1Psychological Assessment of Patients With Behavioral

Symptoms

04/15/2023

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.

2Outlines Background

Behavioral symptoms

Psychiatric evaluation

Intelligence

Determinants of intelligence

Mental age, chronological age, and IQ

Intelligence tests

Giftedness

Achievement Tests

Personality Tests

Conclusion

References

3Background 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.

4Behavioral Symptoms

5PSYCHIATRIC 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.

6PSYCHIATRIC 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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8INTELLIGENCE

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.

9Determinants 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.

10Mental 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 .

11Mental 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.

12Intelligence 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.

13Giftedness

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.

14ACIEVEMENT 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.

15PERSONALITY 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.

16Objective 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.

17Projective 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.

18Projective 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.

19Projective 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.

20ConclusionThe 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.

21References

Behavioral Science in Medicine, 2004