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					            Holden Caulfield Psychiatric Report Assignment

Fill out the following form very neatly in pen or pencil (you can print it from
mrmooreismyteacher if it’s too messy the first time), and then attach a typed sheet to the
back of it.

The typed sheet will summarize in sentences and paragraphs what you feel to be the most
important things you have written on the form in pen.

Here is some help sounding like a psychiatrist:

Refer to Holden mostly as “the subject” or “the patient” rather than by his name, and
occasionally as “Mr. Caulfield.” (Never refer to him as “Holden.”)

Talk about areas in which he is “dysfunctional” and talk about his “inability” to do
certain normal things. Talk about “trauma” and what was “traumatic” for Holden when
referring to bad things that happened to him. Talk about “The patient shows an unusual
focus upon” and “The subject continually mentions” when discussing odd things that
Holden seems to think about and talk about all the time.

Make sure you have expressed in your sentences and paragraphs:
   what you feel is the cause of Holden’s troubles,
   what is odd about him as a result
                     and
   what treatment you think he should receive.

Assignment Upgrades/Powerups/Customization:
          You may put a bold heading over each of these three things (cause,
            oddness, treatment) if you like.
          You may use five words or phrases from the “Transitions” sheet in your
            written summary.
          You may paperclip (to the front of the report) a small “snapshot” printed
            from the Internet of a young man who looks how you think Holden might
            look, were he posing for a picture upon admission to psychiatric treatment.
          You can put the whole thing in a file folder if you like.
                         Princeton Plainsboro Teaching Hospital
                        Psychiatric Assessment Form
                                   Date: March 28, 1945
1. PERSONAL INFORMATION
Name: ____________________________________               Marital status: ______________________________
Sex: ______________________________________              Occupation: ________________________________
DOB: ___________________ Age: ____________               Financial situation: __________________________

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT
(Why is the patient here? When did the trouble start? How long did it last?   What is it like?   Impact on life)




3. POSSIBLE PSYCHIATRIC ISSUES:
 DEPRESSION                                                MANIA  (“Giddiness”)
      Low mood for >2 weeks                                      Speedy, nonsensical talking
      Lack of Sleep                                              Needs less sleep
      Lack of Interest in anything                               Feeling “above” the rules that apply to
      Sense of Guilt/worthlessness                                others
      Low Energy levels                                       Irritability
      Inability to Concentrate                                Recklessness, lack of caution and
      Appetite/weight fluxuation                                  judgement
      Thoughts of death or suicide                            Increased activity
      Suicide attempts                                        Unrealistic, elaborate plans
      Hopelessness                                            Feeling godlike/invincible
 PSYCHOSIS                                                 PANIC ATTACKS
      Hallucinations/illusions                                Trembling
      Delusions                                               Palpitations
 Self-reference:                                               Nausea/chills
      Thinks people are watching him/her                      Choking/chest pain
      Thinks people are talking about him/her                 Sweating
      Thinks radio/television/print media have                Fear of death
          messages to him/her                                  Fear of going crazy
      Random topic-jumping while speaking                     Agoraphobia (fear of crowds, public, open
                                                                   areas)
 GENERALIZED ANXIETY                                       BORDERLINE PESONALITY
     Excessive time spent worrying                            Fear of abandonment/rejection
     Restlessness, edginess                                   A string of unstable relationships
     Easily fatigued                                          A feeling of “emptiness”
     Muscle tension                                           Low self esteem
     Inability to sleep                                       Intense anger/outbursts
     Inability to concentrate                                 Self-injurious behaviour
                                                               impulsivity
 SOCIAL PHOBIA                                             OBSESSIVE-COMPULSIVE DISORDER
     Avoiding social situations for fear of                   Repetitive washing or cleaning
        embarrassment                                          Repetive counting or checking things
     Fear others will humiliate                               Repeating certain words or phrases to self
     Fear of criticism
 ANTISOCIAL BEHAVIORS                                      EATING DISORDERS
     Arrests                                                  Food binging
     Compulsive lying                                         Continually thinking about food
     Incidents of violence                                    Purging (laxatives, forced vomiting)
     Theft                                                    Obsession with body weight/image
     vandalism                                                Unrealistic image of body weight
     Lack of empathy/remorse
     Lack of concern for safety of others
 POST TRAUMATIC STRESS DISORDER                            TOURETTE’S SYNDROME
     Experienced/Witnessed a traumatic event                  Nervous tics/twitches
     Dreams/flashbacks to traumatic event                     Echolalia (immediately repeating sentences
     Continually going over the event in his/her mind           others have just said)
     Fear of things associated with event                     Coprolalia (uncontrollable outbursts of
     Easily startled/jumpy                                      profanity)
4. MEDICAL HX
Previous/current illnesses:




Surgeries/hospitalizations:




Head injury (+/- LOC) and workup/imaging:




Medications:




Alcohol use:




Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)




5. PERSONAL HX
Place of birth:




As a child: (family structure, parents’ occupations; relationships with parents, siblings and friends; abuse, traumatic

 events)




As a teen: (friends, relationships, school, activities, sex, trouble; relationships with parents, siblings and friends;

 abuse, traumatic events)
6.YOUR GENERAL IMPRESSION OF THE PATIENT AFTER SPEAKING WITH HIM/HER




7. POSSIBLE REASONS FOR PATIENT’S PROBLEMS
Axis I: Psychiatric disorder:




Axis II: Personality:




Axis III: Past Trauma:




Axis IV: Social factors:




8. PLAN-RECOMMENDATIONS
Treatment:

    Psychiatric (verbal) Therapy:



    Medication (if so, to alter mood how):



    Institutionalization:




                                             _Dr.___________________________PhD, MD_______
                                                                                  Signature

                                                       ___________________________________
                                                                               Date signed

				
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