20 Sep PSY640 Week Six Clinical Neuropsychological Report for Mr. W
I attached the assignment as well as the case studies .
choose the ONE of the THREE forensic cases
PSY640 Week Six Clinical Neuropsychological Report for Mr. W
CLINICAL NEUROPSYCHOLOGY REPORT Patient's Name: Mr. W Date of Evaluation: 10/10/2014 Date of Birth: 10/02/24 Age: 90 Handedness: Right Education: 6 years Occupation: City worker (retired) Current Medications: Donepezil 5 mg/day, Simvastatin 40 mg/day, Levothyroxin 1.25 mg/day, Losartan 50 mg/day, Warfarin 3 mg/day, Advair Inhaler, Ventolin Inhaler, Alendroate Sodium 35 mg/week, Vitamins B12 and D3 Evaluation Completed by: Dr. K., Ph.D. Evaluation Time: One hour diagnostic interview (90791); One hour test administration, scoring, interpretation and report (96118 x 3) REASON FOR REFERRAL: Attorney Mr. X referred Mr. W for an evaluation of his decision-making capacity. HISTORY OF CURRENT SYMPTOMS: The symptom description and history were obtained from an interview with Mr. W, his sister, and his cousin. Mr. W stated he was seen by a physician in Michigan last year at his son’s urging and was diagnosed with “dementia.” Subsequently, according to the patient, his son reportedly took control of his finances, has withdrawn approximately $28,000 from the patient’s account, and has sold the patient’s coin collection. Mr. W does not feel the diagnosis of dementia is correct and would like to resume control over his financial matters. Reportedly, the incident that initiated the diagnosis of dementia occurred in 2011 when Mr. W was living with his son Anthony. He stated he saw the silhouette of a person walking in another room in the house and believed it was the “Boogie Man.” Several days later, he had what appeared to be a syncopal episode (“I blacked out”) and fell while walking out to the garage. He stated he felt someone “pounding my head and pulling me down the stairs,” and he believed this was also the “Boogie Man”. He was reportedly taken to the ER and released; however, after this incident the patient stated his sons became concerned with his thinking, and this eventually led to an evaluation with a physician and a diagnosis of dementia. Mr. W denied any other instances or auditory or visual hallucinations beyond those described above. He was living in A State (initially with his family and then on his own), but in 20XX, moved to Another State to live with his sister and brother-in-law. According to his sister and his cousin, the patient has not demonstrated any problems with memory or other areas of thinking. He stopped driving two years ago at the insistence of his son, but he remains independent in other activities of daily living, including managing his own medications, self-care, and occasional household chores. He also enjoys playing cards and playing electronic poker, and there has been no reported decline in his ability in these areas. Summary of Previous Investigations and Findings: No previous neuropsychological evaluations. PAST MEDICAL, NEUROLOGICAL, PSYCHIATRIC, SUBSTANCE USE HISTORY: (Inclusive review of symptoms and disorders; only positive features listed) Hypertension, hypercholesterolemia, hypothyroidism, COPD, asthma, myocardial infarction in the past (exact date unknown), and osteoporosis. The patient denied any neurological or psychiatric history beyond that described above. He does not drink alcohol and quit smoking in 1940. He has no history of recreational drug use. BIRTH, DEVELOPMENTAL, OCCUPATIONAL HISTORY: (Review of perinatal factors, early childhood development and milestones, academic history and achievement, employment) No reported delays in reaching developmental milestones. The patient stated he completed 6 years of formal education and worked for the city in the sewer division for many years. FAMILY HISTORY: (First degree relatives; only pertinent features reported) The patient’s mother reportedly died of a stroke at age 57, and the patient’s father died in an accident when the patient was 14. The patient has one full brother, age 81, who is reportedly in good health, and one half-brother with whom
he does not have regular contact. The patient has five children (three sons and two daughters), but he and his wife did not live together consistently at the time the children were born, so he stated he is not sure he is the biological father of his three oldest children. He reported he currently has no ongoing contact with any of his children. PSYCHOSOCIAL HISTORY AND CURRENT ADAPTATION: (Current living situation, social relationships, activities of daily living) The patient lived in A State most of his life, but moved to Another State to be closer to his children about a year ago. He was living with his son and then Another Son until 20XX when he moved into an independent apartment. He lived alone for one year before he moved to Another State to live with his sister and brother-in-law due to his ongoing conflicts with his son regarding financial issues. CURRENT EXAMINATION: Review of records; Clinical Interview; Cognitive Assessment: Wechsler Test of Adult Reading (WTAR); Wechsler Adult Intelligence Scale-IV (WAIS-IV) (partial); Attention Tests: WAIS-IV Digit Span, Trail Making Tests, RBANS Coding, RBANS Semantic Fluency; Language Tests: RBANS Naming Test; Visuospatial Tests: RBANS Figure Copy and