not as an adult!” YK’s gang involvement may function to meet his need to be around others but provide structure to the amount of closeness and involvement he is expected to have in his interactions with other gang members.
Affect/Emotional Control: YK may have great difficulty moderating his aff ect, which leads to his avoidance of highly affect-laden processing (Rorschach, Afr=.50; MMPI-2, 64 code type). Given this, his omission of items dealing with weaknesses on the SCT may be an attempt to avoid uncomfortable emotions or thoughts about which he may be highly ruminative. Such avoidance can also be seen in his Thematic Apperception Test (TAT) responses. YK told stories involving conflicts that were magically solved without much depth of processing. For example, YK told a story about a man and a woman fighting over bills (Card 10). The conflict is resolved when the people in the picture “both start kissing.” Further, in response to pictures that he stated were particularly disturbing
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to him, such as a picture of man standing over a woman with her eyes closed and her arm hanging off the side of the bed and a picture of an operating room scene, YK provided very quick and short responses.
YK may not exert effective control over his emotions (FC:CF+C= 0:2). He may be emotionally immature and exhibit violent outbursts (MMPI-2, 6-4 code type, PAI, AGG-P, T=59). In response to PAI items, such as “Sometimes my temper explodes and I completely lose control,” and “Sometimes I’m very violent,” YK endorsed “Slightly True.” His impaired control of his emotions may also lead to his discomfort and avoidance of complex affective situations and his preference to keep feelings at a peripheral level (Rorschach, Blends/R=0:21, EB is Introversive, Lambda =.75, EBPer=2.5).
Major Needs: YK is likely experiencing very little internal pain at present (Rorschach, D=0, Adj D=1). This does not mean that YK is functioning in a well-balanced and effective manner. Rather, his low level of distress may be due to his ability to restrict his life to try to minimize stress (Rorschach, EA=7). His avoidance of highly affective situations may further his ability to restrict and cope with his environment and to keep disturbing thoughts out of his conscious awareness. In fact, his ability to maintain seeming stability may be quickly diminished when faced with even minor stressors. This is problematic for him given his ruminative style (EB is Introversive, EBPer=2.5). He may experience resentment about events and people in his life, which are likely to be the focus of his rumination (MMPI-2, 6-4 code type; PAI, PAR-R, T=58).
Perceptions of the Environment: YK likely has a negative and uncomfortable view of the world. He appears to view the world as threatening and unsafe. He likely doubts the motivations of others and sees people as generally untrustworthy. He may resent even
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normal demands placed on him by people in his environment (MMPI-2, Pa, T=72, 6-4 code type). As a result, YK may interact with others and operate in the world in a guarded and cautious manner (Rorschach, Dd=6, W:M=3:5). Further, he likely disregards social conventions and as a result may act defiantly or have a skewed view of what constitutes appropriate behavior (Rorschach, P=3, X-%=.24; MMPI-2, 6-4 code type). He may have very high expectations of the people in his life, and may naively expect others to meet his needs (MMPI-2, 604 code type; Rorschach, Food=1). He may also have impaired social perception and a tendency to erroneously perceive people and events (Rorschach, FQx-=5, X-%=.24).
Reactions to Stress: YK likely reacts to stress with impaired cognition and judgment (Rorschach, D=0, M-=2). As previously stated, he may normally limit his environment to avoid stress, but even minor affronts can cause significant and severe stress reactions (Rorschach, EA=7). For YK, stress can lead to a decompensation of his determined effort to maintain stability, and keep disturbing thoughts and feelings at an unconscious or distant level. On the SCT, YK completed an item as, “When the odds are against me I tend to avoid it.” When his stress increases, he may experience decreased frustration tolerance and impulse control. As a result, he may experience violent outbursts (MMPI2, 6-4 code type). In addition, YK may turn to substances to moderate the amount of stress he feels in the short term. He also appears to utilize self-harm as a form of anxiety relief.
Self-Concept: YK, like others with 6-4 code types on the MMPI-2, may be narcissistic and self-indulgent. He obtained an above-average score on the Egocentricity Index on his Rorschach (3r+(2)/R=.57). This means that he tends to be self-centered and focused more on himself than on others. He may seek attention and make excessive demands
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on relationships with others (MMPI-2, 6-4 code type). Unfortunately for YK, his excessive self-focus may breed disappointment as he likely has a pessimistic view of himself (Rorschach, MOR=2). Despite his self-focus, he does not seem to have strong selfawareness (Rorschach, FD=0, V=0; PAI, BOR-I, T=62). This limits his ability to understand and subsequently modify his behavior. He may also experience identity diffusion due to his tendency to relate to others in a partial or imaginary manner (H:(H)=Hd+(Hd)=2:4).
