Occasionally, our glimpses into their personal lives or professional roles offer opportunities for us to observe psychological, emotional, or behavioral indicators suggestive of a mental illness.
For this assignment, complete the following tasks:
o Identify an athlete who is portrayed in the popular media (on a television series, news program, sporting event, or movie) and is someone you believe may be suffering from a psychological disorder. You may have observed signs of a performance-altering condition or behavioral impairment.
o Next, describe the athlete you've selected. Use the intake assessment form attached and fill the form as if you were interviewing the athlete.
Include all relevant information you are aware of, and feel free to extrapolate additional details as necessary. Be sure to include any symptoms you observe and complete as much of the athlete's history as you can.
o After you've completed the intake assessment form, identify a minimum of two diagnostic possibilities you would consider as potentially present in the athlete.
Describe the assessments you might use if you were to be evaluating this athlete as a sport psychologist.
Complete your intake assessment form and diagnostic possibilities in two to three pages and present it in Microsoft Word document format
Could I send a copy of this assessment to your and have a consultation with them as necessary?
o Yes o No
Signature:
Marital Status:
o Married o Single o Divorced o Widowed
Sex:
o Female o Male
Education:
o Jr. High School o Grade School o College (2-4 years
o High school o Graduate School o Degree _______________
Occupation:
Position Employer
Address
Phone
Why do you want to be part of this Fitness Program?
o To know my current level of physical fitness and to be given recommendations for a fitness program.
o Other (please explain)
Current Medical History
Answer the questions to which you answer yes (leave the others blank).
Have you ever been diagnosed with high blood pressure?
Do you ever have heart or chest pains?
Are you often bothered by the way your heart thumps?
Do you have issues with your Heart racing often?
Do you ever notice extra heartbeats or skipped beats?
Have been diagnosed with high cholesterol levels?
Have you ever been diagnosed with an abdominal aortic aneurysm?
Have been diagnosed with a critical aortic stenosis?
Comments:
For women only, do you have?
Problems with the menstrual period?
Childbirth-related problems?
Urine loss when you sneeze a cough or laugh?
Date of the last pelvic exam and / or Pap smear
Comments:
Are you on any medication on hormone replacement?
Past Medical History
Answer only the question that your answer is yes and (leave others blank).
Heart attack if yes then how long ago? ________
Heart murmur
Varicose veins
abnormal blood-sugar tests or diabetes
Phlebitis (inflammation of a vein)
Stroke
Diphtheria
Infectious mononucleosis
Thyroid problems
Pneumonia
Asthma
Abnormal chest X-ray
Injuries to back, arms, legs or joint
Gall bladder problems or jaundice
Comments:
Family Medical History
Father:
o Alive Current age __________
The general health of my father is:
o Excellent o Good o Fair o Poor
Why his health is poor:
o Deceased o Age at death _____________
Cause of death:
Mother:
o Alive Current age __________
The general health of my mother is:
o Excellent o Good o Fair o Poor
Why her health is poor: _____________