Line Orientation, Target cancellation; Learning/Memory Tests: RBANS Word List, Story and Figure recall; Reasoning/Abstraction: WAIS-IV Similarities BEHAVIORAL OBSERVATIONS: The patient arrived on time for his appointment and was accompanied by his sister and his cousin. He was casually dressed and neatly groomed, and his social interpersonal skills were preserved. He was very pleasant and put forth good effort throughout the evaluation. Thought processes were logical and goal directed, and there was no indication of hallucinations, delusions, or other psychoses. No overt behavioral indications of a mood disturbance were observed, and a full range of affect was demonstrated. The results of this evaluation are considered reliable and valid for interpretation. SUMMARY OF FINDINGS: Based on his educational history (6th grade) and performance on the WTAR (est. FSIQ = 68) the patient’s estimated level of premorbid functioning would be within the low-average to borderline range overall. The remainder of the examination was interpreted with the expectation of performance at this level. The patient was fully oriented with the exception of the city, which he did not know. He was able to give detailed information (e.g., specific dates) of his autobiographical history, and his performance on formal memory testing did not indicate any type of retentive memory disturbance. Although he had slight difficulty encoding new information, there was no loss of information over time. The patient’s speech was fluent with normal articulation, and rate and comprehension of auditory information was intact. No significant impairments were noted in naming, reading, or writing. Visuospatial abilities were an area of relative weakness, but there was no indication of hemispatial neglect or inattention, and object recognition was preserved. It is likely his poor performance on the RBANS Figure Copy and Line Orientation was due to difficulties in higher level visuospatial processing and executive functions. Abstract verbal reasoning was within normal parameters. Immediate attention span was intact, and he performed within normal limits on most tests of sustained attention. His score on the RBANS coding subtest, which also has a visuospatial and motor component, was the only area that was below expectation. TESTING SUMMARY:
PREMORBID FUNCTIONING WTAR 10/50 SS = 68 Borderline/Low
DEMENTIA SCREENING MMSE 25/30 — Within Normal Limits
WAIS-IV Digit Span 5 F, 5 B ss = 9 Average RBANS Coding 20/89 ss = 4 Borderline/Low Trail Making Test Part A 49” T = 53 Average Trail Making Test Part B 115” T = 62 High Average
LANGUAGE RBANS Naming 10/10 >75th% High Average RBANS Semantic Fluency 16 words/min ss = 9 Average
VISUOSPATIAL RBANS Figure Copy 10/20 ss = 2 Extremely Low RBANS Line Orientation 4/20 <2nd% Extremely Low
MEMORY RBANS Word List
Learning Trials 17/40 ss = 6 Low Average Delayed Recall 0/10 3-9th% Borderline Recognition 19/20 26-50th Average
RBANS Story Learning Trials 8/24 ss = 4 Borderline/Low Delayed Recall 6/12 ss = 8 Average
RBANS Figure Recall 6/20 ss = 6 Low Average EXECUTIVE FUNCTIONS
WAIS-IV Similarities — ss = 5 Borderline REPEATABLE BATTERY FOR THE ASSESSMENT OF NEUROPSYCHOLOGICAL STATUS*:
Index Scores Mean = 100; std = 15 Current Level Immediate Memory SS = 78 Borderline Visuospatial/Constructions SS = 53 Extremely Low Language SS = 99 Average Attention SS = 68 Borderline/Low Delayed Memory SS = 90 Average
*80-89 year-old norms used because 90 year-old-norms are not available SUMMARY AND IMPRESSION: 1. Neurocognitive Profile: The profile on testing is one of mild weaknesses in some aspects of complex attention/working memory and executive functions within the context of an overall low average to borderline level of general intellectual functioning. Although his primary visuospatial abilities are intact, he demonstrated a weakness on more complex visuospatial processing, most likely due to the executive aspects of these tasks. He had some difficulty initially encoding lengthy (e.g., story) information, but delayed recall and recognition were generally intact, and there is no indication of a primary retentive memory disturbance. The patient did not endorse any symptoms consistent with a mood disturbance and there was no indication of hallucinations, delusions, or other psychoses observed during the interview and examination. 2. Diagnostic Formulation: The profile on testing is consistent with a mild dysfunction in frontal networks. In this case, the differential diagnosis is extensive and includes potential cerebrovascular disease (given his risk factors and history of at least one syncopal episode) and toxic/metabolic abnormalities (e.g., thyroid abnormalities). The etiology of his syncopal episode and confusion is impossible to determine in the absence of medical records from that time, but his hallucinations during that time are consistent with his religious and spiritual beliefs. In addition, there have been no further instances or evidence of hallucinations or other psychoses to suggest this is an ongoing/active problem. Although the possibility can never be fully excluded in this age group, the absence of retentive memory impairment argues
strongly against the likelihood that Alzheimer’s disease is the primary, or a significant cause of, his current cognitive symptoms.
