8 Signature ASSIGNMENT The following is a brief, highly incomplete case study of a fellow who presents with symptoms of a specific psychiatric illness. He is interviewed and given some IQ testing. IQ testing would not be the best test to understand his problems, in fact it might be contraindicated in his current state but for the purposes of the assignment, IQ testing provides the clearest example of data and its use in a critical thinking exercise which is one of the goals of this assignment. CASE STUDY Mr. A. Soprano is a 55-year-old white male who presented as an “emergency” to a psychologist at a local ER. After establishing rules of confidentiality he revealed he was a high level crime boss; essentially a mobster. Throughout the interview he spoke in a rather pronounced Brooklyn accent. He preferred to call himself “a highly creative business man.” The client’s chief complaint was a concern over a vague desire to “hurt” himself, sleep problems and was experiencing disturbing “thoughts that don’t make any sense.” He stated his thinking had become very negative, “and weighs heavy on me”, where he doesn’t see anything good or positive in his life, “and I’m normally a positive kinda guy.” Dr. Psychologist proceeded to request the client cooperate with psychological testing to help determine potential causes for the client’s reported problems. This included a clinical interview. Mr. Soprano began his interview by telling a story about ordering a fellow mobster killed, “a couple months ago.” He said, “I liked the guy. He was my right hand man, but he screwed up Doc and coulda’ got me whacked so ahh, ya know, he had to go but I felt really bad about it. Hey ‘fergit’ about it, it was a business decision. Sometimes ya make those tough one’s but this one really bothered me ya know.” He stated he noticed in the days following, his thoughts would race and be dominated by feelings of guilt. In the last seven weeks, he went through periods of sleeping much more than normal or suffering from insomnia when he felt “stressed out and I don’t get stressed out, Doc. Normally I sleep like a baby.” He also related in the last month, he had been battling with the strong desire to stay home and “hibernate” and would struggle to fight the fatigue and loss of interest through these times “but I have a business to run. So I get out but most days I don’t wanna.” On the days where he simply couldn’t bring himself to leave home he said he sometimes hears voices telling him he is a “bad man” and deserves to die. He added he finds himself peering out the curtains fearing the cops will come arrest him at any moment. He added he’s noticed other changes that cause him concern, “I don’t know Doc, I used to really enjoy roughin’ people up a little. You know, gettin’ their attention, a busted finger or a knee, but here lately I don’t enjoy it so much.” He said these changes in his feelings, thoughts and behaviors had been going on for “a couple months.” When asked ...

1. 8
Signature ASSIGNMENT
The following is a brief, highly incomplete case study of a
fellow who presents with symptoms of a specific psychiatric
illness. He is interviewed and given some IQ testing. IQ testing
would not be the best test to understand his problems, in fact it
might be contraindicated in his current state but for the
purposes of the assignment, IQ testing provides the clearest
example of data and its use in a critical thinking exercise which
is one of the goals of this assignment.
CASE STUDY
Mr. A. Soprano is a 55-year-old white male who presented
as an “emergency” to a psychologist at a local ER. After
establishing rules of confidentiality he revealed he was a high
level crime boss; essentially a mobster. Throughout the
interview he spoke in a rather pronounced Brooklyn accent. He
preferred to call himself “a highly creative business man.” The
client’s chief complaint was a concern over a vague desire to
“hurt” himself, sleep problems and was experiencing disturbing
“thoughts that don’t make any sense.” He stated his thinking
had become very negative, “and weighs heavy on me”, where he
doesn’t see anything good or positive in his life, “and I’m
normally a positive kinda guy.” Dr. Psychologist proceeded to
request the client cooperate with psychological testing to help
determine potential causes for the client’s reported problems.
This included a clinical interview.
Mr. Soprano began his interview by telling a story about
ordering a fellow mobster killed, “a couple months ago.” He
said, “I liked the guy. He was my right hand man, but he
screwed up Doc and coulda’ got me whacked so ahh, ya know,
he had to go but I felt really bad about it. Hey ‘fergit’ about it,
it was a business decision. Sometimes ya make those tough

