TIPPS(TrainingInitiativeforPsychiatryPostgraduates)

STEP-2016(SkillsTrainingExerciseforPsychiatryPostgraduates)

PSYCHOLOGICALASSESSMENTMETHODSINCLINICALPSYCHIATRY

JAPNEETAHLUWALIARAO

ConsultantClinicalPsychologist

contactjapneet@hotmail.com

WHATAREPSYCHOMETRICS?

• Basicallymeans‘mentalmeasurement’(psycho–metrics)

• includesthemeasurementofknowledge,abilities,attitudes,personalitytraits,aswellaseducationalmeasurement

• Anyoneadministeringthemshouldholdappropriatequalificationsintheiruse

• Inpsychologyweareinterestedineitherdescribingthedistributionsofand/orrelationshipsamongabstractconcepts:e.g.

Keyquestionsare:

• Whatarethewaysbywhichpeopledifferandhowcanweobjectivelymeasurethedifferences?

• Overthelast100yearsorsothedisciplinehasbecomeincreasinglymorescientificinitsapproach

Intelligence

Neuroticism

Aggression

DISTINCTION

TYPESOFTESTS

FORMAT

ADVANTAGESOFPSYCHOMETRICTESTS

Individualtests:testadministratorgivesatesttoasingleperson

Grouptests:singleexaminergivesatesttoagroupofpeople

Psychometric Testing

relatively straightforward

process wherein a particular

scale/test is administered to

obtain a specific score

Psychological Assessment

- variety of test scores

- obtained from multiple test

methods

- considers history, referral

information, and observed

behavior

I(Human)Ability/DisabilityTests

• AchievementTests

• AptitudeTests

• IntelligenceTests

• LearningDisabilityTests

• NeuropsychologicalAssessment

IIPersonalityTests:Objective&Projective

• ObjectivePersonalityTests

• ProjectivePersonality/

Psychodiagnostic

Tests

IIITherapyAssessment

• BehaviourAssessment

• CognitiveBehaviourAssessment

IVPsychiatricAssessment

• Assessment(scales)forpsychotic

features,anxiety,

depression,mania,

substanceabuseetc.

Datarepresentednumerically Objective Demonstrable

statisticalvalidityAddreliabilityand

validity

Providinginsightsnotavailablethroughobservationsand

interviews

VARIOUSPSYCHOLOGICALTESTSANDBATTERIES

IQASSESSMENT

¨Testsofintellectualfunctioningaredesignedtomeasureandassessgeneralmentalabilities(relativetopeersofthesameagegroup)andmayincludetestsofthefollowingabilities:reasoning,problemsolving,abstractthinking,judgment,academiclearning,andtosomedegree,experientiallearning

¨IQ(IntelligenceQuotient)=MA(MentalAge)

______________________x100

CA(ChronologicalAge)

RegularlyusedIQTestsinClinicalPractice

1.SeguinFormBoardTest(SFB)

2.VinelandSocialMaturityScale(VSMS)

3.Binet-KamatTest(BKT)

4.WechslerAdultPerformanceIntelligenceScale(WAPIS)

5.Bhatia’sPerformanceTestofIntelligence

6.Malin’sIntelligenceScaleforIndianChildren(MISIC)

7.Raven’sProgressiveMatrices(RPM)

1.SeguinFormBoard

-ascreeningtesttoselecttheappropriatebatteryofIQtests

-measuresspeedandaccuracy

-Usedincaseofspeechimpairment

-Age3½to10years,anduptoadultlevelfortheintellectuallyimpaired

-Administrationtime-10minutes

-3trialsaregiventoputtheblocksintheirappropriateshapepattern

-Thequickesttimeisconsidered

-ThisgivestheMentalAge(fromatable)andthenIQiscalculated

2.VinelandSocialMaturityScale(VSMS)

-originallydevelopedbytheAmericanpsychologistEdgarArnoldDoll

-TheIndianversionisbyDr.A.J.Malin

-Askquestionstoparents/caregiver

-measuressocialcompetence,self-helpskills,andadaptivebehaviorfrominfancytoadulthood

-indicatesthesocialdeficitsandsocialassetsinagrowingchild

-Testitems:89,groupedintoyearlevels,fromage0-15

Domains:

-Thefollowingillustratethecategories:

1.Self-help-general:Reachesfornearbyobjects

2.Self-help-eating:Discriminatesediblesubstances

3.Self-help-dressing:Buttonscoatordress

4.Self-direction:Buysownclothingaccessories

5.Locomotion:Walksaboutroomunattended

6.Occupation:Helpsalittleathouse

7.Communication:Makestelephonescall

8.Socialization:Demandspersonalattention

Procedure:

