Next question. (The first is here.) Worth noting: Groups of answers aren’t in any particular order. Your task is to rate each item and choose the answer group that best answers the question. AATBS advocates using 2s, 1s, and 0s to mark each part of an answer (2s are good answers, 1s okay, 0s bad). Others push a + and – approach. Scratch paper helps. My answer and explanation (using “Yes” as a 2 or +) in comments.
In your first meeting with Kevin, 47, he tells you that he’s been “feeling funny” lately, having trouble getting up in the morning, sleeping “too much.” Kevin says he has “occasionally” used crack cocaine in the past, but says “I haven’t hit the pipe in a week.” Kevin has been homeless in the past. He currently lives in a sober living house downtown. Kevin tells you he sometimes thinks people are talking about him and laughing about him, “but it doesn’t bother me much.” Kevin says he has not worked since being laid off two years ago.
2. What referrals might are most likely to be useful in this case?
1. Physician for medical evaluation
Substance abuse detox
Physician for medical evaluation
A homeless shelter in the event that sober living is problematic for client
2. Physician for medical evaluation
Hospitalization till suicidal thoughts pass
Substance abuse detox
Psychiatrist to address symptoms of depression
3. Physician for medical evaluation
Psychiatrist to help stabilize symptoms
Government assistance program for financial and nutritional support
Alternative housing referrals
4. Vocational counselor
Psychiatrist to help stabilize psychotic symptoms
Outpatient drug program
Cocaine Anonymous
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Thanks, Anon., for weighing in. Why I liked the housing referral: Lots of clients here in L.A. report sober livings that are far less than sober (a real-world fine line that isn't likely to show up on the test). But, right–why refer away from a sober sober living?
I will use AATBS (0,1,2) I think the answer is one as well by my scores differed greatly in some domains(Do we know an answer?). Thank you to whoever posted (created) the vignette and to SWP for her thoughts.
1. 2+1+2+1=6 I disagree with SWP on one element. Why refer from stable living situation that supports sobritey?
2. 2+0+1+2=5 The second element is iatrogenic and disqualifies the answer group.
3. 2+2+2+1=6 Again we disagree on the housing referral. I guess she may be thinking he could lose his placement if he is getting high. I also scored the financial and nutritional assistance element as a low 2 or high 1. There is no evidence outside of his lack of work that he needs money or nutritional assistance. Sometimes guys like this have VA or SSI benifits already or family support.
4. 2+1+2+2=7 This would be the answer except you have to choose the element that refers him to a medical doctor to eliminate GMC from Dx group. If feeling funny and trouble waking are weak mood Sx just as sometimes thinking people are talking about him and laughing about him are weak. These are very mild ideas of reference that many neurotic folks have and not strong indicatiors for Sx of psychosis particularly with his absence of paranoid ideation. He says "but it doesn't bother me much."
Clearly medical and psychiatric referrals are paramount and get the highest score whatever system you are using. Detox or inpatient is not indicated in the vignette.
MY ANSWER: #3 – THE ONLY ANSWER TO SUGGEST BOTH MEDICAL AND PSYCHIATRIC REFERRALS. YOU MIGHT OF LIKED #1, BUT DETOX DOESN'T SEEM TO BE REQUIRED FOR THIS CLIENT RIGHT NOW; HE REPORTS HE HASN'T USED IN A WEEK.
2. What referrals might are most likely to be useful in this case?
1. Physician for medical evaluation (YES)
Substance abuse detox (MAYBE–NO USE IN WEEK)
Physician for medical evaluation (YES)
A homeless shelter in the event that sober living is problematic for client (YES)
2. Physician for medical evaluation (YES)
Hospitalization till suicidal thoughts pass (NO S/I MENTIONED IN EXHIBIT)
Substance abuse detox (MAYBE–SEE ABOVE)
Psychiatrist to address symptoms of depression (SORT OF – WHAT ABOUT PSYCHOTIC SX?)
3. Physician for medical evaluation (YES)
Psychiatrist to help stabilize symptoms (YES)
Government assistance program for financial and nutritional support (SURE)
Alternative housing referrals (YES)
4. Vocational counselor (LATER–STABILIZE FIRST)
Psychiatrist to help stabilize psychotic symptoms (SORT OF – WHAT ABOUT MOOD SX?)
Outpatient drug program (MAYBE)
Cocaine Anonymous (MAYBE)