Discussion on competency assessment

how to do COMPETENCY ASSESSMENT
I need you to write COMPETENCY ASSESSMENT, for Susan’s psychological report. Please start with the templet provided, then follow the Rubric and watch her interview, so you can write the report bast on her answers. There is also another video you can watch that explain the way you should write this paper. let me know if you got all the info that i tried to send.thank you

Psychological Report for Ms. Susan Wilson

 

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NAME OF EVALUATOR: Bayan Alabaishi

 

REASON FOR REFERRAL:

This report is a psychological analysis for a diagnostic clarification of 27-year-old Ms. Wilson. Ms. Wilson has been charged with malicious wounding, child abuse and resisting arrest at Arlington County Police department.

 

 

NON-CONFIDENTIALITY STATEMENT:

Ms Wilson was informed at the onset of each evaluative session of the voluntary nature of this evlauation as well as the limits of confidentiality. She was informed that all the information gathered during this evaluation had the potential to be included in a report that would be submitted to the Court. Ms. Wilson understood the non-confidentiality of the evaluation, its voluntary nature, and agreed to participate.

SOURCES OF INFORMATION

  • Susan’s police report number ARL-18-498273.
  • Terrance’s witness statement.
  • Victim statement.
  • The initial police interrogation.
  • The jail incident reports.
  • The behavioral observations interview was at Arlington County Jail on Day 16.
  • The competency evaluation recording

 

BACKGROUND INFORMATION:

The witness/victim report number ARL-18-498273 by officer Ted Fryberger at Arlington County Police Department indicates that Wilson Susan is accused of malicious wounding, child abuse and resisting arrest. She was arrested following a 911 call at 16:26hrs on day five by her 10-years-old son who had witnessed his mother stab his younger eight-year-old brother severally. Jason Wilson hit his mother with a lamp and dragged his brother into her mother’s bedroom and locked the door. Jason had stated that his mother was yelling while attempting to break into the bedroom. The emergency department dispatched officers Fryberger, Fox and Rahaim. When the officers arrived at the apartment, they found Ms Wilson Susan still yelling at her son and banging the door while saying “Open this damn door Jason, the Devil is coming for you both.” The officers broke in after an unsuccessful communication with Ms Wilson. When the door was opened, they found Ms Wilson still banging the door while holding a knife. She failed to comply on the request to drop the knife prompting the officers to deploy the taser. She dropped the knife and fell. She was cuffed by officer Rahaim.

The medical team arrived, and while they attended to Jason and Peter, Ms Wilson was struggling to get out of her cuffs saying that the little children were not safe and that she should be released so that she can kill them. While being transported to the police station, Ms Wilson kept saying strange things. She claimed that the young children would spend their lives in hell and it would be the fault of the police. The medical team managed to stabilise Wilson Peter and transported him to Virginia Hospital Center. Jason’s statement corroborated police report. Statement by Mr Terrance Jackson indicated potential mental instability. Mr Terrance thought that she disliked him because he was black hence her unwelcoming nature. The Poice interrogation reveals that she is mentally unstable.

 

 

SUMMARY OF INSTANT OFFENSE

Ms Wilson stabbed her son Peter, 14 times. Her elder son managed to hit his mother with a lamp, and dragged Peter in the room, locked it and called the 911. When the police arrived, they broke into the house and found Ms Wilson still holding the knife and attempting to break into her bedroom where the children had locked themselves. The police deployed the taser and restrained Ms Wilson, who had not responded to their call to drop the knife. While being moved to the police station, she claims that the police should allow her to kill them. She claimed that they would spend eternity in hell, and that would be the fault of the police. Neighbours had noticed her erratic behaviour, and on the day of her arrest, Mr Jackson reported to the police. Her responses to the police interrogation also prove that she is mentally disturbed. This report affirms that Ms Wilson is mentally disturbed.

 

 

BEHAVIORAL OBSERVATIONS:

“Clinical Interview” video: On “Day 16” at 14:30 hours in Arlington County Detention Center, in which the interview occurred, Susan was setting in a chair and there was a table in front of her. The room had yellowish wall and the light were kind of bright.

Appearance

Susan was wearing an orange jail uniform. Her hair was messy, and it wasn’t tied. She didn’t make any eye contact. In fact, she was looking around and blinking a lot. Also, under her eyes, were so red, that she looked so sick. Moreover, even though Susan is 27, she looks like she is younger from the way she talks.  She doesn’t look stable or normal by the way she moves her body and also, she move her hand around her hair a lot.

