Information about the patient
Identifying information
Patient: Bouvier
Age: 39
Gender: Woman
Marital status: Married without children
Living situation: Independently with partner
Education: Master’s degree in social work (MSW)
Occupation: Social worker at a non-profit organization
Past diagnosis: Depression
Past treatment efforts: Depression therapy, she discontinued it, deemed it unnecessary
Current treatment efforts: Pain medication, sertraline (sometimes skips a dose), modafinil
Current diagnoses: Multiple Sclerosis (MS), a depressive- and anxiety disorder
Subjective information
While doing her bachelor’s, Ms. Bouvier started having mild fatigue complaints and problems
concentrating. At the time, she reckoned this was due to the stress of being a student. To her, this was
more of a gradual change, they felt like mild symptoms. Nevertheless, when finishing her studies,
classmates started noticing her lack of focus, and the fatigue worsened. Recently her partner and work
supervisor started noticing this worsening of her symptoms as well. On top of this, Ms. Bouvier mentions
low mood, anhedonia and anxiety. Ms. Bouvier does acknowledge her own forgetfulness and problems
concentrating, and is able to reflect on the changes in cognitive function she has been through.
Nevertheless, she tends to minimize her complaints - attributing them to stress or fatigue - and their
effect on her daily life and work. Her supervisor has raised concerns about her performances, and also
her husband notices a worsening of the symptoms. In addition, her husband mentions that she plays
down her difficulties and becomes defensive when others raise concerns. The misattribution leads to
Ms. Bouvier not yet having pursued treatment and workplace accommodations, which causes stress and
frustration in her partner. Thus, there seems to be limited self-awareness regarding her cognitive
difficulties. Due to the fatigue, Ms. Bouvier reports needing extra time for certain tasks, and needing
more rest. For example at work: responsibilities that Ms. Bouvier was able to manage before, now
require significantly more effort. This leads to a greater need for breaks, and the necessity to leave early.
Despite the fatigue, Ms. Bouvier stays committed to her job and other responsibilities. In addition, her
self-care and personal hygiene remain intact, though she is no longer able to manage household chores.
As mentioned before, problems concentrating started when she was studying. Now Ms. Bouvier
struggles with maintaining attention during conversations. She frequently misses details and repeats
questions that have already been asked. The problems concentrating are also evident in Ms. Bouvier’s
increased difficulties with problem solving, multitasking and decision making. Ms. Bouvier faces
increased stress when problem solving or adapting to changes. Important to note is that Ms. Bouvier
reports no difficulties while driving a car, where multitasking is needed. But, due to the fatigue, Ms.
Bouvier usually avoids it. Ms. Bouvier frequently forgets tasks, even with multiple reminders. She forgets
to cook, eat and misplaces important items. Furthermore, she has difficulty remembering recently
learned information, such as conversation topics or appointments. This forms an impairment socially, but
also professionally, where she misses commitments and has misunderstandings. Her long-term memory
, seems to be intact, which could be considered a strength. During her childhood, Ms. Bouvier’s brother
struggled with anxiety. Furthermore, her father has some medical problems, including heart disease and
low cholesterol. Despite the fact that there wasn't an official psychological diagnosis, he also struggled
with anxiety. Her mother is known to have type two diabetes and hypertension, and has been through
multiple depressive episodes.
Objective information
Ms. Bouvier was referred by the neurologist due to cognitive difficulties, fatigue and motor coordination
issues. During the assessment, while discussing her social and professional life, she displayed mild
irritability, which suggests some emotional reactivity. When talking about her cognitive difficulties, Ms.
Bouvier appeared guarded and even downplayed the severity of her symptoms. The effect of the fatigue
and pain on her life were also minimized when asked. On the other hand, Ms. Bouvier attributed her
performal lapses to fatigue or external stress. Based on the test results a valid effort and performance
are indicated. Moreover, Ms. Bouvier frequently requested breaks, mainly after tasks that required
sustained concentration. During the latter half of the assessment, she reported feeling mentally
exhausted, which also became apparent because she slumped in her chair. The test results show a
processing speed below average, which is linked to slow cognitive processing. Throughout the majority
of the assessment, Ms. Bouvier was motivated and cooperative. However, she seemed frustrated with
complex problem-solving or sustained attention tasks. Ms. Bouvier furthermore appeared to struggle
with mental flexibility. Her perseverance became particularly clear in cognitive flexibility tasks, where she
required multiple prompts to change her strategy. The test results also indicate difficulties with
attention, orientation and concentration. On these tasks Ms. Bouvier has a very low to low average
performance. Some executive functioning tasks, where cognitive flexibility is necessary, also show low
average scores. Other executive functions remain intact. Ms. Bouvier scores average on the task
regarding immediate and delayed recall, while very low to low average scores are found for working
memory tasks. Ms. Bouvier’s score on estimated premorbid functioning indicates a high average level,
whereas her current cognitive performance is found to be average. This discrepancy suggests a cognitive
decline, although this is not uncommon compared to similarly educated and aged women. Language
function as well as visuospatial cognition, with average scores, remain unimpaired.
Problems
1. Reduced self-awareness due to cognitive misattribution.
Ms. Bouvier downplays her own symptoms and does not see her complaints as severe, which is
frustrating to her partner. On the other hand, during the assessment, Ms. Bouvier often attributed her
performance lapses to fatigue or external stress. In addition, Ms. Bouvier avoids the fact that her
symptoms might be problematic and does not seem to want to pursue treatment. Thus, she does not
seem to be able to accurately report her own symptoms, which seems to be a recognition problem. Her
inability to recognize her impairments could be affected by executive dysfunction and MS.
