George Washington University Medical Center
Department of Psychiatry and Behavioral Sciences
2150 Pennsylvania Ave., N.W.
Washington, DC 20037
LIMITED PSYCHOLOGICAL EVALUATION
NAME: Gary Freedman
REFERRED BY: Dimitrios Georgopoulos, MD
DATE OF SERVICE 3-11-95 [sic] [should read 3-11-96]
Mr. Freedman was referred for assessment of formal thought disorder as a part of differential diagnostic evaluation.
Wisconsin Card Sorting Test (WCST)
Whitaker inventory (WIST)
PRESENTING PROBLEM AND BACKGROUND INFORMATION:
Mr. Freedman is a 43 year old single white male with complaints of suspiciousness about his ex-employers and depressive feelings. He was terminated from his job in October 1991 after 3 years of employment and since then has been unemployed. His former employers claimed that he was "too paranoid," hostile and potentially violent. Mr. Freedman describes himself as being hypersensitive to peoples' non-verbal cues, tone and inflections. He believes that he is under surveillance by his former employers who do this to protect him and maintain continuity with his life. One of the methods of surveillance, according to Mr. Freedman, is by entering his apartment when he is out. He claims that his special ability to sense his environment validates his belief that there are people who feel hostile towards him and persecute him. As a result, he has isolated himself, and feels lonely and distressed because of this.
Mr. Freedman has been in individual treatment with Dr. Georgopoulos for about two years. Although he reports emotional problems since young adulthood he has never been hospitalized in a psychiatric unit.
A previous psychological evaluation on 5-11-94 reported an enduring pattern of increased sensitivity, hypervigilance, and outright suspiciousness, expressed hostility and self-protective withdrawal. Although no Axis I diagnosis was suggested in this evaluation, Mr. Freedman confided in his therapist that he had denied certain statements pertaining to his persecutory beliefs on the objective tests.
Mr. Freedman was cooperative throughout the session and worked on the tests diligently with good concentration. His speech was somewhat pressured and loud. The content of his speech was somewhat vague, however he did not show any obvious indications of flight of ideas or incoherence. He talked about certain "beliefs" about his ex-employer however his description of these beliefs was not clear. He expressed the belief that his employers have a key to his apartment and have visited his apartment in his absence. He was rather guarded when the examiner asked more questions about these beliefs.
SCL-90-R is a 90 item self-report symptom inventory which measures psychological distress in terms of 9 primary symptom dimensions and 3 global indices of distress. In reference to outpatient norms Mr. Freedman reported very low general symptomatic distress level and overall intensity of distress. Such SCL-90 pattern is often associated with a repressive or defensive response style. However, Mr. Freedman indicated that he is extremely distressed by having ideas or beliefs that others do not share.
The Wisconsin Card Sorting Test is a measure of concept learning and cognitive flexibility. Deficient performance is often associated with dysfunction of frontal lobes. Mr. Freedman performed within normal limits on this test. He completed all 6 category sorts and made only 6 perseverative errors, both within the range of normal functioning.
The Whitaker inventory is a measure of the formal thought disorder. Mr. Freedman revealed no sign of loosening of associations, clanging or other evidence of cognitive slippage on this test; his functioning was within normal range.
CONCLUSIONS AND RECOMMENDATIONS:
In the present limited assessment no signs of the formal thought disorder or frontal lobe dysfunction were observed. Mr. Freedman presents a long history of suspiciousness, lack of trust, reading threatening meanings in benign remarks or events and isolative behavior. These characteristics are consistent with an Axis II diagnosis of a personality disorder with prominent paranoid traits. However, this diagnosis would not explain Mr. Freedman's delusional preoccupations with his former employers. His description of these preoccupations are consistent with the description of systematized and non-bizarre delusional beliefs. Presence of these delusions in the absence of prominent mood symptoms, auditory hallucinations or formal thought disorder is supportive of a diagnosis of delusional disorder. This diagnostic impression is consistent with findings on MMPI and Rorschach from previous psychological evaluation as well as absence of formal thought disorder in this evaluation.
In view of this diagnostic impression a trial on narcoleptic medications is indicated. The benefits of medication and possible side effects need to be discussed with Mr. Freedman in the context of an ongoing therapeutic relationship with his current therapist.
Robert Jenkins, Ph.D.,
Associate Professor of Psychiatry
Comment by Gary Freedman on October 16, 2009 at 10:44am:
"A previous psychological evaluation on 5-11-94 [that included the Minnesota Multiphasic Personality Inventory] reported an enduring pattern of increased sensitivity, hypervigilance, and outright suspiciousness, expressed hostility and self-protective withdrawal [i.e., an elevated Scale 6 score]."
An elevated score on Scale 6 (paranoia scale) of the Minnesota Multiphasic Personality Inventory may suggest a tendency to be distrustful and suspicious or, more positively, a tendency to be investigative, curious, and questioning (qualities associated with being a lawyer, for example). Anastasi, A. Psychological Testing (6th ed., 1988). .
Comment by Gary Freedman on October 16, 2009 at 10:38am Delete Comment Note that vigilance, suspiciousness, skepticism, distrust, and oppositional behavior (protension) can all be signs of high ego strength, and not necessarily indications of paranoia.