Final Exam

Clinical Assessment 2

Psy 623 B

Instructions: Welcome to your "final" chance to display your knowledge on the subject of Clinical Assessment.  Please do not attempt to post your answers in the comments section.  Please cut these questions and post them in a separate email or word processing document with your answers below each question.  
 

1. If you were assigned to see the demented psychiatrist, Hannibal Lector (brilliantly played by Anthony Hopkins) in the movie, Silence of the Lambs,  you would be wise to incorporate the following into your treatment plan:

1. Addressing the patient’s narcissistic wounds
2. Assisting the parolee in taking responsibility for his actions
3. Enhancing the patient’s sensitivity and increasing levels of empathy for his victim.
4. None of the above; if it was determined that you had the training, experience and skills to treat him, society would be more your “patient” than the demented psychiatrist.  Your main concern, with such a patient would be protecting society.

2. T or F

Patients who have legal problems, or who engage in violent, destructive, or disruptive behavior are often prematurely (formally, or informally) assigned the diagnosis of Antisocial Personality Disorder.

3. T or F

Children and adolescence who suffer from depression often act out in violent, rebellious, and destructive ways that obfuscate the underlying sense of hopelessness they feel. 

4. T or F

The psychologist working with Dibbs in the novel, Dibbs: In Search of Self, adopts an approach characterized by direct confrontation.

5. The main character in the song, Mrs. Jones, Mrs. Jones, Mrs. Jones, is the victim

of:

1. drug abuse
2. child molestation
3. domestic violence
4. none of the above

6. Ms. St. George, in the movie, Delores Claiborne abuses alcohol and takes psychiatric medication, in part, because, as a child, she was:

1. the child of an alcoholic father
2. molested by her father
3. the child of a murdering mother
4. all of the above
5. a and b

7. Angelique, in the movie, He Loves Me, He Loves me Not, suffers from:

1. being a naïve adolescent
2. a brief psychotic disorder
3. Delusional Disorder, Erotomanic Type

8. Pete is an unpublished writer.  His writing lacks substance but he uses a lot of journalese.  It is also well known among those he associates with that Pete sees himself as a juggernaut.  The best diagnosis one might immediately entertain would not include:

1. Post-traumatic Stress Disorder
2. Delusional Disorder
3. Narcissistic Personality Disorder
4. Cocaine Intoxication
5. Schizophrenia, Paranoid Type
6. Dysthymic Disorder

9. Polly wants to jettison all of her facebook friends, fearing that they are secretly plotting against her in an effort to poison her through the speakers on her computer.  Polly is likely suffering from:

1. a grandiose delusion
2. a persecutory delusion
3. a paranoid delusion
4. a psychotic episode
5. a and d
6. c and d
7. a, b and c
8. none of the above

10. Billy’s friends say that every time Billy sees a snake he gets the jimjams.  Billy likely suffers from a specific:

1. delusion
2. phobia
3. form of dementia
4. none of the above
5. all of the above, along with atypical Attention Deficit Disorder

11. Don Martin is a serial killer.  He’s also a nouveau riche multi-millionaire and has hired the dream team to prepare and execute (no pun intended) his defense.  A number of so-called “expert witnesses” are brought in to raise the prospect that insanity was behind his every action.  In the end, the judge concluded that he was not insane, and said the defense had a weak case, based on nothing more than “junk science.”  In essence, what the judge was saying is that the defense should have:

1. Brought in more shrinks.
2. Should have relied upon conclusive results from a carefully prepared battery of psychological tests with a high degree of reliability and validity rather than upon an assortment of biased data, false inferences and non sequiturs
3. Should have consulted with students from Dr BLTs Clinical Assessment 623B class.
4. b and c

12. When Gerald, a 52-year-old Japanese man comes in to see you for the first time, you notice that he appears to display hebetudinous, or languorous psychomotor activity.  You look at his face and note a saturnine visage, or physiognomy.  He reports that he used to enjoy “peripatetic peregrinations,” and added that he now regards them as “perilous,” and he prefers to sit around all day and watch television.

