Depression and Psychosis: 32-Year-Old Female Patient Report (Assessment)

Reason for Referral and Background Information

The given scenario focuses on a 32-year-old woman who works as an administrative assistant for the local college. The client’s family history has no records of suicides or any other psychological disorders. She admitted one year ago for possible depression and suicidal ideation. It should be stressed that she presents with the signs of major depression and potential psychosis. This paper aims at analyzing the client’s personality assessment, the use of related instruments, and test interpretations to determine their relevance to the presented case.

Assessment Procedures

There is a range of assessment tools that may be applied to the identified scenario, and the following of them are noted:

• Minnesota Multiphasic Personality Inventory-2 (MMPI-2);
• Review of Prior Psychological Assessment;
• Mental Status Examination;
• Review of Prior Medical Records;
• Clinical Interview.

In addition to the abovementioned tools, there some others that also seem to be appropriate to reveal the client’s needs and respond to them adequately:

• Myers-Briggs Type Indicator (MBTI);
• Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF);
• Personality Assessment Inventory (PAI).

Each of the mentioned instruments may be related to the given client as they are relevant enough to address her current needs. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is known as the measurement option applicable to adults who need cognitive functioning diagnostics, focusing on forensic psychology and assisting in the identification of a differential diagnosis. Specifically to this scenario, one may state that it is one of the most valid, standardized, and culturally-sensitive measures. At the same time, Baum Linda and Haber Jonathan (2014) emphasize that Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a more updated and detailed version of the personality test, consisting of 367 questions that are useful to detect depression, paranoia, et cetera. In this regard, it is possible to assume that MMPI-2-RF will be more effective for this client.

The review of prior psychological assessment is an initial evaluation of a client’s symptoms capabilities, and behavior. It is useful for understanding a person’s condition through interviews and informal assessments, which are beneficial to reveal necessary information about family history, previous states, and any other pertinent data. However, the Personality Assessment Inventory (PAI) seems to be more a more reliable personality assessment test, paying attention to psychopathological syndromes. As reported by Weiner and Greene (2017), it is marked by convergent validity with MMPI-2. The reliability of PAI is supported by the statistical strength and well-designed methodology.

The review of prior medical records, mental status examination, and clinical interviews are also important yet not as informative as the above tools. Even though they may show the change in the client’s condition, the additional tests are necessary to properly diagnose her. In this connection, the Myers-Briggs Type Indicator (MBTI) may be utilized to ensure an appropriate understanding of the client’s feelings and way of thinking. Based on Carl Jung’s ideas, MBTI focuses on intuition, sensation, thinking, and feelings, thus evaluating such issues as perception and judgment pertinent to the personality (Fretwell, Lewis, & Hannay, 2013). Nevertheless, not all existing tools apply to the given client since her situation requires scrutinizing depression symptoms, suicidal ideation, and psychotic features. For example, Disc assessment, process communication model, or Hexaco Personality Inventory would not be useful for the given case as they target some other needs and areas to be explored and understood.

General Observations and Impressions

The client under assessment appears alert and oriented as she properly answers the questions being asked. At the same time, Jane’s behavior is adequate and attentive to the very process of evaluation. Even though the results of the tests reveal the signs of depression, it is difficult to note them as per the general observation. Nevertheless, one should take into account that the client may be introverted and hide her emotions during communication with a counselor or a psychologist. Weiner and Greene (2017) argue that depression may not be evident at first glance, while various factors may affect its development. In this client, it may be relationships with others or her background that caused depression. Therefore, it is important to refer to tests and understand the key reasons that impact Jane (Weiner & Greene, 2017). Such behavior may turn out to be adverse regarding the results of the assessment as currently there is a discrepancy between the overall appearance of the client and her test outcomes.

Speaking of the American Psychological Association’s (APA) Ethical Principles and the Code of Conduct, one may stress the Section 9. In particular, it clarifies the way the counselors should act and speak during personality assessments. While asking questions and interpreting the results, they should be culturally competent and sensitive to any other personal features that impact clients. For example, relationships with the family or partners may be a difficult theme to speak about, when it comes to this client. More to the point, one may suggest that her attitude to work also seems to be controversial. Even though she states she is quite satisfied with her job, it is still unclear whether she has any workplace-related conflicts and challenges or not. The scenario observation shows that the ethical principles mentioned above were followed, and the client felt relatively comfortable during the evaluation.

With the above analysis in mind, it is safe to claim that the assessment is valid yet incomprehensive. There is a need to conduct a further evaluation to align the client’s behavior and her test results. It is possible to assume that long questionnaires may be ineffective in this case, while an open-ended interview may be more suitable. Consistent with Gustafsson Jertfelt, Blanchin, and Li (2016), one may emphasize the role of open-ended questions in providing culturally-competent assistance. The issues that are essential to this client seem to be better revealed through such an approach, which is caused by the opportunity to express feelings and thoughts that concern the client.

