1. Psychological Assessment of Patients
With Behavioral Symptoms
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LEARNING OBJECTIVES
After attending this presentation you will be able to:
1. Describe behavioral symptoms and psychiatric evaluation.
2. Differentiate the intelligence from achievement.
3. Identify intelligence and achievement tests.
4. Classify mental retardation.
5. Determine the personality tests.
3. Background
The evaluation of the patients who show abnormal behavior normally occurs in the
context of the clinical interview.
The psychiatric history and structured instruments, such as the Mental Status
Examination (MSE) and Beck Depression Inventory (BDI), are also used in the evaluation
of such patients.
Helpful methods include psychological tools like intelligence, achievement, and
personality tests.
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 personality/psychopathology.
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5. PSYCHIATRIC EVALUATION
The psychiatric history
A patients psychiatric is taken as part of the medical history. Although both histories focus on
gathering factual information to define the chief complaint and determine the background
of the current illness, the psychiatric history also investigation the patients personality
characteristics, relationships with others and sources of stress.
The mental status examination and related instruments
The mental status examination (MSE) is a comprehensive survey used to evaluate an
individual current state of mental functioning.
The MSE assesses a variety of characteristics, including general presentation ,cognition ,
emotional state ,thought and perception , judgment and insight, reliability and impulse
control.
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6. PSYCHIATRIC EVALUATION (cont.)
Rating scales for depression
The Deck Depression Inventory-II (BDI-II) is a commonly used self-rating scale containing 21
items.
Each items on the BDI-II has four possible answers scored from 0 to 3 (lowest to highest level of
depression): 63 is the highest total score. For example, for item #5, guilt, the patient must
choose one of the following four choices:
1. I don’t feel particularly guilt = 0 points
2. I feel bad or unworthy a good part of the time
3. I feel quite guilt
4. I feel as though I am very bad or worthless = 3 point
Because the BDI-II asks about the presence of depression directly and is easy to administer, it is
particularly useful for primary care physicians.
Other rating scales of depression include the Zung, Hamilton, and Raskin scales.
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8. INTELLIGENCE
Intelligence and achievement, although, related, are entities.
Achievement is a culture-specific measure of knowledge and skills acquired from education
and experience. In contrast, intelligence is measure of individual’s innate potential for
learning.
Intelligence is quantified by the ability to reason, to think logically and come to a conclusion
to understand abstract concepts: to assimilate recall, analyze, and organize information, and
to meet the special needs of new situations.
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9. Determinants of intelligence
Intelligence is determined largely by genetic factors.
Monozygotic twins tend to have equivalent intelligence even if they are raised in separate
household.
Biological factors that negatively affect intelligence include poor nutrition and illness early in
life.
Other factors include Environments factors, social factors, and emotional factors.
Ethnic differences can affect performance on intelligence tests comparison between the two
largest ethnic groups suggest that white American tend to score higher than African
Americans.
In the absence of brain pathology intelligence is relatively stable throughout life.
Although in individual’s intelligence is essentially the same in old age as in childhood.
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10. Mental age, chronological age, and IQ
Many instruments have been developed to assess intelligence one the first
devised by Alfred Binet, presented the contrast of mental age (MA).
In this view mental age reflects a person’s level of intellectual functioning.
For example a child with a test score that reveals an MA of 8 is functioning
like in average 8 year old.
Because mental age has an obvious relationship with actual or
chronological age (CA) Binet’s scale was later adapted to include the
age variable, and the concept of intelligence quotient (IQ) was
produced.
Operationally IQ is the ratio of MA to CA times 100; an equation expressed
as MA /CA*100 =IQ .
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11. Mental age, chronological age, and IQ (cont.)
Because an equal numerator and denominator result in 1, an IQ of 100
means that the persons mental and chronological ages are equivalent, a 10
year old child with an MA of 10 years thus has an IQ of 100.
A 10 year old child with MA of 9 has an IQ of 90.
Because normal IQ varies within the range of 90 to 109, both of these children
are considered average are normal.
DSM –IV-TR classifications of mental retardation are:
1. Mild (IQ 50-70): function at about sixth grade level.
2. Moderate (IQ 35-55): function at about second grade level.
3. Severe (IQ 20-40): function below grade school level.
4. Profound (IQ < 20): function significantly below grade school level.
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12. Intelligence tests
The wechsler intelligence tests, each taking about 2 hour to administer to one subject,
are commonly used in the clinical setting.
The Wechsler Adult Intelligence Scale-Revised (WAISR) is given to adults aged 16 to 75 years.
It has six verbal and five performance subtests.
