Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–7

CLINICAL VIGNETTES

Psychological Impairment
(Problem Area 1)
6–8 Mastering the Kennedy Axis V

Kennedy Axis V—Psychological Impairment (Problem Area 1)

100 Superior psychological functioning/coping, no psychological impairment; life’s everyday problems

never seem to lead to any significant anxiety or depression. No symptoms.

90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good psychological functioning in all
areas; interested and involved in a wide range of activities; generally satisfied with life; no more than everyday
problems or concerns.

80 If symptoms are present, they are transient and expected reaction to psychosocial
stressors (e.g., upset by breakup with girlfriend; difficulty concentrating after a family argument; mild
preoccupation with problems; a woman has many friends, functions extremely well at a difficult job, but says “The
stress is too much”); not considered to have mental problems by those who know him/her.

70 Some mild symptoms (e.g., depressed mood with mild insomnia, occasional truancy, theft within the
household, difficulty trusting others, mild insensitivity to the feelings and needs of others), but generally
functioning fairly well; however, those who know him/her well might express some concerns about his/her mental
state.

60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks; frequently
preoccupied; moderate impairment in attention span); moderate insensitivity to the feelings and needs of others;
to those who know him/her well it is clear that he/she has mental problems.

50 Serious symptoms (e.g., moderately depressed mood, moderate lethargy, severe obsessional rituals, severe
phobia, severe sexual perversion, moderate problems with anorexia/bulimia, frequent shoplifting, frequent anxiety
attacks, moderately guarded, mild but definite manic syndrome).

40 Major psychological impairment; some impairment in reality testing or communication (e.g., speech is
at times illogical, obscure, or irrelevant; moderate paranoia; may have hallucinations or delusions; however,
probably realizes they are not a part of reality); major impairment in several areas, such as judgment, thinking, or
mood (e.g., depressed man avoids friends, neglects family, and is not motivated to work; or, moderate negative
symptoms of schizophrenia); even those who do not know him/her well would likely consider him/her to have
mental problems.

30 Behavior is considerably influenced by delusions or hallucinations; appears to be responding to

hallucinations; serious impairment in communication or judgment (e.g., sometimes incoherent, thinking is
occasionally grossly inappropriate); severely depressed mood; withdrawn, with few spontaneous communications;
inability to function in almost all areas (e.g., stays in bed all day and does not care for own living space; no job,
home, or friends due to paranoia, poor motivation, social withdrawal, extremely poor insight, or being almost
totally insensitive to the feelings and needs of others); at times attention span is markedly impaired; severe
sociopathic behaviors have led to multiple arrests; severe sexual perversion toward prepubescent children.

20 Thinking and communication are generally grossly impaired; manic excitement or catatonia;
largely incoherent or mute; generally markedly impaired attention span; occasionally fails to maintain minimal
personal hygiene due to severe lethargy or very disorganized, bizarre thinking (e.g., too lethargic to attempt to wipe
food off shirt; smears feces for bizarre, delusional reasons).

10 Thinking is totally disorganized; totally insensitive to the feelings and needs of others; completely
incoherent; completely mute, extremely catatonic; persistent inability to maintain minimal personal hygiene or
minimal safety due to totally disorganized thinking or very severe lethargy; unable to focus attention for even a
few seconds; chronic, self-induced vomiting has led to a very life-threatening situation.

NR Not rated
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–9

Psychological Impairment
NAME: Abbott, George
AGE: 35
Pt. does not appear to have any significant psychological problems. He is very satisfied with life. His coping
skills are very good. He is very good about not allowing problems get to him. His spirits are very good. He
has handled the stress of losing his job with no significant difficulty. He is very optimistic about the future,
and his optimism appears to be well founded. He is sleeping very well. His energy and appetite are very
good.

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Ratings

Psychological Impairment = 100

1) PSY = 100 2) SOC = 90 3) VIO = 90 4) ADL = 90 5) SAb = 80 6) MED = 90 7) ANC = 90
GAF Eq = 95
Dangerousness Level = 80

Explanation of Psychological Impairment Rating

No significant psychological problems = 100

Very satisfied with life = 100
Very good coping skills = 100
Very good spirits = 100
6–10 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Caruso, Janice
AGE: 33
Pt. is no longer showing any major manic or depressive features. No delusions or hallucinations. Some
problems with anxiety. She is mildly depressed and tends to isolate herself. Pt. states that she has not heard
voices for about 6 months. Pt. states that she no longer believes that there is a war coming with the Russians.
Pt. states that generally she is somewhat sad and anxious over the loss of her job. No insomnia. Appetite fair.
Mild lethargy. Affect generally flat; however, pt. exhibits an occasional, appropriate smile. No signs of tears.
Few expressive movements. No restlessness.

