1390 Prince of Wales Drive, Suite 301

Ottawa, Ontario K2C 3N6

Tel (613) 680-4550
Fax (613) 695-4551
info@revivalottawa.com
www.revivalottawa.com

PSYCHOLOGICAL ASSESSMENT REPORT

CLIENT: Ms. Iffat Khan

D.O.B.: 1997-05-05
D.O.L.: 2021-03-24
CLAIM No.: 1659126
DATE OF ASSESSMENT: 2021-05-13
REPORT DATE: 2021-06-02
CLINICIAN: Patricia Parmashwar, MA. C. Psych
CPO # 5027
SKCP # 701
Ms. Iffat Khan
DOB:1997-05-05
DOA:2021-03-24

Consent to treatment: Covid-19

Mental Health Services and Assessments meet the definition of essential services and
are conducted following current Provincial guidelines.

Please note that all in-person appointments only proceeded while adhering to all
applicable legislation, guidelines and regulations in Ontario. All clients were pre-
screened prior to the assessment date in relation to their potential exposure to Covid-19
virus and their responses were duly documented and placed on file. Additionally, the
client was informed that a positive response would result in the cancellation of the
psychological assessment appointment.

On the date of the psychological assessment, the questionnaire was reviewed again
with the same understanding as noted above. Prior to the appointment, the client was
informed that wearing a mask or face covering would be required at the interview,
hand sanitizer will be available and physical distancing will also be practiced.

*********************************

REASON FOR REFERRAL

Ms. Iffat Khan was referred to Revival Rehabilitation Centre located at 1390 Prince of
Wales Dr., Suite 301 for a psychological assessment following a Motor Vehicle Accident
(MVA) on 2021-03-24.

The purpose of this report is to assess Ms. Khan’s psychological functioning, identify
treatment targets and recommend treatment while considering any physical
limitations/restrictions and pain that resulted from the MVA.

SOURCES OF INFORMATION

The documentation listed below was reviewed and will be considered in the formulation
of her current psychological functioning without being repetitious. As such, the reader is
referred to the original reports for other relevant details to be considered in conjunction
with her current psychological functioning.

• OCF-18
• Psychological Intake Screen
• TOH Orthopedics Consult - multiple fractures 2021-03-24
Patricia A. Parmashwar, MA. C. Psych 2
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DOA:2021-03-24
• Memo to AB & AC form- Khan2021-04-06,
• OT Discharge Report by K. Bridge – Modern OT. 2021-04-08
• OCF-3 Disability Certificate. 2021-04-13

Other sources of information used in the formulation of this report included a semi-
structured clinical interview (approximately 2.0 hours) and the results from the
psychological tests listed below:

1. Beck’s Depression Inventory II (BDI-II)

2. Beck’s Anxiety Inventory (BAI)
3. PTSD checklist for DSM-5 (PCL-5)
4. Post Concussion Symptom Scale (PCSS)
5. Insomnia Index (ISI)

The results of these relatively independent measures were consolidated into a

comprehensive assessment of her current psychological state.

CLINICAL INTERVIEW/OBSERVATIONS

Consent and Confidentiality

The purpose and nature of the psychological assessment was explained to Ms. Khan, The
limits of confidentiality and consent form was reviewed with her. She acknowledged her
understanding and provided verbal and written consent to proceed with the assessment on
the date of the interview 2021-05-13.

Additionally, she was reminded that the results of the assessment will be shared with the
referral agent, her lawyer, other healthcare professionals and her insurer. She was also
advised that there will be no therapeutic relationship following this assessment. She
acknowledged her understanding and consented to proceed with the session.

Presentation and Mental Status

Ms. Khan was punctual for her scheduled appointment which lasted approximately 2
hours. Based on her injuries and required surgeries she is still wheelchair bound. Her
identity was verified by government issued identification passport as she is an
international student and does not have a driver’s license.

She is presented in a calm, polite and somewhat shy manner. She appeared her
chronological of 24. She was casually dressed in a summer-like dress and bought to the
interview by the driver of the transport service. Her personal hygiene and grooming were
good. She was well oriented to time, place and person. Her affect was neutral and her
mood was euthymic. She displayed a more relaxed demeanour relaxed as the interview
progressed.

