Discussion chapter 4

Class Participation Topic for this week.

In regards to the Psychological assessment, I have a couple of examples that highlight the need for a good assessment. I want to add this little vignette to get you thinking about this subject. A few years ago, I had a case of a man who was sent to me to treat his “psychological condition”. He was an officer in the Navy and he was acting “weird” and was difficult to understand sometimes and to follow what he was trying to say. It is a long story, but when I did the assessment, again using Psychological Tests and a very careful Clinical History, I found significant problems with left temporal functioning (he had a mild expressive aphasia) , in addition to inconsistencies to what “appear” to be a Psychological “Problem”. This guy was not “neurotic” and his symptoms just did not make any sense. I spend a good deal of time listening to him, although this listening was difficult; I spoke to his wife, I learned of their history together, in other words, I aimed at understanding my patient. Given my assessment of his psychological functioning, my interviews with the patient and his family and the results of the Testing, I asked the referring physician to take a second look and she did an MRI and found a huge tumor in his left temporal lobe.

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Again, perhaps this is a more dramatic case, but I want to emphasize the importance of a good assessment, with sound Clinical History, knowledge of Psychopathology (what this course is about!), the development of good listening and perceptive skills and proper Psychological Testing. On the other hand, a few years ago, I was asked to evaluate a man who had lost consciousness, had frequent syncope episodes with loss of memory for the event and he was thought to have a “neurological condition”. His is also a long story that I will not repeat here, but essentially, he was a true case of “Conversion Disorder” (Hysteria), which was resolved, first via hypnosis and later with ongoing psychotherapy. He had been tested with all kinds of technology without arriving to a definitive diagnosis; but it was his particular life-situation, together with a very careful history that pointed in the direction of hysteria (I will talk about him later in the course). In this case, contrary to the one above, the assumption was an “underlying physical condition” which, under careful assessment (and treatment) demonstrated the opposite.

When it comes to children, the assessment takes on a particularly different emphasis, as you need to consider developmental stages, cognitive-emotional development, cultural and family factors and, very important, situational factors. Several years ago, I was asked to evaluate this young 8-year-old boy for ADHD whose behavior appeared to me inconsistent in various settings. I decided to do school observation in a couple of different classes and I found out his behavior was highly depended on the class and teacher present; yes sometimes he acted-out in ways that appeared as ADHD, but it wasn’t ADHD, it was the “situation”, not the child. This is a theme that repeats fairly often and that it takes effort for me to convey to parents and teachers. A child behavior, at any given particular point in his/her life is ALWAYS the interaction of individual factors AND the environment. Frequently we need to intervene on both areas in order to bring a change in behaviors. Now, when I talk about the environment, I do not only refer to physical or social environment, but also family dynamics. When I do an intake for a new kiddo I always have the parent or parents present, not just to get historical information from them, but also to observe how they interact with each other. I use this information later when I present to the parents my observations, and very often they admit they were never aware of this or that until I pointed it out to them. As we go along I will describe some of those cases.

Well I hope you have enjoyed reading these cases and get a sense of the importance of conduction good clinical assessment.

What I would like for you to do is to comment on anything you found interesting in this posting. Remember that:

You have to respond to this posting
keep a copy of your posting in WORD
This posting will be unavailable after two weeks, so you can’t delay.
At the end of the semester you will take ALL of your class Participations and turn them in for grading.
OK, now we are starting and this course will be moving “fast and furious”. Do your readings and ENGAGE!

All My Best

DrF

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