Differential Mental Health Assessment Video Vignettes

This portion of the module includes four video vignettes of older adults in a series of 10 intake assessment interview videos.  Assessment interviews are broken into interactions that cover bio-psycho-social assessment, depression, alcohol and substance use, cognitive ability and decision-making capacity. Interviews are with actual clients using standardized assessment instruments.

Vignette #1 Mr. C is a divorced, African American male in his 70’s with good social and community supports, has type II diabetes, and a history of ischemic stroke in his frontal lobe that has led to problems with impulsivity,  cocaine addiction, and a possibility of bipolar disorder. Support and education for Mr. Smith’s daughter and other family members is vital. Due to cognitive impairments and substance use issues, it may be difficult to leave Mr. C. alone. Mr. C’s score on the Mini Mental State Exam (MMSE) was a 22/30 indicating borderline cognitive impairment. Geriatric Depression Scale (GDS) score was 4 out of 15, just missing the clinical cut-off. His SMAST-G was clinically significant for substance use.
     - Brief Mental Health Screening & Assessment

Vignette #2 Mr. F is a married Vietnam Veteran, African American man in his 70’s who has suffered frontal lobe damage due to multiple ischemic strokes in a 5-7 year span. He has trouble regulating his emotions as evidenced by his frequent tearfulness and mood lability, and is troubled by the changes in his cognitive and physical functioning, particularly as they have affected his relationship with his spouse. Also has interrelated and significant health challenges of type II diabetes, hypertension, and hyperlipidemia (high elevation of lipids in the blood), which can lead to further risk of stroke, depression, dementia and delirium. He has lost mobility to his right side, which has compromised his ability to walk, stand, eat and write and is troubled by incontinence.
     - Bio-Psycho-Social Assessment
     - Alcohol & Substance Abuse Screening
     - Cognitive Screening & Assessment

Vignette #3 Ms K is a divorced, Caucasian woman in her 70’s with a genius level IQ, and medical issues that include Chronic Obstructive Pulmonary Disease (COPD) and a history of bipolar disorder. She has anxiety related to her COPD, has had two heart attacks and a previous suicide attempt. Went much of her life without treating her bipolar disorder and it is expected that this has contributed to her progressive dementia symptoms. Her antidepressant medications could lead to the potential for antidepressant-induced manic episodes, sleep problems and delirium. Her children and grandchildren are geniuses, which presents as clinically significant, as decline in cognitive functioning does not fit the framework of the family. Ms. K’s Mini-cog score was clinically significant for cognitive impairment.
     - Bio-Psycho-Social Assessment
     - Depression Screening and Assessment
     - Cognitive Screening & Assessment

Vignette #4 Ms H is an African American woman in her 70’s, no children, never married with many life threatening issues. Currently lives alone with limited familial and social support. Multiple TIA’s have left her with diffuse memory problems and severe problems in judgment, which may jeopardize her ability to live independently. Her impairment is no longer to the point where she can be taught to take care of her daily living needs. This is a serious issue as Ms. H’s diabetes, circulatory issues, and hypertension are all impacted by her ability to take her medication, get appropriate exercise and eat a healthy diet. Treatment planning for Ms. H may involve helping her to get into an assisted living facility. This may be difficult in that she lives independently and is not aware that there is any problem. 
     - Bio-Psycho-Social Assessment
     - Depression Screening & Assessment
     - Cognitive Screening & Assessment