INTERNATIONAL MENTAL HEALTH NETWORK, LTD.
P.O. Box 578
Poway, CA 92074-0578
Phone: (858) 486-9745
Fax: (858) 486-9760
E-mail: nac01@juno.com
Booklets and answer sheets available from
National Computer Systems (800) 627-7271
Test Description
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S A M P L E P R O F I L E
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PAIN SYMPTOMS INVENTORY INTERPRETIVE PROFILE
IMH-Network, Ltd.
TC: 109
FACILITY ID: 123
SOCIAL SECURITY NUMBER: 123-45-6789
LAST NAME: Doe
FIRST NAME: John
GENDER: Male
AGE: 34
RACE: White
HIGHEST GRADE COMPLETED: 12
DATE OF TESTING: 08/01/1998
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This profile is confidential and is developed for use by professional staff
only. Its intended purpose, combined with other instruments, is to delineate
directions for further assessment of this patient. Recommendations made
in this profile do not imply that other approaches should be replaced or
modified. Statements in this profile should be interpreted as hypotheses for
further consideration in combination with other assessment factors utilized
in the individualized and comprehensive screening and selection process.
____________________________________________________________________________
________________________________ _______________ ______________
Reviewing Professional Title Date
COPYRIGHT (C) 1998 IMH-Network, Ltd. ISBN 1-58028-067-6
_______________________________________________________________________________
Client Id: 123-45-6789 08/01/1998
ISSUES RELATED TO SPECIFIC PAIN SITES
This patient is presenting a moderate degree of specific pain symptoms
indicating specific focal areas of discomfort. Further assessment is
clinically recommended and it should include the following:
- identification and classification of the problem (acute vs chronic);
- quantification of the disruptiveness on the patient's social, marital,
and vocational functioning;
- analysis of the patient's medical history and its impact on current
treatment and rehabilitation expectations, plans, and goals;
- prioritization of the focus of clinical intervention(s);
- establishment of the performance baseline from which to evaluate positive
or negative change in the patient's condition;
- clarification of the situational antecedents and cognitive mediators of
pain reactivity;
- determination whether programmatic treatment alterations would be
required, and what type;
The following specific areas were identified by the patient during the
administration of this instrument:
- Degree of pain and related problems are higher than average.
- Frequency of headaches higher than average.
GENERAL SOMATIC ISSUES
A moderate degree of somatic symptomatology has been identified by the
patient indicating concerns and disturbances in physiological functioning.
Areas specifically emphasized by the patient include the following:
- Frequency of headaches higher than average.
- Has a significant amount of stomach problems.
- Has occasional neck and/or back pain.
- Recurrent back problems.
- Experiencing frequent rapid heart beat.
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Client Id: 123-45-6789 08/01/1998
CURRENT HEALTH CONCERNS
The patient presents a high degree of concern about own health. It is
not uncommon that patients with this profile have had a history of frequent
utilization of healthcare resources, and episodes of care with variable
success. Patterns of patient's health behaviors should be carefully
examined, and any practices discontinued which my hinder and impair the
rehabilitative process.
Self-medication should be discouraged, and a pattern of regular visits
and consultations with a primary physician should be encouraged and
established. Use of alcohol and/or illicit substances should be immediately
discontinued.
Areas of specific concern to the patient were identified, such as:
- Degree of pain and related problems are higher than average.
- Reports chronic fatigue.
SLEEP DISTURBANCES
The patient indicates a severe degree of sleep disturbances. The
specific issues which were emphasized include the following:
- Significant sleep disturbances.
- Frequently wakes up feeling tired.
- Experiences chronic fatigue.
- Inefficacy of rest, thoughts racing.
PSYCHOLOGICAL ISSUES
During the administration of this instrument, the patient indicated
having a moderate amount of psychological disturbances in relationship to
the physical symptomatology. Specifically, the following issues were
emphasized:
- Significant emotional disturbance due to high level of anxiety.
- Not as happy and well adjusted as an average person.
- Some loss of trust in people.
- Tolerance threshold lower than average.
- Inefficacy of rest, thoughts racing.
- Some loss of hope in timely improvement and recovery.
- Spends most of the time worrying about a lot of things.
- Fears losing his/her mind due to present difficulties.
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Client Id: 123-45-6789 08/01/1998
DAILY LIVING FUNCTIONALITY
The patient indicated having a significant degree of difficulties in
performing average daily living functions. Specifically, the following
issues are highlighted:
- Reports inability to perform average daily activities without help.
- Leaving many things undone because of serious problems with
attention and concentration.
- Significant difficulties making decisions.
INTERPERSONAL MALFUNCTIONING
The patient seems to be experiencing a moderate amount of interpersonal
or social difficulties at this time. The following issues were emphasized:
- Occasionally fails to complete tasks and leaves things undone.
- Feels that he/she is being treated unfairly majority of the time.
- Loss of interest in outside activities and social life.
- Some loss of trust in people.
- Often feels overcome with anger.
- Most of the time prefers to be alone.
- Does not feel useful to others as before the onset of difficulties.
QUALITY OF PRESENT LIFE
This dimension is evaluated for purpose of determining not only the patient's
current psychological and physiological status, but also to determine the
rehabilitative potential and resources available to the patient. Accurate
identification of clinically critical areas allows for formulation of proper and
effective treatment intervention and modalities.
The following areas were identified by the patient as being critical at
present:
- Significant sleep disturbances.
- Significant emotional disturbance due to high level of anxiety.
- Reports inability to perform average daily activities without help.
- Degree of pain and related problems are higher than average.
- Frequently wakes up feeling tired.
- Sometimes prefers to tell a lie rather than the truth.
- Occasionally fails to complete tasks and leaves things undone.
- Occasional lapses of memory
- Not as happy and well adjusted as an average person.
- Leaving many things undone because of serious problems with
attention and concentration.
- Reports chronic fatigue.
- Feels that he/she is being treated unfairly majority of the time.
- Loss of interest in outside activities and social life.
- Frequent angry feelings.
- Frequency of headaches higher than average.
- Some loss of trust in people.
- Tolerance threshold lower than average.
- Experiences chronic fatigue.
- Significant difficulties making decisions.
- Inefficacy of rest, thoughts racing.
- Some loss of hope that things will improve.
- Frequently feels overcome with anger.