You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion. Was your colleagueâ€™s proposed assessment battery appropriate for the case they were referred? Evaluate the instrument(s) suggested by your colleague. Would these measures provide reliable, valid, and culturally appropriate results for the given scenario? Use your research to support your assertions. What other measure(s) would you suggest your colleague use in this situation?
The Selected Case Study
The case study I choose was 19.4â€™s â€œA Few Kinksâ€ (Barnhill, 2014).
Background & Initial Diagnosis
In case study 19.4, Wallace Pickering is a patient who self-diagnosed himself with six paraphilias among other disorders including personality disorders and a substance use disorder (Barnhill, 2014). Wallace feels this way because he identifies as homosexual, has some sexual fetishes, uses drugs, and has some obsessive tendencies.
Barnhill (2014) defines paraphilias â€œas intense and persistent sexual interests outside of foreplay and genital stimulation with phenotypically normal, consenting adultsâ€ (para. 1). Per the DSM-5, there are eight identified dysfunctions that are considered paraphilia disorders: voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, fetishistic, and transvestic disorders (Barnhill, 2014). Some of these are taboo yet harmless (i.e: foot fetish). However, there are ones that are illegal, harmful, and victimizing (i.e: pedophilia, voyeurism). The DSM-5 suggests that individuals may have one or more paraphilias, but that does not mean they have the disorder. For Wallace to have a paraphilia disorder, his paraphilias would have to be problematic (Barnhill, 2014).
A diagnosis of a paraphilia disorder can be complex as the topic of what is considered normal in sexuality and sexual desires have changed over the years. For example, homosexuality used to be considered a paraphilia but was removed, therefore, Wallace being homosexual does not constitute for a paraphilia disorder (Barnhill, 2014). To be diagnosed with paraphilia, the DSM suggests that the individualâ€™s dysfunctional sexual behavior victimizes someone or that individual consistently has a non-normative sexual dysfunction (Barnhill, 2014). Because the psychiatrist saw that Wallaceâ€™s sexual experiences did not cause harm to himself, cause harm to others, or cause distress, the psychiatrist did not diagnosis him with the disorder.
Wallace also believed he may be obsessive-compulsive or narcissistic on top of the paraphilias. However, the psychiatrist believed his explanations for these behaviors could not lead to a personality disorder diagnosis (Barnhill, 2014).
The psychiatrist diagnosed Wallace solely with mild tobacco use. This was based on the clinical judgment of the psychiatrist.
Furthermore, the psychiatrist feels Wallace could use psychotherapy as he has indicated potential shame of his homosexuality and possible depression (Barnhill, 2014).
The Second Opinion & Assessment Plan
- Clinical Interview & Observations of the Client
- I would like to expand upon the original psychiatristâ€™s interview and observations as it seemed a depressive disorder may have been revealed.
- Mental Status Exam
- It is important to assess Wallaceâ€™s mental status through examination of his attention, orientation, memory, language, calculations, sequencing tasks, mood, and delusions (Blumenfeld, 2012).
- Intellectual Assessment
- I will need to measure Wallaceâ€™s intellect to validate the first psychiatristâ€™s assessment that he was cognitively adept.
- Assessment Instrument #1: The Behavioral and Psychological Assessment of Dementia (BPAD)
- This test will be used to examine possible sexual dysfunctions as it examines inappropriate behaviors and sexual disinhibition (while testing for dementia in adults) (Gregory, 2014).
- Assessment Instrument #2: Frontal Systems Behavior Scale (FrSBe)
- Wallace was eager to self-diagnosis himself after reading the DSM-5, however, using the FrSBe, I will be able to have a family member or friend assess Wallace which could be more reliable and valid as suggested by Gregory (2014).
In my chosen case study, the psychiatrist relied only on clinical judgement from an interview to diagnose Wallace. Because I am using a standard assessment plan and using two different assessment instruments, I should be able to conclude a valid diagnosis for Wallace. The pros of the BPAD is the many domains the assessment covers which includes:
- Psychopathological Symptom Cluster
- Perceptual Delusions
- Positive Mood/Anxiety
- Negative Mood/Anxiety
- Behavioral Symptom Cluster
- Biological Symptom Cluster
- Biological Rhythms (Gregory, 2014).