Patricia A. Parmashwar, MA. C. Psych 3

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Ms. Iffat Khan
DOB:1997-05-05
DOA:2021-03-24
She maintained appropriate eye contact and did not display any ‘flight of ideas’ or ‘loose
association’. She remained focused on the questions posed and provided thoughtful
responses. Her thoughts were not tangential or circumstantial and she expressed herself
coherently. Her speech was soft and of normal pace and rhythm.

Summary of MVA

Ms. Khan stated that she does not recall the accident. She remembers that she and her
partner had gone to the convenience store and took an Uber round trip. They were on
their way back around 8:40 p.m. when their Uber was rear-ended. The next thing she
recalled, was finding herself in the front seat of the Uber near an air bag. The accident
occurred near Paul Anka drive and Hunt club. She later found out that it was a ‘hit and
run’ which involved a SUV. She stated she believes the driver of the SUV was under the
influence.

She described her injures as severe damage to her hip, pelvic and pubic area bones. She
needed several surgery and pins repair the injuries. She was hospitalised for
approximately 16 days. Her partner was also seriously injured. She indicated that she
went home on April 8th, 2021 and was happier to be home with her cat and partner as he
was released first.

She has been following physiotherapy treatment with gradual increases in strength and
weight bearing exercises. She stated she feels as she is progressing well.

She reported that initially her pain was managed by an intravenous drip but now she was
prescribed hydromorphone but has only used it three times thus far. She informed that
pain is constant but varies in intensity. She experiences pain in her neck, head and
shoulders.

With respect to sleep, she reported to be using Cannabis (0.5 to 1.5 grams) to help with
sleep. She recalled that sleeping was never a problem prior to MVA.

In terms of appetite, she explained that she eats but cannot tell when to stop or if she is
full. She has gained weight.

In terms of suicidal ideation, she denied any current of historical suicidal ideation or
plans. She wants to get better.

Brief Psychosocial History

Ms. Khan was born in Bhopal, India. She informed that she is an international student
who was living in BC and attending Thompson Rivers University in computer science.
She came to Ottawa to do an internship with IBM on Riverside in September 2019.
Although she finished in December 2020, she decided to stay as she was able to do online
courses and still apply to IBM again. She had no main reason to return to BC except to

Patricia A. Parmashwar, MA. C. Psych 4

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DOB:1997-05-05
DOA:2021-03-24
complete the courses as she has no family in BC and her boyfriend moved to Ottawa as
well. She indicated that the pandemic made it possible for online courses.

Her parents live in India and she has an older sister who is married and lives in Dubai.
Her sister works for Amazon and is awaiting an internship in Kuwait. She advised that
both parents were infected with Covid-19 but have since recovered. She is hopeful they
can visit once the travel restrictions are lifted. She added that her father was medical
practitioner in the Indian Army; she described him as an honest and non-violent
individual. Her mother was a government schoolteacher who taught grade 5 English.

She spoke about her life as a child, adolescent and young adult where she loved to dance,
such as, belly dancing, hip hop, samba and even Zumba. She would practice her floor
routine everyday and attended the gym. She described herself as an active child where
academic success was not only encouraged but expected. She added that she did have
good grades. She completed high school and was successful in the government exams.
She reported no behavioural problems at school, no suspensions or disciplinary issues.

She admitted she was homesick at first but made friends and it got better but she has not
seen her parents.

PSYCHOLOGICAL ASSESSMENT

The following measures were administered to assist in evaluating Ms. Iffat Khan
current’s psychological functioning.

Beck’s Depression Inventory-II (BDI-II)

The BDI-II is a 21-item format with four options under each item, ranging from not
present (0) to severe (3). The BDI-II includes the following new items: agitation,
worthlessness, loss of energy, and concentration difficulty. The current item content
includes: (a) sadness, (b) pessimism, (c) past failure, (d) loss of pleasure, (e) guilty
feelings, (f) punishment feelings, (g) self-dislike, (h) self-criticalness, (i) suicidal
thoughts or wishes, (j) crying, (k) agitation, (l) loss of interest, (m) indecisiveness, (n)
worthlessness, (o) loss of energy, (p) changes in sleeping pattern, (q) irritability, (r)
changes in appetite, (s) concentration difficulty, (t) tiredness or fatigue, and (u) loss of
interest in sex.

