Mary's History: Mary is a 58-year-old physician who had a very busy private family practice for the past 19 years before she had to close down her office due to medical issues

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Mary's History:

Mary is a 58-year-old physician who had a very busy private family practice for the past 19 years before she had to close down her office due to medical issues. She was the sole provider in her practice and was working anywhere from 60 to 70 hours a work, which included face to face patient hours as well as administrative duties associated with running her practice. She also managed a staff of six individuals.

 

Prior to her first visit with you, Mary had encountered a lot of personal problems and stressors. Both of her parents became quite ill and she was trying to manage her practice while also intervening and assisting with their needs. It was quite a challenge for her to manage both her work responsibilities along with the unpredictable aspects of caring for her aging mother and father, who eventually required placement to an assisted living facility. On top of all of these responsibilities, she also was the single mother of a 15 year old, who had been shuttling back and forth between her home and her ex-husband's. Over the past year, her son has also gotten into trouble at school a few times for truancy and was caught once by the police at the local mall for underage drinking with a friend. As she was trying to handle all of these issues, she began to make mistakes at work in writing out prescriptions for her patients. Fortunately, her staff caught the errors and no patient harm occurred, but Mary was quite upset and alarmed about these mistakes and sought consultation with one of her peers. She was advised to cut back her hours.

 

Several months passed and Mary began to notice changes in her physical and cognitive functioning. She complained of great fatigue, muscle pain and weakness, and decreased energy. She also started experiencing significant problems with memory, which she felt was worsening over time. She began to have problems managing her own personal finances that included missing or making double payments on bills. One evening she put a pot of tea on the stove and forgot that it was there until she smelled the pot burning. She was most upset by an incident of getting lost while driving in an area that she had been before in the remote past. These incidences were quite worrisome to her and she sought out the assistance of her primary care physician who eventually suggested that she might benefit from a therapist and perhaps down the line a memory evaluation. In the midst of all of these changes, Mary felt that she could no longer maintain her private practice and she began to consider the possibility of closing her private practice after dedicating most of her life to get it up and running.

 

Mary's Wechsler Adult Intelligence Scale IQ: 120 (above average)

MMPI data -  highest scores on Scale 1 (Hypochondriasis) and Scale 2 ( Depression).

 

 

 

 

Topic: Neuropsychological Testing and Cognitive Disorders: You may use any research via the web to help you understand the pattern of performance below. You do not need to spend a lot of time learning about the specific tests, other than what they generally purport to assess. Note that only general descriptors are provided rather than specific test scores for ease of interpretation.

 

 Neuropsychology is a branch of clinical psychology that focuses on understanding brain-behavior relationships. This is a relevant area to cover for your patient Mary, because she has come to you with complaints of memory problems along with other issues related to functional decline in her ability to work as a physician. You have completed a thorough history and have the Wechsler Adult Intelligence Scale IQ and MMPI data from your prior discussions.

 

This week, you do a neuropsychological screening evaluation to address the issue of "organicity" and the importance of neuropsychology in a clinical context. Does Mary have acquired cognitive and memory impairment that cannot be accounted for by her current psychological and social history? In other words, does the data that you obtain from her testing below rule out or rule in the possibility that she might have acquired a neurologically based disorder? Attempt an interpretation based on the following information. There are no right or wrong answers, but just support your assertions using your understanding of the test data below or any other research.

 

Wechsler Memory Scale - Note that the descriptors of Mary's test performances are relative to her age peers. For example, if she scores average on a test, then it is the average or mean compared to others her age. Mildly impaired suggests a below average score (at least 1. 5 standard deviations below the mean)

Logical Memory I - measures immediate memory for stories (relies heavy on attentional skills) - mild to moderately impaired

Logical Memory II - ability to remember the material she learned in Logical Memory I about 30 minutes later- within normal limits

 

Visual Reproduction I - immediate memory for pictures involving abstract geometric shapes (relies heavily on visual attention) - mildly impaired

Visual Reproduction II - ability to remember the geometric pictures she learned in Visual Reproduction I about 30 minutes later- within normal limits.

 

Boson Diagnostic Aphasia Exam

Verbal naming (name common objects shown through pictures)- within normal limits

Speech functions (observations of her conversational speech)- normal

 

Trail Making Test

Part A - measures scanning ability and speed based on the ability to sequence numbers from 1 to 25 as fast as you can- low average

Part B - alternating visual sequencing between number and letters such as 1A2B3C, etc. as fast you can - low average

 

Beck Depression Inventory (a self-report inventory of depression symptoms) - Mary's endorsements suggest a high level of depression