2. one’s but this one really bothered me ya know.” He stated he
noticed in the days following, his thoughts would race and be
dominated by feelings of guilt. In the last seven weeks, he went
through periods of sleeping much more than normal or suffering
from insomnia when he felt “stressed out and I don’t get
stressed out, Doc. Normally I sleep like a baby.” He also
related in the last month, he had been battling with the strong
desire to stay home and “hibernate” and would struggle to fight
the fatigue and loss of interest through these times “but I have a
business to run. So I get out but most days I don’t wanna.” On
the days where he simply couldn’t bring himself to leave home
he said he sometimes hears voices telling him he is a “bad man”
and deserves to die. He added he finds himself peering out the
curtains fearing the cops will come arrest him at any moment.
He added he’s noticed other changes that cause him concern, “I
don’t know Doc, I used to really enjoy roughin’ people up a
little. You know, gettin’ their attention, a busted finger or a
knee, but here lately I don’t enjoy it so much.” He said these
changes in his feelings, thoughts and behaviors had been going
on for “a couple months.” When asked if he had any thoughts of
suicide he said, “I’ve thought about wanting to die a couple
times, here lately when whoever this is talking to me in my
head, but I don’t think I’d actually do it. I don’t want my kids
livin’ with that, ya know. I just sometimes feel like hurtin’
myself for what I’ve done, but I’m not sure what that would
be.”
Two days prior to this interview, Mr. Soprano said he was
very disturbed when his wife came up to the restaurant table he
was sharing with his girlfriend and called him a, “cheater and a
murderer.” He added, “First time in a while since I went to
restaurant ‘cause my appetite’s been off for weeks. I’ve lost
about 30 pounds.” He said his wife knew he had a girlfriend but
had never confronted him. His wife stormed out and he cut the
evening short because of intense feelings of guilt and the
sudden onset of deprecating voices that led to a brief
consideration of suicide but he said he had no plan, just fleeting

3. “thoughts of dying or deserving to die. But it went away.” He
added that he has noticed frequent mood changes, ”Doc, these
‘blue moods’ just come over me. I ain’t no crier but suddenly
I’m sad and ballin’ like a baby and I don’t even know why.” He
also reported a loss of sexual interest, “My girlfriend is a real
good lookin’ broad Doc, ya know buddaboom(!) but she’s
frustrated with me cause I ain’t really interested lately, if ya
know what I mean. And that really ain’t like me.”
The client reported a very similar episode at age 28, with
most of the same symptoms, many years ago after he began his
life of crime. After killing his first victim, a “business”
associate, Mr. Soprano recalled becoming withdrawn and
emotional and hearing a similar voice repeatedly speaking to
him that he was “a bad man.” At that time, Mr. Soprano’s wife
actually considered having him committed but decided against
doing so. After several weeks his symptoms subsided without
treatment. “I just threw myself into my work and got over it.”
He also reported that he never wanted to be in this life. He said
he was “a good kid”. Until he was 24 he worked for a second
cousin in a successful chain of shoe stores and looked forward
to becoming a partner but his father was killed and he was
enlisted to “take over the family business. “Just like in the
godfather movie Doc. I’m like a real life version of Michael
Corleone.”
After assurances that he would not try to harm himself he
agreed to come in for testing.
END OF CASE STUDY
One of the requirements of this assignment is to diagnose what
psychiatric illness Mr. Soprano is suffering from. Be assured he
is suffering from one of the four diagnoses listed in the answer
sheet portion.
The following list of diagnostic criteria and symptoms is not
comprehensive but gives sufficient information for you to
determine which diagnosis best fits. Many psychiatric problems

