Comprehensive Examination: MA in Forensic Psychology

The principal purpose of this evaluation is to determine if Mr. Martin was cognizant or not due to his mental illness that led to the uncontrolled, impulsive reaction.

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Reason for Referral

Mr. Martin was involved in arson where he intentionally started a fire at his apartment with the intent to damage the building and harm the people in it. As Mr. Martin was being escorted from the site, he began to ramble and not making any sense. Mr. Martin blamed Officer Smith for setting the fire as well as the apartment complex failing to fix the stove right. He started raving and ranting about the Fire Department having taken his doorknob and broken into the apartment. He did not want to leave the apartment even though there was a fire. Because he was believed to be a danger to himself and others who lived in his multi-building, Mr. Smith to Southwest Hospital for an emergency evaluation. Mr. Martin denied that there was any fire and the police came up with the whole story (Case Vignettes 2016). While not being interviewed, Mr. Martin could be seen talking to himself or yelling and screaming at the hospital staff. Mr. Martin could not calm down, and he had to be sedated in order to attend to his medical needs and assess his mental status.

Current Life Situation

Mr. Martin was not being formally charged with First-degree arson. According to Criminal Law-FreeAdvice.com, the range of punishment for first-degree arson varies by state. Next to murder, however, first-degree arson is usually listed as one of the most severe offenses. A defendant in Texas stands five to ninety-nine years or life in prison. A defendant in South Carolina can face a fifty-year sentence (FreeAdvice, 2016).

Presentation

Mr. Martin showed signs of active psychosis and it is likely that he would be deemed incompetent to stand trial. Mr. Martins state of mind at the moment of committing arson points to insanity.

Background Information

Mr. Martin is a 58-year-old African-American who appears his chronological age. He is of average height and slightly obese. He has been hospitalized for psychiatric reasons at Veterans Affairs Medical Centers including New York, Martinsburg, WV, Nashville, TN, and Birmingham, AL. He did not show any presence of hostility or irrational thoughts during the time he was being interviewed by the police because he had been given medication prior. Mr. Martin was very talkative and appeared to enjoy being interviewed. He was quick to elaborate, happy to clarify his point if something was unclear and was very cooperative. For example, he mentioned the military, kisses, the differences between male and females, halos, the importance of first impressions and government conspiracies all in the same run-on sentence.

According to Martin, he earned Bs and Cs while he was in elementary and high school. He reports that he was in the military, but did not finish. Upon completing high school, Mr. Martin stated that he did not do anything for a year after school, then he started working for a catering company. In 1975, Mr. Martin enlisted in the US Army after high school reporting that he was posted in Germany, where he worked as a Crewman in the Hawk missile program. Mr. Martin held the rank of Private First Class. In 1978, he stated that he was honorably discharged from the Army (Case Vignettes, 2016). After one year from leaving the army, he stated that he went to the Air Force Reserve. In the Air Force Reserve, he said that he drove heavy equipment reporting that he left the Air Force Reserve when he was the Staff Sergeant in 1982 and was awarded one hundred percent service-connected disability compensation. Several months later he was given his SSDI benefits while living with his sisters and her children. Mr. Martin reported that he worked as a cook, a dishwasher, and a mechanic. From 1985-1995, he worked for the U.S. Postal Service. At this present time, Mr. Martin is unemployed. Mr. Martin has a long-term relationship which lasted from the age of 23 to 49. He also reports that he has had 50 to 60 different sexual partners throughout his lifetime.

Family History

Mr. Martin is the youngest of seven children. His father was an alcoholic who abused him and his family. He also states that his father was arrested once for fighting when he was drunk on the street. He was removed from the home at the age of nine by Social Services and sent to live with his grandmother who then places the children in an orphanage. After Mr. Martins mother and father had been legally separated, all the children moved back to their mother (Case Vignettes, 2016).

Substance Abuse History

At the age of nine, Mr. Martin stated that he was smoking a pack of cigarettes a week. At the age of 12, he commenced smoking marijuana and drinking alcohol at the age of 13. At the age of 22, Martin began using cocaine, and there were times he mixes cocaine and heroin. In his mid-thirties, he states that he began using crack cocaine and heroin (Case Vignettes, 2016). All of this information is self-report by Martin.

Medical information

Mr. Martin stated that he had been diagnosed with, and treated for, gastroesophageal reflux disease (ranitidine), dyslipidemia (statin drugs), hypertension (atenolol), elevated glucose, and obesity.

