VERBAL SAMPLE ANALYSIS REPORT Gottschalk-Gleser Content Analysis Method (Computer Version) Report Date: May 23, 1999 This report is copyright (c) 1999 by GB Software, and may not be reproduced without written permission. GB Software, 4607 Perham Road, Corona del Mar, CA 92625 Telephone: (949) 824-6415 Fax: (949) 824-7012 Page 1 INTRODUCTION This assessment procedure is designed to provide the clinician with useful information concerning patients with mental disorders who are being evaluated. It may not be entirely reliable in individuals who are functioning, for the most part, in a healthy way mentally and physically. It is important, also, to realize that mentally ill individuals often behave in ways that are indistinguishable from people who are mentally well. And people who enjoy good mental health are able to express their fear, anger, and sadness appropriately. Hence, the assessment of emotions from verbal samples may reveal an individual's reactions to distressing current events. What distinguishes mental health from mental disorders is not merely the intensity of emotional reactions, but also the timeliness and appropriateness of these emotions as well as the defenses and coping mechanisms the person has available. These are matters about which the clinician has to make the major judgments. These evaluations from verbal samples are capable of detecting signs of minor and major mental disorders as well as signs of early cognitive impairment and cerebral organic malfunctioning. The diagnostic classifications, conforming to the DSM-IV criteria, that are offered for consideration here to the clinician do not include all the conditions that may be legitimate areas of treatment or research efforts. Also, the clinician should be reminded that the diagnostic classifications suggested are based solely on the content analysis of single verbal samples produced by an individual, and all the specialized clinical training and skills of the clinician should be included in order to corroborate which suggestions are most relevant and valid. The reliability of this psychiatric assessment with regard to giving a description of the typical trait-like characteristics of an individual is more stable if at least three speech samples are used. Scoring is not reliable on samples of less than 80 words. This evaluation consists of a single verbal sample containing 216 words. SPECIFIC ANALYSIS This individual's total anxiety score is mildly elevated. Mildly increased anxiety may occur transiently in normal persons with stressful events of everyday life. Long-standing mild anxiety, by itself, is suggestive of a mild anxiety disorder. With other elevated psychopathological dimensions it may signify other mental disorders. Certain anxiety subscale scores are mildly elevated. These are: death anxiety Page 2 mutilation anxiety diffuse anxiety Those anxiety subscale scores which are elevated provide clues concerning the dynamics of the contributions to the total anxiety. This information offers guidelines to the clinician for psychosocial or biomedical areas meriting more inquiry and investigation. This individual has a normal range of hostility outward scores. This individual's hostility inward score falls within the range of normal individuals. This individual has a normal range of ambivalent hostility. This individual's social alienation-personal disorganization score falls within a normative range. The lower this score within this range the less likely the individual has some form of psychiatric problem or tendency to such and the greater the person's ego strength. This individual has a cognitive impairment score that falls within the normal range. The clinician needs to consider obtaining further neurological and neuropsychological evaluations in order to determine the pathogenesis of the cognitive impairment. To support this further consideration, there are available a series of mathematical models that employ the scores from selected verbal categories of the Gottschalk-Gleser Social Alienation-Personal Disorganization (SAPD) scale to derive estimates of scores that would be obtained by the administration of certain widely used neuropsychological tests from the Halstead-Reitan battery of tests. The raw category counts from the SAPD scale are multiplied by the correction factor for the sample. Neither age nor educational level information is available for this subject, so test scores will be predicted using formulas which do not rely on that information. These predictions may be slightly less accurate than those which include age and educational level. Predicted Scores (1) TPT Time (impairment if greater than 15.7 minutes) = 29.89 - 6.87(IIB5) - 6.91(IIIB1b) = 26.71 minutes (impairment possible) (2) TPT Memory (impairment if less than or equal to 5 figures) = 7.73 - 0.59(IIB1b) = 7.46 figures (impairment not indicated) Page 3 (3) TPT Location (impairment if less than or equal to 4 figures) = 2.53 - 0.69(IIB1b) + 5.99(IIC) - 1.46(IIB5) + 1.33(IIIB2c) + 0.79(IIIA1) - 3.82(IIIA3) = 2.35 figures (impairment possible) (4) Tapping (impairment if less than or equal to 45 taps) = 43.39 + 8.61(IA1) - 13.39(IB2) = 43.39 taps (impairment possible) (5) Trails A (impairment if greater than 40 seconds) = 84.67 - 16.56(IB2) + 66.82(IIA) - 5.81(IIB5) + 24.40(IID1) = 81.98 seconds (impairment possible) (6) Trails B (impairment if raw score equal or greater than 92 seconds) = 280.23 - 118.46(IB2) - 40.63(IIIA1) = 280.23 seconds (impairment possible) (7) Categories (impairment if equal or greater than 51 errors) = 145.69 - 13.72(IA1) - 5.88(IIB1b) - 14.14(IIB5) + 67.15(IIC) + 5.18(IIIA1) - 6.18(IIIA2) = 136.42 errors (impairment possible) (8) Speech perception (impairment if less than 52 correct) = 53.48 - 6.51(IB2) - 5.12(IIIA1) - 3.82(IIIB1b) = 53.48 correct (impairment not indicated) (9) Wisconsin Card Sorting (impairment if less than 6.0) = 2.77 + 2.07(IC2) - 0.98(IIIB1b) - 5.38(IIIB2a) + 1.65(IIIB2c) + 0.97(IVB) = 0.94 (impairment possible) (10) Digit Symbol (impairment if raw score less than 35) = 45.23 - 7.07(IIB5) = 41.96 (impairment not indicated) (11) Digit Span (impairment if raw score less than or equal to 8) = 11.78 - 0.99(IC3) - 0.64(ID2) + 4.81(IIC) - 10.23(IIF2) Page 4 - 0.94(IIIB1b) - 0.13(IIIB2b) = 10.65 (impairment not indicated) (12) Object Assembly (impairment if less than or equal to 19) = 29.78 - 17.68(IIB1c) = 29.78 (impairment not indicated) (13) Benton Visual (impairment if 6 or less correct) = 6.12 - 3.59(IIE1) - 1.47(IIIA2b) = 6.12 correct (impairment not indicated) (14) Shipley Hartford Verbal (impairment if less than 12.00) = 31.72 - 3.31(ID2) - 10.57(IIB1c) - 12.77(IID1) + 9.68(IIE1) + 3.85(IIIA2c) = 28.66 (impairment not indicated) (15) Shipley Hartford Abstract (impairment if less than 10.00) = 10.20 - 2.57(IIIA2c) = 10.20 (impairment not indicated) This individual has a hope score within the normal range. This individual's depression scale score is within the normal range. The clinician should examine the subscale scores to see if there are specific areas with significant elevations, which would indicate 'hidden' depression. Page 5 In the process of selecting a diagnostic classification that fits a patient's circumstances and life history from among the many possibilities that need to be considered, the clinician needs to review a number of factors: 1. Is the patient currently taking some sort of medication or drug, legal or illegal? a. Many legal drugs have definite effects on cognitive functions. Some antihistamines, anticholinergic agents, most benzodiazepines, and many sedatives reduce cognitive performance, especially when using timed testing procedures. Lithium, especially at higher dosages, may interfere with cognitive competence. The major tranquilizers and antidepressant psychoactive pharmacological agents can have adverse effects on cognitive and intellectual function. b. Illegal drugs can inhibit the quality of cognition. Current use of marihuana impairs cognitive performance. So do the psychotomimetic drugs, for example, LSD. Morphine and heroin at higher dosages produce sedative