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REFERRAL LETTER AND REFLECTION 1 Glenda’s Case Report Author’s name Institutional Affiliation

REFERRAL LETTER AND REFLECTION 2 Glenda’s Case Report Referral Letter Demographic Data Glenda is an older woman who lives with her spouse, Mick (aged 70 years), in Inverell. She has two children, twin boys named George and Tim. Her children live far from where she currently resides. The client is average in her financial status. Glenda claims to have had an extensive social network throughout her life. She recently retired and said she missed her daily routine of going to work. Glenda identifies as a social drinker and does not smoke. She claims to drink four to five standard drinks every day. Reasons for Referral The letter is a referral to a neuropsychologist for cognitive screening and check for problems with brain functions. I am a psychologist, and my client Glenda shows symptoms of cognitive impairment characteristic of dementia that is supported by evidence from the MMSE score, which is lower than the cut-off (23). Prior to her assessment at the Psychology department at the Sunrise Hospital's Mental Health Unit, Glenda was discovered by the patrolling officers early in the morning, wearing only her nightgown and, without any shoes, wandering the streets. Upon arrival at the facility, standard procedure was maintained, and the patient's symptoms were assessed and an examination done using the MMSE (Philipps et al., 2014). When her performance is contrasted with those of people in the MMSE normative sample who are of a comparable age and educational background, Glenda was diagnosed with dementia (Folstein et al., 2020). The diagnosis was backed with information about her siblings, who had been diagnosed with mental illnesses. Glenda reveals that an Alzheimer's diagnosis has been made for

REFERRAL LETTER AND REFLECTION 3 her younger sister. Her youngest sibling was just identified to be battling with depression, and her elder brother was found to have cyclothymic disorder when he was in his forties. I am writing to refer Glenda to a neuropsychologist so that she can be tested further for brain issues and suggestions on a subsequent treatment plan for any specialized diagnosis. The neuropsychologist will assist Glenda in identifying signs of cognitive deterioration. They will advise on the brain area where the cognitive impairment is located. They will also elaborate on the possible etiology of the cognitive impairment and how bad it is, if any. Tests Administered Upon arrival at the hospital, the patient was assessed using the Mini-Mental State Examination (MMSE) (Philipps et al., 2014). Her Cognitive Change characteristics were examined through the following areas: her orientation to time, orientation to place, comprehension of current and past events, reading capabilities, writing ability, and drawing competence. After the evaluation, the following was observed: The patient uses their right hand. The patient was responsive and awake when she arrived at the mental facility. She had trouble focusing, paying attention, and staying oriented during and after the examination. Her appearance matched her stated age. During the assessment, there was good eye contact. The patient looked messy and was wearing a nightgown. There were no apparent anomalies in the way her motor functioning was assessed. No abnormalities in gait were observed. There was some indication of visual impairment since she could not see items further than five meters away. There were noticeable word-finding issues in her speech. The rhythm and intonation while speaking were well-adjusted. Appropriate rise and fall in her voice were observed. No apparent issues with auditory comprehension were found. While there were no apparent issues with remote memory, there was evident impairment in both recent and immediate memory. After

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REFERRAL LETTER AND REFLECTION 4 assessing her reading and writing abilities, it was determined that the patient's intellectual capacity was average. Deficits in organization and planning were indicators of executive functioning issues. Glenda exhibited restricted expression of emotion, attributed to a flat affect. She was in a nervous mood. There was no documentation of the patient's social interactions. The patient denied having thoughts of suicide or murder. Her level of thought was suitable given the circumstances. There were disparate and inconsistent thought processes. The patient expressed no delusions. She refuted having any hallucinations. Poor insight, logic, and judgment were present. Recommendations Given your expertise, please conduct follow-up tests on Glenda and provide a diagnosis of any cognitive deterioration that might exist. Conduct further cognitive and neuropsychological tests on the patient. Given her low score on the MMSE test, advise if there is a cognitive impairment in her brain. Kindly specify the area of her brain where the cognitive impairment is located. Please elaborate on the possible etiology of the cognitive impairment—advice on how bad the cognitive impairment is. Recommend treatment or management options best suited to your diagnosis. Summary Despite being under our care for some time, her symptoms have not gone away. I would appreciate your clinical evaluation and performing a relevant assessment to confirm this diagnosis and advise on any other pathology causing the problem. Kindly elaborate on your diagnosis and advise if treatment is possible. The information obtained from cognitive testing will assist Glenda and her family in making future care plans, even if the cause of cognitive impairment cannot be addressed. Reflection