1. Mr. W’s cognitive weaknesses are not sufficient to render him incapable of making his own decisions regarding his finances and/or health care, and therefore, guardianship is not appropriate.
2. Mr. W should continue to refrain from operating a motor vehicle or engaging in any potentially
dangerous activities (such as the use of heat generating appliances or power tools) due to his visuospatial and attentional weaknesses.
3. Mr. W was encouraged to follow-up with his primary care physician to a) ensure that all treatable
causes of cognitive impairment are well-controlled (e.g., thyroid, blood pressure, diabetes, etc.), and b) review and update his medications. He may also want to discuss with his doctor whether a neurological work-up (including some form of brain imaging) would be helpful to further clarify the etiology of his current cognitive symptoms
4. A follow-up evaluation can be conducted in the future if there is evidence of symptom change or
__________________________, Ph.D., ABPP-CN Board Certified Neuropsychologist Licensed Clinical Psychologist cc: Mr. X, Attorney at Law
Dr. Diaz Mr. W
This is a graded discussion: 6 points possible due Sep 22 at 1:59am
Week 6 – Discussion 4 4
Your initial discussion thread is due on Day 3 (Thursday) and you have until Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your initial post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Settings icon above for guidance on how your discussion will be evaluated.
Forensic Assessment Cases
Prior to beginning work on this discussion, read Chapter 12 in the textbook and the required articles for this week. For this discussion you will take on the role of a psychologist assigned a case in which the client has a legal concern. For your initial post, select one of the three forensic case scenarios below and follow the instructions.
Forensic Scenario One: Mr. W (Attempting to Obtain Legal Guardianship Over an Elderly Parent): Attorney Mr. X referred Mr. W for an evaluation of his decision-making capacity. Mr. W’s children do not agree with the findings from a prior evaluation and have requested a second opinion. Review the PSY640 Week Six Clinical Neuropsychological Report for Mr. W (https://content.bridgepointeducation.com/curriculum/file/743be14e-18b8- 4609-9ff2- 38f7934a0152/1/PSY640%20Week%20Six%20Clinical%20Neuropsychological%20Report%20for %20Mr.%20W.pdf) , and begin your post with a one-paragraph summary of the test data you deem most significant. Utilize assigned readings and any additional scholarly and/or peer- reviewed sources needed to develop a list of assessment instruments and evaluation procedures to administer to the client in addition to those used in the current evaluation. Justify your assessment choices by providing an evaluation of the ethical and professional practice standards and an analysis of the reliability and validity of the instruments. Note: It is common for there to be a delay between the time a test publisher updates a test and the time the textbook and other authors can update their information about the new version of the test. Be sure to do online research to make sure you are recommending the most
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the test. Be sure to do online research to make sure you are recommending the most current version of the test. If there is a newer version than the version discussed in the textbook or other readings, present information about the newest version.
Forensic Scenario Two, Mr. M (Not Guilty Plea): Your client, Mr. M., was referred by the court for an evaluation of his mental condition after his attorney entered a plea of not guilty on his behalf. Review the Case Description: Mr. M—Forensic, Pre-trial Criminal Score Report (https://www.pearsonclinical.co.uk/content/dam/school/global/clinical/uk- clinical/files/mmpi2-rf-forensic-pretrial-criminal-score.pdf) , and begin your post with a one- paragraph summary of the test data you deem most significant. Based on the information provided, determine if retesting with the MMPI-3 is recommended at this time and explain your rationale. Utilize assigned readings and any additional scholarly and/or peer- reviewed sources needed to develop a list of assessment instruments and evaluation procedures in addition to the MMPI-2-RF and/or the MMPI-3 to administer to the client. Justify your assessment choices by providing an evaluation of the ethical and professional practice standards and an analysis of the reliability and validity of the instruments. Note: It is common for there to be a delay between the time a test publisher updates a test and the time the textbook and other authors can update their information about the new version of the test. Be sure to do online research to make sure you are recommending the most current version of the test. If there is a newer version than the version discussed in the textbook or other readings, present information about the newest version.
