PS380 Unit 4 Clinical Interview and Assessment Paper Example

The Electrician Who Thought It Was His Heart: A PS380 Unit 4 Clinical Interview and Assessment Paper

[Student Name]

Purdue University Global

PS380: Clinical Psychology

Unit 4 Clinical Interview and Assessment Paper

[Instructor Name]

[Date]

The client, the clinic and the scores are composite; the measures and manual cited are real.

Referral

Travis is a 34-year-old maintenance electrician at a taconite processing plant on Minnesota's Iron Range. He was referred to our clinic by his family physician after two emergency room visits in six weeks for chest pain, a pounding heart, air hunger and a sudden certainty that he was dying. Both times his heart tests were normal, and the emergency physician suggested he might be having panic attacks. Travis was skeptical but agreed to an intake appointment.

I observed the intake as part of my training, with Travis's consent. Dr. Lund, our clinic's licensed psychologist, conducted it. This paper describes the interview, the mental status examination and the screening measures, interprets the results and explains the provisional diagnosis and its limits.

The Interview

Dr. Lund used a semi-structured intake interview, moving from open questions to specific ones. She began by asking Travis what brought him in, in his own words. He said that his heart had been acting up and that his doctor thought it was nerves.

The history that followed was detailed. His first attack came seven months earlier while he was climbing a ladder in the crusher building, about forty feet up, during a routine inspection. His chest tightened, his hands tingled and he became convinced he would pass out and fall. He climbed down, sat in his truck for an hour and drove to the emergency room. Attacks now come roughly twice weekly, on shift and off, including one that woke him from sleep. He now arranges his schedule to avoid high work, has stopped driving on the highway to Duluth and checks his pulse many times a day.

Dr. Lund then asked about mood, sleep, substance use, medical history, family history and safety. Travis described his mood as frustrated rather than sad. He sleeps about five hours a night. Most evenings now involve six to eight beers, up from two or three before the attacks began, because beer helps him calm down. He has never seen a counselor or taken medication for his nerves. His mother had anxiety. He denied any thoughts of suicide or harming others.

The most important finding of the interview came not from a symptom question but from asking how he copes, which revealed a doubling of his drinking.

Mental Status Examination

The mental status examination is a structured description of a client's presentation during the interview. Travis arrived on time in work clothes, with good hygiene. He was cooperative but tense, sat near the edge of his chair and shook his leg throughout. His speech was unremarkable. Asked about his mood, he answered on edge, and his affect was anxious and restricted, brightening when he talked about his daughter. His thought process was logical and goal-directed. His thought content focused on fears of a heart problem; there was no evidence of delusions or hallucinations. He was alert and oriented, with intact memory and concentration. His insight was partial; he accepted that anxiety might play a role but still suspected a hidden heart problem. His judgment was fair.

Screening Measures

Travis completed three screening measures in the waiting room. Each measure flags symptoms; none provides a diagnosis on its own.

The PHQ-9 asks how often each of nine depressive symptoms bothered the client over the prior fortnight, giving a total out of 27; its authors set bands at 5 for mild, 10 for moderate, 15 for moderately severe and 20 for severe (Kroenke et al., 2001). Travis scored 9, in the mild range, with points mostly from sleep, fatigue and concentration. Those items overlap with anxiety and with heavy drinking, so the score does not by itself suggest a depressive disorder.

The GAD-7 covers seven generalized anxiety symptoms over the same fortnight, totals out of 21, and uses 5, 10 and 15 as cutoffs for mild, moderate and severe anxiety (Spitzer et al., 2006). Travis scored 13, in the moderate range. Its developers noted that the GAD-7 also performs reasonably well as a screen for panic disorder, so a moderate score is consistent with what he described.

The Alcohol Use Disorders Identification Test asks ten questions about consumption, dependence symptoms and alcohol-related problems over the past year, scored from 0 to 40 (Saunders et al., 1993). Travis scored 16. Scores of 8 or more are generally considered to indicate hazardous or harmful drinking, and scores of 16 to 19 are often treated as a level calling for brief counseling and continued monitoring. His answers showed high consumption and drinking to calm down, but no morning drinking or blackouts.

Differential Diagnosis

Dr. Lund considered several explanations. Panic disorder, in the DSM-5-TR, requires panic attacks that recur and arrive unexpectedly, plus a month or more in which the person either worries steadily about the next one or reorganizes daily life to prevent it (American Psychiatric Association, 2022). Travis's history fits: some of his attacks came without warning, including one that woke him, and he has changed his work and driving to avoid them.

Generalized anxiety disorder was less likely, because his worry focuses on his heart and the attacks rather than on many areas of life. A medical cause had been largely ruled out by two normal cardiac workups, though Dr. Lund asked his physician to check his thyroid. The most important alternative was alcohol. Heavy evening drinking can produce morning withdrawal symptoms, including anxiety and a racing heart, and could worsen or even cause some of his attacks. The timing helped here: his first attack came before his drinking increased, which suggests that drinking followed the panic rather than causing it.

Dr. Lund recorded a provisional diagnosis of panic disorder and noted hazardous alcohol use to be assessed further. She did not diagnose an alcohol use disorder at intake, choosing to gather more history first.

Limits of the Assessment

The assessment has clear limits. Screening measures rely on self-report, and Travis may have underreported his drinking. A single interview captures one day. A structured diagnostic interview, such as those designed for anxiety disorders, would provide more reliable diagnostic information, and Dr. Lund planned to complete one at the second session. Finally, his partial insight means that his account of symptoms is filtered through his belief about his heart.

Conclusion

Travis's intake shows how an interview, a mental status examination and screening measures work together. The interview gave the history that fits panic disorder, the examination showed anxiety and partial insight, and the screening measures added numbers that had to be read against that history. The AUDIT score, which would not have come up if Dr. Lund had not asked how he copes, will shape the next step in his treatment.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092