4. share similar symptoms and this can be confusing. What you are
looking for is the best match for the largest group of symptoms
that match Mr. Soprano’s story. For the most part these are the
same criteria any professional would use to diagnose Mr.
Soprano, only some of the wording has been simplified. Confine
your consideration of symptoms to the facts of the story to
determine THE BEST FIT.
The four diagnoses for you to consider are:
· Major Depressive Disorder, Recurrent, with Psychotic
Features
· Bipolar I Disorder
· Antisocial Personality Disorder
· Erectile Disorder
1. These are the diagnostic criteria of Major Depressive
Disorder and regardless of the other symptoms must include
either depressed mood or loss of interest or pleasure.
· Must have at least 5 of the following symptoms for at least 2
weeks.
· Feels sad, hopeless, helpless and empty
· Significant decrease in interest or pleasure in all or almost all
activities.
· Significant weight loss not from dieting or weight gain with
decrease or increase in appetite daily.
· Sleeping too much or too little
· Fatigue or loss of energy
· Feelings of worthless or inappropriate guilt
· Decreased ability to think or concentrate or indecisiveness.
· Recurrent thoughts of death or thoughts of suicide
Sometimes the person may or may not experience
psychosis (a distortion of reality in some way that can be
problems with who they are, when it is or where they are, or
strange thoughts that are not logical or hearing or seeing things
that no one else can see or hear that reinforces their depression.
Meaning, the psychosis seems somehow tied to the depression,
appears driven by the depression and may make it worse. Where

5. if the depression goes away, the psychosis goes away.
2. The diagnostic criteria of Bipolar I Disorder
Bipolar disorder is a cycling mood disorder. That means the
sufferer has distinct episodes where they are markedly (very)
different from their normal personality. These episodes can
come frequently or may have years between. However to be
considered a bipolar episode it must persist for a week or more
and they come in two types: Bipolar I and Bipolar II.
Bipolar I is an episode of mood and behavior change dominated
by mania. They may have also suffered from depression in the
past, or prior to, or following a manic episode. Lastly, the
depression portion can be like the symptoms of depression
described above but episodes of depression are not necessary
for the diagnosis of Bipolar I Disorder.
Bipolar II is dominated more by episodes of depression with a
least one time where the person exhibited some symptoms of
mania called hypomania (manic light) and is not offered for
your consideration.
The symptoms of mania in Bipolar I Disorder are listed below
for you to consider for Mr. Soprano.
Bipolar I:
· Must exhibit a period where there is a distinct episode of
abnormal and persistent elevated or irritable mood. Increased
focus on activities or energy for at least a week.
· During this period of elevated mood the person must exhibit at
least three of the following
· Inflated self-esteem/ grandiose
· Much less need for sleep
· More talkative or a pressure to keep talking
· Racing thoughts
· Either increased focused on work, sex or other endeavors or
unfocused purposeless activity
· Overly involved in activities that involve high risk of painful
consequences such as spending or sex.
· These changes are sufficient to cause significant impairment

6. in functioning.
· Not attributable to drugs. Some stimulants can cause a similar
presentation as mania.
3. The diagnostic criteria for Antisocial Personality Disorder.
A personality disorder is a pervasive personality style that
would describe the person. It is not a mental illness in that the
person may not clearly appear psychiatrically ill. The main
feature of this disorder is a pervasive pattern of disregard for,
and violation of, the rights of others that begins in childhood or
early adolescence and continues into adulthood.
Antisocial Personality Disorder:
· Does not obey the law by engaging in behaviors that are
grounds for arrest.
· Is deceitful with patterns of lying, using aliases or conning
others for profit or pleasure
· Impulsive with no planning
· Irritable with arguments or physical fights
· Reckless disregard for safety of self or others
· Irresponsible including failure to sustain consistent work or
honor financial obligations
· Lack of remorse with indifference to hurting others or
rationalizing hurting or mistreating others.
· Must be 18 or older
· Evidence of conduct problems before age 15.
· The behaviors of the disorder can’t be tied to a more severe
mental illness such as schizophrenia.
4. The diagnostic criteria for Erectile Disorder.
Erectile Disorder is part of a group of Sexual Dysfunction
Disorders. These are disorders where the person has a
significant problem in their ability to respond sexually or to
experience sexual pleasure. Erectile Disorder is essentially a
problem for a man to get and/or keep an erection during sexual
activity.
Erectile Disorder:
· Must have one of the three of the following on all or almost