 

Behavior

Susan was respectful, she didn’t curse or yell at anyone. Susan’s movement was abnormal, she moved her body very often. Susan didn’t do any eye contact. In addition, she was looking everywhere but not to the people’s eyes. Susan’s rate of movement would be 8/10.

 

Mood and Affect:

Susan’s range affect was limited in some moments. For example, when she was asked if she have ever been in the hospital for anything other than her gallbladder surgery and her son’s birth, she didn’t reply, and she was only staring. On the other hand, her affect stability was normal because her affect changed in the right time. Susan’s affect was appropriate because she wasn’t happy in the interview and she did express a normal reaction, because she wasn’t laughing in the interview. Susan’s mood affect changed depending on the topics discussed in the interview. For example, in the beginning of the interview, when she was investigated, she was asked if she know why she is here. Susan was moving her body a lot and she was asking how I knew her name. After almost one minute, her mood changed when I asked her “can you tell me more about the lights.” Then, she started talking about the noises under her house and more. Susan than looked more comfortable, because she started to express her feeling, when she was asked too. Susan’s mood changed when the topic changed from investigating her to listing to her talking.

 

Speech

The rate of Susan’s speech is normal, she didn’t speak so fast or too slow. And the volume of her voice also normal, she is not too loud or even whispering. Her speech was clear, when it comes to her pronunciation. However, it is unclear when it comes to the quality of the speech, because her answers were unrelated to the questions that were asked to her. When it comes to her quantity of speech, it can be said that she talked a lot in the interview.

 

Cognition

In the interview Susan aperid in some moment that she is having hard time paying attention, concentrating, and remembering things. An example about her short-term memory, she asked “didn’t you say they were goanna turn off these lights?” and I told her that I couldn’t turn off the lights and I asked her “do you remember me saying that just a second ago?” Moreover, she then mentioned that sometimes she has hard time concentrating on things. In addition, when I asked her “so, you have hard time concentrating?” She was staring at me and she said “hooh.” Then, I asked her if she always found it hard to concentrate? after that she started talking about her teacher in school, which is not related to the topic and didn’t answer the question. On the other hand, Susan wasn’t asked any question that would display if she was orientated or not. It is unclear if from the interview if Susan was aware of what day and year it is or why she was there.

 

Thought Process

Her thoughts are not clear, because she is changing the topic a lot when speaking.

Moreover, she is mostly focused on the animals in her house and the lights. She seems obsess about them. Most of the topics she talked about were irrelevant to the subject. She had perseveration because she stayed in one idea, which was the animals in her house. She has delusions because she has false believed, which is that she thinks that she hears cats in her house and many more. She has paranoia because she has schizophrenia and she talk about things that are unrealistic.

 

Insight and judgment

She doesn’t belief that she has a mental illness, as a result; she doesn’t belief that she need a treatment. She also mentioned that the doctor wanted her to take medicine, but she thinks that she doesn’t need them.

 

Suicidality & Homicidality

Susan didn’t think about suiciding or even planning to do it in the future, because she believed that it is against the rule and it’s a sin. However, she wanted to kill her son’s, because she belives that she is pertecting them this way.

 

DIAGNOSIS

Introduction:

In order for someone to be diagnosed with schizophrenia they need to meet two or more of the following critiria for one-month period (duration) according to the DMS 5. The criteria include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. These criteria impact the individual’s work, self-care, etc.

 

The criteria required for Susan to qualify for a diagnosis of schizophrenia are delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms. These criteria impact the individual’s work, self-care, etc. These are the criteria that Susan met for more than one-month period.

 

 

 

Delusion:

Susan meets the criteria for delusion based on the fact that she mentioned that the Devil was going to take her kids away. Moreover, in the police report, when she was asking her son to open the door for her, she stated “open this damn door Jason, the Devil is coming for you both.” She appears to believe that the Devil is coming for her kids.  She also mentioned “the little ones are not safe here. Why won’t you let me kill them?” Another example is that she believes that animals are living under her house. To illustrate more, during the behavioral observations interview she said, “There are owls under my house… Owls, cats, foxes, and other things.”

 

Hallucinations:

Susan meets the criteria for hallucinations because she keeps saying that she hears noises in her house. In fact, in the behavioral observations interview she mentioned “I hear the cats barking all the time.” Also, she has visual hallucinations and sees birds flying when there aren’t any. To explain more, in the initial police interrogation report she stated, “Then we can’t talk… not while the birds are flying.” She cannot recognize the difference between the reality and her imaginations. For example, she hears cats in her house even though there are no cats because none of the neighbors has cat. Another evidence from the Witness-Report-Terrance, said “She will come over and knock on my door to ask me if I have a cat (I do not) because she hears cat’s making noises.” Another fact that Terrance mentioned is that Pets are not allowed in their building.

