CLINICAL

NEUROPSYCHOLOGICAL

TESTING• PRESENTED BY: DR.SHILPA PRAJAPATI ( 1ST YR M.P.T)

TESTING OF INTELLIGENCE AND PERSONALITY

• Intelligence & personality plays a relatively minor role in psychiatric diagnosis its more use in some special situation like:

– To establish the degree of mental retardation

– Neuropsychological tests help quantify and localize brain damage.

TESTING OF INTELLIGENCE AND PERSONALITY

• TYPES OF TESTS : introductionObjective test:– Pencil and paper tests based on specific items and question

– They yield numerical score and profile easily subject to mathematical or statistical analysis

Projective test:– These tests present stimuli whose meanings are not

immediately obvious; some ambiguity forces persons to project their own needs into the test situations

– These test presumably no right or wrong answers.

INTELLIGENCE TESTING– Defined as the ability to assimilate factual knowledge, to

recall either recent or remote events, to reason logically, to manipulate concept, to translate abstract, to analyze and synthesize forms and to deal meaningfully and accurately with problems and priorities important in a particular setting.

• In1905, Allred Binet, introduced

IQ= MA*100/ CA

• An IQ of 100 results when chronological and mental age are equal.

INTELLIGENCE TESTING• IQ is a measure of present functioning ability.

• Although, under ordinary circumstances the IQ is a stable throughout life.

• The most useful intelligence test must measure a variety of skill and abilities, including;– Verbal and performance,– Early learned and recently learned,– time and untimed,– culture free and culture bound

INTELLIGENCE TESTING• WECHSLER ADULT INTELLIGENCE SCALE(WAIS):– This is best standardized and most widely used test given

by David Wechsler at New York university medical center and Psychiatric hospital,1939.

– The latest revision, the WAIS-III, is designed foro persons 16 to 89 years of age,o children 5 to 15 years,o children 4 to 6.5 years

INTELLIGENCE TESTINGConstruction of the test• VERBAL SKILL: 1. Information:

– It covers general information and knowledge and is subject to cultural variables

– Person from lower socioeconomic with little schooling do not perform as well as those from high socioeconomic with more schooling

2. Comprehension: it measures subjects knowledge of social convention and

common sense and examine quality of persons thinking and how persons ought to behave under certain circumstances

INTELLIGENCE TESTING3. Arithmetic:– ability to do arithmetic and other simple calculations, which is

adversely influenced by anxiety and poor attention concentration

4. Similarities:– sensitive indicator of intelligence.– it covers the ability to abstract by asking subjects to explain

the similarities btw two things.

5. Digit span:– immediate retention is measured– Subjects are ask to learn a series of 2 to 9 digits. Immediately

recall

INTELLIGENCE TESTING6. Vocabulary: – Intelligence has a high correlation with vocabulary which

is related to level of education, definition of words may give clues to personality structure.

• PERFORMANSE:1. Picture completion:– It initiates the consist of completing a picture in which a

part is missing .– Visuoperceptive defects become evident when mistakes

are made on this test

INTELLIGENCE TESTING2. Blok design– To match colored blocks and visual design. brain dysfunction

interferes with in performance.

3.picture arrangement– Subjects are required to arrange a series of picture in a

sequence that tells a story. Cognitive style is tested.

4. object assembly:– Subject must assemble objects, like figure of animal, In the

proper order and organization.– Visuoperception, somatoperception, and manual dexterity

are tested

INTELLIGENCE TESTING5.Digit symbol:– Subject receive a code that pairs symbols with digits.

Matching a series of digits to their corresponding symbols in as little time as possible

INTELLIGENCE TESTING• CLASSIFICATION OF INTELLIGENCE BY IQ RANGE:

Profound mental retardation(MR)

Severe MR

Moderate MR

Mild MR

Borderline

Dull normal

Normal

Bright normal

Superior

Very superior

Below 20 or 25

20-25 to 35-40

35-40 to 50 55

50-55 to about 70

70-79

80 to 90

90 to 110

110 to 120

120 to 130

130 and above

ADULT PERSONALITY ASSESMENT• Objective assessment:– Characterized by reliance on structured, standardized

measurement devices, which have a self report nature– Structured reflects the straightforward test stimuli.