Mental Status Examination

A Mental Status Examination (MSE) would be very helpful in to evaluate Mr. Martin thoroughly. The MSE would provide insights into his thought content, thought process, cognition, and perception. The examiner will also document his mood and appearance. With a reliable knowledge of the factors that characterize the clients life including history, family, job, sickness, medication, substance abuse among, the examiner has a better place to start regarding the diagnosis and treatment.

What assessments (general and specific) would you conduct to enhance your understanding of the clients problems and how would your choice of assessment(s) inform your diagnostic impression and treatment planning? Assessments may include structured or unstructured interviews, valid and reliable assessment measures, and/or formalized assessment procedures that may be conducted by yourself or by someone else referred by you.

The psychological assessment also referred to as psychological testing is the process of using various techniques that can lead to formulating a hypothesis about an individual, their personality, behavior, and capabilities. Also known as performing a psychological battery on a person, psychological assessment should always be conducted by an authorized psychologist or a psychology intern. The primary purpose of psychological assessment is to build up a precise picture of the client needs (McReynolds, Rosen & Chelune, 2012). Some professionals provide a myriad of services, and that might include more than one professional handling the client. Psychological testing helps professionals determine the core components of an individuals mental or psychological health problems, IQ, personality and other elements. It also gives insights into a persons weaknesses and strengths.

Psychological testing measures present functioning of the client and they cannot predict the future. Ideally, it is not a single test, and neither is it carried out in a vacuum. It involves a whole body of dozens of research-backed procedures and tests of assessing specific aspects of an individuals psychological makeup. Some of the tests used are for personality while others are used to determine the IQ or something else. A thorough psychological assessment would involve a full medical examination on the client to rule out any possibility of disease, medical or any other organic cause for the persons behavior.

In the case of Mr. Peter Martin, I would use several psychology assessment methods to get a solid understanding of his condition. I would consider the following pointers during the evaluation.

His mental health symptoms and experiences,

his thoughts, feelings, and actions,

his well-being and physical health,

his financial and housing circumstances,

his training and employment needs,

his family and social relationship,

his culture and ethical background,

his use of alcohol and drug,

his sexuality and gender issues,

any past experiences particularly of similar problems,

his safety issues,

if anybody depends on him maybe a child or an elderly relative,

his skills and strengths and what helps him the best and

his aspirations and hope for the future.

Psychological testing can be divided into four major types including assessment of the IQ (Intellectual Functioning), Personality Assessment, Clinical Interview, and Behavior Assessment. Additional, there are other psychological tests available including career or work counseling, aptitude or achievement in school, career planning, and management skills. For a proper diagnosis of Mr. Martin, it will require the assessment of his intelligence, personality and if there is any organic involvement (Uher, 2013). A quintessential battery of tests includes objective personality tests such as MMPI-Minnesota Multiphasic Personality Inventory, projective tests to assess personalities such as TAT- the Rorschach and the Thematic Apperception Test. There is also an intelligence test mostly WAIS-R- the Wechsler Adult Intelligence Scale-Revised and a semistructured test like the Rotter Incomplete Sentence test.

The Clinical Interview

They form a core component of psychological assessment can last from 1 to 2 hours. I would use the clinical interview to gather important family and background data about Mr. Martin. Interviews provide valuable information because there are less structured and more open and the client will convey the information with so much ease. The examinee is given a chance to recall details about various stages of their lives (McReynolds, Rosen & Chelune, 2012) Some aspects of clinical interviews are also computerized where a series of questions are fed into the computer for the client to answer. It can be helpful when gathering demographic information and to help the psychologist formulate an initial diagnostic impression. Neighbors and other relevant people can also be interviewed in the case of Mr. Martin for more details.

Assessment of the Intellectual Functioning (IQ)

The intellectual quotient (IQ) is a theoretical construct of a measure of the general intelligence. IQ tests do not particularly measure the actual intelligence but rather the components believed to be important. The two ultimate tests that are applied to measure intelligence include the neuropsychological assessments and the intelligence tests. In the case of Mr. Martin, the intelligence test is the most viable since it forms the foundation of differential diagnosis to the psychologist. It is used to measure mental abilities that may be affected by the presence of an organic injury or disease, environmental stress or thought disorder. There is patterning on the intelligence score which gives the psychologist to the extent, presence and relative influences of any of the factors mentioned above. Wechsler Adult Intelligence Scale is the most administered IQ test. WAIS-R is an empirically sound intelligence test that was revised in 1981 and contains eleven tests, five nonverbal and six verbal. Its primary score is the intelligence quotient and can be used by individuals from age 16 to age 74 (Uher, 2013). Each of the 11 tests contains its scores and are conversions from raw scores compare to the reference groups. Neurologic testing may be used such as the Aphasia Screening Test and the Category Test to rule out organic brain syndrome. IQ tests not only answer about information and vocabulary but also taps into other different components of an individuals brain and thought process.