REFERRAL LETTER AND REFLECTION 5 Psychometric testing entails evaluating a client's personality and cognitive capacity (Gary et al., 2023). There are two main types of psychometric testing: aptitude tests and personality tests. An applicant's cognitive ability can be assessed through aptitude testing. It can evaluate their attention/concentration, motor function, executive functioning, and judgment, to mention a few. The goal of personality tests is to comprehend the stimulus and behaviors of the candidates. There are type-focused personality tests and trait-focused personality tests. Through a series of questions and activities, personality assessments evaluate the degree to which five traits— conscientiousness, extraversion, agreeableness, openness, and neuroticism—are present. Critics in the summative assessment field have argued that there is an inherent absence of cultural representation during assessments. Suggestions have been made for evaluations that consider the clients' personal histories, ethics, morals, convictions, experiences in life, and anything else that influences their behavior, learning, and communication. Strengths and Limitations of Psychometric Testing Educational settings employed psychometric evaluations when they were first created in the early 20th century. Eventually, these tests' value moved beyond the academic setting and into psychology (Cooper, 2023). Psychometric testing is made to assess several metrics based on intellect and personality. The testing techniques have their pros and cons. In terms of Clinical Use The capacity of psychometric testing to provide information beyond what the client is willing to give the counselor is one of its most important advantages. These assessments are valuable for determining a client's strengths and shortcomings and establishing a substantial diagnosis (Cooper, 2023). In a relatively short time, comprehensive psychological testing provides a wealth of information about many aspects of an individual's life, such as their general

REFERRAL LETTER AND REFLECTION 6 cognitive aptitude, unique behaviors and traits, and personality functioning. The information gleaned by psychological testing allows the client and the physician to see the world from the client's particular point of view (Cooper, 2023). In Glenda's case, using the MMSE assessment report provided additional information on her Visual perception, immediate and recent memory, executive functioning, thought process, reasoning, and insight. Identifying patients with critical symptoms is an excellent way psychometric testing can enhance psychology. The psychologist or therapist can take action to address the underlying causes of these individuals' symptoms and stop them from getting worse by recognizing them early on. However, it is expected to over-interpret test results. This may occur when examinations are given out without the necessary context or when test takers place excessive weight on their results (Cooper, 2023). In terms of Cultural Consideration When using psychometric tests, an individual's cultural context is considered (Cooper, 2023). The tools used are suitable for various demographics and sensitive to cultural differences. Cultural disparities and biases may affect client responses and jeopardize the evaluation's validity (Broesch et al., 2020). Glenda’s social and cultural orientation was highly observed during the assessment. Psychometric tests usually require participants to divulge personal data. Assessment providers may need to ensure stringent data security and confidentiality guidelines. Data se would go against the individual's privacy rights and break their trust (Cooper, 2023). Many psychometric tests rely on self-reporting, in which subjects submit personal data. Mood might impact self-reported data during evaluation, social desirability, or self-perception. The patient