effects that slow down cognition. Although the psychomotor stimulants, such as the amphetamines and cocaine, may have a temporary initial stimulating effect on intellectual function, the withdrawal effect from such drugs is often associated with impairment of cognitive function. c. All of the legal psychoactive drugs, such as antianxiety agents, antidepressants, and major tranquilizers, do have effects on their so-called target symptoms--for example, the emotional states of anxiety and hostility, depressed mood, social alienation-personal disorganization, and/or psychotic manifestations. Hence, patients taking such drugs are likely to have reduced manifestations of these target symptoms. d. Many other medications administered routinely for nonpsychiatric medical disorders may produce cognitive or psychological side-effects. Even the birth control pills tend to block the emotional variations peculiar to each woman and associated with the menstrual cycle. And the anticancer drugs can have temporary adverse effects on memory and cognition. 2. Very recent alcohol use definitely impairs cognition. A history of prolonged alcohol abuse, although the patient is now a 'recovered' alcoholic, is associated with persisting signs of cognitive impairment by neuropsychological testing. A history of alcohol abuse by the patient's mother during the patient's fetal life is accompanied by evidence of cognitive impairment during later development. 3. Medical disorders associated with occasional cerebral anoxia or circulating biochemical abnormalities can adversely affect cognitive function of mental well-being. 4. And, certainly, age, educational level, and gender influence cognition and, to some extent, mental function. These Page 6 are taken into consideration with the normative scores that are used, but they must be thought of in selecting a diagnostic classification. In summary, the clinician needs to be aware of the influence of these factors on the patient's mental status. Since this computerized program does not have access to all of these important and relevant data, the diagnostic classifications suggested cover disorders with overlapping or shared descriptive manifestations and yet are broadly scattered in terms of possible pathogenesis. So the clinician must make selections among the possible classifications suggested that take into consideration these causative factors. If the clinician is in the process of making a neuropsychiatric diagnosis, the DSM-IV diagnostic classifications to consider are: For Adults: Axis I: Panic Disorder or Anxiety Disorder, with agoraphobia (300.21) or without agoraphobia (300.01). Adjustment Disorder with anxious mood, mild (309.24) Adjustment Disorder with mixed anxiety and depressed mood (309.28) For Children: Axis I: Separation Anxiety Disorder (309.21) Anxiety Disorder not otherwise specified (300.00) Page 7 TABULATION OF VERBAL SAMPLE CODED FOR ANXIETY Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Total Weight Raw Score Subscale Score `Human' Score (W.) (W. x C.F.) SqRt(RS+1/2CF) Death . . . . . . . . 1 0.463 0.833 0.927 1c1 X 1 Mutilation. . . . . . 4 1.852 1.443 1.067 2b2 X 1 2c1 X 2 Separation. . . . . . 2 0.926 1.076 0.735 3c1 X 2 Guilt . . . . . . . . 0 0.000 0.481 0.558 Shame . . . . . . . . 0 0.000 0.481 0.699 Diffuse . . . . . . . 3 1.389 1.273 1.172 6a3 X 1 TOTAL . . . . . . . 10 4.630 4.630 + (1/2 * C.F.) = 4.861 Square Root = 2.205 Human Equivalent = 2.260 Based on norms for white male adults, the score is slightly high for the Anxiety scale. It is between one and two standard deviations above the mean. Page 8 TABULATION OF VERBAL SAMPLE CODED FOR HOSTILITY DIRECTED OUTWARD Word Count = 216 Correction Factor (C.F.) = 0.463 OVERT Subcategory Total Weight Total 0 Raw Score 0.000 Corrected Score (+ 1/2 C.F.) 0.231 Square Root 0.481 Human Equivalent 0.798 Based on norms for white male adults, the score is in the normal range for the Hostility Outward (Overt) subscale. It is within one standard deviation of the mean. Page 9 COVERT Subcategory Total