name of book-Abnormal Psychology (Chapter 4) by Butcher, Mineka and Hooley

 

Jack is a 35 year old man and came into the mental health clinic last week. Three weeks ago, he suffered a concussion after a car accident, but was medically cleared after 24 hours of observation. He has been cleared after 24 hours of observation. He has been referred to your program after he reportedly began “acting strange” according to family members.  Jack insists he has never had problems before, “feels fine”, and believes everyone is over-reacting, yet agreed to come to the clinic.

There are four questions relating to this case study: They are labeled, question #1, 2, 3, and 4.

1. What methods of assessment might be used in an evaluation? These are possible assessments that I read in the chapter that may be deemed appropriate for this particular patient.

A Physical examination, Neurological examination-EEG, MRI, CAT scan, and PET scan-determine brain abnormalities.  Neuropsychological Examination, Halstead Category Test, Psychosocial Assessment, Unstructured Assessment Interview, Clinical Observation of Behavior (self- monitoring)-self-observation and objective reporting of behavior, thoughts and feelings as they occur in various natural settings. This method is can be a valuable tool in determining the kinds of situations in which maladaptive behavior is likely to be evoked.  Psychological Tests-assess psychological  characteristics. Personality tests (MMPI-2)

2. What specific areas of functioning would you want to inquire about?

3. How might your assessment approach differ if Jack was an adolescent?  What if he was 65 or older?

4. What are possible conditions might you wonder about if Jack was a teenager, a middle age adult, or senior adult?

Discussion

Most people believe that mental illness is caused by a sudden a chemical imbalance. This belief draws from the chemical imbalance theory that was put forward in the 1950’s. Depression results from psychological and physical stress, as well as concussions. However, genetic defects are the major causes if other deficits are prevented. Mental diseases reside in the brain and are caused by biological factors and alterations. Since the propagation of the chemical theory, companies stopped producing soothing tonics for mental disorders and instead embarked on manufacturing medications to treat these diseases (Leo, J., & Jeffrey, R. L., 2008).

Mental problems need to be diagnosed. This is however not dependent on the physical state only. The symptoms of the disease must also be identified and come up with a distinction between normal and abnormal diseases. The main category of the abnormal disease should then be identified. In psychology, interpersonal processes, obsessions, and personality disorders; to a greater length characterize social dysfunction, and can help distinguish normal and abnormal processes.

In Jack’s case, clinical assessment will be mandatory. This will involve collecting his clinical history, symptoms and behaviors. All this will be sourced from the family members. The intellectual and sensory capabilities of the patient will also be investigated. This assessment should include all medical problems, neurological disorders and medications. Jack’s family history too must be assessed.

Mental status examination will be conducted after determining the language, visual and auditory capability of the patient. This will be carried out in a conducive environment. Symptoms such as hallucinations, distractions or speaking to himself will show different degrees of mental illnesses.

Behavioral assessment will be used to show new behavioral problems which reflect a change in the clinical condition. The frequency, duration and features of each behavior must be determined. Psychiatric symptoms must be assessed to patients with intellectual problems. Functional behavioral assessments should be performed for individuals with behaviors resulting from learning.

Neurological exam will be conducted if the patient is mentally retarded and should remain stable. New neurological deficits will suggest a new problem rather than a continuation of the old problem.

Laboratory assessment will be the final stage and will include blood sugar, electrocytes, blood count, thyroid studies and therapeutic blood levels for medication. Complete psychiatric examination requires complete medical and dental evaluation to exclude medical or dental mimics of psychiatric disorders.

The main areas of interest in Jack’s case will be behavior patterns, thoughts and actions, speech the words, mood and emotion. All these are basic elements of defining and assessing mental illness. Ludwig and Lexington (1975) stated that the main premise of the model is that the disease is due to natural causes (i.e., brain dysfunctions), either biochemical or neurological in nature. Abnormal behavior is caused by biological mechanisms and so medication only regulates neurotransmission problems and that these are the underlying causes of abnormal conduct. However, any behavior is mediated by neurochemical processes and does not necessarily indicate causality. Involvement of a neurotransmitter system does not imply that it is the cause of behavior. Behavior may be a result of the interplay of biological and social variables whose effects are mediated by neurotransmitters (Stravynski & Greenberg, 1992).

Diagnosis of mental illness is different in children, adolescents and adults. This is because of their different ages and stages of life. The causative agents will therefore be differently motivated. In adults for example, these can be traced from their work status and their desire of living independently. In adolescents, it can be traced from their relationships, passions and addictions while in children, schoolwork and social interest activities could be the main motivation. In children, it is harder to assess mental illness as they portray a variety of behavioral patterns as part of their development. This therefore will call for different methods of assessment in different ages. However, a written diagnosis of a novel patient would provide a direct measure of clinical decision making. An advantage of this type of data is that writing promotes not only higher quality writing but higher quality thinking (Susan Logsdon-Conradsen. (2004).

In conclusion, as  Peter, C. W. (1997) notes, acquiring the clinical skills necessary to tease out all aspects of a clinical problem, is an important step in training and includes attention to the nonspecific factors operating in therapy. The skills of the future mental health professional trained in a clinical science would be eclectic, combining observational, listening, and other communication skills with knowledge of interpersonal and group processes, anthropology, epidemiology, cognitive, and behavioral psychology and the relevant applied physiology and pharmacology. At present, neither psychiatrists nor clinical psychologists possess all of these skills.

References

 

Leo, J., & Jeffrey, R. L. (2008). The media and the chemical imbalance theory of depression.

Society, 45(1), 35-45. doi: http://dx.doi.org/10.1007/s12115-007-9047-3

 

Peter, C. W. (1997, Making sense of mania & depression. Psychology Today, 30, 34-38+.

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