The Elements of Psychological Case Report Writing in Australia

Nadine J. Pelling, Lorelle J. Burton, Nadine J. Pelling, Lorelle J. Burton

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780815367185
• eBook ISBN: 9781351258029
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The Elements of Psychological Case Report Writing in Australia is a comprehensive and applied review of material required for basic case conceptualisation and report writing in Australia. This book is the first of its kind to offer a one-step resource to success in submitting concise case reports that demonstrate basic applied psychological competence. For anyone looking to submit case reports to the Psychology Board of Australia to support their application for general registration this is an absolute must-have resource.

Most notably this book provides:

Numerous assessment focused and intervention focused case report examples:

• A presentation of case report requirements for 4+2 and 5+1 internship programs;
• A review of important case conceptualisation areas necessary for applied psychological understanding;
• Time management tips and guidance for making focused progress on the production of required case report and avoiding procrastination.

Both early career and experienced psychologists will find the case reports illustrative of various assessments and interventions in applied psychology in Australia. No other resource has collected together in one place multiple case reports illustrating the use of so many assessment instruments nor such a variety of interventions for the treatment of psychological difficulties in Australia.

Part B

Assessment cases

5	Using the PAI for evaluation of substance use and comorbid depression and anxiety

Deah Abbott and Caleb W. Lack

Case details

• Diagnosis: substance use, depression, anxiety
• Client Age: 30
• Client Gender: M
• Occupation: barrister and solicitor
• Number of Sessions: 1
• Place of Treatment: private practice
• Treatment Approach: assessment
• Treatment Mode: not applicable

Background

Lachlan Q. is a 30-year-old single Caucasian male who was referred to the psychologist by his general practitioner for a substance abuse assessment. In the referral, the practitioner reported that Lachlan had back surgery two years ago and was placed on muscle relaxers and painkillers at that time. After the surgery and an expected recovery period, though, Lachlan continued to call in and state that he needed more pills to control his pain. The doctor eventually discontinued the prescription, concerned that Lachlan was abusing the painkillers. At his most recent appointment, Lachlan reported that even though his back has healed, he can’t seem to cope with life without taking medication and so he has been self-medicating. Lachlan reported to the psychologist that he feels “out of control” and is having trouble going to work or social functions without taking something to “take the edge off.” He was seen for only one session.

Assessment

Lachlan reported having frequent difficulty concentrating at work and reported feeling less and less interested in spending time with friends and engaging in other activities he used to enjoy. Lachlan states that he worries about work and the future frequently, and sometimes wonders if it is all “worth it.” Lachlan reports feeling sad and worthless much of the time. Though Lachlan’s work in a large law firm has been previously praised as superior, he has received criticism for making “sloppy mistakes” and missing deadlines in the last six months. Lachlan expressed concern that his work is slipping because he has been taking medication both before and during work to cope. Lachlan reports consuming several alcoholic drinks most nights and taking prescription medication (primarily Oxycodone and Diazepam) during the day. During the assessment, Lachlan sat with slumped shoulders and frequently looked down at the ground when he was not maintaining eye contact with the psychologist.

Lachlan stated that he had an unremarkable prenatal, infant, and childhood history and that he met all physical and social milestones. Lachlan began working at a large medical malpractice defence firm shortly after completing law school, after graduating in the top 10% of his class. He has worked at the firm since that time and is a senior associate who is on a partner track.

Lachlan currently lives alone in a studio apartment in downtown Sydney. Lachlan has never married, but prides himself in being able to “pick up” ladies from bars or using smartphone dating apps. Lachlan has not been in a serious dating relationship since his girlfriend of five years broke up with him shortly before he received back surgery. While he stated that he has “lots of friends,” Lachlan followed that up by saying that over the past year or so he rarely goes out with them or has them over to his apartment.

Lachlan has no criminal record or history of receiving psychiatric services, but was not very forthcoming about if or how much difficulty he has had with emotional or behavioural issues in his life. Medically, he reported that he was generally in good health but has had one surgery, a back surgery for a slipped disc, which took place approximately two years ago. He reports that went well and that he has fully recovered at this point. Lachlan reports that he has been a heavy drinker on the weekends and occasionally on week nights since he was 19 or 20 years old and attending university. After receiving back surgery and recovering, Lachlan continued taking Oxycodone and/or Diazepam to “take the edge off” his stress and help him relax. At first he did this primarily in the late afternoon or evening, but for the last six months he has taken pills every day, throughout the day.