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Ratings

Psychological Impairment = 65
1) PSY = 65 2) SOC = 70 3) VIO = 90 4) ADL = 80 5) SAb = 80 6) MED = 80 7) ANC = 90
GAF Eq = 75
Dangerousness Level = 75

Explanation of Psychological Impairment Rating

No delusions or hallucinations = 50 or better

No voices for last 6 months = 50 or better
Some problems with anxiety or sadness = 70
No major manic or depressive features = 40 or better
Isolates herself = 50 or better
Generally flat affect = 60
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–11

Psychological Impairment
NAME: Cross, Anthony
AGE: 24
Staff states that pt. is continuing to have problems with depression. Pt.’s energy and motivation appear low.
Staff states that he often complains of feeling very tense. Staff states that he often worries over almost
anything. Staff states that he often has various physical complaints. Generally, pt. appears apathetic. No
crying spells. Pt. does not appear to have a thought disorder; however, at times pt.’s thinking seems
somewhat disorganized. Staff feels that pt.’s depression would prevent him from working at a competitive
job; however, he is able to stay focused on most tasks at his day program. Pt. states that his mood varies a
lot. Pt. states that generally he is moderately sad and somewhat tense. Pt. states that his self-worth is often
low. Pt. states that his energy is good. Denies insomnia. Appetite good. Few expressive movements. Mild
restlessness.

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Ratings

Psychological Impairment = 45
1) PSY = 45 2) SOC = 60 3) VIO = 50 4) ADL = 80 5) SAb = 95 6) MED = 70 7) ANC = 80
GAF Eq = 60
Dangerousness Level = 50

Explanation of Psychological Impairment Rating

Moderate depression (few vegetative signs is a plus) = 45

Moderate anxiety = 50
Apathetic = 50
Thinking is somewhat disorganized = 40
6–12 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Davis, Richard
AGE: 45
Pt. is very incoherent. There is marked impairment in his attention span, that is, his attention span is
generally less than 10 seconds. Often hears voices. Often talks or giggles to himself. Few significant interests
other than clothes, cigarettes, and satisfaction of basic sex drive. Despite his limited interests, pt.’s motivation
to be involved in group activities is very good; however, his capacity to engage productively is very limited.
He demonstrates ritualized learned patterns for getting by with no involvement or interaction, such as
answering questions with the first thing that comes to mind. It appears that he does this with the hope that
the answer is satisfactory and the person will go away. Pt. states the he is feeling fine. Pt. states that
sometimes he hears voices inside his head. Pt. states that the voices say both good and bad things to him.

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Ratings

Psychological Impairment = 20
1) PSY = 20 2) SOC = 35 3) VIO = 50 4) ADL = 25 5) SAb = 80 6) MED = 80 7) ANC = 70
GAF Eq = 35
Dangerousness Level = 35

Explanation of Psychological Impairment Rating

Very incoherent = 20
Marked impairment in attention span = 20
Often talks or giggles to himself (appears to be responding to hallucinations) = 30
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–13

Psychological Impairment
NAME: Griffin, Paul
AGE: 30
Pt.’s thinking is somewhat bizarre at times; however, he is usually able to interact with very little apparent
bizarreness. Occasionally pt. is very circumstantial in his speech. His attention span is generally very limited;
however, if given an immediate reward, his attention significantly improves. Pt. is very uncooperative and
unmotivated to do much of anything. Staff reports that pt. spends most of his time in bed; however, he goes
through periods during which he is fairly energetic. Staff feels that pt. is very manipulative. Pt. states that
generally he is happy and relaxed. Pt. states that he ignores the voices, and he doesn’t let them bother him
because he knows they are just his mind playing tricks on him. No insomnia. Appetite good. Denies lethargy.
Moderate expressive movements. Mild restlessness.

