Mental health - Clinical practice PDF

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Clinical practice...

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Swift River

Phase One: Psychiatric definitions " Thepr es enc eofhal l uc i nat i ons ,audi t or yorv i s ual ,ordel us i ons ,i r r at i onalbel i ef ,per sec ut i ons ,fl at affec t ,nomot i v at i on,nos peec hormi ni mal ,ors peaksaswor ds al ad. " Par anoi dSchi z ophr eni a

" Abs enc eofal cohol cons umpt i onpr oducesphy s i cals y mpt omsr angi ngf r om mi l ddi s comf or tt os ev er et r emor s , v i t al si gnc hangesandev endeat h. " ETOHDependence

" Pat i entobser v edpos t ur i ngandst ayi ngi nt hes ameposi t i onf orex t endedper i odsoft i me,fl ataffect ,echol al i a, waxyfl ex i bi l i t y . " Cat at oni a

" Per sonc ompl ai nsofphys i cali l l ness ess i xmont hsorl onger ,usual l yf ours y st emsaffect ed:pai n, gast r oi nt est i nal ,sexuali ncl udi nger ect i l edy sf unct i onori r r egul armenses,andneur ol ogi cal wi t hpar al y si sor weakness . " Somat i z at i onDi sor der

" Aneat i ngdi sor derc har act er i z edbybi ngeeat i ngandpur gi ngorconsumi ngal ar geamountoff oodi nas hor t amountoft i me,f ol l owedbyanat t emptt or i donesel foft hef oodcont ent( pur gi ng) . " Bul i mi a

" Di sr es pectf orl awf ulbehav i or s ,r epeat edl yi ng,i nt er est edi nonl ypl easi ngs el ffir s t ,nogui l torr emor s e. " Ant i s oci alPer sonal i t yDi s or der

" Thei nabi l i t yt os i ts t i l l ,f ai l ur et oc ompl et et as ks ,easi l ydi s t r act ed,l ast i ngs i xmont hs ,i mpul si v e. " ADHD

" Ex per i encedov er whel mi ngnegat i v eev enti nl i f ec har act er i z edbyni ght mar es ,flas hbacksoft het r aumat i c ev ent s,wi t hdr awni ndeni alorov eranx i ousandpani ck y .Af r ai dofc r owds ,hy per v i gi l ant ,unabl et or et ur nt o pr ev i ousf unct i oni ngl ev el s . " PTSD

" Aneat i ngdi sor derc har act er i z edbyex cess i v ef oodr es t r i ct i onandi r r at i onal f earofgai ni ngwei ght ,anda di s t or t edbodysel f per cept i on.I tt ypi cal l yi nv ol v esex c ess i v ewei ghtl oss . " Anor exi a

" Sl owons etf or get t i ngmos tr ecentev ent s ,i nabi l i t yt opr ocessnewi nf or mat i on,eas i l yconf used,canbe depr es sedoranxi ous ,l acki ngf ami l i ar i t y . " Dement i a

" Cannotr ememberanyt hi ngc oncer ni ngr ecentpas tex per i ence,andcannotf unct i oni ndai l yact i vi t i es.No pr ev i ousevi denceofdement i a. " Di ss oci at i v eAmnesi a

" I nflat eds el fest eem,gr andi osi t y ,decr eas edneedf ors l eep,ex c ess i v et al ki ng,fli ghtofi deas ,easi l ydi st r act ed, engagi ngi nr i sk yact i vi t i esphy si cal orfi nanc i al . " Bi pol arMani c

" Last i ngatl eas tt woweeks ,f eel i ngs ad,empt yort ear f ul( anhedoni a) ,i nsomni aorhyper s omni a, wor t hl es sness ,poorconcent r at i onandsui c i dal i deat i on. " Maj orDepr ess i v eDi sor der

" Anxi et ysoi nt ensec ausesper sont of eardeat h,f earmor eepi sodes ,af r ai dofc r owdsoropenspaces ,l ast i ng atl eastonemont h. " Pani c Di s or derw/Agor aphobi a

Phase Two: Match psychiatric term to patient scenarios Thet er my ous el ec t ed," Di s soci at i v eAmnes i a, "wasCORRECT. Defini t i on:

Har r yBak er ,age41,r ecent l ywasi nasev er emot orv ehi cl eacc i dentwi t hhi sf ami l yi nt hec ar .Hi swi f eandt wo ofhi st hr eechi l dr enwer ek i l l ed.Henowr emember snoneoft heev ent .Hedoesnotknowwher ehi swi f eand t woc hi l dr enar e. Di ss oci at i v eAmnesi a

Har r yRoger s ,age46,ar r i v esatt heERbr oughtbypol i c e.Anei ghborcompl ai nedt hathewaspl ayi nghi s t el ev i s i onv er yl oudl yal lni ghtwi t hal lt hel i ght soni nhi scondomi ni um.Uponk nock i ngont hedoort oas khi m t obequi etandmor er espect f ul oft hecondomi ni um c ommuni t y ,hewasnotabl et ohav eameani ngf ul conv er sat i onwi t hhi snei ghbor .Mr .Roger st ol dhi snei ghbort hathewasget t i ngr eadyt ot ak eat r i pt ot heFar Eastt hatmor ni ngands eemedt oj umpf r om t opi ct ot opi c.Thenei ghbor ,f r us t r at ed,l ef tandcal l edt hepol i cet o i nt er v ene.Whent hepol i cespok et ohi m,t heyr eal i z edt hatt hi smanwasment al l yunst abl eandbr oughthi mt o t heER. Bi pol arMani c

Dur i nghos pi t al i zat i ononaps y c hi at r i cuni t ,LenaSmi t h,26y ear sofage,i sobser v edi nanawkwar dposei nt he day r oom.Shehasbeeni nt hes ameposi t i onf ors ev er al hour s ,andi snotr espondi ngt ov er bal commands .The pat i enti snotr espondi ngt oanyv er bals t i mul iandi sexhi bi t i ngwaxyfl exi bi l i t y . Cat at oni a

Bet t yPar man,31y ear sol d,uponawak eni ngi nt hemor ni ng,goest oherson' sr oom andfi ndsi tempt y .She becomeshy st er i cal .Shec annotr ememberwhathappenedl astweek.Herhusbandr epor t st hatt hei r15mont hol dsonSt ev encont r act edavi r usandwashospi t al i z edandpl acedonav ent i l at or .Hedi edl astweek , andt hef uner al wast hr eeday sago.Bet t yr emember snoneoft hi s . Di ss oci at i v eamnesi a

Rosi eMor al es ,an18y ear ol dwhor ecent l yr el ocat edf r om Puer t oRi cowi t hherf ami l y ,beganhav i ng s y mpt omssoonaf t erar r i vi ngi nNewYor k .Shehasmul t i pl ephy si calcompl ai nt s .Thesec ompl ai nt sr angef r om anupsets t omach,headac hes ,andmusc l epai ns.Af t erherf our t hvi si tt oherdoct orwi t hnophys i calfi ndi ngst o j us t i f yhers y mpt oms ,shei sconvi ncedsheneedsanot herdoct or . Somat i z at i ondi sor der

J ohnLewi s,35y ear sofage,pr esent saf t erbei ngpi ck edupbypol i cef ordomest i cvi ol ence.Hei sadmi t t edt o t heps y c hi at r i cuni tandhashadanunev ent f ul fir s tday .Ont hes econdday ,hedev el opsel ev at edbl ood pr ess ur e,di aphor esi s ,andfi nehandt r emor s ,al ongwi t haheadache,nauseaandanxi et y . ETOHdependence

Ral phSant or o,i sa36y ear ol dmar r i edf at heroft hr eechi l dr enwhowor k sf r om home.Heav oi dsc r owdsand hasal i stoff r i endsandf ami l ywhoacc ommodat ehi smanyr eques t st obr i ngt hi ngsheneedst ohi shome.He hass hor tper i odsofanxi et yandpai nt hatusual l ypeaki n10mi nut esorl ess .Hear r i v esatt heERwi t hbot h c hestpai nandnumbnessandt i ngl i ngi nhi shands. Pani cDi sor derw/agor aphobi a

Uponmaki ngr oundsatt heendofy ours hi f tonabus ymedi cal sur gi caluni t ,Sam Gr egor yi sl yi ngi nbedand doesnotacknowl edgey ourpr esencewheny ouent erhi sr oom.Hedoesnotr espondt oy ourv er bal quest i oni ng,hasaflataffect ,andmumbl esbacky ourwor dst ohi m.Sam wasfineear l i eri nt heshi f t ,andt hi s as uddenchange.Whenhi sar mi sl i f t ed,i tr emai nsel ev at ed. Cat at oni a

