ICL 4.0: Behavioral & Cognitive Screening & the Mental Status Exam

Question 1

what can psychological assessments be used to identify?

Answer 1

1. if a person has clinically significant depression
2. this person has clinically significant OCD
3. this infant/child/adolescent/adult likely has intellectual disability
4. this person may be denying symptoms or pretending to have symptoms they don’t actually have
5. this adolescent is at high risk for suicide
6. this parent is at risk for abusive behavior
7. this child has autism spectrum disorder
8. this person’s ADHD symptoms have improved significantly
9. this perpetrator of intimate partner violence may benefit from treatment

Question 2

what is an objective assessment?

Answer 2

it’s very structured and standardized

there are clear instructions, direct questions, usually self-report –> sometimes parent and teacher reports are collected for children

methods and instructions are consistent, unvarying

the results are compared to a test norm

Question 3

what is a test norm?

Answer 3

a collection of normative data based on key demographics that allows for comparison of the score to a “standard”

ex. comparing the moodiness of a teenage to what is a “normal” level of moodiness for that same demographic

Question 4

what is the BRIEF exam?

Answer 4

measures executive function!

so this is nice for disorders like ADHD where executive function might be effected

Question 5

what are the types of assessments frequently used in medical settings?

Answer 5

1. personality/emotional/behavioral assessments
2. intelectual assessments
3. neuropsychological assessments
4. behaviorsal

Question 6

what does MMPI stand for?

Answer 6

Minnesota Multi-phasic Personality Inventory

it’s probably the most often administered psychological assessment

Question 7

what is the MMPI?

Answer 7

a psychological assessment that measures adult psychopathology and personality

the results from answering 100s of questions can tell you if they have features of certain disorders, what diagnosis you might want to consider, if they would be good candidates for certain therapies, what they might be like in therapy, if medications would be useful for that person, etc.

Question 8

what is a structured interview?

Answer 8

1. often used for research–> they have an algorithm where you ask the first question and then the next question is based on their answer to the first so they’re very structured
2. questions asked verbatim
3. highly structured versions do not require much clinical judgment
4. many can be administered by non-clinicians
5. some can be administered by computer
6. most result in clinical diagnoses, as opposed to T-scores, clinical cut-offs, severity ratings, etc.

Question 9

what is a projective assessment?

Answer 9

tests that use unstructured, often ambiguous stimuli

it was originally thought that when faced with an ambiguous stimulus,
people unintentionally reveal/“project” information about themselves, unconscious conflicts

however, research shows that the most useful findings are tendencies,
language seen during the test that may be apparent in everyday life

for example, odd language and logic or bizarre connections are commonly seen in psychotic individuals

Question 10

what are the 2 most common projective assessments?

Answer 10

1. Thematic Apperception Test

show the patient a picture and ask them to tell us what happened in the picture, what happened before and after the picture too

2. Rorschach Inkblot

show the patient an inkblot and ask the patient what they see

Question 11

what is the definition of intelligence?

Answer 11

the ability to adjust or adapt to the environment, the ability to learn, or the ability to perform abstract thinking (to use symbols and concepts)

it is NOT someone’s ability to do math problems; it’s how well you can learn new information and adapt to the environment

Question 12

what are the 3 types of intelligence assessments?

Answer 12

1. mental age
2. chronological age
3. IQ

Question 13

what is mental age?

Answer 13

defined by Alfred Binet, describes a person’s level of intellectual functioning

Question 14

what is chronological age?

Answer 14

the person’s actual age

Question 15

what is IQ?

Answer 15

the ratio of MA to CA multiplied by 100

MA/CA x 100= IQ

Question 16

what is the most often used intelligence tests?

Answer 16

Wechsler Scales

these are a series of many different subtests that we administer to the patient one on one and it takes about 1.5-2 hours

the subtests are then put together into 4 different cognitive areas:

1. verbal comprehension
2. working memory
3. perceptual reasoning
4. processing speed

Question 17

what is the average IQ score?

Answer 17

full scale IQ test has an average of 100 and SD of 15

IQ is a bell curve!

Question 18

what are the most commonly used standardized individual intelligence tests?