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REFERRAL LETTER AND REFLECTION 7 may lie or deliberate answers for more precise outcomes. Glenda reported about her personal and social attributes, which might have been biased in her favor. Individual Difference Factors Individual difference factors like intelligence, personality traits , education, age, family traits, social orientation, and values impact the scoring and interpretation of psychometric tests (Barańczuk, 2019). Biased scoring occurs during testing when an individual member of the group has mental or physical characteristics that differ from the group's average. During the assessment of Glenda, her age, family traits, social orientation, and medical history were examined. However, very few of these appeared in the MMSE report. This shows that most of her differences were not used during the diagnosis (Hayes et al., 2019). The extent to which her drinking habit could cause or accelerate her symptoms should be measured further before a conclusion is made on the matter. The fact that all her siblings have been diagnosed with mental illnesses should be considered. The fact that her children live far from where she resides should be a significant consideration while assessing her condition. Benefits and Challenges of Communicating with a Professional from another Discipline. A single medical professional does not represent the entire team regarding patient care. For this reason, establishing a first-rate healthcare experience requires interprofessional communication or collaborating with other medical professionals to enhance patient care (Bell et al., 2019). When two or more professionals communicate on a common objective or task, it is called cross-discipline communication. For instance, an occupational therapist and physical therapist may work together when a patient has a hand injury. Whereas the occupational therapist would concentrate on the patient's everyday functioning at home, the physical therapist would

REFERRAL LETTER AND REFLECTION 8 concentrate on the patient's muscles. They would cooperate as a team to determine the patient's best action (Bell et al., 2019). Communication in healthcare can improve patient care by lowering the incidence of avoidable adverse drug reactions, decreasing morbidity and death rates, and maximizing medication dosage (Bell et al., 2019). Communication among professionals of different disciplines also has the following benefits: increased patient contentment. It increased retention and contentment among employees. It reduces medical mistakes and avoidable complications. Professional languages used by various professionals in the healthcare sector are fundamentally different. As a result, miscommunication or misunderstandings may happen, particularly when members of this team must collaborate with people on the other side of the table. Resulting communication gaps are frequently more severe when under stress. Professionals must exercise caution to avoid stereotyping by making unwarranted generalizations (Bell et al., 2019). Key Considerations Healthcare professionals must learn each other's viewpoints, speak the same language, and—above all—make deliberate efforts to break down barriers if they want to communicate with individuals from various disciplines (Bell et al., 2019). Use phrases and language that everyone can comprehend. If required, spend some time explaining the specific terms and phrases in the context of the discussion. You can connect with people more effectively the more you know them. We are all human, no matter how differently we may think or communicate. Improved communication fosters a sense of belonging, mutual respect, and understanding and produces better outcomes. References

REFERRAL LETTER AND REFLECTION 9 Barańczuk, U. (2019). The five-factor model of personality and emotion regulation: A meta- analysis. Personality and Individual Differences , 139 , pp. 217-227. Bell, S. K., Langer, T., Luff, D., Rider, E. A., Brandano, J., & Meyer, E. C. (2019). Interprofessional learning to improve communication in challenging healthcare conversations: What clinicians learn from each other. Journal of Continuing Education in the Health Professions , 39 (3), 201-209. Broesch, T., Crittenden, A. N., Beheim, B. A., Blackwell, A. D., Bunce, J. A., Colleran, H., ... & Mulder, M. B. (2020). Navigating cross-cultural research: methodological and ethical considerations. Proceedings of the Royal Society B , 287 (1935), 20201245. Cooper, C. (2023). An introduction to psychometrics and psychological assessment: using, interpreting and developing tests . Routledge. Folstein, M., Folstein, S., & McHugh, P. (2020). 5.2 Mini-Mental State Examination (MMSE). Manual of Screeners for Dementia , 51 . Gary, S., Lenhard, W., Lenhard, A., & Herzberg, D. (2023). A tutorial on automatic post- stratification and weighting in conventional and regression-based norming of psychometric tests. Behaviour Research Methods , pp. 1-11. Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy , 117, pp. 40–53. Philipps, V., Amieva, H., Andrieu, S., Dufouil, C., Berr, C., Dartigues, J., Jacqmin-Gadda, H. & Proust-Lima, C. (2014). Normalized Mini-Mental State Examination for assessing cognitive change in population-based brain aging studies. Methods in Neuroepidemiology, 43, pp. 15-25.

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