RogerMcCl usky ,70y ear sol d,ar r i v esatERacc ompani edbyhi sdaught erwhost at esherf at heri si r r i t abl e, anxi ous ,k eepi ngt ohi msel f ,andhaspr obl emssl eepi ng.Shest at esi ti sget t i ngwor s e,andi sconcer nedabout memor yl os sofr ecentev ent s . Dement i a

Mar t haSi mmons ,a76y ear ol dr et i r edsc hoolt eacherwhowasr ecent l ywi dowed,pr esent swi t hheadac he, nausea,gener alweakness ,andc hr oni cconst i pat i on.Al lherdi agnos t i ct est sar enegat i v e. Somat i z at i onDi sor der

J ani eRobi ns on,r ecentTus cal oosahur r i canesur v i v orwhol os therhome,pr es ent st oERcompl ai ni ngof i nsomni a,ni ghtsweat s ,pal pi t at i ons,andpani cat t ack s .Shehasbeenunabl et omai nt ai nc ons i s t ent empl oy mentsi ncet heev ent . PTSD

Ri ckMast er soni sa22y ear ol dmedi cals t udentwhohasbeenwei ghtl i f t i ng,r unni ng,ands t r engt ht r ai ni ng.He f eel st hathei sov er wei ghtandwant st opor t r ayaheal t hy ,fitappear ance.Af or merc hi l dmodel ,hehasbeen v omi t i ngandus i ngl ax at i v esal ongwi t ht heex er c i set oc ont r ol hi swei ght .Gast r i cac i di ser odi nghi st oot h enamel . Bul i mi a Robi nWes t ,a19y ear ol df emal e,r epor t seat i ngagal l onofi cec r eam,abagofpot at oc hi ps,andadoz en c hocol at ec hi pc ooki es ,f ol l owedbyt hr ees l i cesofpi zz a-al li nt hemi ddl eoft heni ght .Shet el l sherPCPt hat s hef eel sv er ygui l t ybecaus es hei smaki ngher sel fv omi t ,buti ss t i l lgai ni ngwei ght .Shei sst ar t i ngt ot ak e l ax at i v es ,anddepr es si oni sesc al at i ng. Bul i mi a

Sal l ySt ov al ,a25y ear ol dst at ess hewi l l beanas t r onaut .Shei sexhi bi t i ngpr omi sc uousbehavi or s,buti sal so v er yr el i gi ous ,evi dencedbyherc onst antpr eachi ng.Hers peec hi spr ess ur ed.Shei ss l eepi ngpoor l y ,wor r yi ng aboutherl ar gec r edi tc ar ddebt . Bi pol arMani c

Shi r l eySt ev ens,anunmar r i ed24y ear ol d,i swal ki ngbackandf or t hi nt hedayr oom.Shewav esasi ft oan audi ence.Shet el l sy oushei spr act i c i ngheracc ept ancewal kwhens hei scr ownedMi ssAmer i ca. Bi pol arMani c

Mar yJ ane,a21y ear ol dwhohasc uther sel ff ourt i mesi nt hepastt hr eey ear s ,sl eepsex cess i v el y ,f eel s wor t hl es s,i sunabl et ocompl et et as ks ,dr oppedoutofcol l egeandi sl i vi ngwi t hherpar ent s . Maj orDepr ess i v eDi sor der

Char l esWheel er ,18y ear sol d,pacesi nt hedayr oom.Dur i nggr oup,pat i entcons t ant l yi nt er r upt s,unabl et o wai tf orhi st ur nt os peak.Hebl ur t soutans wer s ,obl i vi oust oot her si nt hegr oup. ADHD

Kat hyMi l l s ,a19y ear ol df emal epr esent st ot heMedi cal Cent erwi t hsev er ewei ghtl os s.Herf at heri saf our s t argener al .Shei sat t endi ngt heAi rFor ceAcademy .Shes t at est hatt hef ami l yi magei sv er yi mpor t ant .She s eesher s el fneedi ngt ol ose10mor epoundsbuthercur r entwei ghti s92pounds,andshei s5f eet6i nc hes t al l . Anor exi a