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Ratings

Psychological Impairment = 40
1) PSY = 40 2) SOC = 50 3) VIO = 40 4) ADL = 55 5) SAb = 30 6) MED = 70 7) ANC = 50
GAF Eq = 45
Dangerousness Level = 30

Explanation of Psychological Impairment Rating

Thinking is somewhat bizarre at times = 40

Occasionally very circumstantial in his speech = 40
Very unmotivated and spends most of his time in bed = 40
Reward significantly improves his limited attention span = 40
Realizes the voices are not real = 40
6–14 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Mann, William
AGE: 47
Pt. continues to demonstrate frequent stereotypical movements and bizarre posturing. Sporadically, pt. will
do simple chores around the ward. Persistent inability to maintain personal hygiene. Thinking is almost
totally disorganized. Focal attention is markedly impaired. Pt.’s motivation is markedly impaired. He is almost
completely incoherent; however, at times he will use a complete sentence. Actively delusional and
hallucinating. Pt. continues to do very bizarre things, such as licking the floor on all fours. Pt. states that he is
sad but relaxed. Pt. states that he feels sad when people die. Pt. states that his father recently died (pt.’s
father is not dead). Pt. states that at the funeral, his father was just sleeping. Mild to moderate restlessness.

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Ratings

Psychological Impairment = 15
1) PSY = 15 2) SOC = 10 3) VIO = 50 4) ADL = 20 5) SAb = 50 6) MED = 60 7) ANC = 80
GAF Eq = 25
Dangerousness Level = 15

Explanation of Psychological Impairment Rating

Bizarre posturing = 20
Persistent inability to maintain personal hygiene = 10
Thinking is almost totally disorganized = 20
Almost completely incoherent = 20
Licking the floor on all fours = 20 or worse
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–15

Psychological Impairment
NAME: Powers, Jennifer
AGE: 35
At times, pt. feels that the pace of her life gets to her a little. She states that she works full time and has two
young children at home. Her husband also works full time and is often away on business trips. He helps with
some of the work at home. A part-time maid and relatives also help with babysitting and housework. She is
able to have some time to rest and relax. Pt. denies feeling sad or anxious. Generally, her energy and spirits
are very good. She is sleeping well at night. Despite feeling somewhat overwhelmed at times, she is generally
satisfied with her life.

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Ratings

Psychological Impairment = 90
1) PSY = 90 2) SOC = 100 3) VIO = 100 4) ADL = 100 5) SAb = 100 6) MED = 100 7) ANC = 100
GAF Eq = 100
Dangerousness Level = 90

Explanation of Psychological Impairment Rating

At times the pace of life gets to her a little = 90

No sadness or anxiety = 80 or better
Generally satisfied with life = 90
6–16 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Renaldo, Alice
AGE: 24
Due to increasing stress, pt. has been having more trouble with depression, and her bingeing and purging
have increased to three times a day. Staff states that pt. is also having increasing difficulty focusing on
conversations. Pt. states that generally she is moderately sad and tense. Pt. states that she is sleeping well.
Denies lethargy. Mildly spontaneous. Speech not slowed or subdued. Occasional smiling. No signs of tears.
Mild restlessness. No evidence of psychotic thinking.

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Ratings

Psychological Impairment = 50
1) PSY = 50 2) SOC = 80 3) VIO = 70 4) ADL = 90 5) SAb = 90 6) MED = 70 7) ANC = 90
GAF Eq = 70
Dangerousness Level = 65

Explanation of Psychological Impairment Rating

Bingeing and purging have increased to three times a day = 50 or worse (increasing is a negative sign)
Moderately sad and tense = 50
No evidence of psychotic thinking = 50 or better
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–17

Psychological Impairment
NAME: Rosenthal, William
AGE: 51
Gross impairment in thinking and communication. Very impaired attention span. Pt. is felt to be
hallucinating. Occasionally noted to be talking to himself. Often laughing to himself. Pt. is actively delusional,
and he is cognitively loose and disorganized. Usually has trouble remembering; however, he is able to
remember names of other pts. with no difficulty. Extremely withdrawn with few spontaneous
communications. Shows little interest in his surroundings or social activities. Rarely tries to be friendly. Pt.
states that he is happy and relaxed. No complaints. Pt. states that he is sleeping well. Pt. states that he
doesn’t listen to the voices. Appears fairly relaxed. Moderate smiling. No signs of tears. No restlessness.