From these subtests, a verbal IQ, performance IQ, and full-scale IQ are derived. Although the
WAIS-R is not specifically designed as a neuropsychological test, large differences between
verbal and performance IQs suggest that the person has cerebral impairment.
The Wechsler Intelligence Scale for Children-Revised (WISC-R) is used to test intelligence in
children 6 to 161/2 years of age, and
The Wechsler Preschool and Primary Scale of intelligence (WPPSI) is used to test intelligence in
children 4 to 61/2 years of age.
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13. Giftedness
Clearly, high IQ as measured by standard tests is one aspect of a gifted child.
However, most educators agree that gifted children not only have outstanding
intellectual abilities, they are also capable of outstanding performance in
other areas. These areas can be academic, such as mathematics, or creative
are such as dance, music, or art.
In contrast to common beliefs, gifted children are more likely than nongifted
children to be well adjusted emotionally and to demonstrate social and
educational achievement.
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14. ACIEVEMENT TESTS
Achievement tests evaluate how well an individual has mastered specific
subject areas such as reading and mathematics. These tests are used for
career counseling in schools and industry.
Achievement tests include :
1. the Scholastic Aptitude Test (SAT),
2. Medical College Admissions Test (MCAT), and
3. the United States Medical Licensing Examination (USMLE).
Wide-range Achievement Test (WRAT) are used clinically to evaluate
arithmetic, reading, and spelling skills in patients.
A school system uses these test result not only to evaluate individual student
performance, but also to monitor the effectiveness of its teaching program,
teachers, and administrator and to compare itself with other school systems.
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15. PERSONALITY TESTS
Personality tests are used to evaluate psychopathology and personality
characteristics in patient in whom a behavioral disorder is suspected.
These tests can help distinguish between a personality trait and personality
disorder.
Personality tests are classified as either objective or projective.
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16. Objective personality tests
The Minnesota Multiphasic Personality Inventory (MMPI) is the most commonly used
objective personality test. Patient answer 566 true (T) or false (F) items about themselves
(for example,” My mother is (was) a good person,” “I never do anything for the thrill of
it,” and “my work is very tension – provoking”).
Validity scales identify trying to look ill (“faking bad “) or trying to look well (“faking
good”).
The Million Clinical Multiaxial Inventory -II (MCMI-II) Generates scores that are directly
compatible with personality disorders (pds) and other diagnosis in the DSM-IV-TR.
The MCMI-II contains 175 item and, like the MMPI, these item are answered true are
false.
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17. Projective personality tests
The Rorschach Tests is the most commonly used projective
personality test.
Is used primarily to identify thought disorders and defense
mechanism.
In the Rorschach, patient are asked to interpret 10 bilaterally
symmetrical inkblot design.
Five of the designs are in black and white, two are in black and red
and three are in pastel colors.
The patient is first told to view the figures and, without any direction,
is told to describe what you see in this figures. The patient is then
asked why he responded the way that he did.
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18. Projective personality tests (cont.)
In the projective Thematic Apperception Test (TAT) stories are used to
evaluate patient’s unconscious emotions and conflicts.
The patient can be shown a series of 30 cards, although sometimes only a few
cards are used. Each card depicts an ambiguous social situation that can be
interpreted in several ways the subject is then told.
Using this picture, make up a story that has a beginning a middle, and an end,
the examiner interprets the subject’s responses which are believed to reflect
basic personality characteristics and motivation.
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19. Projective personality tests (cont.)
The sentence completion test (SCT) is used to identify a patient worries and problems by
verbal association. In the SCT, the patient is told to complete nonstructural sentences started
by the examiner for example: my father… "I wish …" most people…." And so on.
The examiner then analyzes the responses to the sentence completions with respect to the
patient’s motivation and conflicts.
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20. Conclusion
The evaluation of the patients who show abnormal behavior normally occurs in the context
of the clinical interview.
The psychiatric history and structured instruments, such as the Mental Status Examination
(MSE) and beck Depression Inventory (BDI), are also used in the evaluation of such patients.
Helpful methods include psychological tools like intelligence, achievement, and personality
tests.
Intelligence and achievement, although, related, are entities.
Achievement is a culture-specific measure of knowledge and skills acquired from education
and experience. In contrast, intelligence is measure of individual’s innate potential for
learning.
In individual’s intelligence is essentially the same in old age as in childhood.
Achievement tests include the Scholastic Aptitude Test (SAT), Medical College Admissions
Test (MCAT), and the United States Medical Licensing Examination (USMLE), evaluate how
well an individual has mastered specific subject areas.
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