-Startwithitemnumber1,whatevermaybetheageofthechildandgoontilltheitemappropriatetohis/heragelevel

-Stopwhenallitemsintheagecategoryscorenegative

Scoring:

-RawscoresareconvertedtoanageequivalentscoreexpressedasSocialage

-TheSocialageisthendividedbytheChronologicalage,multipliedby100yieldingaSocialquotient(SQ)

-TheSocialQuotientcanbeconsideredaproximateintelligencequotient(IQ)(Highcorrelationof0.80)

3.Binet-KamatTest(BKT)

-Agerange:3andabove

-Itemsarearrangedchronologically

-Domainsofcognitiveabilities:Language,MeaningfulMemory,Non-MeaningfulMemory,Conceptual,Non-VerbalReasoning,Verbal,Numerical,Visuo-Motor,SocialIntelligence

-SimplifiedExamplesofitems:whichlineislonger?,puttingdifferentshapescut-outsinthecorrectslot,whichfaceisprettier?,whatarethemissingparts?,whatisthepictureabout?,copyingasquare.Copyingadiamond,arrangingblocksinascendingorderofweight,fittingtheblocksgiveninthebox

ICDCLASSIFICATIONOFMR

IQRange Classification

50-69 Mild

35-49 Moderate

20-34 Severe

Below20 Profound

4.WechslerAdultPerformanceIntelligenceScale(WAPIS)

• AdaptationofWechslerAdultIntelligenceScale

• ByPrabhaRamalingaSwamy

• Agerange:15-44years

• Educationnorms:Literate-5thstdandabove

• IQrange:40-139

Sub-tests:

i.Picturecompletion

ii.Digitsymbol

iii.BlockDesign

iv.PictureArrangement

v.ObjectAssembly

i.Picturecompletion

-26cards

-pointoutthemissingpart

-measuresVisualAcuity

ii.Digitsymbol

-needtodrawthecorrespondingsymboltothedigitsin90seconds

-measuresMentalSpeed

iii.BlockDesign

-Reproducethedesignonthecardusingtheblocksgiven

-Initially4-blockdesignsthen9-blockdesigns

-measuresAnalyticandSyntheticAbility

iv.PictureArrangement

-Arrangethepicturesgiveninaparticularsequenceandformalogicalstory

-measuresSocialIntelligence

v.ObjectAssembly

-assemblethegivenpiecesandmakeanobject

-measuresVisualIntegration

WECHSLERCLASSIFICATIONOFIQ

IQRange Classification

Above130 VerySuperior

120-129 Superior

110-119 AboveAverage

90-109 Average

80-89 BelowAverageorDullNormal

70-79 Borderline

Below70 Extremelylow

PERSONALITYASSESSMENT

RegularlyusedPersonalityTestsinClinicalPractice

1.16PersonalityFactorTest(16PF)

2.MinnesotaMultiphasicPersonalityInventory(MMPI)

3.TemperamentCharacterInventory(TCI)

4.ClinicalAnalysisQuestionnaire(CAQ)

1.16PFTEST

-LexicalHypothesis

-Extracted18,000personalitydescribingwords

-In1946,Cattellwiththehelpofacomputerorganizedthelistinto181clusters

-Byusingfactoranalysisgenerated12factors,andthenincluded4factors

-105statements;3optionseachtochoosefrom

-Itmeasuresnormalrangetraits

-usedextensivelyincounsellingandclinicalsetting

-Availableinmorethan30languagesworldwide

-Lowerreadinglevel(5thgradeaverage)

-Updatednorms

-Easyhandscoring

-Goodpsychometricproperties(ReliabilityandValidity)

PrimaryFactorsinCattell's16PersonalityFactors

Warmth(A);Reasoning(B);EmotionalStability(C);Dominance(E);Livelness(F);Rule-conscious(G);SocialBoldness(H);Sensitivity(I);Vigilance(L);Abstractedness(M);Privateness(N);Apprehension(O);OpennesstoChange(Q1);Self-Reliance(Q2);Perfectionism(Q3)andTension(Q4)

