Psychological Assessment of Patients with Behavioural Symptom

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					Psychological Assessment of
       Patients with
   Behavioural Symptoms
Psychiatric Evaluation
 Taken as part of Medical History
 Personality chararterestics
 Relationships with others
 Sources of Stress
                     together with
Chief complaints
History of illness
 Evaluation of patients who show abnormal behaviour
 normally occurs in the context of clinical interview.

 Psychiatric History
 Self Report inventories
      Mental Status Examination (MSE)
 MSE - comprehensive survey used to evaluate an individuals
  current state of Mental Functioning.
                           Assesses:-
 General Presentation (Appearance , behavior, attitude
  toward the examiner, and level of consciousness)
 Cognition (orientation, memory, attention and
  concentration, cognitive ability, and speech)
 Emotional state (mood and affect)
 Thought and perception (form or process, content, and
 Judgment and Insight
 Reliability and Impulse control
Assessment Approaches

 Self Report Measures = Questionnaires
 Interviews
 Observational Ratings
 Objective Tests
 Projective Tests
                      Self Report inventories
 Evaluation instruments can be administered to an individual
  or to a group of individuals at one time.
 Individually administered tests allow careful observation and
  evaluation of that person.
 Tests given to a group of people simultaneously have the
  advantages of efficient administration, grading, and
  statistical analysis.
 Tests used in the psychological evaluation of patients: 3 main
              Intelligence
             Personality/psychopathology

 Most common method for personality
 Great for detailed self descriptions in bigger
 Rely on the info the participant is willing & able to
 “Faking good” can be assessed
 Controlled testing situation
 Interpretation is exclusively on behalf of the
  applicant, not the interviewer
 Objectivity guaranteed
 Uses verbal interaction to determine personality

 Structured, semi-structured or unstructured

 Involves many information processes for interviewer and

 Not particularly reliable or valid for personality

 Less accurate than people believe
      Psychometric approach

 Focuses on how well people perform on standardized
  mental tests and with what the scores correlate

   Achievement tests - based on learning

   Aptitude tests--measure the ability to acquire skills in the

      ---the difference is really one of degree and intended use
   since all are based to some extent on experience with words,
   objects, etc.
 Intelligence is a measure of individual’s innate potential for
                 It includes Quantification of :

 Ability to reason: to think logically and come to a
 To understand abstract concepts
 To assimilate, recall, analyze
 Organize information
 To meet the special needs of new situations.
    Determinants of Intelligence
                             Genetic Factors
                 Biological Factors ( -ve effect)
 Poor Nutrition
 Illness, early in life
                      Environmental Factors
 Exposure to education Enrichment
                              Social Factors
 Good Parent -Child Relationship
                            Emotional Factors
 Positive response to a testing Situation
  Invention of IQ Tests

 Alfred Binet:   1904        Mental Age

 Lewis Terman: 1916          Stanford     IQ

Divided child’s mental age by the child’s chronological age
 to yield an Intelligence Quotient (IQ): MA/CA x 100

All average children, regardless of age,would have an IQ of
           IQ tests
 Weschler Adult intelligence scale – revised (WAIS-R)
  – adults (16-75 yrs)

 Weschler intelligence scale for children –revised – for
  testing children b/w 6 & 16 ½ (WISC-R)

 Weschler preschool and primary scale of
  intelligence – 2.5 yrs to 7 yrs and 3 months (WPPSI)

 Vineland social maturity scale – evaluates skills for
  daily living in mentally retarded and other challenged
  people (Eg. Visually impaired)
              Achievement tests
 Achievement is culture specific measure of knowledge
 and skills achieved from education and Experience

 Scholastic aptitude test (SAT)

 Medical college admissions test (MCAT)

 US medical licensing examination (USMLE)

 Wide range achievement test (WRAT) – evaluate
 arithmetic, reading, and spelling skills in patients
  Achievement tests in schools
 Evaluate individual student performance
 Monitor effectiveness of teaching program, teachers &
 Compare with other school systems

 Eg. California, Iowa, Stanford & Peabody achievement tests
Objective Personality Tests
 Participant could be unaware what is tested

 Result can’t be faked

 Based on easily scored & statistically analyzed

 May be administered without special training
   Objective tests
 Minnesota Multiphasic Personality Inventory (MMPI)
   the most widely researched and clinically used of all personality
   developed to identify emotional disorders

 MMPI: examples
 “Nothing in the newspaper interests me except the
 “I get angry sometimes.”
 Million Clinical Multiaxial inventory -2 (MCMI-2)
   generates scores directly compatible with personality disorders
    and other DSM-4 disorders
   Separates clinical syndromes into more severe and less severe
  Projective Personality Tests

 Idea: reaction to ambiguous material shows more about
 you than about the material

 Rorschach Inkblot
 Thematic Apperception Test (TAT)

 Objectivity, reliability & validity doubtful
 Main problem: subjective interpretation of answers
  Assessing the Unconscious

 Projective Tests
    Used to assess personality (e.g., Rorschach or TAT tests)

    How? provides ambiguous stimuli and subject projects his or
     her motives into the ambiguous stimuli
Rorschach Ink Blot Test

                          used to identify
                          people’s inner
                          feelings by
                          analyzing their
                          of the blots
 The most widely used projective test
 A set of 10 inkblots designed by Hermann Rorschach
Assessing the Unconscious--TAT
                  Thematic Apperception Test
                   people express their inner
                  motives through the stories
                  they make up about ambiguous
     Sentence completion test
 Used to identify patient’s worries & problems by verbal
 Patient is told to complete non-structured sentences started
  by the examiner

 My father…
 I wish…
 Most People………………

Description: Lecture slides on behavioral sciences, psychology.