Forensic Scenario Three, Ms. X (Personal Injury Lawsuit): Ms. X was referred for a forensic neuropsychological evaluation in connection with a personal injury lawsuit she had filed. Review the Case Description: Ms. X—Forensic, Neuropsychological Score Report, (https://www.pearsonclinical.co.uk/content/dam/school/global/clinical/uk- clinical/files/mmpi2-rf-forensic-neuropsych-score.pdf) and begin your post with a one- paragraph summary of the test data you deem most significant. Based on the information provided, determine if retesting with the MMPI-3 is recommended at this time and explain your rationale. Utilize assigned readings and any additional scholarly and/or peer- reviewed sources needed to develop a list of assessment instruments and evaluation procedures in addition to the MMPI-2-RF and/or the MMPI-3 to administer to the client. Justify your assessment choices by providing an evaluation of the ethical and professional practice standards and an analysis of the reliability and validity of the instruments. Note: It is common for there to be a delay between the time a test publisher updates a test and the time the textbook and other authors can update their information about the new version of the test. Be sure to do online research to make sure you are recommending the most
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Search entries or author
current version of the test. If there is a newer version than the version discussed in the textbook or other readings, present information about the newest version. Guided Response: Review several of your colleagues’ posts, and respond to at least two of your peers by 11:59 p.m. on Day 7 of the week. You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion. Indicate the extent to which you agree or disagree with your colleague’s choice of information to include in the summary of test results. Suggest any additional significant test results that you would have included in the summary. Identify additional assessment measures you would recommend for the client. Assess the personality instrument(s) suggested by your colleague. Would these measures provide reliable, valid, and culturally appropriate results for the given scenario? Use scholarly and peer-reviewed sources published within the last fifteen years to support your assertions. Continue to monitor the discussion forum until 5:00 p.m. Mountain Standard Time (MST) on Day 7 of the week, and respond to anyone who replies to your initial post.
(https://uagc.instructure.com/courses/121360/users/266156)Adam Henning (https://uagc.instructure.com/courses/121360/users/266156) Wednesday
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Hello Classmates and Dr. K,
Forensic Scenario Three, Ms. X (Personal Injury Lawsuit): Ms. X was referred for a forensic neuropsychological evaluation in connection with a personal injury lawsuit she had filed.
Ms. X suffered injuries in an automobile accident. She remembered hitting her head
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Ms. X suffered injuries in an automobile accident. She remembered hitting her head on a window, but she wasn't sure if she fell unconscious. She was taken to a nearby hospital, where she spent a few days being treated. Following a diagnosis of a serious neck sprain, a seatbelt-related contusion, a bladder infection, ruptured ligaments in her left leg, and nerve damage in her left foot, Ms. X was released from the hospital. After being released, following a string of complaints, Ms. X was determined to be unable to meet her own basic requirements and qualified to receive round-the-clock support with everyday tasks. The Glasgow Coma Scale (GCS) result for Ms. X was 15/15. According to these documents, she presented with a number of hazily connected symptoms and concerns that were looked at during her hospital stay. The maximum (GCS) score that may be achieved is 15, while the lowest is 3. A score of 15 indicates that you are totally alert, receptive, and free of any cognitive or memory issues (Jain & Iverson, 2023). No anomalies were found in the medical imaging investigations. Following her accident, tests as part of the neuropsychological test battery were given, and the outcomes showed that Ms. X made a satisfactory attempt.
In spite of this, it is highly recommended for a litany of reasons that Ms. X be retested with not only the MMPI-3 but with the Posttraumatic Stress Disorder Checklist (PCL) as well. From an "independent variable impact on a dependent variable perspective", Ms. X's injuries she sustained from her accident 10 years ago could potentially become worse due to the new accident. This factor alone creates the potential for implementing other assessments outside of what was mentioned earlier. In order to assess and diagnose mental health complications including depression, schizophrenia, and anxiety, professionals in the field of mental health mostly employ the MMPI (Whitman & Sellbom, 2023). This leads me to my next point which is"how has this impacted her mental and emotional health?"