Gerald believed himself to be a member of the literati, or cognoscente, if you prefer, and though initially, you think he may be delusional, you eventually believe that he is such a member, either becoming part of his delusional system, or simply suspending the questioning of his veracity, or validity of his claim.

Yet, you also note that his erudite, sagacious presentation belies a certain social ineptness.  He experiences all social events in an exceedingly minatory manner.  He said he rarely goes to parties, but attended on at Christmas that doubled as a required staff meeting.  He said, “A gentleman there who identified himself as “Nicholas,” offered him some brownies, and he “politely refused.” 

He added that he overheard some folks at the party calling him “Spock.”  I never fit in at parties,” he said, “so I prefer to be by myself.”  Gerald said he could really identify with the words to the David Bowie song, Modern Love.  When you ask him if he has ever had a girlfriend, he smiled, and dryly noted, “That would involve kissing, perhaps even sex.  So, no.”  You eventually decide he suffers from Dysthymia and Schizoid Personality Disorder.   Your treatment plan should:

1. take into account cultural issues
2. not begin until you have added “provisional” to your diagnosis, with the intention of further exploring cultural matters
3. involve referring him to an assertiveness course
4. planning parties once a week at his own place of residence, where he is likely to feel safer
5. a, b and d
6. involve establishing rapport
7. a, b, d and f
8. a, b, and f

13. T or F: It’s a good idea to tell a schizophrenic patient that his delusions are based on non-reality or distorted reality ab initio

14. T or F: If you’re going to say anything about his/her delusions, ab initio, it’s a better idea to tell the schizophrenic patient that his/her delusions are experienced by him/her as reality, and leave it at that

15. T or F: A depressed mood may be experienced by an adolescent and/or interpreted by his/her peers as liverishness, a splenetic disposition, or irascibility

16. (Bonus Question; worth 5 extra credit points) Dr. Bealty was a Jungian analytic psychologist.  He was working on a paper that would confirm and build upon Jung’s notion that dreams should be interpreted as wise teachers guiding patients on their respective journeys and showing them the way they should go. 

Jack Indabocks, a borderline patient and an alcoholic, who was aware of Dr. Bealty’s bent for a Jungian interpretation of dreams, as well as his predilection for writing songs said this before reporting his dream to Dr. Bealty:

“Well doctor, before I tell you my dream, I think I better warn you.  Rather than putting this in your paper, this dream would be better off in one of your songs.” 

Assuming that Dr. Bealty wrote this song based on Jacks’s dream (the content of which is strangely missing in Dr. Bealty’s notes, and in his paper), what can you infer about Jack’s dream? 

More specifically, after listening to the audio sample of the song that Dr. Bealty subsequently wrote, with Jack’s dream as the subject, what would you say is the reason Jack’s dream did not fit a typical Jungian interpretation?

Halloween with Jim Beam

Dr BLT

Words and music by Dr BLT copyright 2009

Halloween with Jim Beam  

1. It was not based on the Oedipus Complex
2. If Jung’s theory fit, the dream would be telling Jack something counter to common sense and against proper mental health practices, essentially telling Jack to self-medicate over the break up of a relationship
3. The dream was probably physiologically driven, as a result of Jack eating something that his stomach didn’t agree with the night before
4. None of the above 

    17.  Dr BLT relies heavily on music, fictional literature, music, and drama to teach psychology courses because:
     a.  they are more fun than traditional lectures
     b.  it is more useful to observe and analyze "living, breathing" examples of cases and clinical conditions than simply
     or studying textbook descriptions of such
     c.  it requires less concentration
     d.  none of the above
     e.  a and b

   18.  Provide a self-generated vignette that illustrates a disorder most intriguing to you.
   
   19.  Describe, in a brief paragraph, your approach for treating the patient you've described in your vignette

   20.  Describe what you, as a clinician, would want to rule out in order to make your diagnosis definitive.