7. all (75%-100%) occasions of sexual activity.
· Significant difficulty obtaining an erection during sexual
activity
· Or maintaining an erection until completion of sex.
· Significant decrease in erectile rigidity.
The symptoms must be for a period longer than 6 months and
are distressing to the sufferer. It is not better explained by
stress or relationship problems and is not the result of drugs,
alcohol or a medical condition.
Test Results and Interpretations
Intelligence
The Wechsler Adult Intelligence Scale, Fourth Edition
(WAIS-IV) is a cognitive assessment for those aged 16-89. It
provides scoring representative of intellectual functioning in
specific cognitive domains, as well as a composite score
representing general cognitive ability. This administration of
the WAIS-IV of Mr. Soprano yielded the following results. All
the ranges are calculated at the 95% confidence interval.
Factor
Standard Score
Percentile
Description
Range
Verbal Comprehension
96
42nd
Average
91-101
Perceptual Reasoning

8. 92
30th
Average
87-97
Working Memory
102
51st
Average
97-107
Processing Speed
102
51st
Average
97-107
Full Scale IQ (FSIQ)
45th
Average
Assignment Assist and Guidance Sheet
This is to help you complete the assignment.
Critical Thinking: Choose the diagnosis. This is what clinical
psychologists do. A clinical psychologist is provided
information through interviews, outside information and
assessment and then they put it together to ‘figure out’ what is
going on. Those conclusions are then used to guide treatment.
In explaining why you did not choose the other three diagnoses,
focus on a few symptoms that are not present that caused you to
rule that diagnosis out.

9. Interventions – pick two. There is one intervention that is not
appropriate for Mr. Soprano. The other two address specific
symptoms both physiologic and psychological that Mr. Soprano
clearly presents. However there is one treatment that is just not
indicated. One helpful hint; many studies show that two of the
treatments in combination are much more effective in treating
Mr. Soprano’s problem than either one alone.
Quantitative skills:
An IQ test is made up of many smaller tests. These then produce
the subtest scores you see on the left. The Full Scale IQ is that
one number we always hear when talking about a person’s
Intelligence Quotient or IQ. For the purposes of the assignment
the Full Scale IQ is an overall average of the individual subtest
scores.
The column with all the “average”(s) merely means that all the
scores fall in the average range of IQ scores. Meaning most
people have scores like these. Not exceptionally high or low;
they are average.
Understanding and calculating confidence intervals:
No one will get exactly the same score on an IQ test every
time. There are variables in the person and in the administration
that can introduce variance in the scores. The assumption is
there is an optimal or true performance score for this person.
This true IQ score would reveal itself as the most common score
through multiple administrations of the test but of course you
can’t keep giving the test over and over again because of
something called ‘practice effect’. So you calculate using
statistical methods how confident you are that the score you got
would be captured in a range of scores the vast majority of the
time if you could give the test repeatedly; say a hundred times.
This is called a confidence interval. Another way to say it as a
percentage, how confident am I, as the tester that the client’s
actual, true IQ score falls in a specific range of scores most of
the time on repeated administrations? In this case we are
looking at ranges that capture a 95% confidence interval.
Simply stated, as the tester, “I am confident that 95% of the