After the initial intake interview, and given Lachlan’s self-reported difficulties with both substance use and a number of other mental health concerns, the psychologist decided to use the Personality Assessment Inventory (PAI; Morey, 1991) to assist in the evaluation. Lachlan completed the PAI at the psychologist’s office. The PAI is a self-administered, objective inventory of adult personality designed to provide information on critical clinical variables to screen for psychopathology. The PAI was specifically administered because little was known about Lachlan’s mental health history and he had difficulty describing his mental state. The PAI offers a broad picture of behavioural, affective, and cognitive factors that assist in diagnosis and treatment planning. The PAI contains 344 items which comprise 22 non-overlapping full scales: four validity scales, 11 clinical scales, five treatment scales, and two interpersonal scales. The scales are presented in the form of linear T-scores, with a mean score of 50 and a standard deviation of 10. Scores and interpretations are presented in Tables 5.1 and 5.2 below, with significant scores presented in bold.

Table 5.1 PAI validity scales and scores

Validity Scales	Scale Abbreviation	T-Score	Range
Inconsistency	ICN	52	Normal Limits
Infrequency	INF	59	Normal Limits
Negative Impression	NIM	59	Normal Limits
Positive Impression	PIM	53	Normal Limits

Table 5.2 PAI clinical scales and scores

Clinical Scales	Scale Abbreviation	T-Score	Range
Somatic Complaints	SOM	60	Mild Elevation
Anxiety	ANX	72	Moderate Elevation
Anxiety Related Disorders	ARD	67	Mild Elevation
Depression	DEP	81	Moderate Elevation
Mania	MAN	51	Average Score
Paranoia	PAR	51	Average Score
Schizophrenia	SCZ	58	Average Score
Borderline Features	BOR	64	Mild Elevation
Antisocial Features	ANT	58	Average Score
Alcohol Problems	ALC	73	Moderate Elevation
Drug Problems	DRG	89	Marked Elevation

As shown in Table 5.1, the PAI results provide four validity scales which can identify if the test responses indicate factors which could distort the results of the test. The validity scales provide information on Lachlan’s response style. According to these scales, Lachlan’s responses did not appear to be the result of inconsistent answering, nor endorsement of infrequently answered items, nor attempts to present an exaggeratedly negative or positive view of himself. In short, there is no indication that the results of this assessment are skewed or are demonstratively inaccurate.

In regards to the clinical scales on the PAI (see Table 5.2), Lachlan scored in the moderate or marked elevation range on four scales: Drug Problems (DRG), Depression (DEP), Alcohol Problems (ALC), and Anxiety (ANX).

The DRG scale addresses behaviours and effects of drug use, abuse, and dependence. Lachlan’s marked elevation on DRG likely indicates drug dependence, extended periods of drug use, and symptoms of abuse and withdrawal. The ALC scale addresses behaviours and effects of drug use, abuse, and dependence. Lachlan’s moderate elevation on this scale indicates that his current functioning is likely compromised by his drinking and he likely meets criteria for alcohol abuse.

The DEP scale assesses features such as pessimism, feelings of unhappiness or apathy, negative expectations, and physiological symptoms such as difficulty sleeping, all of which are associated with depression. Lachlan’s moderate elevation in DEP indicates that he has withdrawn from previously enjoyable activities (which matched what he reported during the interview) and is experiencing dysphoria. The ANX scale indicates a person’s level of tension and negative affect as expressed by three subscales which assess anxiety-related cognitive, affective, and physiological features. Lachlan’s moderate elevation on this scale indicates that he may be experiencing significant anxiety in regards to tension, worry, and/or somatic concerns.

Lachlan’s high scores on the DRG, ALC, ANX, and DEP scales together indicate that he fits the Cluster 4 criteria on the PAI. Individuals in Cluster 4 typically have a history of acting out in multiple areas, especially in substance abuse behaviours. These actions often lead to significant impairment in social and vocational roles. These behaviours often alienate the individual from peers and family members. Many Cluster 4 individuals have impulsiv...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Contributor information
• Part A: Introductory information
• Part B: Assessment cases
• Part C: Intervention cases
• Index