Psychological Examination

Psychological Evaluation
Confidential

Name:
Birthdate:
Age:
Gender:
Education:
Report Writer:
Date of report:

Sira Uro Mo
October 17, 1968
43 years, 0 months
Male
College
Dr. Anne Cruz
November 2, 2011

Instruments Administered:
Clinical interview
Reason For Referral
Mr. Mo, is a 43 year old Japanese national, married to a Filipina named Ina Grabyado-Mo. He
was referred to the clinic for a psychological evaluation with regard to his alleged failure or
lack of desire to consummate his marriage with Mrs. Grabyado-Mo.
Health History
Mr. Mo denied having a history of health or reproductive problems. No history of being
diagnosed as being incapable of reproducing an offspring.

Mental Status Examination

Mr. Mo presented as a well-socializing person, capable of engaging random conversations. He
was casually dressed and his manners and demeanors seemed to be that of an educated
person. He, like other me, are into sports and cars. However, when asked about his daily
routines, he divulge that he tends that he was more concerned with his physical appearance
and that it would take him a long time to get dressed.
Behavior Observations
Mr. Mo approached the testing session in a cooperative and friendly manner. Neither
disruptiveness nor difficulty in cooperation and compliance were noted during the evaluation.
Her appearance and grooming were adequate and appropriate. He had a deliberate style of
answering and working on most problems. Attention and effort were age appropriate. Most
work was completed with an orderly plan and self-correction. Responses were usually made in
a reflective, thoughtful manner.
Signs of different facial expressions were observed. He seemed to be not interested to talk
about his wife or his family life. He was more interested in talking about his work friends and
the outings or adventures they had together. He had difficulty explaining why at his age, hes
till has no children even if he was healthy.
Repetition and emphasis were not needed. When new tasks or new instructions were
presented, there was no difficulty adjusting or responding appropriately, and no signs of
emotional reactions or unexpected errors on early items. He made an adequate effort on
most tasks, and reacted to failure without clear frustration or renewed effort. In general,
the obtained results are considered a valid and reliable sample of his percent level of
functioning.
Summary

Psychological Examination
Mr. Mo is a 43 year old Japanese who is married to a Filipina. He has no history of health or
reproductive problems but he is unable to engage in sexual intercourse with his wife and
seemed to be emotionally detached to her. He has no signs of any desire that he would want
to improve their marital relationship and is unwilling to participate in any marital counseling.
Diagnostic Impressions - DSM-IV
Axis I:312.8 Conduct Disorder, Adolescent onset type, moderate.
305.60 Inability to be emotionally attached to women
312.30 Impulse Control Disorder, Not Otherwise Specified.
V61.20 Spouses Relational Problem
Axis II:
V71.09 No Diagnosis on Axis II
Axis III:
None
Axis IV:
None
Axis V:
70.
Respectfully submitted,
____________________________
Dr. Anne Cruz