• Minnesota multiphasic personality inventory(MMPI):– Developed in 1937, by Starke Hathaway and J. Chamley

McKinley. Its eventually updated and now called the MMPI-2.– It consists of more than 500 statements to which subject must

respond ‘true’ ,’false’ or ‘cannot say’– Test may be used in car or booklet form and several computer

programs.

ADULT PERSONALITY ASSESMENT• Projective personality assessment:– Defined by the use of unstructured , often ambiguous test stimuli.– It is assume that persons bring certain needs characteristics,

defenses, and other qualities that be– come apparent through the testing process

1) Rorschach Test:– Study designed by Herman Rorschach, 1910– standard set of 10 inkblot serves in number from I to X.– Five of blot are black and white and five include colors.– Cards are shows in a particular order and psychologist keeps a

record of patients verbatim response along with time spend for each card.

ADULT PERSONALITY ASSESMENT• Name description

1. Rorschach test

2. Thematic apperception test

3. Sentence completion test

4. Holtzman Inkblot Tech

5. Figure drawing

6.Make-a –Picture story(MAPS)

10 card of inkblots, Some colored other acromatic

20 cards depleting num. of scenes of varying ambiguity

A num. of different devices available, all sharing the same format with more similarities than differences

Two parallel forms of inkblot cards with 45 cards per form

Typically human forms but can involve houses or other forms

Similar to TAT; however , stimuli can be manipulated by the pt.

ADULT PERSONALITY ASSESMENT

• Thematic Apperception Test(TAT):– Study designed by Henry Murray Christiana Morgan, in

1943.– It consists of series of 30 cards `– TAT requires patient to construct or create a story.– No generally accepted scoring system results in poor

consistency in interpretation; time consuming administration

– Their stories reflect their own approaches to organization, sequence, vocabulary, style, preconception, assumption and outcome.

ADULT PERSONALITY ASSESMENT• Sentence completion test(SCT):– To tap patients conscious associations to areas of

functioning– Compose of series of sentences stems usually 75-100 .– Such as , I like……., sometime I wish…….., etc – That patients are ask to complete in their own word.

• Word association tech.:– Carl Gustav Jung presented stimulus word to pt. and had

them respond with the first word that come to mind

ADULT PERSONALITY ASSESMENT• Draw a person test:– First used as a measure of intelligence in children.– Easily administrated with the instruction “I ‘d like you to

draw the picture of person, draw the best person you can.

– After completion of 1st drawing a patient is asked to draw a picture of a person of the sex opposite that of 1st drawing

– Generally, the drawing of person represents the expression of the self in environment

– Primarily it’s a screening technique particularly for the detection of the brain damage

ASSESSMENT OF ADULTS• It is examines the relationship btw behavior and

brain functioning in the realms of cognitive, motor, sensory and emotional functioning

• AIM: To achieve quantifiable and reproducible result

• Assessment is indicated to identify cognitive defects– to differentiate incipient depression from dementia,– to determine the course of an illness,– to assess neurotoxic effects,– to evaluate the effect of treatment

ASSESSMENT OF ADULTS• The Wisconsin card sorting test(WCST):– It assess abstract reasoning and flexibility in problem solving– Stimulus card of different color, form and number are

presented– As the pt. sort the cards he is told the response s are correct

or incorrect, number of trials are 10.– When the pt. has mastered the task, examiner change the

principle of sorting– The procedure repeated several times, measures the

capacity for abstract thinking and flexibility.– Person with frontal lobes or to the caudal damage and

person with schizophrenia give abnormal responses.

ASSESSMENT OF ADULTS

• MEMORY: types

1) Immediate memory: reproduction of perceived material within a period up to 30 sec. after presentation.

2) Recent memory: concerns events over the past few hours or days, can be tested by asking patients ‘what they had for breakfast’ etc.

3) Resent past memory: concern the retention of information over the past few months.

4) Remote memory: is the ability to remember the events in the distance past.

ASSESSMENT OF ADULTS• Memory theories have described 3 more parts:– Episodes for specific events eg. Telephone message,– semantic for knowledge and facts eg. First president or etc, and– implicit for automatic skill eg. Speaking grammatically or

driving car• Testing :– Wechsler memory scale: the scale yield memory questions

which is corrected for age and generally approximate the WAIS IQ

– Benton visual retention test: sensitive to short term memory loss.

