I would let Dr. Binet know that I am referring Mr. Jones to him for a neuropsychological evaluation and then I would explain the reason for the referral. I had my initial intake interview with Mr. Jones two weeks ago and today I saw him for a second follow-up visit. He is 68 years old and initially came to see me for depression. He stated that since he retired (approximately 2 months ago), he has been feeling depressed.
He is divorced and has two grown children that live in a different state, which makes him feel lonely. He also reports recent wait loss, loss of concentration, insomnia, sadness, and loss of interest in previously enjoyed activities. He denies suicidal ideation. I diagnosed him with Major Depressive Disorder, Mild, Recurrent (because he admitted to experiencing several of these episodes in the past). I developed a CBT treatment plan, which included progressive muscle relaxation, thought records, and identifying and modifying dysfunctional thoughts.
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During my three session with Mr. Jones; however, I noticed some additional symptoms whose source I have been unable to identify. He seems to search for words, often pausing in the middle of sentences. It is difficult to tell whether he is having trouble articulating or whether he is searching his memory for the answer (or both). He seems to have more trouble when it comes to recent events (short-term memory) than events from the distant past (long-term memory). For example, he is able to tell me details of his childhood and teenage years, but he has trouble telling me what he did in the past week.
He also seems to get nervous, which seems to exacerbate the symptoms. He also seems to have an “odd gait,” where he slightly drags his left leg. When I asked him about these symptoms, he laughed it off and stated that it was just a consequence of “old age.” While this may be true, all of the symptoms combined made me question whether there is an underlying neurological condition. I have some suspicions of MS, but there could be any number of causes, which is why I wanted you to evaluate Mr. Jones.
One of the tests that Dr. Binet is likely to administer is the WAIS-IV in order to establish a baseline IQ. It can also give him information about working memory, verbal reasoning, visuo-spatial skills, and motor skills. Another test that Dr. Binet may administer is the PASAT, which would help assess Mr. Jones’ auditory information processing speed and flexibility, as well as calculation skills.
The issue with administering the test myself would be that if I am not familiar with this type of testing and not trained to do it, then it would be unethical to do so. In addition, if I administered it improperly and misdiagnosed the patient, it could have legal ramifications. For example, a diagnosis could be missed and Mr. Jones could miss an opportunity to get treatment for his condition. Mr. Jones could then sue me.
I could use the results of the evaluation to help guide my therapy with Mr. Jones. For example, if Mr. Jones is diagnosed with a chronic condition, I would help him cope with the diagnosis. It may further exacerbate his depressive symptoms, so incorporating ways to learn how to live with a chronic illness. I could also use the information to help Mr. Jones improve the particular problems that Dr. Binet finds. For example, if he has problems with working memory, I could give him some tools for improving his working memory.
