Neuropsych Lec 7 Psych Diagnostic Procedures In Psych

DIAGNOSTIC PROCEDURES IN PSYCHIATRY Raymond L. Rosales, MD PhD Department of Neurology & Psychiatry UST Faculty of Medicine and Surgery

DIAGNOSTIC PROCEDURES IN PSYCHIATRY PSYCHOLOGICAL TESTS Projective Testing • Neuropsychological testing • Psychiatric symptoms and Personality testing by Questionnaire • Standardized Psychiatric Interview NEUROIMAGING TESTS • CT • MRI • SPECT • PET • NEUROPHYSHIOLOGIC TESTS • EEG • Evoked Potentials • Brain Mapping PROJECTIVE TESTS

1)

2)

Rorschach: 10 inkblots 3 categories a) location/area of the inkblot on which response is based b) specific aspects/determinants of the blot used to form the percept c) Content of Percept Thematic Apperception Test (TAT): o 20 cards of ambiguous scenes o Content analysis of story

WHEN SHOULD PATIENTS BE REFERRED FOR PROJECTIVE TESTS? • The nature and level of depression, anxiety and/or anger • Level and style of impulse control • Quality and clarity of thinking • Coping styles and capacities • Style and capacity for relatedness to others • Experience of others • Style of solving problems • Originality and integrative capacities • Emotional responses to stress • Emotional reactivity • Defensiveness and style of defense • Level of personal adjustment or ego functioning • Ability to tolerate stress • Adequacy of daily functioning • Reality functioning • Level of self-esteem • Experience of family dynamics CLASSIFICATION OF PROJECTIVE TESTS BASED ON THE NATURE OF THE PROJECTIVE ACTIVITY: 1. Associations = Rorschach, word-association tests 2. Completions = Sentence completion tasks 3. Constructions = Thematic apperception test 4. Choice/Ordering = Ranking of objects to categories 5. Self-experience = Drawing tasks, Dramatic plays NEUROPSYCHOLOGICAL TESTING • Uses behavioral measures to assess skills and abilities that relate to brain functioning • Tests are fatiguing and recommended therefore in an order of administration that: Intersperse easier and harder tests Begins testing with tasks that reduce rather than increase anxiety Places tests with demanding attentional/speed requirements when the patient is fresh and wellrested, yet past the initial anxiety WHY APPARENT DISCREPANCIES/CONTRADICTIONS MAY EXIST BETWEEN NEUROBEHAVIORAL AND NEUROIMAGING STUDIES • There may be long-standing, probably congenital, structural abnormalities, but the patient has relatively normal neurocognitive functioning because the brain organized with the abnormality already in place • The physiological changes associated with brain lesions identified by CT or MRI may exceed the boundaries of the structural abnormality • Individual differences in functional brain organization are complex and not yet completely understood

• •

Neurobehavioral measures may be incorrectly interpreted, e.g., interpreting errors on sensory or motor tests resulting from PNS injury -08united_irregs07as CNS impairment Changes at a microscopic level may cause behavioral 2008SecD-USTFMS change, but may not be visible-AsMwith current imaging technology.

PSYCHIATRIC SYMPTOMS AND PERSONALITY TESTING BY QUESTIONNAIRE Potential Uses: • history taking and formulating clinical hypothesis • Screening and diagnosis of clinical problems and mental disorders • Determining appropriate referral to specialty services • Monitoring change and response to treatment and interventions • Conducting research into factors associated with the disorders • Auditing and assessing clinical services STANDARDIZED PSYCHIATRIC INTERVIEWS (SPI): • Necessary when collecting data for research or for comparing patients with those reported in the psychiatric literature • Desirable in everyday clinical practice because it provide a systematic means of evaluating patients that is less subject to bias or incomplete assessment WHAT ARE THE MOST COMMONLY USED FULLY STRUCTURED DIAGNOSTIC INTERVIEWS? • DIS (Diagnostic Interview Schedule): questions organized by symptoms and patients are asked 1) Whether the symptom(s) has/have ever occurred in their lifetime 2) Whether the symptoms occurred within the last 1month, 6-month or 12-month period • Cross-sectional assessments, HAM-D/A; MADRS, BPRS, GAF IMPORTANT FEATURES OF BRAIN IMAGING MODALITIES CROSS SECTIONAL ASSESSMENTS