It is important to note that both increases and decreases in appetite are assessed in the
same item and both hypersomnia and hyposomnia are assessed in another item; the BDI-
II ratings are over the past 2 weeks including the date of the administration of the
inventory.

The BDI-II measures the severity of depression and the overall score indicates the level
of depression. The Coefficient alpha estimate of reliability for the BDI-II with outpatients
was 0.92 and 0.93 for the nonclinical sample.

Patricia A. Parmashwar, MA. C. Psych 5

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DOB:1997-05-05
DOA:2021-03-24
Ms. Khan’s score (25) on the BDI-II placed her in the category associated with
moderate depressive symptoms. She gave the highest rating to one statement:
Indecisiveness. The second highest rating was recorded for Loss of pleasure, Crying,
Loss of interest, Loss of energy, Changes in sleep pattern and Tiredness or Fatigue.
She reported the following statements as mildly problematic: Sadness, Pessimism, Guilty
feelings, Punishment feelings, Agitation, Worthlessness, Irritability, Changes in appetite
Beck Anxiety Inventory (BAI)

The BAI is list of 21 common symptoms of anxiety. The individual is asked to provide a
rating (0-not at all to 3-severe) on a Likert scale for each item that has been experienced
during the past week.

Ms. Khan’s score (36) placed her in the category where her reported symptoms indicated
a severe degree of anxiety. She reported the following items as most severely
bothersome: Fear of the worst happening, hands trembling, fear of losing control and
indigestion or discomfort in abdomen.

She further self reported the following items as Moderately bothersome: Numbness or
tingling, Feeling hot; Wobbliness in legs, Dizzy or lightheaded, Nervous, Shaky,
difficulty in breathing, face flushed and sweating (not due to heat). She self reported
another 6 items as mild.

PTSD Checklist for DSM-5 (PCL-5)

The PCL-5 is a self-report measure that can be completed in approximately 5-10 minutes.
The preferred administration is for the patient to self-administer the PCL-5. It is intended
to assess patient symptoms in the past month. The self reported measure is a list of
problems that people sometimes have in response to a stressful experience. It measures
the severity of the events experienced in the past month.

The PCL-5 is a psychometrically sound measure of DSM-5 PTSD. Respondents are

asked to rate how bothered they have been by each of 20 items in the past month on a 5-
point Likert scale ranging from 0-4. Items are summed to provide a total severity score
(range = 0-80). 0 = Not at all 1 = A little bit 2 = Moderately 3 = Quite a bit 4 =
Extremely.

It is valid, reliable and useful in quantifying PTSD symptom severity and sensitive to
change. The PCL-5 may be used to help determine the appropriate next steps or treatment
options. The PCL-5 can determine a provisional diagnosis in two ways:

• Summing all 20 items (range 0-80) and using a cut-point score of 31-33 appears
to be reasonable based upon current psychometric work. However, when choosing
a cut-off score, it is essential to consider the goals of the assessment and the
population being assessed. (The lower the cut-off score, the more lenient the
criteria for inclusion, increasing the possible number of false positives. The higher

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DOA:2021-03-24
the cut-off score, the more stringent the inclusion criteria and the more potential
for false negatives).
• Treating each item rated as 2 = “Moderately” or higher as a symptom endorsed,
then following the DSM-5 diagnostic rule which requires at least:
1 Criterion B item (questions 1-5)
1 Criterion C item (questions 6-7)
2 Criterion D items (questions 8-14)
2 Criterion E items (questions 15-20)
• In general, use of a cut-off score tends to produce more reliable results than the
DSM-5 diagnostic rule. If a patient meets a provisional diagnosis using either of
the methods above, he or she needs further assessment.
• A total score of 31-33 or higher suggests the patient may benefit from PTSD
treatment. The patient can either be referred to a PTSD specialty clinic or be
offered an evidence-based treatment for PTSD such as Prolonged Exposure (PE),
Cognitive Processing Therapy (CPT), or Eye Movement Desensitization and
Reprocessing (EMDR)
• Scores lower than 31-33 may indicate the patient either has subthreshold
symptoms of PTSD or does not meet criteria for PTSD, and this information
should be incorporated into treatment planning.

