Download psychological evaluation: confidential

PSYCHOLOGICAL EVALUATION: CONFIDENTIAL
**THIS WRITE UP IS NOT FOR A REAL PERSON. IT WAS WRITTEN FOR A CHARACTER
IN AN OLD SCIFI ANIME SERIES
Date: March 29, 2011
Client: George Asakura (Joe)
DOB: November 15
Gender: Male
Age: 19
Marital Status: Single
Place of Examination: ISO Health Center
Presenting Problem:
Joe is a 19-year-old heterosexual Caucasian male referred by Dr. Kozaburo Nambu of the
International Science Organization. Joe reports dizziness, blinding headaches, and strong
reactions to bright lights. He also states that he has recently remembered parts of his
childhood that he "had totally forgotten." These memories were also preceded by
reactions to flashes of light. His current symptoms are often juxtaposed by stressful
situations, such as having to fight, or being in a situation in which the team is relying
upon him.
Joe describes himself as "someone who likes to be left alone," who would "rather do
something than stand around discussing options," and who has at times been censured
for his temper and behavior, including recently "taking off when Dr. Nambu told me he
wanted me to talk to a head-shrinker." He noted that he was speaking with the
interviewer under duress, and had agreed to do so to keep from being removed from the
Gatchaman team.
Behavioral Observations
Joe arrived for his intake appointment several minutes late. He was appropriately dressed
but initially reticent with the interviewer. His affect [2] was slightly depressed, bordering
at times on sullen.
Family History
Joe states that his parents were killed when he was a child; this information is confirmed
by Dr. Nambu. The client found his parents' bodies, and was confronted with "the bitch
that murdered them." He reports that he experienced feelings of horror and rage and, in
spite of significant reported derealization , he attempted to shoot the assassin, but
instead was caught in the explosion caused by her rose grenade. Though Joe is able to
recount what happened to him after the explosion (being taken to the hospital, going to
stay with Nambu), he says these are repetitions of what he has been told; he has no
memories for several days following the explosion.
Joe reports that his memories of his parents, Giuseppe and Katarina Asakura, are warm,
which is "why Jun says I'm still so pissed off that Galactor killed them." Joe's memories of
his parents' murder were repressed until recently. At that time, with the help of Ken, he
was able to recover them. Prior to the recovery of the memories, he reports intrusive and
distressing piecemeal recollections in response to particular stimuli, including bright lights.
These recollections took the form of dreams, illusions [4], visual and auditory
hallucinations, and dissociative flashbacks [5], and left him in a state of heightened
arousal, indicated by a racing heart, panting, and sweating. His repeated attempts to
avoid or push away the memories were futile.
Relationship History
Joe is not currently in a romantic or sexual relationship saying he doesn't "have time for
that kind of thing." However, when pressed, he said that he "tend[s] to pick the wrong
kind of girls…like Galactor agents." He became angry when the interviewer asked him to
say more, and refused to discuss the issue further, saying "you keep it up and we're going
to be done right now."
Occupational History
Joe is a member of the Kagaku Ninjatai, "the best shot on the team," and maintains a
cover occupation of private race car driver. He reports that he enjoys the "adrenaline
rush" of both occupations and "can't imagine doing anything else."
Medical History
Joe reports several past head injuries, followed by periods of unconsciousness lasting
anywhere from "a few minutes" to "probably an hour." The most recent significant injury
led to shrapnel lodged in the client's skull; it was removed with the use of an
experimental centrifugal method [10] with unknown side effects. Joe reports that he did
not have any of his current symptoms after that injury.
Joe was also injured in an explosion when he was a boy.
Joe states that he has not used recreational or illegal drugs, though he commented that
he wouldn't tell the interviewer if he had. When assured that a full assessment of drug
and alcohol history is necessary to rule out the influence of a substance, he reported that
he drinks "rarely" and "tried marijuana a total of once…I'm not good to be around when
I'm paranoid." He noted that at times he resents not being able to live "a normal life like
other kids…being able to drink and party," but rather one that requires him to constantly
be alert.
Documentation received from neurologist Jane Doe suggests that symptoms cannot be
fully explained by a medical condition. She and her colleagues are continuing their
investigation, which has to date included an MRI, a CAT scan, and a PET scan. Though
"negligible" remnants of shrapnel have been found in the parietal and temporal lobes,
they are, according to Dr. Doe's report, "in associative areas [6], and should not affect
speech, temperament, or functioning in any way other than the loss of information
contained by the damaged neurological areas."
Summary and Differential Diagnostic Impressions:
Given Joe's history of dissociative amnesia, derealization, and avoidant behavior, and his
recent experiences with intrusive symptoms and hyperarousal, a preliminary diagnosis of
PTSD is appropriate. Given the significant neurological and sensory impairments, as yet
unexplained by a medical condition, a diagnosis of Conversion D/O may also be
appropriate; the examiner has chosen to leave this as a rule-out [7]pending additional
medical results at the end of this week.
In addition, Joe's extensive history of irritability and withdrawal, particularly given his
unusual upbringing, may indicate a mood disorder. Because the client articulated bouts of
moodiness, rather than a consistent lack of energy, appetite, or sadness, a major
depressive disorder currently seems diagnostically more appropriate than dysthymia [8];
because features of mania were not indicated, even during periods of irritability, the
bipolar [9] disorders were not included for consideration.
Axis I:
309.81 Posttraumatic Stress Disorder, acute, with delayed onset
296.3 Major Depressive Disorder, Recurrent, with Melancholic features
R/O Conversion Disorder
Axis II:
No diagnosis
Axis III:
Traumatic brain injury, including shrapnel lodged in the brain.
Axis IV:
Work pressures, incomplete social system, unusual upbringing
Axis V:
GAF current 50
Notes for my students -
[1] Deficits affecting voluntary motor or sensory function that suggest a neurological or
other general medical condition. Psychological factors are judged to be associated with
the symptom or deficit because the initiation or exacerbation of the symptom or deficit is
preceded by conflicts or other stressors. The symptom or deficit cannot, after appropriate
investigation, be fully explained by a general medical condition, or by the direct effects of
a substance, or as a culturally sanctioned behavior or experience.
[2] Emotional presentation
[3] Derealization is feeling like things aren't real, like they're happening in a dream, or
are otherwise strange -- sounds, time, and objects can be distorted.
[4] Misperceptions of real external stimuli -- as opposed to hallucinations, in which you
see something that totally isn't there.
[5]Dissociation is when you split off from yourself in some way -- for example,
derealization is a kind of dissociation.
[6] Associative areas are parts of the brain that do whatever specialized parts of the brain
don't -- mostly, they hold memories.
[7] Under the medical model of psychology, you make an actual diagnosis (so you can bill
the insurance!) but you "rule out" the diagnoses you're not sure about. They're things you
need to get more information about before you're prepared to make an official diagnosis.
Actually, the way I wrote this, if this was real, I wouldn't have ruled out depression, I'd
have made the actual diagnosis, but since I know there are people who won't like the idea
of Joe being depressed, I left it as a rule-out. (In the biz, we call that "politics." ;-)
[8] Long-term, low-grade depression
[10] It is inappropriate to write "moronic treatment method," so you learn to use
euphemisms like "experimental." See how that works? ;-)
[11] Global Assessment of Functioning – let's just say that's as high as the number can
possibly be, and if he goes much lower, he's not going to be functioning much at all. But
then, that's the problem he's facing, isn't it?