A26y ear ol df emal e,Mar c i aJ ohnson,i saccompani edbyhermot herwhoex pr ess esconcer nt hatMar c i ai s l osi ngwei ghtandeat i ngonl yv er ysmal lamount soff ood.Shei s5f eet10i nc hesandwei ghs98pounds .She i shavi nghear tpal pi t at i ons .Sheex cel si ns choolandi sanacc ompl i shedbal l er i na. Anor exi a

J amesThomas ,a52y ear ol ddi v or cedmal e,i ss i t t i ngal ongt hewal l i nt heday r oom r eadi ngabook.You not i cehei snott ur ni nganypages .Hi smoodi ss ad,i sol at i v e,andbl unt ed.Hehasahi st or yoft wos ui ci de at t empt s . Maj orDepr ess i v eDi sor der

El l i otSi mpson,42y ear sol d,i sbr oughti nbyambul ancewi t hc hes tpai n,nausea,acc el er at edhear tr at e,and f ear sdeat h.EMTsr epor t eddi ffic ul t ywi t hpat i entwhowasr es i s t antt ol eavi nghi shouse.Hi sl absar eal l negat i v e.Pat i ents t at eshehasbeenunabl et ol eav ehi shousef ort hepastf ewmont hs .

Pani cDi sor derw/Agor aphobi a

Mar yEngl i s h,a78y ear ol dwi dow,i ss i t t i ngandst ar i ngatt hewal l .Sheget supands t ar t swal ki ngt oherr oom andst opsbecauseshedoesnotr ememberwhi c hr oom i sher s . Dement i a

BobMc Kay ,70y ear sol d,ar r i v esatERacc ompani edbyhi sdaught erwhost at esherf at heri si r r at i onal , i r r i t abl e,anxi ous ,i s ol at i v e,andi shavi ngpr obl emss l eepi ng.Thi sappear st obeget t i ngwor se,andt hepat i ent ' s daught eri sconcer nedaboutmemor yl oss ,espec i al l yofr ecentev ent s . Dement i a

Ar t hurSi l v er st ei n,a68y ear ol dVi etNam v et er anwhowasi mpr i s onedbyVi etCongands ev er el yabus ed dur i ngt hewar .Hes ubsequent l yhasbeenunabl et omai nt ai nl ongt er mr el at i onshi psorconsi st ent empl oy ment .Hei snowhomel essandex per i enc i ngfl as hbacksandni ght mar es . PTSD

Vet er anr et ur nsf r om ac ombat r el at edt ourofdut yi nI r aq.Hecannotr ememberwhohei sorany onei nhi s f ami l y .Uponfindi nghi ms omet i mel at er ,hedoesnotr ecogni z ehi sf ami l ynori sheabl et or ememberanyt hi ng. Af t ersi xmont hs ,hebegi nst or emembers eei ngbat t l ebuddi esmor t al l ywoundeddur i ngcombat . PTSD

Gi naSmi t h,a56y ear ol ds ucces sf ulgr aphi car t i s tr ecent l yl os therj ob,andi sdepr es sedandanxi ous .Her l i v erenzy mesar eel ev at ed.Shei scompl ai ni ngofepi s odi cgas t r i cpai n. ETOHDependence

J effer sonMar s hal l ,an18y ear ol dmal epr es ent st ohi spedi at r i ci anf orar out i nephy si cal .Thepat i enti snot ed t obe5f eet ,10i nchest al l ,andhewei ghs105l bs .Hei sr equest i ngas si st ancewi t hwei ghtl oss .Hei sal s o not edt ohav ewor nt oot henamel anddent al cavi t i es. Anor exi a( Ichos ebul i mi aandi twasi ncor r ect ,chos ei tduet ot eet hdecay)

Tom Mar s hal l ,a33y ear ol dcombatv et er anr ecent l yr et ur nedf r om Af ghani st an,i scompl ai ni ngofpoor concent r at i on.Hi shi st or yi nc l udesani nabi l i t yt ok eepaj ob,andunst abl er el at i onshi ps .Hehasbeenmar r i ed t wi ce,andhasonechi l dbyeac hwi f e.Heal sohasl egali ss uespendi ngi nv ol vi ngdomest i cvi ol enceand nonpay mentofc hi l dsuppor t .Hes har est hathes l eepspoor l yandof t enhasfl as hbacksorni ght mar esof combatday s .Hef r equent l yus esal cohol orot hers ubst ancest or el ax .Hei seasi l yanger edandhasbeeni n s ev er al fight satl ocalc l ubsandatpastempl oymentposi t i ons . PTSD