Ms. Khan’s score (30) placed her below (upper limit) the established threshold (31-33)
and her score did not meet criteria for Criterion C or D. As such, she does not meet the
criteria to be diagnosed with PTSD as the responses did not meet the criterion for C and
D, persistent avoidance and Negative alterations in cognition and mood; however, she
does experience intrusive symptoms and alterations in arousal and reactivity.

Post-Concussion Scale (PCS)

The Post-Concussion Scale presents clinical properties of 21 concussion symptoms.

Individuals sustaining mild traumatic brain injuries often report a constellation of
physical, cognitive, and emotional/behavioral symptoms referred to as post concussion
symptoms. The rating scale for the PCS ranges from 0 (no symptoms) – 3 (moderate) – 6
(severe).

Typical post concussion symptoms are headache, dizziness, decreased concentration,

memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment
problems, depression, and anxiety.

It is important to note that “Although these PCS often resolve within one month, in some
individuals PCS can persist from months to years following injury and may even be
permanent and cause disability. When this cluster of PCS is persistent in nature, it is
often called the post concussion syndrome or persistent PCS. Both physiological and
psychological etiologies have been suggested as causes for persistent post concussion
symptoms” …. “Most investigators now believe that a variety of pre-morbid, injury-
related, and post-morbid neuropathological and psychological factors contribute to the

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DOB:1997-05-05
DOA:2021-03-24
development and continuation of these symptoms in those sustaining mild traumatic brain
injury (MTBI)” (2).

Ms. Khan provided the following ratings for the following symptoms with a ‘5-6”
(severe): Headache, Balance problems Trouble falling asleep, feeling more emotional,
Numbness of tingling, feeling slowed down, feeling mentally ‘foggy’, difficulty
concentration and difficulty remembering. She rated sensitivity to light and noise as
mildly problematic along with vomiting. In sum, she rated 20 out 21symptoms, omitting
one item (oversight; exhaustion). Ms. Khan continues to experience symptomatology of
post concussion syndrome.

Additional research on Post concussion syndrome as discussed in the study “Persisting

symptoms after mild head injury: A review of the post-concussive syndrome” (1)
summaries the following:
“Seemingly mild head injuries frequently result in persisting post-
concussive syndromes. Neuropsychological, neurophysiological, and
neuropathological evidence that brain damage can occur in the absence of
gross neurological deficits after mild injuries suggest that “Direct impact
to the head is not required to cause brain injury”. Furthermore,
“psychological factors also play a role in post-head-injury disability”. The
study also indicated that “Persons over age 40 or with a history of
previous head injury are more vulnerable to protracted symptomatology”.

Insomnia Severity Index (ISI)

Insomnia is a prevalent complaint with significant consequences on the quality of life,

health, and health care utilization; however, it often remains undiagnosed and untreated
in primary care settings. The Insomnia Severity Index (ISI) is a brief instrument that was
designed to assess the severity of both nighttime and daytime components of insomnia.

ISI internal consistency was excellent (Cronbach α = 0.92), and each individual item
showed adequate discriminative capacity (r = 0.65-0.84). The area under the receiver
operator characteristic curve was 0.87 and suggested that a cut-off score of 14 was
optimal (82.4% sensitivity, 82.1% specificity, and 82.2% agreement) for detecting
clinical insomnia. Agreement between the ISI cut score and the diagnostic interview was
moderate (κ = 0.62).

Ms. Khan’s score (21) on the ISI placed her at the upper limit of the range for Clinical
Insomnia (moderate severity).