– Presentation of each geometric figure for 10 sec., after which the pt. attempts to draw the figure.

ASSESSMENT OF ADULTS• ORIENTATION:– For person or place is rarely disturbed in brain damage

pt who are not psychotic or severely demented

• Temporal Orientation ScheduleAdministration– What is today’s date?– What day’s of the is it?– What time is it now?

ASSESSMENT OF ADULTS• PERCEPTUAL &PERCEPTUOMOTOR PERFORMANCE:– Many pt. with brain disease shows an impaired ability to

analyze complex stimulus constellation or an in ability to transfer their perception into appropriate motor action

– Double simultaneous stimulation is tested by lightly touching one of the pt.s cheeks with one hand and simultaneously touching the back of one of pt.s hand with the other

– A pt. with brain dysfunction is unable to recognize one or both of the stimuli

HEMISPARIC DOMINANCE AND INTRAHEMISPHARIC LOCALIZATION

• HEMISPHERE DAMAGE• LEFT SIDE RIGHT SIDE

Aphasia

Right left disorientation

Finger agnosia

Dysgraphia

Dyscalculia(number alexia)

Constructional apraxia(details)

Limb apraxia

Visuospatial deficits

Impaired visual perception

Neglect

Dysgraphia (spacial neglact)

Dyscalculia(spacial)

Constructional apraxia(Gestalt)

Dressing apraxia

Anosognosia

HEMISPARIC DOMINANCE AND INTRAHEMISPHARIC LOCALIZATION

• Bender visual Motor Gestalt Test:– This test of visuomotor co-ordination is useful for both

children and adult.– The test material consist of 9 separate designs.– Each design is printed against a white back ground on a

separate card .– Presented with paper, pt are ask to copy each design

with the card in front of them– There is no time limit– This test is used most frequently with adults as a

screening device for sign of organic dysfunction

HEMISPARIC DOMINANCE AND INTRAHEMISPHARIC LOCALIZATION

• Complex visual discrimination:– Judgment of line orientation test, has been found to

demonstrate failing performance in an impressive proportion of pt. with right hemisphere disease

– Test requires matching the slope of visually presented lines or pairs of lines

– The pt. points to or verbally identifies the line of the display

– As with facial recognition, pt with rt. hemisphere lesion are frequently defective in visuospacial test.

LANGUAGE• The affective part of speech that conveys mood is called prosody

and is controlled by the non-dominant hemisphere.

• Fluency is tested by asking pt. to give all the words they can think of beginning with the given letter of the alphabet

• Pt. with a lt. hemisphere disease fail this test

• Reading and writing are also associated with dominant hemisphere

• And are tested by asking read write

• Dyslexia and dysgraphia are suspected

ATTENTOIN AND CONCENTRATION

• This impairment is reflected in an oscillation in performance level for continuous or repeated activity

• Some evidence indicates that the instability in performance is related to an electro-encephalographic abnormality

• The reaction time needed to respond to stimulus is impaired in 40-45% of brain damage patient

• And is sensitive indicator of cerebral integrity.

COMPREHENSIVE TESTING• Luria-Nebraska neuropsychological battery:

– Developed at the uni. Of Nebraska

– The test assesses a wide range of cognitive function; memory; motor function; rhythm; tactile; auditory and visual function; receptive and expressive speech; writing: spelling; reading; and arithmetic

– The test is extremely sensitive for identifying specific types of problems like dyslexia and dyscalculia

RELIABILITY AND VALIDITY

• The reliability and validity of this test may be affected by many factors like; mood states, motivation, effort and cooperation

• Results may be confounded by medication effects ; anticonvulsants and antipsycotic

THERAPEUTIC DISCUSSION• A discussion of results of test with the pt. and family, is an imp.

Component of neuropsychological examination

• This will provide therapeutic opportunity to educate them and clarify individual and relationship issues .

• It is useful to review the goals of examination with the pt. and family or caregivers.

• This includes information about the pt.’s diagnosis with emphasis upon the natural course and prognosis as well as compensation and coping strategies.

• It is imp. To relate the impact of the results to the pt.’s current living circumstances, future goals and course

•THANK YOU !!