SecondOrderFactors

Extraversion;Anxiety;Tough-Mindedness;IndependenceandSelf-Control

Administration

-PaperandPencil/Computerformat

-Checkthereadingabilityandcomfortwiththelanguageoftestadministration

-Ensuretesttakersarerespondingappropriatelyandnotskippingitems

-Readtheinstructionsaloud

-Clarifytheirdoubtsifany

-Attitudetowardthetesting

-Physicalcomfort

-Psychologicalcomfortwiththetesting

-Ruleoutanypsychologicalconditionsuchasseveredepressionoranxiety

Instructions

-Mostofthequestionsonthetestaskaboutyourfeelings,attitudesorbehavior

-therearenorightandwronganswers

-givetheanswerthatcomestoyoufirst

-Trytoavoidthemiddle(b)answerandstaywiththe(a)or(c)answersbutifyoureallycan’tdecide,justchoose(b)

MotivationalDistortion(MD)

-Denotesinaccuracyinquestionnaireresponses:

¤Presentingselfinafavorablemanner

¤Presentingselfinanunfavorableway

-FG(fakegood)andFB(fakebad)

2.MINNESOTAMULTIPHASICPERSONALITYINVENTORY(MMPI)

Features

-mostfrequentlyusedclinicalpersonalitytest

-self-administered

-usuallytakesbetween1–1.5hourstocomplete

-TheclientsimplyrespondsT(True)orF(False)toeachitemonthebasisofwhetherthestatementappliestohim/her

-canbeadministeredfromaprintedbooklet,byaudiocassette,orbycomputer

-translatedintomanylanguages

-sixthgradereadinglevel

-easyandobjectivescoring

-ensuresobjectiveinterpretationsthatarehighlyreliableovertime

-Measuresthetesttakingattitudesoftheclient

-providesclear,validdescriptionsofpeople’sproblems,symptoms,andcharacteristics

-enablethepractitionertoestimatepotentialfuturebehaviors

ClinicalScales(10)

ContentScales(15)

• (Scale1)-Hypochondriasis

• (Scale2)-Depression

• (Scale3)-Hysteria

• (Scale4)-PsychopathicDeviate

• (Scale5)-Masculinity-Femininity

• (Scale6)-Paranoia

• (Scale7)-Psychasthenia

• (Scale8)-Schizophrenia

• (Scale9)-Hypomania

• (Scale10)-SocialIntroversion

• Anxiety(ANX)

• Fears(FRS)

• Obsessiveness(OBS)

• Depression(DEP)

• HealthConcerns(HEA)

• BizarreMentation(BIZ)

• Anger(ANG)

• Cynicism(CYN)

• AntisocialPractices(ASP)

• TypeA(TPA)

• LowSelf-Esteem(LSE)

• SocialDiscomfort(SOD)

• FamilyProblems(FAM)

• WorkInterference(WRK)

• NegativeTreatmentIndicators(TRT)

PROJECTIVETESTS

Whatis“projection”?

• Adefensemechanismwithwhichtheegoprotectsitselffromanxietybyexternalizingunpleasantfeelingsorexperientialelement

Whatare“projectivetechniques”?

• Theuseofvague,ambiguous,unstructuredstimulusobjectsorsituationsopentodifferentinterpretationsinwhichthesubject“projects”hisorherpersonality,attitude,opinionsandself-concepttogivethesituationsomestructure

• Thereareno“right”or“wrong”responsestothestimuli

• butwhethertheresponsesarenormativeornon-normativeisofgreatimportance

AdvantagesofProjectiveTechniques

-noreadingabilityrequired

-resultsareverydifficulttofalsify

-enableawidevarietyofassumptions

-abroadandcomprehensiveviewofthesubject’spersonality

DisadvantagesofProjectiveTechniques

-relativelysubjectivescoring

-theyaredifficulttocompareandretest

-thenormativenessofresponsesismostimportant

-theirstatisticaldependabilityisweak

Mostprominentprojectivetests:

1.WordAssociationTest(WAT)

2.SentenceCompletionTest(SCT)

3.ThematicApperceptionTest(TAT)

4.RorschachInkblotTest(RIBT)

5.House-Tree-PersonDrawingTest

1.WordAssociationTest(WAT)

-Thetestinvolvesconnectionandproductionofotherwordsinresponsetoagivenword,donespontaneously

2.SentenceCompletionTest(SCT)

-Sentencecompletionteststypicallyproviderespondentswithbeginningsofsentences,referredtoas“stems,”andrespondentsthencompletethesentencesinwaysthataremeaningfultothem

-Theresponsesarebelievedtoprovideindicationsofattitudes,beliefsandmotivationsorothermentalstates.

