Dr. QQ requested this evaluation to help in the differential diagnosis of the Mr. [patient].
Tests Administered:
Clinical Interview
Rorschach
Minnesota Multiphasic Personality Inventory - II
Background Information
Mr. [patient] is a 57-year-old Caucasian man. He was originally evaluated by Dr. RR in the clinic and is being evaluated with testing to complete that evaluation. He was on Cylert, Remeron, and Wellbutrin at the time of the evaluation. He does feel that while all drugs have improved somewhat his condition, none of the drugs have improved it to "a good enough" situation for him. He has symptoms that include depression and fatigue. He provided this examiner with a printout of the symptoms that he is concerned with. He does feel that there are a certain set of symptoms that are affected by his antidepressants and anxiolytics, which include fatigue and lack of endurance, muscular discomfort, concentration difficulty, and depression. Thee are another set of symptoms which have not responded to medication, and these include increased muscular discomfort from getting wet, a blue cast to the head of his penis after bathing, rose colored lips after bathing, and muscle vibration sensation. He stated that he had a medical work-up for chronic fatigue syndrome and while he had an abnormal level of intracellular magnesium, he did not meet criteria for that syndrome. He does now take a magnesium supplement. He stated that he could not identify any trigger for when the symptoms started.
Behavioral Observations:
Mr. [patient] arrived on time for his appointment. He was alert, pleasant and cooperative with the evaluation. Speech was fluent, prosodic, and without paraphasic errors. He appeared to put forth good effort on testing tasks and so the result appear to be a valid indicator of his functioning level.
Interpretation of test results:
He completed the Rorschach with sixteen responses. He was not significantly elevated on any index, and this included the schizophrenia index. His record is valid, although it probably showed some situational guardedness and a reluctance to be forthcoming. Consequently, his responses may not reveal the full extent of his coping capacities or adjustment difficulty. He tends to try to reduce or narrow the information that he attends to, and if this is generalized to his environment, he may put himself at risk for becoming easily stressed. This is because, if he needs to simplify what he is attending to or to simplify his daily life in order to cope with it, any minor stressor can be upsetting. He likely may form mistaken impressions of people and what their actions signify. He may fail to anticipate the consequences of his action and have difficulty formulating what might constitute appropriate behavior in a situation. He tries to think problems through logically and coherently, but he does not have a well defined coping style, based on the Rorschach data. He is likely to alternate between expressive and ideational ways of dealing with situations, which can result in less effective coping and can result in more unpredictable behavior on his part. He seems inclined to identify with imaginary figures or people who do not regularly participate in his everyday world, and he may have difficulty forming a clear and stable sense of his own identity. Although he may not necessarily avoid interpersonal relationships, he may tend to keep people at arm's length.
His MMPI also was valid. It suggested that he may be blunt and openly complain to others about the problems he is having He may be quite self critical. At this time, his MMPI-II would suggest that he may feel that things are not in his control and feel unmanageable.
His clinical profile would be consistent with a high degree of psychological distress at this time. He may appear tense and depressed, and he may be agitated about problems in his environment. He may have a pattern in his life of poor impulse control, and he may not accept societal standards for behavior. He likely feels very angry about his situation, and he may blame others for the problems he is having. His profile would be consistent with a long-standing personality problem. These personality problems are likely to persist even after current stresses subside and he feels somewhat more comfortable. He likely feels that his physical heath is failing. He may feel that life is no longer worthwhile and that he is losing control of his thought processes.
This profile has high definition, which means that if he is retested, he is likely to show a similar pattern. His relationships, consistent with the Rorschach, are likely to be somewhat superficial. He may be rather introverted and have difficulty meeting other people. He may view family relationships as problematic. His MMPI profile would be consistent with someone who might have a personality disorder and also possibly an affective disorder. He has endorsed symptoms related to familial discord, authority problems, social alienation and self alienation. He also has endorsed symptoms related to a stressful current home situation. He has been having some difficulty with the manager and landlord of the building he lives in.
Conclusions:
Based upon the patiens's evaluation, he would appear to have evidence for an affective disorder and a personality disorder. He was not significantly elevated on the schizophrenia index on the Rorschach, nor was he above threshold for the schizophrenia index for the MMPI-II. He does likely have strained interpersonal relationships and in part may keep people at arm's length when relating to them.
Recommendations:
Based upon the evaluation, the following recommendations are made:
Mr. [patient] may be focused on medical treatment for the symptoms he is experiencing. He reported having gone through a number of years of individual therapy and so may not see as much benefit to that now. If possible, it likely would benefit him to continue to focus with a mental health provider on ways to cope with the symptoms while he continues to experience them and explore the possibilities for their development.
Thank you for this consult, and please do not hesitate to call me if you have any questions.
Dr. RR, Ph.D.
Clinical Neuropsychologist
Doctor's File Notes
History
Lab Test Results
Medication
Symptoms
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