10. time the person’s true IQ will be in the range of __A___ to
__B____. Where A and B are the outside limit of the range of
possible scores with the actual tested IQ score as the middle of
that range. Or conversely there is a 5% chance their true IQ
score falls above or below the range of scores given.
The percentile is where the person’s score falls, in relation to
the standard distribution of scores. For instance a person with a
score of 115 is at the 84th percentile, meaning about 84% of the
population would score at or below below 115 and 16% at or
above 115. (Average IQ is 100 at the 50th percentile).
Now, look closely at the scores and ranges. As stated these are
at 95% confidence interval. It remains the same for the blank
confidence interval for you to fill in for the Full Scale IQ.
Again, because we don’t exactly know where the range of
scores fall in relation to the person’s true IQ, we consider the
score we do have as the center of the interval (with the
understanding it may not be). With this information you should
be able to calculate the FSIQ and the confidence interval
numbers and explain Mr. Soprano’s percentile rank.
Social Responsibility: Now that you know the person a bit, what
community resources would best fit Mr. Soprano needs? To do
this you have to have some understanding of what those
resources try to accomplish and would that be beneficial to this
person and explain why. There is no singular right answer. It
rests more on your explanation and educated knowledge of
those listed resources.
Communication skills: This is to see if you can distill the
background, interview content, test results and treatment
recommendations into a short summary where the reader would
still have a good understanding of the case without all the
quotes or details.
Writing is a combination of aptitude and knowledge of grammar
and sentence structure. As a college educated person the ability
to write is essential to the appearance of competence. You don’t
have to be an accomplished author but basic skills are a
necessity. So here are a few rules:

11. · This is a professional, formal writing task. It is not writing a
note or sending a text.
· Do not refer to yourself. No “I” or “me”. If you must, you are
“this writer”.
· Do not use slang
· Do not use abbreviations. Texting has ruined people in this
regard. IMHO ;)
· Read what you’ve written, aloud. If it sounds disjointed or
doesn’t make sense then guess what?
· Do not answer with your opinion
For the case summary let’s see what a summary would look like
of a similar length case study of Ms. Jane summarized in 1
paragraph as follows:
Ms. Jane is a 44 year old, white, female who presented
with a complaint of anxiety. She reported experiencing anxiety
in the form of severe nervousness, panic, fear and foreboding in
most social situations, especially where she feels pressured to
meet and speak to unfamiliar people. She is terrified she will
embarrass herself by having nothing to say or humiliate herself
in some way. She stated she has suffered with this for years but
never sought treatment until now because her daughter is
marrying in 6 months. She is terrified she will embarrass herself
and her daughter. She was assessed and found to meet the
criteria for Social Anxiety Disorder. IQ testing indicated that
Ms. Jane’s intellectual functioning is in the average range. She
was prescribed short term psychotropic medication in the form
of an anxiolytic to relieve her sense of panic and nervousness.
She also contracted for at least 5 sessions of Cognitive
Behavioral Therapy to help her identify triggers for her anxiety
and strategies to reduce her fearfulness. She was also referred to
a support group of people with social phobias.
This reads very similarly to an actual summary paragraph of a
psychological assessment. Note most of the details of the
interview and assessment are omitted but there is enough to
give you a pretty good idea what is going on with Ms. Jane and
her treatment plan. Obviously Mr. Soprano’s will read

12. differently because he has a different history and disorder but it
should contain similar kinds of points.
Corporate Finance 11th edition
Stephen Ross; Randolph Westerfield; Jeffrey Jaffe; Bradford
Jordan
Ch 5, 6 AND 7
Respond to the following in a minimum of 175 words:
Discussion 1
Identifying and estimating pertinent project cash flows is
conceivably the most challenging phase of economic analysis.
Cash flows may be ordered into one of three groups: operating
activities, investing activities, and financing activities.
Respond to the following in a minimum of 175 words:
· Explain four problematic situations that will make determining
incremental cash flows difficult.
· Explain two incremental cash flows that will occur at the
investment outlay.
Reply to at least 2 of your classmates. Be constructive and
professional in your responses.
#2 will add later
#3 will add later