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Ratings

Psychological Impairment = 20
1) PSY = 20 2) SOC = 10 3) VIO = 45 4) ADL = 20 5) SAb = 70 6) MED = 40 7) ANC = 70
GAF Eq = 25
Dangerousness Level = 15

Explanation of Psychological Impairment Rating

Gross impairment in thinking and communication = 20

Very impaired attention span = 30 or worse
Extremely withdrawn = 20
Appears to be responding to hallucinations = 30 or worse
6–18 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Scott, David
AGE: 50
Pt. is alert and oriented. Pt. is able to carry on a coherent, focused conversation. Pt. has a long history of fairly
fixed delusions of being a great police hero; however, he realizes that these thoughts are probably not real.
Currently he denies having any feelings that he needs to save anyone from the Mafia. Pt. states that relaxing
seems to get rid of the voices. Pt. states that the voices do not command him to do things. Pt. states that the
voices are primarily of people who have passed away, including his deceased mother (he murdered her). Pt.
states he believes the voices are probably an internal “malfunction” of his brain; however, he cannot rule out
the possibility that they could be real. Pt. shows strong interest in walking, photography, movies, playing
pool, pets, visiting with others, and dating. During the interview, pt. was pleasant, cheerful, and cooperative.

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Ratings

Psychological Impairment = 40
1) PSY = 40 2) SOC = 75 3) VIO = 50 4) ADL = 75 5) SAb = 60 6) MED = 70 7) ANC = 70
GAF Eq = 60
Dangerousness Level = 50

Explanation of Psychological Impairment Rating

Fairly fixed delusion of being a great police hero; however, he realizes that these thoughts probably are not
real = 40
Hallucinations; however, he believes that the voices are probably an internal “malfunction” of his brain = 40
History of murdering his mother would be rated under the Violence subscale
 Scoring Clinical Vignettes (Self-Examination)—Psychological Impairment 6–19

Psychological Impairment
NAME: Sellers, Mark
AGE: 63
Pt. is actively delusional and only partially oriented. He is often talking or laughing to himself. He has a poor
attention span. He is very socially withdrawn with few spontaneous communications. He reports being happy
and relaxed. He is sleeping well. He reports having good energy and appetite.

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Ratings

Psychological Impairment = 30
1) PSY = 30 2) SOC = 45 3) VIO = 40 4) ADL = 30 5) SAb = 85 6) MED = 40 7) ANC = 80
GAF Eq = 35
Dangerousness Level = 40

Explanation of Psychological Impairment Rating

Pt. is actively delusional, often talking or laughing to himself = 30

Poor attention span = 30
Very socially withdrawn with few spontaneous communications = 30
Happy and relaxed (these are positive factors)
Sleeping well and has good energy and appetite (these are positive factors)
6–20 Mastering the Kennedy Axis V

Psychological Impairment
NAME: Woods, Gilbert
AGE: 28
Pt. is actively delusional and is continually hallucinating. Staff feels that pt. is obsessed with politics and
violence. Pt.’s behavior is considerably influenced by hallucinations. At times, pt. yells at the hallucinations.
There is gross impairment in thinking and communication. Markedly impaired attention span. Pt. is socially
withdrawn. Pt. is sexually preoccupied. When on privileges, pt. simply wanders around the canteen and
lobby or talks on the phone to the hallucinations. Pt. states that he feels fine. Pt. denies having any confusion
in his thinking. During the interview, pt.’s thinking was very disorganized. It was very difficult to make any
sense out of what pt. was saying. Pt. states that the date is November 23, 1943. Pt. states that he doesn’t
know what day of the week today is. Pt. did know the name of the hospital; however, he did not know what
ward he was on.

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Ratings

Psychological Impairment = 20
1) PSY = 20 2) SOC = 35 3) VIO = 35 4) ADL = 30 5) SAb = 90 6) MED = 90 7) ANC = 70
GAF Eq = 30
Dangerousness Level = 35

Explanation of Psychological Impairment Rating

Actively delusional and continually hallucinating = 30 or worse

Considerably influenced by hallucinations = 30
Gross impairment in thinking and behavior = 20
Markedly impaired attention span = 20
Very disorganized thinking, which made little sense = 20