A con about this assessment is the focus on finding symptoms of dementia (which does not necessarily need to be ruled out in Wallaceâ€™s case).
A pro about the FrSBe is the ability to use family members or friends to assess the patient. Wallace could be exaggerating on his behaviors so having a third party describe Wallaceâ€™s behaviors can give a lot more insight. A con about this assessment is Wallace may not have anyone close to him that could take this test. A coworker may be more promising since he stated he works a lot.
Barnhill, J. W. (Ed.). (2014). DSM-5 Clinical Cases. Washington, D.C.: American Psychiatric Association.
Blumenfeld, H. (2012). Neuroanatomy through Clinical Cases (Links to an external site.)Links to an external site.[Video files]. Retrieved from http://neuroexam.com/neuroexam/content.php?p=3
Case # 16.3 Addiction â€“ Case Studies in Assessment
Case 16.3 Addiction:
Oliver Vincent is a 35-year-old male who owns a successful business, and who is openly gay. He is a weekend partier, who with the help of a few drinks, has begun to frequently use cocaine, and on occasion has used crystal methamphetamine (tina) and a mixture of synthetic stimulants in powder form known as bath salts. He has sought out help because he has experienced many failed attempts to curtail, what he now sees as, his drug problem during the past six months. Dr. Levounis has diagnosed him, according to DSM-5, as having a moderate cocaine use disorder since Mr. Vincent has started using cocaine regularly, lost weight, is having trouble sleeping and is having unsafe sex while under the influence.
Evaluate and describe the ethical and professional interpretation of any assessment information presented in the case study.
Because Mr. Vincent is gay, he is stereotyped as living a lifestyle (drinking, using drugs, and sex) that is normal to the subculture in which he is placed. The case study even mentions that his parents are under the assumption that he is destined to live miserable and lonely life. Being stereotyped in this manner can lead to the clinician to be ineffective in his/her role. Mr. Vincent was diagnosed as he was due to the fact that his behaviors while under the influence were becoming risky and dangerous. The doctor also mentioned that he did not appear to be suffering from trauma, depression, anxiety, or a personality disorder, however, the doctor did not note that he was tested for any of these.
According to the NIH National Institute on Drug Abuseâ€™s DASTâ€10 Questionnaire, further investigation is required.
Assessment of Executive Functions â€“ using The TinkertoyÂ® Test â€“
This test consists of giving the examinee pieces, 50 to be exact, and asking them to construct something from them. According to Gregory (2013) â€œthe test seems particularly well suited for demonstrating the presence of deficits in executive functioning, which have proven to be difficult to demonstrate with clinical tests even though they have catastrophic sequelae in daily vocational or psychosocial endeavorsâ€ (sect. 10.19).
I feel that this test will help to determine if Mr. Vincent is experiencing problems with his way of thinking and processing. This could help in determining a treatment plan for his cocaine use disorder, and/or determining if further psychological testing is needing to address other disorders that he may be suffering from.
This test may be seen as testing his intellect, or abilities, and may pose a problem in that he may develop self-doubt in his ability to run his business.
While I agree with the original doctorâ€™s diagnosis, I do not feel that he looked deep enough into other areas that may be contributing to Mr. Vincentâ€™s disorder. The doctor stated that he was â€œliving it up,â€ and not like his parents assumed he would be living, however, he could be merely living in a manner befitting to the stereotype of male gay so that he would fit in.
American Psychiatric Association. (2013). Online assessment measures for the diagnostic and
statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing.
Barnhill, J. W. (Ed.). (2014). DSM-5 Clinical Cases. Washington, D.C.: American Psychiatric
Gregory, R. J. (2014). Psychological testing: History, principles, and applications (7th ed.). San
Diego, CA: Bridgepoint Education.
NIH National Institute on Drug Abuse (2015). Received from:
http://www.drugabuse.gov/nidamed-medical-health-professionals (Links to an external site.)