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>>>>>PSYCHOLOGICAL
IMPAIRMENT VIGNETTE
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VIGNETTE:
Allen Brown is a 24 y/o white
male. He has had problems with depression and auditory
hallucinations off and on since he was 18. Currently he is
feeling very depressed, worthless, and hopeless. He is
having self-deprecating hallucinations that frequently tell
him how inadequate he is and how no one cares about him. He
understands that the hallucinations are not real; however,
he still feels very tormented by them. His deterioration
appears to be associated with his stopping his medication
because he was doing well and felt he didn't need the
medication.
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KENNEDY AXIS V -
PSYCHOLOGICAL IMPAIRMENT
100
Superior
Psychological Functioning/Coping, no psychological
impairment; life's everyday problems never seem to lead to
any significant anxiety or depression.
No Symptoms.
90
Absent or
Minimal Symptoms (e.g., mild anxiety before an exam),
good psychological functioning in all areas; interested and
involved in a wide range of activities; generally satisfied
with life; no more than everyday problems or concerns.
80
If Symptoms
Are Present, They Are Transient and Expected Reaction to
Psychosocial Stressors (e.g., upset by breakup with
girlfriend; difficulty concentrating after family argument;
mild preoccupation with problems; a woman has many friends,
functions extremely well at a difficult job, but says “The
stress is too much.”); not considered to have mental
problems by those who know him/her.
70
Some Mild
Symptoms (e.g., depressed mood with mild insomnia,
occasional truancy, theft within the household, difficulty
trusting others, mild insensitivity to the feelings and
needs of others), but generally functioning fairly well;
however, those who know him/her well might express some
concerns about his/her mental state.
60
Moderate Symptoms
(e.g., flat affect and circumstantial speech, occasional
panic attacks; frequently preoccupied; moderate impairment
in attention span); moderate insensitivity to the feelings
and needs of others; to those who know him/her well it is
clear the he/she has mental problems.
50
Serious Symptoms
(e.g., moderately depressed mood, moderate lethargy, severe
obsessional rituals, severe phobia, severe sexual
perversion, moderate problems with anorexia/bulimia,
frequent shoplifting, frequent anxiety attacks, moderately
guarded, mild but definite manic syndrome).
40
Major
Psychological Impairment; some impairment in reality
testing or communication (e.g., speech is at times
illogical, obscure, or irrelevant; moderate paranoia; may
have hallucinations or delusions; however, probably realizes
they are not a part of reality); major impairment in several
areas, such as judgment, thinking, or mood (e.g., depressed
man avoids friends, neglects family, and is not motivated to
work or moderate negative symptoms of schizophrenia); even
to those who do not know him/her well would likely consider
him/her to have mental problems.
30
Behavior Is
Considerably Influenced by Delusions or Hallucinations;
appears to be responding to hallucinations; serious
impairment in communication or judgment (e.g., sometimes
incoherent, thinking is occasionally grossly inappropriate);
severely depressed mood; withdrawn with few spontaneous
communications; inability to function in almost all areas
(e.g., stays in bed all day and does not care for own living
space; no job, home, or friends due to paranoia, poor
motivation, social withdrawal, extremely poor insight and/or
being almost totally insensitive to the feelings and needs
of others); at times attention span is markedly impaired;
Severe Sociopathic
Behaviors Have Lead to Multiple Arrests; severe sexual
perversion toward prepubescent children.
20
Thinking
and Communication Are Generally Grossly Impaired; manic
excitement or catatonia; largely incoherent or mute;
generally markedly impaired attention span; occasionally
fails to maintain minimal personal hygiene due to severe
lethargy or very disorganized, bizarre thinking (e.g., too
lethargic to attempt to wipe food off one’s shirt; smears
feces for bizarre, delusional reasons).
10
Thinking Is
Totally Disorganized; totally insensitive to the
feelings and needs of others; completely incoherent;
completely mute, extremely catatonic; persistent inability
to maintain minimal personal hygiene or minimal safety due
to totally disorganized thinking or
Very Severe Lethargy;
unable to focus attention for even a few seconds; chronic,
self-induced vomiting has lead to a very life threatening
situation.
NR
Not Rated
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