3.ThematicApperceptionTest(TAT)(IndianAdaptation)

Procedure

-GivenbyHenryA.Murray

-IndianadaptationbyUmaChoudhary

-Presentingaseriesofsemi-structuredpicturestothepatientandencouraginghim/hertotellstoriesaboutthem,inventedonthespurofthemoment

-10+1blankcard

-Givesanindepthknowledgeofthepatient’spersonalityandhis/herinterpersonalrelations

Instructions

“Iamgoingtoshowyousomepictures,oneatatime,andyourtaskistomakeastoryaboutit.Whathasleduptotheevent(past),whatishappeningatthemoment(present),whatthecharactersarethinkingandfeelingandwhatistheoutcome(future)”

Somecardsandtheirsignificance:

CardI–AchievementCard

CardII–Biological/FamilyCard

CardV–AggressionCard

CardVI–SuicideCard

CardIX–SexCard

CardX–DepressionCard

Interpretation

! Thestoriesarereadandcorroboratedwiththeclinicalhistory

! Whodoesthepersonrelatetointhestories

! Whatisthemainthemeofthestories

! Whatarethepredominantneedsexpressed(e.g.achievement,affiliation,aggression,harmavoidance,nurturanceetc.)

! Whatarethepredominantpressesexpressed(lack,rejection,aggression,illness,inferiority)

! Whatarethepredominantdefensemechanisms?

! Howdothestoriesend?

4.RorschachInkblotTest(RIBT)

-DevelopedbyHermannRorschach

-patients'perceptionsofinkblotsarerecorded

-Providesindepthinformationaboutaperson'spersonalitycharacteristicsandemotionalfunctioning

-detectsunderlyingthoughtdisorder,especiallyincaseswherepatientsarereluctanttodescribetheirthinkingprocessesopenly

-detectspsychosisevenattheprodromelevel

Procedure

-Bilaterallysymmetricalinkblots

-10cardsonawhitebackground

" 5inkblotsareofblackink" 2areofblackandredink" 3aremulticolored

Instructions

-Freeassociation/responsephase:

“Whatthismightbe”

(Patientseesandrespondstoalloftheinkblots)

-Inquiryphase:

“I’llshowyouallthecardsagainonebyone.Wheredidyouseewhatyouoriginallysawandwhatmakesitlooklikethat?TellmesoIcanalsoseeitlikeyoudo.”

SystemsofInterpretation

-SomesystemsofRorschachinterpretations:

" Beck" Klopfer" Piotrowski" Exner-(currentlymostwidelyusedwiththemostobjectivescoringand

comprehensiveinterpretation)

Popularresponsesofthe10cards:

•CardI-Bat/Butterfly

•CardII–Bear,Dog,ElephantorLamb(Headorwholeanimal)

•CardIII–HumanFigureorrepresentationthereof

•CardIV–Humanorhuman-likefigure

•CardV–Bat/Butterfly

•CardVI–Animalskin,hide,peltorrug

•CardVII–Humanheadorface

•CardVIII–Wholeanimalfigure

•CardIX–Humanorhuman-likefigures

•CardX–SpiderorCrab

Interpretation

-providesdataabouttheperson’scognition,personalityvariables,affectivity,personal/interpersonalperceptions

-Somefactorstakenintoconsiderationwhileinterpreting:

! Content(e.g.humans,animal,nature,blood)

! Location(e.g.wholeorpart)

! Determinants(e.g.form,colour,texture)

! Popularity/Originality

! Specialscore(unusual/deviant/inappropriateresponses)

SpecialIndices

Perceptual-ThinkingIndex

-Indicatesthepresenceofpsychosis

-Somecontributingfactorsare:

" Lessresponsesclosetothenorm" Moredeviantresponsesandverbalizations" Inappropriatecombinationsandcontaminatedresponses" Higherspecialscore" Higherlevel–2deviantresponsesandverbalizations

Organicity

-ThestrongestindicatoroforganicityinRIBTis:

-Perseveration(especiallyMechanicalPerseveration-patientgivingthesameresponsefordifferentcardslikeamachine)

NEUROPSYCHOLOGICALTESTS

-Neuropsychologicalassessmentisaclinicalexaminationofboththeworkingbrainandthedysfunctionalbrain

-Thegoalistoidentifyadeficitinfunctioningandnottotestthelimitsofthetopendofperformance

SuicidePotentialIndex

DepressionIndex

Coping-DericitIndex

Hyper-vigilanceIndex

Obsessive-styleIndex

Perceptual-ThinkingIndex

ApproachesinNeuropsychologicaltests

1.Ideometricapproach

• Clinicalexaminationrequiringin-depthexaminationofindividualpatients• Emphasizesthepatient’spremorbidfunctioning(education,occupation,social

functioning)