Answer 18

1. Bayley Scales of Infant and Toddler Development®, 3rd Ed

(Bayley-III®), ages 1 month to 42 months

2. Stanford Binet Intelligence Scale: 5th edition

ages 2 years to 85+ years

3. Wechsler Preschool and Primary Scale of Intelligence

ages 2:6 - 7:7

4. Wechsler Intelligence Scale for Children

ages 6 -16:11

5. Wechsler Adult Intelligence Scale – 4th edition

ages 16:0-90:11

Question 19

what is academic achievement?

Answer 19

academics are NOT the same as intelligence!!

academic achievement is stuff like reading, math, spelling etc.

they are not IQ tests but are used along with IQ tests to measure learning disorders

Question 20

what are some of the academic achievement tests?

Answer 20

1. Weschsler Individual Achievement Test**

ages 4-85

2. Wide Range Achievement Test

ages 5-75

3. Kaufman Test of Educational Achievement

ages 4-25 for comprehensive form and ages 4-90 for brief form

4. Woodcock-Johnson

ages 2-90+

5. Peabody Individual Achievement Test

ages 5-22 –> good for people with limited expressive language ability/severe disabilities

Question 21

what are adaptive behavior scales?

Answer 21

they asses adaptive skills for daily living

so can they dress themselves, can they eat independently, can they cross the street alone, pay their bills etc.

results can be given as age equivalents so if someone is 11 but they’re only functioning at a 4 year old level

often given with an IQ test

Question 22

what is the definition of a neuropsychological assessment?

Answer 22

evaluation of brain function through systematic analysis of behavior using standardized psychological assessment procedures

measures motor, sensory, spatial abilities, language, intellectual functioning, attention, memory, emotional function

an IQ test is usually part of a neuropsychological assessment!

Question 23

what are the common uses of a neuropsychological assessment?

Answer 23

1. functional description
2. diagnosis
3. staging and prediction of disease course when it’s repeatedly administered
4. rehabilitation
5. evaluating effects of treatment

Question 24

what are behavioral medicine diagnostic assessments?

Answer 24

these tests are primarily designed to provide information to clinicians who deal with physically ill and behavioral medicine patients

they’re used in assessing psychological factors that might affect diagnosis and treatment of medical patients

ex. is this patient appropriate for bariatric surgery, do they have diagnosis that they can’t cope with that surgery, will the behavioral changes needed for after the surgery be something they can handle?

Question 25

what is SAMHSA?

Answer 25

screens for problems with mood, anxiety, alcohol, eating

Question 26

how do you refer for a psychological assessment?

Answer 26

Refer to a psychologist or neuropsychologist, specify your concerns and questions, what to rule out if anything

what are your questions and concerns about the patient?

typically not a request for a particular test

Question 27

when would you refer a patient for intellectual assessment?

Answer 27

1. suspect intellectual disability (also need adaptive functioning assessment), borderline IQ, other developmental disorder
2. suspect learning disorder (need additional tests for this)
3. consistently poor school performance in 1 or more areas or decreased academic performance without recovery (do not wait or suggest student be “held back”)
4. need to adapt educational program to specific learning style / to address weaknesses
5. infant/toddler/child with sensorimotor delays or delays in meeting developmental milestones
6. to establish the need for services such as developmental disability , BVR, etc.

Question 28

when would you refer a patient for personality/emotional/behavioral assessment?

Answer 28

1. help with case conceptualization and diagnosis
2. diagnostic clarification – e.g., OCD, Thought Disorder, Depression, etc.?
3. clarify level and severity of symptoms
4. evaluate malingering
5. track progress in treatment
6. determine if/what type of treatment is needed, appropriate recommendations
7. prior to procedures.
   e. g., bariatric surgery: assess motivation, need for behavior modification, and possible eating disorders. capable of understanding what they are agreeing to? Intact social supports? psychiatric conditions that would impair the patient’s ability to handle the surgery?

Question 29

what things are you looking for during a mental status exam?

Answer 29

1. appearance
2. behavior
3. motor
4. speech
5. mood
6. affect
7. thought process
8. ability to abstract
9. thought content
10. perceptual disturbances
11. insight
12. judgement
13. memory
14. concentration
15. orientation