Screening Tools and Testing Instruments

Transcription

1 Screening tools are meant to initially discover a potential problem in chemical use, dependency, abuse, and addictions. They are typically done in conjunction with a more in-depth assessment. For example, you are working in a mental health outpatient unit, and a client comes into your agency for the first time. Some of the questions in a psychosocial interview or in a psychological evaluation cover the family history of chemical dependency as well as the current use of substances by the client. The screening within the assessment asks questions such as drug/s of choice; use in terms of daily, weekly, monthly duration of use, as in how long the client has used each substance; and quantity of use in ounces, grams, and the like per incidence of use. If use is apparent, then a quick assessment tool such as the CAGE (based on four questions in an acronym for feelings about use such as the need to cut down, others annoyed you about quitting, you feel guilty about your use, eye opener needed in the morning to start the day), AUDIT (alcohol use disorders identification test), DAST (drug abuse screening test), SASSI (substance abuse subtle screening inventory), and finally the MAST (Michigan alcohol screening test), and its abbreviated forms (B-MAST for Brief MAST, S-MAST for Short MAST might be used). The MMPI is a psychological test that takes an afternoon to complete, or it can be divided into two sessions. However, the MMPI can uncover many hidden issues with the use of its many scales. Some of these are the validity scales where feigning mental illness can be detected. Also included are issues of deviance and a range of mental health issues from depression to anxiety and psychosis. It is an in-depth testing instrument that needs special training to score and interpret. A simple report using the MMPI is as follows. Often the MMPI is also administered with other tests such as the M-FAST and SIRS. EXAGGERATING SYMPTOMS Correctional Institution Results of Psychological Testing Inmate: Number: Tests: Guiness A XXX-XXX MMPI II, M-FAST, SIRS Date of Tests: 7/14-23/06, 7/20/06, 7/24/06 1

2 Date of Report: 8/4/06 Mr. Guiness is a 39-year-old African-American male who was referred for psychological testing to outpatient mental health services to determine severity of mental illness. Mr. Guiness s test results strongly suggest he is exaggerating symptoms as evidenced by his elevated scaled scores on the validity scales of the MMPI-II. The F and Fb scaled scores were marked elevated indicating he was attempting to present himself as severely mentally ill, which per test results would also be more consistent with patients hospitalized for psychosis. He also scored 13 on the M-FAST, which has a cut-off of 6 for feigning symptoms of mental illness. The SIRS results were inconclusive in most scales with a high score on the blatant symptoms scale of 13. A high score >10 on the BL scale indicates that the client is endorsing a very high proportion of symptoms associated with major mental illness. This elevated score may also be indicative of malingering because the contents reflect more obvious signs of a mental disorder. On the IA scale for improbable or absurd symptoms, he scored in the honest range. While records indicate he has a long history of contact with mental health issues, and his history supports symptoms of paranoid schizophrenia, testing clearly indicates he is most likely exaggerating mental illness. However, this does not exclude the possibility that he exhibits traits of a cluster A personality disorder. He presented with a marked level of paranoia as evidenced by his mental status at the time of each testing session, which was highly suspicious in nature over a variety of contexts. In conclusion, while F and Fb scores greater than 100 can be indicative of serious psychopathology and possible organicity, the overwhelming evidence in his responses appears to be made to grossly exaggerate his symptoms and the resulting protocol must be considered invalid. Date MINIMIZING SYMPTOMS Results of MMPI II Inmate Name: Andrews Examiner: Inmate Number: A XXX-XXX Date(s) Exam June 12, 2

3 2006. Mr. Andrews is a 53-year-old White male who was referred for psychological testing to determine severity of mental illness. Mr. Andrews test results strongly suggest he may be more defensive than the average person. It also suggests that he presents himself in a favorable light and denies psychopathology to maintain the appearance of adequacy, control, and effectiveness. The elevated K scaled score suggests he is denying symptoms and problems. The elevated L scaled score indicates an increased likelihood that he is trying to present a picture of himself as honest, moral, and conforming. The congruent elevations on scaled scores for psychopathic deviate and paranoia may tentatively suggest a profile indicative of a poorly adjusted person motivated to appear well adjusted. This is further evidenced by a lowaverage scaled score for schizophrenia in which the questions are less subtle and thus more recognizable to the test taker. However, any interpretation is limited by poor validity. Records state he has a history of hospitalizations in the community that indicate symptoms of delusional psychosis. Testing indicates he is most likely minimizing his symptoms due to paranoia. Date VALID TEST RESULTS Correctional Institution Mental Health Services Results of the Diagnostic Assessment Inmate: Glass Instruments: MMPI-2, MFAST, SIRS Number: XXX-XXX Presentation/Validity Scales: 3

4 Mr. Glass presented with noticeable signs of depression and anxiety with congruent effect. He appeared distressed and exhibited abnormal, delusional perceptions regarding persecutory voices he hears through the vents and flooring, which he clearly stated were factual and real. While he denied current lethality, Mr. Glass admitted to the possibility of increasing his potential risk to act on suicidal ideation depending on the situation. He further discussed a long history of pathologic behaviors, which he is unable to claim any responsibility. He reported a number of symptoms that reflect a psychotic process. Mr. Glass s MFAST was well below the cut-off score for feigning mental illness. A majority of his scores on the SIRS Primary Scales were in the Indeterminate Range with the remainder in the Honest Range of responses. However, in the SIRS, he exhibited some difficulty in concentration and memory with minimal ability in abstract thinking. The MMPI-2 Validity Profile was unremarkable and suggests a valid profile. His elevated score on the Fb (Infrequency/Back) is more suggestive of fatigue with the last half of the test. All other validity scales are normative to a person who attempted to give honest responses to the test questions. Therefore, further exploration of his clinical scales is appropriate in lending clarification regarding Mr. Glass s mental illness. Clinical Scales: Mr. Glass scored the highest elevation on scale 6 (paranoia) followed closely by scale 8 (schizophrenia). The code type 68/86 is suggestive of a person who is experiencing severe emotional distress characterized by dysphoria, agitation, worrying, and anhedonia. The third elevated score was on scale 4 (psychopathic deviate). In conjunction with the elevations on scales 6 and 8, Mr. Glass s profile becomes even more pathological. This is further evidenced by the relationship between scales 7 and 8, which are strongly suggestive of severe psychopathology with a chronic thought disorder. Further, the correlation between scale 4 and scale 3 (hysteria) indicate that Mr. Glass is more likely to act out his problems impulsively. Scale 4 and 6 are elevated above the normal range, which further suggests he has intense unresolved anger. Further, this profile exceeds Peterson s diagnostic signs that are characteristic of psychotic (schizophrenic) MMPI patterns. Conclusion: This profile appears to be valid and is consistent with his presentation that is strongly suggestive of a person who has paranoid delusions. These patients generally feel hopeless and have sleep difficulties, which exacerbate their 4

5 problems. They are likely to experience suicidal ideation as well as poor impulse control and need to be monitored carefully. The nature of his illness appears to be a long-term, chronic mental illness which is substantially characterized by a chronic, paranoid thought disorder, more specifically typical of schizophrenia, paranoid type. date 5