 

Disorganized speech:

Susan also meets the criteria for disorganized speech, specifically frequent derailment, because she was jumping from one idea to another and her thought seemed to be frequently interrupted. Furthermore, in the behavioral observations interview, she appeared to be bothered by the light and asked if something can be done about it. Then all of the sudden she talked about a different topic and stated, “The people at the grocery store do a lot of talking, I see them staring at me whenever I’m there.” Also, when she was asked to speak more about the lights, she talked about a different topic and replied, “The owls make noises from under my house.” These quotes from Susan illustrate that her ideas and thoughts are not organized. Another example is that sometimes she repeats words and during the behavioral observations interview she repeated the word “talk” eight times “Talk, talk, talk, talk, talk, talk, talk, talk.”

 

Catatonic Behavior:

She experiences cognitive problems because she has hard time concentration. Additionally, in the behavioral observations interview, she mentioned “Sometimes I have a hard time concentrating on things.”  She was also looking down frequently. Moreover, she has stereotypy which explain her repetitive movements on touches her hair, for no reason. Another odd behavior, when she was asked if she was hospitalized for anything beside her labors and her gallbladder surgery she started to breathe heavily, and she didn’t want to reply. Finally, her action about closing the AC with pillows, was a weird behavior.

 

Negative Symptoms:

Susan meets the criteria for negative symptoms based on the fact that she lacks of emotion, no motivation, withdrawing from social situations and relationships. Susan doesn’t express any type of emotion like joy or sadness. She didn’t appear emotional at all. To illustrate, she didn’t have any face expression in the interview. She also didn’t show any anger, anxiety, disgust, excitement, fear, happiness, joy or sadness. She doesn’t show any motivation for anything. For example, when they took her for the interview, she was fine staying in there and she even mentioned that she wants to stay where they turn off the light early. She didn’t seem like she want to get out of this place so she can do her own stuff. And Susan show that she avoids social situations and relationships. For instance, she doesn’t say hi back to Terrance and she doesn’t let her kids either.

 

Interpersonal Relations and Self-Care:

Susan’s work, Interpersonal Relations and Self-Care are affected because of the symptoms she is experiencing. For example, Susan doesn’t have a job and no employer would hire her due to her symptoms mentioned above. In addition, Terrance from the Witness-Report mentioned that She gets some disability services due to her condition. The relationship between Susan and her neighbors are not good because when Terrance greets her and her kids, she would tell her kids to not say hi back to him. He even thought that is was because he is black man, but he mentioned that “it is something else.” And “Susan is always paranoid.” Also, as mentioned previously in the behavioral section, Susan doesn’t take care of herself because of her appearance during the interview; she looked tired and had redness under her eyes, and her hair was not tied and messy.

 

Duration:

During her interview she mentioned that she has concentration issue since she was young. Also, she mentioned that the second time she lived in her grandma’s house, when she was young, she started to hear noises. She said “Her house got weird after I quit school…”  Terrance also mentioned that two weeks ago, he noticed Susan’s odd behavior when she closed the vents on AC system with pillows and taped over top of them which led to throwing the whole system off for everyone in the third floor. Therefore, Susan has been experiencing the symptoms explained above for a long time.

 

Statement of Diagnosis of Schizophrenia:

Finally, Susan is diagnosed with schizophrenia because she meets more than one of the DSM 5 criteria such as delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms. These criteria impact the individual’s work, self-care, etc. These are the criteria that Susan met for more than one-month period.

 

Substance use disorder: 

Susan could be possibly be diagnosed with a substance use disorder. However, more information is required in order to make a diagnosis.

 

Future directions and/or changes in diagnosis:

There is a possibility to update Susan’s current diagnosis if anything changed in the situation, more information was provided, such as information about the medications that the doctors prescribed to Susan, why Susan’s mother didn’t want her, why she kept moving from one place to another and why she quit school. This information will help update Susan’s current diagnosis.

 

 

 

 

TREATMENT RECOMMENDATIONS

 

 

Need for Treatment:

Susan has been diagnosed with schizophrenia since she meets more than one of the DSM 5 criteria, including delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms. Susan requires treatment to be in a position to work, take care of herself and her family and co-exist well with her neighbors. Before she was incarcerated, Susan experienced delusions, whereby she believed that the devil was coming to take away her children. Therefore, the best way to address the situation, according to her, was to kill them. She was also experiencing hallucinations as she heard the noises of different animals, which she believed lived under her house. Susan, while incarcerated, could not take care of herself because her hair was messy, and her eyes were red may be due to paranoia.

