Psych238/Lim/Sections I & JGlobal Assessment of Functioning (GAF) Scale (DSM - IV Axis V)Code Description of Functioning91 - 100 Person has no problems OR has superior functioning in several areas OR is admired and sought after by others due to positive qualities81 - 90 Person has few or no symptoms. Good functioning in several areas. No more than "everyday"problems or concerns.71 - 80 Person has symptoms/problems, but they are temporary, expectable reactions to stressors.There is no more than slight impairment in any area of psychological functioning.61 - 70 Mild symptoms in one area OR difficulty in one of the following: social, occupational, or school functioning. BUT, the person is generally functioning pretty well and has some meaningful interpersonal relationships.51 - 60 Moderate symptoms OR moderate difficulty in one of the following: social, occupational, or school functioning.41 - 50 Serious symptoms OR serious impairment in one of the following: social, occupational, or school functioning.31 - 40 Some impairment in reality testing OR impairment in speech and communication OR serious impairment in several of the following: occupational or school functioning, interpersonal relationships, judgment, thinking, or mood.21 - 30 Presence of hallucinations or delusions which influence behavior OR serious impairment in ability to communicate with others OR serious impairment in judgment OR inability to function in almost all areas.11 - 20 There is some danger of harm to self or others OR occasional failure to maintain personal hygiene OR the person is virtually unable to communicate with others due to being incoherent or mute.1 - 10 Persistent danger of harming self or others OR persistent inability to maintain personal hygiene OR person has made a serious attempt at suicide.CASE SCENARIOSAnthony’s Case Anthony is a single veteran in his mid 60s who was admitted into the Intensive Psychiatric Community Care (IPCC) in Massachusetts about 2 years ago following lengthy hospital stays and repeated failures to adjust to residential care placements. One residential care staff described him as being very dependent and requiring constant supervision and attention. Anthony was re-hospitalized in 2002 when he assaulted a residential care staff after she told him to take a shower because he had been unable to retain his feces voluntarily. During that admission he developed some delusions about having cancer, his activities of daily living (ADL) continued to be very poor, and he began to smear feces. With IPCC support, he was discharged in Nov. 2005 and placed in a rest home because he required a high levelof care and supervision of his activities. Anthony attends activities at the community-based IPCC dayPsych238/Lim/Sections I & Jprogram 3 days a week. His speech is digressive and incoherent at times, but he will usually cooperate if given explicit directions. Despite the fact that Anthony has been able to live outside the hospital for the past 2 years, he remains very dependent on the rest home and IPCC staff for all his needs, and smearing feces continues to be a problem. (Vignette adapted from the Brockton/West Roxbury VAMC)Henry’s CaseHenry is a divorced in-country Vietnam Veteran in his late 40s with a dual diagnosis of depressive disorder with psychotic symptoms and alcoholism, although he has been abstinent from alcohol for several years and has not been overtly psychotic since entry into the IPCC program in 2000. However, he becomes very anxious in social situations or when confronted with a stressful situation. He had not worked for several years until two years ago when he obtained part-time employment bagging groceries at a supermarket. Henry worked successfully part-time, and then quit the part-time job in order to try full-time employment in a job which required a higher level of skill. He couldn't cope with the demands ofthe new full-time position, so he quit that job and remains unemployed because he did not go back to part-time work. His employment record suggests he is capable of holding down a part-time job at an appropriate skill level. Due to unemployment, he became depressed and required admission to inpatient psychiatry. He resides in a rooming home and manages his own medications and funds. (Vignette adapted from the Brockton/West Roxbury