Simulation 2 Flashcards
(38 cards)
You are an outside-contract forensic counselor for a locked state
hospital. You are called to evaluate a 61-year-old widowed Southeast
Asian (Laotian) male for his capacity to stand trial. He speaks no
English, but a skilled interpreter is made available to you. The patient
was arrested for a charge of indecent exposure (“Flashing” a passerby in
a shopping mall lingerie outlet). At the time of his arrest, his family
acknowledged that he has episodically engaged in this behavior at
times throughout his life. The current arrest was for a flagrant episode
of conduct, witnessed by numerous persons, and therefore, no
questions of actual intent remain. However, due to questions about
culture, the language barrier, and the patient’s reluctance to discuss
anything with legal staff (including his public defender), competency to
stand trial could not be adequately ascertained. Thus, he was remanded
by the courts into the state facility for further psychiatric evaluation.
You are to provide that evaluation.
You are an outside-contract forensic counselor for a locked state
hospital. You are called to evaluate a 61-year-old widowed Southeast
Asian (Laotian) male for his capacity to stand trial. He speaks no
English, but a skilled interpreter is made available to you. The patient
was arrested for a charge of indecent exposure (“Flashing” a passerby in
a shopping mall lingerie outlet). At the time of his arrest, his family
acknowledged that he has episodically engaged in this behavior at
times throughout his life. The current arrest was for a flagrant episode
of conduct, witnessed by numerous persons, and therefore, no
questions of actual intent remain. However, due to questions about
culture, the language barrier, and the patient’s reluctance to discuss
anything with legal staff (including his public defender), competency to
stand trial could not be adequately ascertained. Thus, he was remanded
by the courts into the state facility for further psychiatric evaluation.
You are to provide that evaluation.
What is the age and marital status of the patient?
61-year-old widowed male
The patient is a refugee from Laos.
What charge was brought against the patient?
Indecent exposure
The patient was accused of ‘flashing’ a passerby.
What significant behavior has the patient exhibited throughout his life?
Episodically engaged in indecent exposure
This behavior has been acknowledged by his family.
What is the purpose of the psychiatric evaluation?
To assess competency to stand trial.
What was the result of the mental status screening?
Cognitively intact with a score of 24 out of 24.
What was the patient’s residential history prior to arriving in the U.S.?
Born in Laos, conscripted into the military, lived in refugee camps in Thailand.
What medical history factors were noted about the patient?
No history of head trauma, neurological disorders, or metabolic issues; chronic smoker.
What educational background does the patient have?
Completed approximately 4th grade education in Laos.
What are the psychosexual cultural norms for the patient?
Similar to those in the United States regarding modesty and sexual propriety.
What significant psychiatric history does the patient have?
Issues maintaining relationships, possible past PTSD, no known psychiatric treatment.
What substance abuse history does the patient report?
Very remote history of opium use, denies current use.
How did the patient present in terms of mood?
Quite depressed, affectively restricted, and episodically tearful.
What legal history does the patient have?
No known prior legal history.
What areas were identified as needing further evaluation?
Support systems, suicidality, stress management, communication issues, impulse control.
What is the patient’s relationship with his family?
Embarrassed by his conduct, willing to offer distant support.
Why is exploring suicidality important for the patient?
His depressive state could worsen as he understands his situation.
What communication issues does the patient face?
Language barrier and cultural issues with the interpreter.
What evidence indicates the patient has poor impulse control?
Admitted to acting on impulse and minimized recent conduct.
What is the patient’s current behavior towards staff?
Initially compliant but later became resistant and non-compliant.
What additional data may help determine the client’s level of function?
Direct interviews with daily attending staff, staff psychiatry contacts, medical records review.
What did the medical records review reveal?
No apparent organic deficits or physiological impediments.
What kind of support could benefit the patient?
Further social support from family and community.
What was noted about the patient’s daily functioning?
Maintains a well-ordered room, dresses properly, interacts with other patients.
