Behavioral Assessment - Boulger Flashcards
When are mental status exams indicated?
- Patients with documented brain lesions such as tumors, trauma, vascular accidents, etc
- Patients with suspected brain lesion because of recurrent seizure, headache, behavioral change, or head trauma
- All psychiatric patients
- Depression most commonly seen with frontal and temporal tumors, hydrocephalus, or cortical atrophy
- Patients who have vague complaints - memory, concentration, declining interests, various physical complaints without organic etiology
What does a mental status exam in psychiatry consist of?
- Presentation
- LOC, GCS, alert, cooperative, appearance
- Motor Behavior and Affect
- movement, mannerisms, facial expression
- Cognitive Status
- attention, alertness, orientation, speech, language, memory, calculation, reasoning
- Thought
- coherence, insight, goals, ideations
- Mood
- anger, suicidality, hopelessness, guardedness, variability
What are the five parts of the Mini-Mental Status Exam?
- Orientation
- Language function
- Registration & Recall
- Attention/Simple Calculations
- Constructional Praxis
How many total points are in the MMSE?
- 30 points
- Orientation to time (5) - year, season, month, day of the week, date
- Orientation to place (5) - where are we now, what state are we in, what country is this, what city is this, what floor are we on
- Language - reading (1), writing (1), naming (2), comprehension (3), repetition (1)
- Registration (3) - repeat 3 words back
- Recall (3) - remember the 3 words
- Attention/simple calculations (5) - serial 7s or spell world forward and backwards
- Constructional praxis (1)
What MMSE score indicates normal cognition?
Any score greater than or equal to 27 points (out of 30) indicates a normal cognition.
What MMSE score is the widely accepted cut-off?
23 points
What MMSE score indicates mild cognitive impairment?
21-26
What MMSE score indicates moderate cognitive impairment?
11-20
What MMSE score indicates severe cognitive impairment?
0-10
What office screening assessment techniques can be used for depression?
- Hamilton Rating Scale for Depression (Ham-D)
- Patient Health Questionnaire (PHQ-9)
- Geriatric Depression Scale (GDS)
What office screening assessment techniques can be used for anxiety?
- Hamilton Rating Scale for Anxiety (Ham-A)
- Patient Health Questionnaire (GAD-7)
What office screening assessment technique can be used for alcohol use?
Alcohol Use Disorders Identification Test (AUDIT)
What screening assessment techniques can be used for ADHD and Childhood Behavior Problems?
- SNAP-IV Rating Scale:
- 90 questions designed to be answered by classroom teachers
- Also contains items to screen for Oppositional Defiant Disorder
- Vanderbilt ADHD Diagnostic Teacher and Parent rating scale
What are the four levels of cognitive and neuropsychological examination measurements with varying degrees of precision and usability?
- Nominal Scales
- Ordinal Scales
- Interval Scales
- Ratio Scales
What is a nominal measurement in cognitive and neuropsychological examinations?
- Least precise, assigning numbers or labels to identify categories to which individuals belong
- Ex - diabetic or not diabetic
What is an ordinal measurement in cognitive and neuropsychological examinations?
- Arrange or sort individuals in a series ranging from highest to lowest according to an observed characteristic
- Ex - test scores
What is an interval measurement in cognitive and neuropsychological examinations?
- Gives numbers for which not only order but also differences between numbers are meaningful
- No absolute zero, assignment of the zero value is arbitrary
What is a ratio measurement in cognitive and neuropsychological examinations?
- All arithmetical operations can be used - addition, subtraction, multiplication, and division
- Highest level of measurement
- True zero point
What does reliability refer to in assessment techniques?
Consistency of predictive statements over time, over predictors, over individuals and/or over assessment techniques
What does validity refer to in assessment techniques?
- “Truthfullness”
- Degree of accuracy of predictive (concurrent or prospective) statements
How are intelligence tests scored today?
Statistically derived most commonly using:
- Wechsler Adult Intelligence Scale (WAIS-IV for ages 17+)
- Wechsler Intelligence Scale for Children (WISC-IV for ages 6-16)
What is average IQ classification based on the Wechsler Adult Intelligence Scale?
90-109
What are the most common examples of memory screening tests used in cognitive and neuropsychological examination?
- Rey-osterreich Figure
- Rey Auditory-Verbal Learning test
- California Verbal Learning test
(relatively short: 15-30 minutes)
What is the most common memory test batteries?
Wechsler Memory Scale (WNS-IV)
(Takes approximately 60-90 minutes to administer)
What is the most common neuropsychological test battery?
Halstead-Reitan Neuropsychological Test Battery
- contains 10 subtests
- abstract reasoning
- kinesthetic and sensorimotor ability
- attention
- auditory perception
- sensory-perceptual ability
- language
How are neuropsychological test batteries useful?
- many types to examine specific brain functioning
- some very sensitive and highly accurate in assessing damage
- used to help target brain damage before other techniques are used
- BUT, they are very expensive to administer and are only available in larger cities and test centers
What is the aphasia screening test?
A simple card can be used to simulate various types of aphasia
What is the Rey Complex Figure used for?
To assess the individual’s ability to recall complex information presented visually
What are the two types of measures in a personality assessment?
Objective measures
&
Projective measures
What do projective tests show in personality assessments?
Reveal hidden emotions and internal conflicts via a subject’s responses to ambiguous stimuli
- Rorschach Inkblot tests
What do objective tests show in personality assessments?
Determine whether the person taking the test is responding truthfully
- restricted response format (T/F)
- Ex. Minnesota Multiphasic Personality Inventory (MMPI)
What is the MMPI?
- Minnesota Multiphasic Personality Inventory (MMPI)
- Most frequently used clinical testing instrument
- one of the most researched psychological tests in existence
- 567 true-false items
