lec 7/8 clincal neuropsychology assesment (PYSC ASSESMENT) Flashcards
case study of Mrs Y
-shows how important clincal neuropsyc is
- Goldstein & McNeill, Chapter 1, p10.
-gp refused referral to clinical neurpsychologist, but social worker insisted and it still went through
-CNP needs to understand the history
* Head injury 25 years previously
-her life changed after the head injury
-Distractible during testing
WAIS FSIQ = 98. Estimated premorbid IQ = 115.
* Memory OK but learning poor
* Performance on planning and sequencing poor
* Concluded historic head injury caused lasting executive dysfunction,highly likely this caused her difficulties to cope with life/have 3 children etc
-we know now to support people with head injuries, to help executive dysfunction issues
use of clinical neuropsychological assesment
-main aim
Main aim = understand
nature of problems (related to brain illness) and how
best to support functioning
in everyday life
-to test if someone has brain illness/injury
-Case formulation: understand nature of psychological problems
-to get to the bottom of the problems
-Patient care, prognosis, planning of
interventions
-Legal assessment
-involved in Research
procedure of assessment for clinical neuropsychology
- start by understanding Medical history , -medical assessment
- Including neuroimaging, history, medication
- Personal & family history, demographics (education etc)
- Structured clinical interview (try understand from patient perspective what their problems are)
: Assess symptoms and awareness, Assess mental state - Observations
- Tests
- Questionnaires/informant ratings etc asses mood/adaptive functioning
Test selection: issues to consider when choosing tests:
main aims of assessment
-Screening, (is there a memory problem?) diagnosis , case formulation, progress over time
* Assessment of care needs or functional potential
* Developing or measuring rehabilitation/treatment package
test selection: issues to consider when choosing tests
- Validity and reliability of tests
-predictive ability is often important : does the test predict whether the person will be able to function daily
- - Normative data
- Global or specific deficits?
- Patient characteristics
reporting scores of neuropsyc test
-raw scores rarely ever used
-can compare scores to normative data
- Standard scores: e.g. IQ (given to large sample and then normed)
- Percentiles: percentage
of the population who achieve less than a given score - IQ of 70 = 2nd percentile. (2 standard deviations below average score)
- How decide cut-off point for ‘impairment’?
How decide cut-off point for ‘impairment’?
what factors need to be considered when interpreting test scores
Consider test scores in context of:
* Medical history, behaviour, self-reports, and personal information
- Litigation and malingering (faking for some reason)
- Multiple testing sessions, over time
- Inconsistencies in performance?
- Trajectory of scores
Concentration, motivation and emotions
- Distractibility & fatigue
- Emotions: Flat affect, anxiety, depression and frustration
all these things can impact any assesment
sensitivity vs specificity
-does someone have a cognitive impairment
sensitivity :
-the percent of diseases patients a test can capture
-all genuinely have cognitive impairment
-also known as ‘true positive impairment
specificity:
-the percent of healthy patients a test can exclude
(misdiagnosis of healthy people)
-also known as ‘true negative rate’
part 2
Mood disorders following brain illness- Scholten et al., (2016) systematic review
- Anxiety and depression common following brain injury
- High long term prevalence of anxiety (36%) and depression (43%).
- Risk factors: gender (woman), unemployment, psychiatric history
Mood disorders following brain illness
-Other psychiatric factors (Brown, 2013)
Apathy, psychosis, functional neurological disorder
* May impact on all aspects of cognitive and social functioning
Methods of assessing mood in clinical neuropsychology
- structured interviews
-SCID = Structured Clinical Interview for DSM
-DSM = Diagnostic and Statistical Manual of Mental
Disorders
-brief psychiatric rating scale
-observations
-informant reports
-self reports
* E.g. Beck Depression Inventory,
* Hospital Anxiety and Depression Scales (HADS) - a brief 14 item scale designed to give a basic assessment of anxiety - ‘often feel butterflies etc;
* Importance of insight (do they know what they have)
Using the HADS to assess mood following brain injury
-Whelan-Goodinson et al. (2009)
100 participants with traumatic brain injury
* Completed SCID and HADS
* HADS high Cronbach’s alpha (>.85)good internal reliability
* SCID and HADS convergent validity
* But 31% of participants scored in clinical range for anxiety in HADS did not meet criteria for clinical anxiety in SCID (specificity vs sensitivity problem)
-suggests HADS is not being specific enough for diagnosing anxiety (too many false positives) - cant understand if its at a clinical level
HADS = Hospital Anxiety and Depression Scales
SCID = Structured Clinical Interview for DSM
part 3
-assesing change in cognitive function
-why a crucial aspect
Crucial question in clinical assessment:
has ability/behaviour changed since
illness/injury?
What was PREMORBID ABILITY? - before ilness
Demographic methods to estimate premorbid ability (what function was like before ilness
-Use age, sex, gender, ethnic and cultural background, education and
occupation to predict premorbid IQ
* Regression methods
E.g. Crawford & Allan (1997)
* Demographic variables predict about 50% of variance in FSIQ
* Better at predicting verbal than non-verbal ability
* Poor at estimating IQs < 69, and > 120
* Occupation best predictor
16
