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MENTAL STATUS EXAM/Psychology Consult: Kathryn is a thin , bleach ed blond woman who appears her stated age. She is dressed in skin tight, provocative clothing, costume jewelry earrings that eclipse her ears and hang to her shoulders, heavy make-up and elaborately styled hair. She has difficulty sitting still and fidgets constantly in her chair. Her body language throughout the interview remains sexually provocative. Her speech is rapid , mildly pressured, and she rarely finishes a sentence . She describes her mood as “anxious.” Her affect is anxious. Her thought processes show mild circumstantiality and tangentiality. More significant is her inability to finish a thought as exhibited by her incomplete sentences. Her thought content is focused upon sexual themes, including frequency of sexual encounters, worry over vaginal cleanliness. Kathryn denies suicidal or homicidal ideations, auditory or visual hallucinations.
PSYCHOSOCIAL HISTORY Kathryn was born and raised in a large city. She had a brother who was 3 years younger. She described her father as morose, withdrawn, and recalled that he has said, ” I don ‘t like my children.” One of the patient’s earliest memories of was being told by him that her “behind was too big.” Her father was physically and verbally abusive throughout her childhood . She had always longed for a good relationship with him. Kathryn described her mother as the family martyr and the glue that held the family together. She states that she was very close to her mother; her mother always listened to her and was always available to talk with her. Kathryn was a poor student, had difficulty all through school, and described herself as ” always disrupting the class by talking or running a round.” She had a best friend through grade school whom she states ” deserted” her in high school. She has maintained few close friends since then. Kathryn graduated high school with much difficulty and effort. She dated on group dates but never alone. She remained a virgin until her marriage at 19 years old which lasted less than one year. Her husband left her while she was pregnant with her son. The husband was abusive and had not had a role in their lives since the divorce. After the divorce, Kathryn moved back to her parents’ home with her son and remained there until getting her own apartment 3 years ago. Her son is currently 21 years old, recently graduated from college and lives with Kathryn’s parents. Kathryn has worked for the same company in various positions for the past 22 years. She currently works as a file clerk.
1. what significant events and/or relationships may have had the greatest impact on her mental health and why?
2. What non-pharmacological interventions will you suggest for Kathryn? What is your rationale?

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