Comprehensive Exam

Case Vignette for Comprehensive Exam

Based on the vignette provided, please compose a well-written and organized response to each of the questions that follow.

Presentation of the Problem

Mr. Jack Sizemore is a 37-year-old white single male who has a long history of psychiatric problems.  Mr. Sizemore is on disability and lives off a family trust fund. He has a two-bedroom apartment which he shares with his girlfriend.  Mr. Sizemore’s girlfriend also has a lengthy psychiatric history. Both he and his girlfriend are on psychotropic medications.  Mr. Sizemore and his girlfriend are typically compliant with their medications and are seen monthly at a mental health clinic. However, there have been several occasions when Mr. Sizemore either forgets or refuses to take his medications.  At these times his behavior becomes erratic but his family is usually able to intervene rather quickly to get him back on his medications.  Mr. Sizemore has no prior criminal history.

On August 30, 2009 Mr. Sizemore was involved in an altercation at a drive-through window of a fast food restaurant.  Reports indicate that at three clock in the morning (3:00 AM)  Mr. Sizemore became involved in a verbal argument with three men in a car while waiting in the drive through lane.  The manager of the restaurant called the police.  When the police arrived the incident escalated and the police used physical force to restrain Mr. Sizemore.  He was arrested for disorderly conduct but the charges were subsequently dismissed by the prosecutor.  However, Mr. Sizemore filed a police brutality complaint with the police department and provided photographic documentation of cuts and bruises he alleges that he sustained due to the police using excessive force. The police brutality complaint is an ongoing investigation.

After the incident, Mr. Sizemore’s behavior appeared to deteriorate.  He made numerous phone calls to the FBI, the CIA, the Secret Service, and the DEA alleging that the police in his community were involved in drug trafficking.  During this time he was also frequently calling his parents, who live approximately 200 miles away from him.  Mr. Sizemore began to believe that he was Tubbs, a character on the detective series, Miami Vice.  His family became concerned and called a cousin asking him to check-up on Mr. Sizemore. The cousin lived approximately 70 miles away from Mr. Sizemore.  He called the police in Mr. Sizemore’s town, explained his concerns for his cousin and asked if the police would be able to check-up on him. The police consented.

On October 18, 2009 the police sent a marked police unit to Mr. Sizemore’s apartment to check on him.  When the police knocked on the door, Mr. Sizemore called out “who is it?”  The police replied, “It‘s the police”.   Based on his report, Mr. Sizemore feared that they had come to his house due to his police brutality complaint. He also feared that the police knew that he had uncovered their drug trafficking trade.  Mr. Sizemore feared for his safety and in an attempt to scare off the police he fired a shot from his handgun into the ceiling of his apartment.  The police retreated and called for backup. Several marked units arrived including a SWAT team who took  position in the apartment across the hall from Mr. Sizemore’s apartment door.   From a second story apartment window, Mr. Sizemore could see numerous police units in the parking lot and all the police were heavily armed.  Since Mr. Sizemore had already fired a shot the police decided not to attempt to negotiate but rather opted to storm his apartment.  As the police burst through the door of his apartment, Mr. Sizemore fired several shots and leaped out of the second-floor window.  Both the police in the apartment and the police in the parking lot returned fire.  Mr. Sizemore was hit twice though neither wound was life-threatening.

Mr. Sizemore was discharged from the hospital after seven days.  Mr. Sizemore was charged with four counts of attempted murder of a law enforcement officer.  He was also charged with four counts of aggravated assault with a deadly weapon on a law-enforcement officer.  Mr. Sizemore was able to post bail and remains free pending his trial.  He was required to move out of his apartment complex but has found a new apartment which he continues to share with his girlfriend.  Since his release from the hospital he has been compliant with his psychotropic medications.

Based on the vignette provided, please compose a well-written and organized response to each of the following questions.  When writing your responses, please:


·         Use APA (6th edition) Style, with 1-inch margins, double-spaced, 12 font, with a reference list at the end.

·         Write clearly and concisely.

·         Cite appropriate, and especially current, literature (empirical and/or theoretical).

·         Avoid all sexist idioms and allusions.

·         Remember to demonstrate your multicultural competence where appropriate.


Psychological Theory and Practice


A.    What assessments would you conduct to enhance your understanding of the client’s problems and how would your choice of assessment(s) inform your diagnostic formation and treatment planning? Assessments may include structured or unstructured interviews, valid and reliable assessment measures, and/or formalized assessment procedures that may be conducted by yourself or by someone else referred by you. 


B.     Provide your diagnostic impressions (based on either the DSM-5 or DSM-IV-TR) for this individual. In narrative form, please describe how the individual meets the diagnostic criteria for the disorder(s) chosen in addition to the differential diagnostic thought process that you used to reach your hypotheses. Be sure to include any additional (missing) information that is needed to either rule out or confirm your differential diagnoses.



Legal Theory and Application


A.     Explain the background, current presentation, and behavior of the client utilizing theories of offender and/or victim psychology and personality/psychological theories to support your position. Do not simply restate the client’s presentation from the vignette. Instead, provide a theoretical-based discussion of the client’s behaviors as presented in the vignette. 


B.     Describe the psycholegal standards and/or definitions for each of the following: competence to stand trial, risk of dangerousness, and insanity.

Identify and describe one or more landmark case(s) for each standard (at least three cases total). Describe the elements or issues that a mental health professional usually focuses on when assessing a person’s adjudicative competence, risk and insanity, and any additional items that might be especially important to focus on in the provided vignette.


Research and Evaluation


A.    Describe tests or assessment procedures you would employ to address the psycholegal issues of (competence to stand trial, risk of dangerousness, and insanity). You may refer to these from the Psychological Theory and Assessment Section “A” if you already covered them there.  Discuss what the anticipated conclusions would be based upon information provided in the vignette.


B.     Develop one empirically supported therapeutic treatment plan for the client in the vignette. Please make sure you summarize the empirical evidence with appropriate citations to support your treatment choice(s) in working with your client. Be sure to discuss the effectiveness and limitations in working with this particular client, including this client’s background, using the above treatment plans.


Interpersonal Effectiveness

A.    What diversity factors, cultural considerations, or other demographic variables pertaining to this client would you take into account in rendering diagnoses, choosing assessment measures, forming case conceptualizations, and designing the treatment plan?  Be sure to discuss cultural/diversity factors that could apply even if they are not explicitly mentioned in the vignette.


B.     Your writing, use of citations, ability to form a logical argument, and proper APA Style, including the use of paraphrasing, will be evaluated as a measure of your interpersonal effectiveness. No response is required for “B”. 

Leadership, Consultation, and Ethics

A.    Describe how you would work within a professional treatment team to consult, triage, and treat this case. Include a description of the various members of the professional team with whom you would be likely to interact. Additionally, explain the roles and responsibilities of each member of the treatment team. 


B.     What are the ethical and legal dilemmas this vignette introduced? What would be your immediate steps and why? Please be specific and make sure that you describe your process of ethical decision making and the solutions/consequences to which this process might lead. Your discussion should be informed by the American Psychological Association’s Ethics Code as well as the Specialty Guidelines for Forensic Psychologists


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