2.Psychometricapproach

• Assessmentofabilities/aptitudesusingquantitativescores• Interpretationthroughnormativedatanottakingintoaccountprevioushistoryor

functioning

! AcomprehensiveNeuropsychologicaltestisacombinationofboththeseapproaches

NIMHANSNEUROPSYHOLOGICALBATTERY

I. TestsofAttentionII. TestsofExecutiveFunctionsIII. TestsofSpeedIV. TestofComprehensionV. TestsofLearningandMemory

I.TestsofAttention

1.ColourTrailsTest

-Measuresfocusedattention

-ColourTrails1:Thesubjectisaskedtopointtosuccessivenumbersinascendingorderfrom1–25

-ColourTrails2:Thesubjectisaskedtopointtonumbersinalternatingcolours(pinkandyellow)inascendingorderfrom1–25

-Thetimeforbothisnoteddown

2.DigitVigilanceTest

-Measuressustainedattention

-Thesubjectisaskedtoscanthesheetandcancelthetargetnumbers‘6’and‘9’(bydrawinga‘/’markonthem)asfastaspossiblewithoutmissingthetargetsorcancellingwrongnumbers

-Thetimetakenanderrorsmadearenoted

3.TriadsTest

-Measuresdividedattention

-Thesubjectistoldthatthetwotaskswillbegivensimultaneouslyandattentionshouldbedividedbetweenboth

-Thesubjectisaskedtocallouttheoddwordfirstandthenthenumber(writtenonthepalmofthenon-dominanthand)

-Thetotalnumberoferrorsmadearenoted

II.TestsofExecutiveFunctions

1.CowaTest

-Measuresphonemicfluency

-ThesubjectgenerateswordsbeginningwiththelettersF,A,SorKa,Pa,Maforoneminuteeach

2.AnimalNamesTest

-Measurescategoryfluency

-Thesubjectgeneratesnamesofanimalsforoneminute(excludingfish,birdsandsnakes)

3.N-BackTest(Verbal)

-Measuresworkingmemory

-Inthe1-backtestthesubjectrespondswheneveraconsonantisrepeatedconsecutively

-Inthe2-backtestthesubjectrespondswheneveraconsonantisrepeatedafteraninterveningconsonant

4.TowerofLondonTest

-Measuresplanning

-Thesubjectispresentedwithagoalstateofthearrangementofthe3ballsononeoftheboards(neartheexaminer)

-Thearrangementoftheballsintheotherboardistheinitialstate(nearthesubject)

-Thesubjecthastoarriveatthegoalstatewithaminimumof2,3,4and5moves

-Themeantimeandthemeannumberofmovesarenoted

5.WisconsinCardSortingTest

-Measuressetshiftingability

-The4stimuluscardsareplacedinfrontofthesubject

-Thedeckof128cardsisarrangedaccordingtothesequenceinthetestmanual

-Thesubjectisinstructedtostudythecardsandmatcheachsuccessivecardfromthepacktooneofthe4stimuluscards

-Thesubjectistoldonlywhethereachresponseisrightorwrongandisnevertoldthecorrectsortingprinciple

-Thesubjecthastoguesstheconceptbasedontheexaminer’sfeedbackandcontinuewiththetest

-Thenumberoftrialstaken,errorsmade,perseverationisnoted

6.StroopTest

-Measuresresponseinhibition

-Thesubjectisaskedtoreadthestimulisheet(containingnamesofcoloursprintedindifferentcolours)column-wiseassoonaspossibleandthetimeisnoted

-Thenthesubjectisaskedtonamethecolourinwhichthewordisprintedcolumn-wiseandassoonaspossibleandthetimesisnoted

-Stroopeffectscore=timetakentonamethecolour–Timetakentoreadthewords

OtherTests

III.TestsofSpeed

(FingerTappingtest,DigitSymbolSubstitutionTest)

IV.TestofComprehension

(TokenTest)

V.TestsofLearningandMemory

(AuditoryVerbalLearningTest,LogicalMemoryTest,ComplexFigureTest)

SUMMARY

• Thepsychologicalassessmentsseektodescribethewaysinwhichpeoplediffer

• tounderstandhowandwhythesearise

• thereareavarietyoftestsandtheyareusedwidely

• foundeduponanobjective,scientificandempiricalapproach