Identifying information
Patient: Bouvier
Age: 39
Gender: Woman
Marital status: Married without children
Living situation: Independently with partner
Education: Master’s degree in social work (MSW)
Occupation: Social worker at a non-profit organization
Past diagnosis: Depression
Past treatment efforts: Depression therapy, she discontinued it, deemed it unnecessary
Current treatment efforts: Pain medication, sertraline (sometimes skips a dose), modafinil
Current diagnoses: Multiple Sclerosis (MS), a depressive- and anxiety disorder
Subjective information
While doing her bachelor’s, Ms. Bouvier started having mild fatigue complaints and problems
concentrating. At the time, she reckoned this was due to the stress of being a student. To her, this was
more of a gradual change, they felt like mild symptoms. Nevertheless, when finishing her studies,
classmates started noticing her lack of focus, and the fatigue worsened. Recently her partner and work
supervisor started noticing this worsening of her symptoms as well. On top of this, Ms. Bouvier mentions
low mood, anhedonia and anxiety. Ms. Bouvier does acknowledge her own forgetfulness and problems
concentrating, and is able to reflect on the changes in cognitive function she has been through.
Nevertheless, she tends to minimize her complaints - attributing them to stress or fatigue - and their
effect on her daily life and work. Her supervisor has raised concerns about her performances, and also
her husband notices a worsening of the symptoms. In addition, her husband mentions that she plays
down her difficulties and becomes defensive when others raise concerns. The misattribution leads to
Ms. Bouvier not yet having pursued treatment and workplace accommodations, which causes stress and
frustration in her partner. Thus, there seems to be limited self-awareness regarding her cognitive
difficulties. Due to the fatigue, Ms. Bouvier reports needing extra time for certain tasks, and needing
more rest. For example at work: responsibilities that Ms. Bouvier was able to manage before, now
require significantly more effort. This leads to a greater need for breaks, and the necessity to leave early.
Despite the fatigue, Ms. Bouvier stays committed to her job and other responsibilities. In addition, her
self-care and personal hygiene remain intact, though she is no longer able to manage household chores.
As mentioned before, problems concentrating started when she was studying. Now Ms. Bouvier
struggles with maintaining attention during conversations. She frequently misses details and repeats
questions that have already been asked. The problems concentrating are also evident in Ms. Bouvier’s
increased difficulties with problem solving, multitasking and decision making. Ms. Bouvier faces
increased stress when problem solving or adapting to changes. Important to note is that Ms. Bouvier
reports no difficulties while driving a car, where multitasking is needed. But, due to the fatigue, Ms.
Bouvier usually avoids it. Ms. Bouvier frequently forgets tasks, even with multiple reminders. She forgets
to cook, eat and misplaces important items. Furthermore, she has difficulty remembering recently
learned information, such as conversation topics or appointments. This forms an impairment socially, but
also professionally, where she misses commitments and has misunderstandings. Her long-term memory
, seems to be intact, which could be considered a strength. During her childhood, Ms. Bouvier’s brother
struggled with anxiety. Furthermore, her father has some medical problems, including heart disease and
low cholesterol. Despite the fact that there wasn't an official psychological diagnosis, he also struggled
with anxiety. Her mother is known to have type two diabetes and hypertension, and has been through
multiple depressive episodes.
Objective information
Ms. Bouvier was referred by the neurologist due to cognitive difficulties, fatigue and motor coordination
issues. During the assessment, while discussing her social and professional life, she displayed mild
irritability, which suggests some emotional reactivity. When talking about her cognitive difficulties, Ms.
Bouvier appeared guarded and even downplayed the severity of her symptoms. The effect of the fatigue
and pain on her life were also minimized when asked. On the other hand, Ms. Bouvier attributed her
performal lapses to fatigue or external stress. Based on the test results a valid effort and performance
are indicated. Moreover, Ms. Bouvier frequently requested breaks, mainly after tasks that required
sustained concentration. During the latter half of the assessment, she reported feeling mentally
exhausted, which also became apparent because she slumped in her chair. The test results show a
processing speed below average, which is linked to slow cognitive processing. Throughout the majority
of the assessment, Ms. Bouvier was motivated and cooperative. However, she seemed frustrated with
complex problem-solving or sustained attention tasks. Ms. Bouvier furthermore appeared to struggle
with mental flexibility. Her perseverance became particularly clear in cognitive flexibility tasks, where she
required multiple prompts to change her strategy. The test results also indicate difficulties with
attention, orientation and concentration. On these tasks Ms. Bouvier has a very low to low average
performance. Some executive functioning tasks, where cognitive flexibility is necessary, also show low
average scores. Other executive functions remain intact. Ms. Bouvier scores average on the task
regarding immediate and delayed recall, while very low to low average scores are found for working
memory tasks. Ms. Bouvier’s score on estimated premorbid functioning indicates a high average level,
whereas her current cognitive performance is found to be average. This discrepancy suggests a cognitive
decline, although this is not uncommon compared to similarly educated and aged women. Language
function as well as visuospatial cognition, with average scores, remain unimpaired.
Problems
1. Reduced self-awareness due to cognitive misattribution.
Ms. Bouvier downplays her own symptoms and does not see her complaints as severe, which is
frustrating to her partner. On the other hand, during the assessment, Ms. Bouvier often attributed her
performance lapses to fatigue or external stress. In addition, Ms. Bouvier avoids the fact that her
symptoms might be problematic and does not seem to want to pursue treatment. Thus, she does not
seem to be able to accurately report her own symptoms, which seems to be a recognition problem. Her
inability to recognize her impairments could be affected by executive dysfunction and MS.