Personality Assessment

Personality is so complex usually developed through an individuals childhood and young adulthood. Personality Assessment helps the psychologist get a better understanding of a persons character. So many factors shape character ranging from genetic, social and environmental components. Personality assessment tests have put into consideration the rich texture and complexity of dispositions. The two major personality assessment tests used are objective and projective tests.

Objective Tests

They include MMPI-2 (Minnesota Multiphasic Personality Inventory), the Million Clinical Multiaxial Inventory-III (MCMI-III) and the 16PF. The most common one, however, is MMPI-2 which is a 567 true or false test that is used to measure personality dysfunction. It measures personality threats such as social introversion, psychopathology, paranoia, masculinity/ femininity, hypomania and so much more (Uher, 2013). The answer sheet is either hand or machine-score and can be used in the case of Mr. Martin. He will be asked questions then mark true/false as applied to him. The test contains eight clinical scales and four validity scales.

Projective Tests

The projective test that is commonly used is the Rorschach Inkblot Test. It includes ten symmetrical inkblots with five that are asymmetrical. Usually, the respondent is assured there are no right or wrong answers. He/she is given the one card after another and asked to describe what they have seen, and the tester records the responses verbatim (Uher, 2013). During the second phase, the responses are scored based on where the inkblot is located and its determinants. The Thematic Apperception Test (TAT) entails 31cards which depict people in different situations. The client is asked to tell a story about what they see in the cards, the characters thoughts, and feelings. It can be used to determine the recurring themes in the life of Mr. Martin.

Behavioral Assessment

It entails observation of the client in their natural setting to acquire more valuable assessment information. It can also involve observing and be measuring an individuals actual behavior to have a better understanding of the thoughts behind it. In the case of Mr. Martin, it will require observing how he behaves in the neighborhood or at home. It will help create a better picture of him and the setting and the way they function. It will assist in the better formulation of the treatment options. Self-monitoring can also be used when Mr. Martin will be asked to track their moods in the mood journal.

Psychological assessments entail so many different types of tests, techniques, and procedures. After carrying out the test, it will require compiling, interpretation, and write a personalized assessment report about the patient. The report will be around 2 to 3 pages long divided into four sections. The first section will include the description of Mr. Martins presentation and his test-taking behavior. The second one will contain his strengths and weaknesses, intellectual functioning, and availability of any organic symptoms. The third one will include his current social and emotional functioning. The final section will include the summary of the findings and the recommendations. All tests uniquely contribute to the overall clinical picture and will help in the interpretation of the results for proper examination and diagnosis.

Provide your diagnostic impressions (based on the DSM-5) for this individual. In narrative form, please describe how the individual meets the diagnostic criteria for the disorder(s) chosen in addition to the differential diagnostic thought process that you used to reach your hypotheses. Be sure to include any additional (missing) information that is needed to either rule out or confirm your differential diagnoses impressions

The Diagnostic and Statistical Manual Disorder (DSM) offers the standard language that psychologists use to communicate about mental disorders (Skodol et al., 2011; APA, 2013). Making a good differential diagnosis of borderline personality disorder 301.83 (F60.3) using DSM-5 entails the following steps.

Step 1: Ruling out Malingering and Factitious Disorder

This initial step will entail determining whether Mr. Martin is faking the symptoms maybe because he wants to avoid the responsibilities of his actions or he will get a psychological benefit from taking the role of a sick person. In Mr. Martins case, he was very talkative and enjoyed being interviewed and he was even quick to clarify and elaborate his point whenever it appeared unclear. He was very cooperative, and his explanations were compelling enough and in this case we rule out any malingering of factitious disorder.

Step 2: Ruling out drug-related disorders

Some drugs including both legal and illegal can result or cause personality disorder symptoms. Considering Mr. Martins narrative, he has been abusing drugs ever since he was the age of twelve, but around age nine or ten, he was already a heavy smoker. At the sixteen, he would drink on daily basis, smoke and do marijuana at the same time. He then started doing crack cocaine and heroin in his mid-thirties. The tremor on his would also...