SUMMARY/RECOMMENDATIONS

Ms. Iffat Khan is a 24-year-old, international student from Bhopal, India who was
enrolled in Thompson Rivers University in BC studying computer science. She travelled
to Ottawa in September 2019 for an opportunity to do an internship with IBM. She stayed

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Ms. Iffat Khan
DOB:1997-05-05
DOA:2021-03-24
in Ottawa after December 2020 as she was able to continue her courses online and still
apply to IBM again. Her boyfriend also oved from BC to Ottawa.

After the Uber in which they were sitting was rear ended by a ‘hit and run’ driver of an
SUV, she was left with significant physical injuries and a concussion, when she ‘came to’
she noted she was in the front seat with air bag deployed beside her. She had several
injuries including pelvic, hip and pubic bone damage. Her life has changed dramatically
and drastically.

The results of her psychological assessment clearly indicated issues of depression,

general anxiety, insomnia and post concussive symptoms. Ms. Khan wants to heal, both
physically and mentally to be able to resume her life and career path. At age 24, her
future has changed from a medical perspective and she may be faced further life or
medical challenges as her future unfolds.

Based on file information, the semi-structured clinical interview and psychological tests,
Ms. Khan continues to exhibit signs and symptoms that are associated with Somatic
Symptom Disorder, with predominant pain, persistent and severe, Major Depression
Disorder, single, moderate and Generalized anxiety disorder with a high level of severity.
Her symptomatology does not meet the criteria for a diagnosis of PTSD; however, her
score on the PCSS indicated severe post concussion symptoms.

Her exhibited features are consistent with the following disorders as defined by the
Diagnostic and Statistical Manual, 5th edition (DSM-5).

• 300.82 (45.1) Somatic Symptom Disorder, with predominant pain, persistent

and severe
• 296.22 (F32.1) Major Depressive Disorder, single episode, moderate
• 300.02 (F41.1) Generalised anxiety disorder
• 780.52 (G47.00) Insomnia Disorder
• Post Concussion Syndrome (not defined in DSM-5)

Based on the above noted diagnosis, the follow treatment and interventions are
recommended:

• Psychotherapy (anxiety, depressed mood, GAD, insomnia)

• Physiotherapy, Massage therapy, Hydrotherapy and/or Kinesiology to reduce
discomfort, pain management clinic or specialist.
• Follow recommendations of OT assessment report.
• Neurologist (to assess, monitor and treat any neurological symptoms of PCSS)
that may assist with restorative sleep and chronic pain.

These recommendations will address her current needs and her long-term progress in the
rehabilitation process.

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DOB:1997-05-05
DOA:2021-03-24
Please note: The opinions and formulation of a diagnosis in this report are based on the
documented information and self reports referred to in this assessment. The reader is
reminded that a client’s motivation, level of pain, state of mind, medication and
emotional functioning undoubtedly affect the results of the measure. It is cautioned that
the assessor cannot vouch for the veracity of the information provided by the client
during the semi-structured clinical interview. The professional opinion expressed is
based on the information garnered through this assessment.

REFERENCES

1) Laurence M. Binder (1986) Persisting symptoms after mild head injury: A review of
the post-concussive syndrome, Journal of Clinical and Experimental
Neuropsychology, 8:4, 323-346,
DOI: 10.1080/01688638608401325

2) Laurie M. Ryan & Deborah L. Warden (2003) Post Concussion Syndrome,

International Review of Psychiatry, 3:4, 310-316

Professional Qualification

I am a Registered Psychologist in good standing with the Saskatchewan College of

Psychologists (SKCP) since 2008 and with the College of Psychologists of Ontario since
2012. I am licensed with competencies to provide psychological services in the areas of
Clinical, Clinical neuropsychology, Forensics and Rehabilitative psychology.

I trained in both clinical and forensic settings and have served on the Examination board
for the Saskatchewan College of Psychologists.

I maintain a current membership with the Canadian Psychological Association (CPA) and
was a member of the American Psychological Association (APA).

___________________________________ ___2021-06-02__
Patricia Parmashwar, MA, C. Psych (ON, SK). Date
CPO#5027

Original: Psychology file

cc. Revival Rehabilitation Centre
Patricia A. Parmashwar, MA. C. Psych 10
CPO#5027
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