Char l esSt ar k ,51y ear sol d,appear st onev ers i torr el ax .Hes t ar t st ask sandal mos tnev erc ompl et est hem. Heof t enmak esqui ckdeci s i onst hatar enotal way si nhi sbes ti nt er est .Hef r equent l yt ak esr i s kst hatar e fi nanci al l yunsoundorl i f et hr eat eni ng.Thesebehavi or shav ebeenocc ur r i ngf ors ev er almont hs . ADHD

Scot tDavi s ,21y ear sol d,wi t hnopr i orps y chi at r i chi st or y ,i sbr oughtt ot heERbyhi sf ami l y .Hei sr ef usi ngt o bat he,t hi nkshi sf oodi spoi soned,andwi l lonl yeatwr appedf oods.Suddenl y ,hei st al ki ngt oi magi nar ypeopl e, andhi ss peec hi snonsensi cal . Par anoi dSc hi z ophr eni a

Beck yWat son,25y ear sol d,pr esent st oERwi t haudi oandv i s ualhal l uci nat i ons.Pat i ent“ r i desahor s e” t hr ought hehal l s,i r r i t abl e,st r i k esoutatst affati nt er v al s ,r espondi ngt ohal l uci nat i ons .Shespeaksi ngar bl ed s ounds .Heraffecti sflat ,hermoodi ssad,ands heshowsl i t t l eornomot i v at i on. Par anoi dSc hi z ophr eni a

Dav eNel son,64y ear sol d,ar r i v esatt heERaccompani edbyhi swi f ewhos ay ss hecannotmanagehi m at homeany mor e.Dur i ngass es sment ,hei sunabl et os t ays eat edandi snoteasi l ydi r ect ed.Whenask ed quest i onsdi r ect l y ,heof t enmumbl eswor dst hatcannotbeunder s t ood.Hi swi f es t at est hathehasnott ak enhi s medi cat i onsf ort hepastt woday s . Dement i a

DannyWi l es ,age23,hasnotbeenabl et ohol ddownaj ob.Hest at est hat ,whenhewasi nhi ghsc hool ,he coul dnotcompl et et ask s ,r esul t i ngi nhi snotgr aduat i ng.Whenat t endi ngagr oupact i vi t y ,pat i enti sunabl et o r emai ns eat edorf ocused. ADHD

Har ol dWi l l i ams ,58,CEO ofal ocalphar maceut i cal company ,hasbeenmar r i edf ourt i mesandi snowdi v or ced andl i vi ngwi t hhi sgi r l f r i end.Hehassi xgr ownchi l dr en.Hei sest r angedf r om hi schi l dr enands eems unaffect edbyt hei rl ackofi nv ol v ementi nhi sl i f e.Hepr esent swi t hbackpai n.Uponquest i oni nghi m abouthi s c ur r entbackpai n,hehaspr esc r i pt i onbot t l esf r om s ev er al phar mac i es.Hec l ai mshehasnor efi l l sav ai l abl ef or pai nmedi cat i on.Heappear st enseandi npai n.Heal socompl ai nsabouthi sext endedERwai tt i mebef or e s eei ngy ou.Het el l sy out hathehear danot herpat i ents ayt haty oual waysmak epat i ent swai tf ort r eat ment . Ant i s oci alPer sonal i t yDi s or der

Edwar dMar t i n,age44,ar r i v esatt heERacc ompani edbyt heci t ypol i cewhoappr ehendedhi mf orabus i ness di s t ur bancewher ehewashar ass i ngpat r onsataf ur ni t ur es t or e.Her ef usest ousehi scel lphonebecaus eof hi sf eart hatt hephonei sconnect edandmoni t or edbyt heCI A.Att hef ur ni t ur es t or e,hewask eepi ng c ust omer sawayf r om t het el evi si ons ect i ont ok eept hem f r om hear i ngs peci al mess agesmeantonl yf orhi m. Par anoi dsc hi z ophr eni a

Tom Ri char ds ,age25,hasahi st or yofadol esc entbehavi orpr obl ems ,i ncl udi ngani malabuseandaggr es si v e behavi or s.Hei si nt oxi cat edandhasr ecent l ybeenengagedi nphy si cal ass aul t satal ocalbar . Ant i s oci alPer sonal i t yDi s or der