Weight IIa3 x 1 3 Total 3 Raw Score 1.389 Corrected Score (+ 1/2 C.F.) 1.620 Square Root 1.273 Human Equivalent 0.734 Based on norms for white male adults, the score is in the normal range for the Hostility Outward (Covert) subscale. It is within one standard deviation of the mean. Page 10 TOTAL Total (overt+covert) Total 3 Raw Score 1.389 Corrected Score (+ 1/2 C.F.) 1.620 Square Root 1.273 Human Equivalent 1.124 Based on norms for white male adults, the score is in the normal range for the Hostility Outward scale. It is within one standard deviation of the mean. Page 11 TABULATION OF VERBAL SAMPLE CODED FOR HOSTILITY DIRECTED INWARD Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Total Weight Total 0 Raw Score 0.000 Corrected Score (+ 1/2 C.F.) 0.231 Square Root 0.481 Human Equivalent 0.750 Based on norms for white male adults, the score is in the normal range for the Hostility Inward scale. It is within one standard deviation of the mean. Page 12 TABULATION OF VERBAL SAMPLE CODED FOR AMBIVALENTLY DIRECTED HOSTILITY Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Total Weight Total 0 Raw Score 0.000 Corrected Score (+ 1/2 C.F.) 0.231 Square Root 0.481 Human Equivalent 0.676 Based on norms for white male adults, the score is in the normal range for the Ambivalent Hostility scale. It is within one standard deviation of the mean. Page 13 TABULATION OF VERBAL SAMPLE CODED FOR SCHIZOPHRENIA Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Count Weighted Score IA1 IA2 IB1 IB2 IC1 3 -6.00 IC2 IC3 1 -2.00 ID1 2 0.00 ID2 2 -2.00 IIA1 IIA2 IIA3 IIB1A IIB1B 1 1.00 IIB1C IIB2 IIB3A 2 -2.00 IIB3B IIB4 IIB5 1 0.50 IIC IID1 IID2 IIE1 IIE2 IIF1 IIF2 IIIA1 IIIA2 IIIA3 IIIB1 IIIB2 4 4.00 IVA IVB 1 0.50 V Total -6.000 Corrected Score (R.S. x C.F.) -2.778 Human Equivalent -2.419 Based on norms for white male adults, the score is in the normal range for the Social Alienation/Personal Disorganization scale. It is within one standard deviation of the mean. Page 14 TABULATION OF VERBAL SAMPLE CODED FOR COGNITIVE IMPAIRMENT Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Count Weighted Score IB1 IC1 3 -1.50 IC2 1 -0.50 IC3 1 -0.50 IIA IIB1 1 -0.50 IIB3 2 0.50 IIB5 1 1.00 IIC IID2 IIIA2 IIIB2 4 4.00 IVA Total 2.500 Corrected Score (R.S. x C.F.) 1.157 Human Equivalent 0.888 Based on norms for white male adults, the score is in the normal range for the Cognitive Impairment scale. It is within one standard deviation of the mean. Page 15 TABULATION OF VERBAL SAMPLE CODED FOR HOPE Word Count = 216 Correction Factor (C.F.) = 0.463 Subcategory Count Weighted Score H1 5 5.00 H2 3 3.00 H3 H4 H5 H6 3 -3.00 H7 Total 5 Corrected Score (R.S. x C.F.) 2.315 Human Equivalent 1.056 Based on norms for white male adults, the score is in the normal range for the Hope scale. It is within one standard deviation of the mean. Page 16 TABULATION OF VERBAL SAMPLE CODED FOR DEPRESSION Word Count = 216 Correction Factor (C.F.) = 0.463 Weighted Human Subcategory Count Score Equivalent I. Hopelessness I1 I2 3 3.00 I3 Subscale I 1.273 0.395 II. Self-Accusation IIA. Guilt Depression IIAA IIAB IIAC Subscale IIA 0.481 0.558 IIB. Shame Depression IIBA IIBB IIBC Subscale IIB 0.481 0.699 IIC. Hostility Directed Inward IIC1A IIC1B IIC2A IIC2B IIC3A IIC3B IIC3C IIC4A IIC4B IIC4C Subscale IIC 0.481 0.750 Subscale II 0.481 0.838 III. Psychomotor Retardation III Subscale III 0.481 0.322 IV. Somatic Concerns IVA IVB IVC IVD IVE Subscale IV 0.481 0.700 V. Death and Mutilation Depression Page 17 VA. Death Depression VAA VAB VAC 1 1.00 VAD Subscale VA 0.833 0.927 VB. Mutilation Depression VBA VBB 1 2.00 VBC 2 2.00 VBD Subscale VB 1.443 1.067 Subscale V 1.596 1.409 VI. Separation Depression VIA VIB VIC 2 2.00 VID Subscale VI 1.076 0.735 VII. Hostility Directed Outward VIIA. Hostility Directed Outward (Overt) VIIA1A VIIA1B VIIA1C VIIA2A VIIA2B VIIA2C VIIA2D VIIA3A VIIA3B VIIA3C Subscale VIIA 0.481 0.798 VIIB. Hostility Directed Outward (Covert) VIIB1A 1 3.00 VIIB1B VIIB1C VIIB2A VIIB2B VIIB2C VIIB2D VIIB2E VIIB2F VIIB3A VIIB3B VIIB3C VIIB3D VIIB3E VIIB3F Subscale VIIB 1.273 0.734 Subscale VII 1.273 1.124 Final Score 6.661 Human Equivalent 6.459 Page 18 Based on norms for white male adults, the score is in the normal range for the Depression scale. It is within one standard deviation of the mean. Page 19 Ok, I guess / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IIB3A);C:(IIB3);H:(H1); DEP:No Score I'll tell you about my cat. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IVB);C:No Score;H:No Score; DEP:No Score / She is a rather small black cat, but a rather vicious cat to other people. AX:(2c1);HO:No Score;HI:No Score;AH:No Score;S:(IIIB2);C:(IIIB2);H:(H6); DEP:(VBC I2) / She's had eighteen litters of kittens in the last seven years. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IIIB2);C:(IIIB2);H:No Score; DEP:No Score / One of her babies / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score that we kept / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score was very friendly and gentle. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / She always protected him / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IC1);C:(IC1);H:(H1);DEP:No Score even when he bit her tail / AX:(2c1);HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:(VBC) when he was playing. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(ID2 IIIB2);C:(IIIB2);H:(H2); DEP:No Score / But then he was killed out in front of the house. AX:(1c1);HO:No Score;HI:No Score;AH:No Score;S:(IIIB2);C:(IIIB2);H:No Score; DEP:(VAC) / We always thought / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score that he would be / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score because he ran across the busy street frequently. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / Let's see. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / Back to the mother, I guess. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IC1);C:(IC1);H:(H1);DEP:No Score / Sometimes we'd find her sitting on the roof. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / Then she'd pretend / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; AX-Anxiety;HO-Hostility Outward;HI-Hostility Inward;AH-Ambivalent Hostility S-Social Alienation/Personal Disorganization;C-Cognitive Impairment H-Hope;DEP-Depression;HS-Health/Sickness Page 20 DEP:No Score she couldn't get down, / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score and we'd always climb up for her on a ladder. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / One neighbor was afraid of our older cat, / AX:(6a3);HO:No Score;HI:No Score;AH:No Score;S:(IIB1B);C:(IIB1);H:(H6);DEP:(I2) and then another was allergic to them. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(ID1);C:No Score;H:No Score; DEP:No Score / So my mother used to lock them out of the house / AX:(3c1);HO:No Score;HI:No Score;AH:No Score;S:(ID1 IC3);C:(IC3);H:(H6 H1); DEP:(VIC I2) when that neighbor came to visit. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score / Once we had a visitor along with her baby / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:(IC2);H:No Score; DEP:No Score and we could see / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:No Score that the baby was going to drop the ashtray / AX:(3c1);HO:No Score;HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:(VIC) she was playing with. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(ID2);C:No Score;H:(H2); DEP:No Score / And the mother cat went over, stood up on the table with her front feet / AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IC1);C:(IC1);H:(H1);DEP:No Score and she just smacked the baby's hands. AX:(2b2);HO:(IIa3);HI:No Score;AH:No Score;S:No Score;C:No Score;H:No Score; DEP:(VBB VIIB1A) / I had to laugh out loud at that one. AX:No Score;HO:No Score;HI:No Score;AH:No Score;S:(IIB3A IIB5);C:(IIB3 IIB5);H:(H2); DEP:No Score AX-Anxiety;HO-Hostility Outward;HI-Hostility Inward;AH-Ambivalent Hostility S-Social Alienation/Personal Disorganization;C-Cognitive Impairment H-Hope;DEP-Depression;HS-Health/Sickness