As stated by Beck and Coffey (2007), those who are involved in catastrophic auto accidents are more likely to develop psychiatric issues, notably Posttraumatic Stress Disorder (PTSD). In order to assess the symptoms of PTSD, numerous individuals utilize the Posttraumatic Stress Disorder Checklist (PCL) (Blevins et al., 2015). Furthermore, traumatic events like this affect many people differently. Sometimes trauma can have a delayed effect. According to the Trauma-informed Care in Behavioral Health Services. (2014). (Ser. 57), "Delayed responses to trauma can include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or
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activities that are associated with the trauma, even remotely"(para.6). See below Exhibit 1.3-1 for the illustration of this.
In conclusion, Ms. X's speech issues were her primary grievance during the examination. Her complaints focused on how difficult it was for her to talk and how her speech was slurred as well as dysfluent. This could result from an automobile accident causing "Dysarthria". Although it may sound complicated, vehicle accident victims frequently experience it (Mitchell et al., 2017). A person with dysarthria, to explain it plainly, has trouble pronouncing their words (Pennington et al., 2016).
Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations. Professional Psychology: Research and Practice, 38(6), 629–639. https://doi.org/10.1037/0735-7028.38.6.629
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for dsm-5 (PCL-5): Development and initial Psychometric Evaluation. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059
Jain, S., & Iverson, L. M. (2023, June 12). Glasgow coma scale – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513298/
Mitchell, C., Bowen, A., Tyson, S., Butterfint, Z., & Conroy, P. (2017).
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Mitchell, C., Bowen, A., Tyson, S., Butterfint, Z., & Conroy, P. (2017). Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Cochrane Database of Systematic Reviews, 2017(1). https://doi.org/10.1002/14651858.cd002088.pub3
Pennington, L., Parker, N. K., Kelly, H., & Miller, N. (2016). Speech therapy for children with Dysarthria acquired before three years of age. Cochrane Database of Systematic Reviews, 2016(7). https://doi.org/10.1002/14651858.cd006937.pub3
Trauma-informed care in Behavioral Health Services. (2014). (Ser. 57). U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
Whitman, M. R., & Sellbom, M. (2023). Construct Validation of minnesota multiphasic personality Inventory-3 (MMPI-3) scales relevant to the assessment of Bipolar Spectrum Disorders. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23568
(https://uagc.instructure.com/courses/121360/users/329250)Rachael Herman (she/her/hers) (https://uagc.instructure.com/courses/121360/users/329250) Friday
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For this weeks discussion I choose the second forensic scenario with Mr. M who entered a non guilty plea based off of reasons of insanity.
Mr. M is a 21 year old male who's attorney has put in their plea of insanity for them. On the MMPI assessment that was taken there are 7 scales that have shown to have critical scores. The scales are as followed: suicidal/death ideation, helplessness/hopelessness, anxiety, ideas of persecution, aberrant experiences, substance abuse, and aggression. These scales indicate the immediate recommendation for intervention. Additionally there were a few items that were unable to be properly scored due to test taker inability.
A plea of insanity defense is based off of mental state at the time of the offense, as well as mental capacity in the current to stand trial. All jurors should be instructed during trail that the individual is competent and if otherwise is believed should be proven within the court. The battery of tests should include the Rogers Responsibility assessment scales (R-CRAS) that consists of 5 scales to measure the offenders reliability, organicity, psychopathology, cognitive control, and behavioral control. (Gregory, R. J. (2014) 12.5). This would be to evaluate criminal responsibility. As well as MacArthur Competence assessment tool (MacCAT-CA) that is designed to measure competency to stand trial. This is done by measuring for three items, understanding, reasoning, and appreciation (Gregory, R. J. (2014) 12.5). In addition to these assessments it is not recommended that they retake the MMPI assessment as the results are not relevant to the current plea. The mentality at the time of offense is the time this would be implemented. Further results could cause bias within perceptions. Which in itself brings up ethical concerns.
Thank you for your time,
Gregory, R. J. (2014). Psychological testing: History, principles, and applications (https://uagc.instructure.com/courses/121360/external_tools/retrieve? display=borderless&url=https%3A%2F%2Fcontent.uagc.edu%2Flti%3Fbookcode%3DGreg ory.8055.17.1) (7th ed.). Boston, MA: Pearson.
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(https://uagc.instructure.com/courses/121360/users/42460)Samantha Sullivan (https://uagc.instructure.com/courses/121360/users/42460) Friday
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Forensic Scenario Two, Mr. M (Not Guilty Plea): Your client, Mr. M., was referred by the court for an evaluation of his mental condition after his attorney entered a plea of not guilty on his behalf.
Mr. M is 21 years old and was evaluated after a plea deal, he took stating that he was not guilty for the reason of insanity after an accident that happened in
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