 

 

Need for Medication:

Susan requires psychiatric intervention, including medication. Antipsychotics help to ease the symptoms, for example, delusions and hallucinations. Susan also needs to be referred to a jail psychiatrist who can help offer the therapy required to manage her condition and live everyday life in jail. Individual therapy can help Susan know how to deal with their thoughts and behaviors.

 

 

Justification of Medication:

There is a need for Susan to receive psychiatric medication because it is possible for her situation to improve after using the medication. According to Hagger et al. (1993), psychiatric medication such as clozapine can help improve psychopathology and cognitive function. The use of medication such as Clozapine can help Susan her to concentrate, organize her speech, and be able to remember things and pay attention. According to Ascher-Svanum et al. (2006), patient outcomes of schizophrenic patients tend to improve among patients who adhere to medications. Susan ought to take medication to reduce her hallucinations, paranoia, and anxiety, among other issues.

 

 

Appropriateness of Group Therapy:

For Susan, the symptoms that she experiences for schizophrenia may make it difficult for her to participate in group therapy. Susan is mentally disturbed, she cannot concentrate, and therefore this can make it difficult for the instructed psychotherapist to coordinate the group.

 

 

 

Need for Individual or Group Therapy – Medication Adherence:

Compliance training can be used to help Susan to adhere to taking medications. This therapy aims to educate the patient on the importance of taking medication to improve the likelihood that the patient will stick to their medication regimens.

 

 

Need for Individual or Group Therapy –  Description of Chosen Therapy for “Medication Adherence”:

 

Medication adherence is the ability of patients to take medication as prescribed. Compliance training allows patients to understand why they have to take drugs as recommended by a physician. A patient has to undergo the training until they know what and why they need to do it. The idea is that exercise can help remove ignorance and misunderstanding that hinder many from taking medications.

 

Need for Individual or Group Therapy –  Insight Into Mental Illness:

Cognitive-behavioral therapy is appropriate for Susan because it is a short-term therapy that aims to solve problems. It helps teach individuals with schizophrenia different coping skills to help them manage their conditions (Steel, 2013). This therapy is often given once per week for a period of 12 to 16 weeks. CBT will help Susan know how to cope with her behaviors. It can help her be able to function independently, reduce distress, and manage their schizophrenia.

 

 

Need for Individual or Group Therapy –  Description of Chosen Therapy for “Insight Into Mental Illness”:

Cognitive-behavioral therapy is a technique that is employed to help patients with mental illness to cope with their behaviors. The length it takes for CBT to be completed is 12 to 16 weeks. The process involves the participation of mentally ill patients in helping each other change their personalities and characters in a supervised environment. The idea is that people, while in group therapy, can influence each other to change their behaviors and start to live normal lives.

 

Need for Individual or Group Therapy in the Future – Issues Related to Depression and Anxiety:

Taking psychiatric medication has side effects. Susan can experience depression and anxiety related to her past actions, where she hurts her son. It could also emerge due to her family situation criminal actions. Treatment for these issues will be provided when they arise.

 

Benefits and Complications Associated With Treating Susan While Incarcerated:

The benefit of treating Susan while she is incarcerated is that it can reduce the symptoms she has been experiencing while serving her jail term. The complication is that it can be difficult for her to receive the right care because her situation being in jail limits her interaction with psychotherapists, medications, and care.

 

 

MACARTHUR COMPETENCY ASSESSMENT

  • Follow syllabus and lectures for instructions on how to write this section.

 

ULTIMATE OPINION ON COMPETENCY TO STAND TRIAL

  • Follow syllabus and lectures for instructions on how to write this section.
  • There should be no new information in this section. Jut a review of the Dusky standard and how it applies to Susan’s presentation, in addition to a clearly articualted position on competnecy to stand trial.

 

 

 

 

REFERENCES

Include your DSM reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of

mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Ascher-Svanum, H., Faries, D. E., Zhu, B., Ernst, F. R., Swartz, M. S., & Swanson, J. W. (2006). Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. The Journal of clinical psychiatry.

Hagger, C., Buckley, P., Kenny, J. T., Friedman, L., Ubogy, D., & Meltzer, H. Y. (1993). Improvement in cognitive functions and psychiatric symptoms in treatment-refractory schizophrenic patients receiving clozapine. Biological psychiatry34(10), 702-712.

Steel, C. (2013). CBT for schizophrenia: Evidence-based interventions and future directions. Hoboken, NJ: Wiley, Blackwell.

 

 

 

 

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