Test Results and Interpretations

The assessment tests take about the given client to demonstrate depression signs, low self-esteem, and inadequate emotional control. First of all, it is critical to identify the results that indicate that the client has depression. There are increased levels of Depression (T = 94) and Psychasthenia (T = 92), which point to her dissatisfaction with life and a low adjustment level. Similar results are illustrated by Harris-Lingoe’s subscales on depression along with the social Introversion scale. The anxiety levels are also high, which shows that the client feels unsafe and perceives the world as dangerous and hostile (Malone & García‐Penagos, 2014). Such an attitude to the environment and people may be characterized as potentially contributing to suicidal ideation. Evans-Lacko and Knapp, (2014) state that people with depression are less likely to show openness and readiness to dialogue, while they need to see that counselors are sensitive to their needs. The consideration of other findings seems to clarify the client’s condition in an in-depth manner.

It is important to note that Jane has low self-esteem and poor reaction to stress due to their low ego. In other words, any stressful situation may significantly affect her and cause negative consequences. While having inadequate self-concept, she is also prone to insufficient emotional control, which is expressed in such feelings as despair and hopelessness. If any person may encounter these feelings, their frequent experience signalizes that the client is in depression. Her interpersonal relationships with the family members and partners seem to be poor and lacking confidence, which means that her communication abilities are not strong enough to build effective connections with people. More to the point, she has limited psychological resources to support her emotional state and keep it comfortable. It is also essential to pinpoint the fact that psychological resources are useful while facing emotional challenges.

The situation when low self-esteem is aligned with the depressive signs as in this client may be especially dangerous to his or her emotional state. In particular, it should be stressed that the lower the self-esteem indicators, the higher the risk of suicidal ideation, and the associated consequences (Heo, Jeong, & Kang, 2018). Furthermore, some complications such as the inability to establish proper relationships may also worsen the existing situation and lead to additional signs, including paranoia, hysteria, and so on. Heo et al. (2018) consider low self-esteem seriously affects the quality of life, a sense of happiness and joy, and, often, leads to depression. The main problem of low self-esteem is that it creates a vicious circle of feelings, thinking, and behavior, which leads to an even greater reduction in self-concept (Heo et al., 2018). Also, such people often behave in a way that leads to confirmation of their negative thoughts about themselves and even lower self-esteem.

The review of the test results shows that the client is likely to be resistant to the therapy options that would be selected upon the completion of this interpretation. Therefore, the most relevant options should be chosen and agreed upon with Jane. As for the social dynamics, the parents’ conflicts and divorce seem to largely affect her. In this context, it may be difficult to overcome feelings of anxiety and depression (Hasking & Rose, 2016). In the view of the mentioned observations, one may argue that this client has suicidal and depressive symptoms, and she should receive the corresponding therapy. Even though she is not dangerous to society at this moment, her condition is alarming and may deteriorate if left without attention.

Summary and Recommendations

To sum it up, the given scenario assessment revealed that the client encounters depression signs and she is at high risk for suicidal ideation. To understand the reasons for her current condition, it is necessary to take additional tests such as Myers-Briggs Type Indicator (MBTI), Personality Assessment Inventory (PAI), or Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Even though the tests that were already provided to this client indicate her self-esteem, perception of others, and other related issues, it is still unclear how to address them most appropriately. Therefore, group sessions with a counselor may be recommended to help her in becoming more open to the therapy. At this point, the group members should have similar problems with depression, which will allow the client to feel more involved and less hopeless.

References

Baum Linda, J., & Haber Jonathan, C. (2014). Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) scales as predictors of psychiatric diagnoses. South African Journal of Psychology, 44(4), 439-453.

Evans-Lacko, S., & Knapp, M. (2014). Importance of social and cultural factors for attitudes, disclosure, and time off work for depression: Findings from a seven-country European study on depression in the workplace. PLoS One, 9(3), 1-10.

Fretwell, C. E., Lewis, C. C., & Hannay, M. (2013). Myers-Briggs type indicator, A/B personality types, and locus of control: Where do they intersect? American Journal of Management, 13(3), 57-66.

Gustafsson Jertfelt, I. H., Blanchin, A., & Li, S. (2016). Cultural perspective in open-ended interviews–The importance of being adaptable. Culture & Psychology, 22(4), 483-501.

Hasking, P., & Rose, A. (2016). A preliminary application of social cognitive theory to nonsuicidal self-injury. Journal of Youth & Adolescence, 45(8), 1560-1574.

Heo, E. H., Jeong, S. H., & Kang, H. Y. (2018). Comparative study on personality assessment inventory and MMPI-2 profiles of groups with high and low depression and suicide ideation in psychiatry patients and discriminant variables of depression and suicide ideation. Journal of Korean Neuropsychiatric Association, 57(1), 86-95.

Malone, J. C., & García‐Penagos, A. (2014). When a clear strong voice was needed: A retrospective review of Watson’s (1924/1930) behaviorism. Journal of the Experimental Analysis of Behavior, 102(2), 267-287.

Weiner, I. B., & Greene, R. L. (2017). Handbook of personality assessment (2nd ed.). Hoboken, NJ: John Wiley & Sons.