J enni f erEv ans ,a20y ear ol dst udentpr es ent st ot heERwi t hsui c i dal i deat i onsands omec onf us i on.Shehas ani r r egul arhear tr at e.Hermot heraccompani esherandpr ov i desar ecenthi st or y .Jenni f erv omi t saf t ereach mealandhasdi ar r hea.Labr esul t ss howl owpot ass i um andl ows odi um.Quest i oni ngr ev eal sJenni f erhas beenusi ngl ax at i v esl i ber al l y . Bul i mi a

Mar yRot hc hi l d,a36y ear ol dmot heroft hr eechi l dr en,mar r i ed15y ear s ,pr es ent swi t hsui c i dal t hought s wi t houtapl an.Herhusbandaccompani esherandst at esshesl eepsmostoft het i meathomeandf ort hepast mont hav oi dsconv er s at i onwi t hhi m andt hec hi l dr en.Shewasf or mer l yanex c el l enthous ek eeperbutnow s howsl i t t l ei nt er est .Uponi nt er vi ewi ngher ,sheappear ssadbuti sal er tandor i ent ed,andi scooper at i v et oal l r eques t s . Maj orDepr es si v eDi sor der

Li z aMoor e,21y ear sol d,i sf oundonr oundss t andi ngoffi nt hedi st ance.Uponappr oach,s hei snonr esponsi v e t ov er balorphy si cal st i mul i .Sher emai nsi nt hes ameposi t i onf orl ongper i odsoft i me. Cat at oni a

J osephDi ck son,a33y ear ol dengi neer ,pr esent swi t hc ompl ai nt sofbl i ndness ,j oi ntpai n,headache,and er ect i l edy sf unct i on.Fort hepas ty ear ,hehasbeent os ev er al doct or sandemer genc yset t i ngsseeki ngan ans wer .Noev i denceofor gani ccaus ehasbeendi scov er ed. Somat i z at i onDi sor der

Sal l yMcPher son,28y ear sol d,hashadpr obl emsl eavi ngherhomef ort hepas tt woy ear s .Herhus banddoes t hegr ocer yshoppi ng,andheal sot ak est hec hi l dr ent os c hool .Todays hear r i v esbyambul ancewi t h t ac hy car di a,ches tpai n,andf eel i ngi mpendi ngdoom. Pani cDi s or derw/Agor aphobi a

Phase Three: Assess stress and assign action Sam Gregory (catatonia) – increasingly loud/boisterous, hyperextended neck - severe Assess and assign – make simple and direct statements Harold Williams (antisocial personality disorder) – hitting pt/staff, gross motor skills at highest - panic Assess and assign – therapeutically contain pt Sally Stoval (bipolar manic) – “I don’t know what to do, I feel anxious” - moderate Assess and assign – explore alternative coping mechanisms Rick Masterson (bulimia) – refusing to follow directions, advance/retreat fr staff - severe Assess and assign – make simple and direct statements Gina Smith (ETOH dep) – pacing, ruminating about situation - moderate Assess and assign – help pt focus on here and now Harry Baker (dissociative amnesia) – full flight/fight mode, throwing objects - panic Assess and assign – assess potential for injury to self or others James Thomas (Major depressive disorder) – sleeping in chair, reading - mild

Assess and assign – assist in problem solving Tom Richards (antisocial personality disorder) – asking about dental, sleeping in chair - mild Assess and assign – allow expression of feelings

Judith Hanks (ETOH dep) – hyperextended neck, pressured speech - severe Assess and assign – notify md and admin meds Joseph Dickson (somatization disorder) – spitting on staff, throwing objects – panic Assess and assign – call md for onsite assessment Robin West (Bulimia) – throwing objects, spitting on staff – panic Assess and assign – conduct debriefing of staff and pt post-containment Marcia Johnson (anorexia) – tapping feet, “I don’t know what to do” - moderate Assess and assign – help pt focus on here n now Tom Marshall (PTSD) – swearing, shouting loudly - severe Assess and assign – notify md and admin meds Betty Parman (dissociative amnesia) – asking about dental, w/ family visitor – mild / normal Assess and assign – demonstrate active listening Elliot Simpson (panic disorder w/ agoraphobia) – eating dinner, listening to radio – mild / normal Assess and assign – evaluate, explore results, plan Jennifer Evans (bulimia) – “I d...