Psychological Resources: YK likely has very limited psychological resources. He may have a small number of coping skills on which he relies (D=0). One such tactic is his attempt to narrow the scope of his environment to eliminate stress (EA=7). While this may work for him at times, he does not appear to experience effective control over his emotions at other times (6-4 code type). Another resource that YK may rely on is his tendency to keep people at a distance (T=0). Further, his ability to detach himself from his distress and disordered behavior, either unconsciously or consciously, may be an attempt at self-preservation. Conversely, this same detachment may be what prevents him from learning from his past and keeps him from seeking treatment and complying with medication.
Summary YK is a twenty-three-year-old Korean-American male who was admitted to a local hospital on 1/9/2003. He was determined to be a danger to self and others, as he was acting aggressively and impulsively in his home and was experiencing auditory hallucinations and paranoid thinking. He is diagnosed with Schizoaffective Disorder.
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Regarding his cognitive abilities, YK appears to be generally functioning in the Average Range of intelligence. However, he appears to function better using verbal modalities. Within the Verbal domain, verbal expression is a stronger ability for YK than is memory and attention. Within the Performance domain, YK appears to be more evenly matched in his visual motor processing speed and his non-verbal reasoning ability.
Assessment findings suggest that YK continues to have paranoid thoughts and is experiencing anxiety periodically. His ability to control his stress may appear strong at times but may be superficial and easily overwhelmed by situational stress. He may have used drugs as an ineffective method for dealing with such stress. In addition, his gang involvement may be a superficial way of meeting his social needs without interfering with his need to keep people, even loved ones, at a distance.
Diagnostic Impressions Based on YK’s psychosocial history, behavioral observations, and assessment data, the following diagnosis should be considered: Axis I: R/O R/O R/O Axis II: R/O R/O Axis III: Axis IV: Axis V:
295.70 Schizoaffective Disorder (per chart) 305.20 Cannabis Abuse 295.30 Schizophrenia, Paranoid Type, Episodic With No Interepisode Residual Symptoms 292.12 Cannabis Induced Psychotic Disorder, With Hallucinations 304.80 Polysubstance Dependence 301.22 Schizotypal Personality Disorder (Premorbid) 301.7 Antisocial Personality Disorder None Death of father (at onset of psychiatric problems) Inadequate finances GAF= 60 (current) GAF= 20 (on admission)
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Implications for Treatment and Recommendations YK has a history of failing to comply with treatment recommendations and psychotropic medication. Although he is taking his medication and attending substance abuse and recreational therapy groups in the hospital, it is unlikely that he would continue to do so on his own once released. YK’s assessment results provide further evidence that he is unmotivated to seek and/or follow up with treatment (PAI, RXR, T=59). He appears resistant to change and is likely to become less resistant only if his disturbances were to come into his conscious awareness (Rorschach, D
Because of his history of noncompliance with treatment and medication, paired with the problems and unsafe environment he creates in his home, YK has been placed on conservatorship under Court order. This means that an unbiased third party is making decisions about his mental health treatment. YK remains hospitalized awaiting placement at a therapeutic residential facility. He has done well with the structure imposed on him in the hospital, and it is hoped that his progress would continue in another less-restrictive environment. YK would benefit from slowly reentering the “real” world with strong social and emotional supports. He should continue to receive substance abuse group therapy. He would benefit from further education about the effects that his substance use has on his life, as he appears to be holding on to the
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belief that he will be able to continue using psychoactive substances on a recreational level. Education about Schizoaffective Disorder should also be presented to him. He would also benefit from cognitive-behavioral therapy. Although the therapeutic relationship would likely be fraught with difficulty at times, this method of treatment would provide the structure that may help YK to feel safe in therapy. Other insight-oriented or interpersonally demanding types of therapy may prove too affect-laden for YK; thus causing his rejection of treatment. Within the cognitive-behavioral framework, YK should receive multiple skill building components, perhaps focusing on anger management, social skills, and problem-solving skills. Finally, family therapy may be beneficial for YK and his family to improve relationships and enhance his support.
Recommendations: 1. YK should continue to comply with his psychotropic medication regimen. 2. YK should be transferred to a less-restrictive environment that will slowly reintegrate him back into society. 3. YK should attend substance abuse groups to continue his education about the effects of his substance use. 4. YK should receive cognitive-behavioral treatment with components focusing on anger management, social skills, and problem-solving skills.
____________________________ Examiner
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