Behavioral Assessment - Boulger

Question 1

When are mental status exams indicated?

Answer 1

• Patients with documented brain lesions such as tumors, trauma, vascular accidents, etc
• Patients with suspected brain lesion because of recurrent seizure, headache, behavioral change, or head trauma
• All psychiatric patients
• Depression most commonly seen with frontal and temporal tumors, hydrocephalus, or cortical atrophy
• Patients who have vague complaints - memory, concentration, declining interests, various physical complaints without organic etiology

Question 2

What does a mental status exam in psychiatry consist of?

Answer 2

• Presentation
  
  • LOC, GCS, alert, cooperative, appearance
• Motor Behavior and Affect
  
  • movement, mannerisms, facial expression
• Cognitive Status
  
  • attention, alertness, orientation, speech, language, memory, calculation, reasoning
• Thought
  
  • coherence, insight, goals, ideations
• Mood
  
  • anger, suicidality, hopelessness, guardedness, variability

Question 3

What are the five parts of the Mini-Mental Status Exam?

Answer 3

1. Orientation
2. Language function
3. Registration & Recall
4. Attention/Simple Calculations
5. Constructional Praxis

Question 4

How many total points are in the MMSE?

Answer 4

• 30 points
  
  • Orientation to time (5) - year, season, month, day of the week, date
  • Orientation to place (5) - where are we now, what state are we in, what country is this, what city is this, what floor are we on
  • Language - reading (1), writing (1), naming (2), comprehension (3), repetition (1)
  • Registration (3) - repeat 3 words back
  • Recall (3) - remember the 3 words
  • Attention/simple calculations (5) - serial 7s or spell world forward and backwards
  • Constructional praxis (1)

Question 5

What MMSE score indicates normal cognition?

Answer 5

Any score greater than or equal to 27 points (out of 30) indicates a normal cognition.

Question 6

What MMSE score is the widely accepted cut-off?

Answer 6

23 points

Question 7

What MMSE score indicates mild cognitive impairment?

Answer 7

21-26

Question 8

What MMSE score indicates moderate cognitive impairment?

Answer 8

11-20

Question 9

What MMSE score indicates severe cognitive impairment?

Answer 9

0-10

Question 10

What office screening assessment techniques can be used for depression?

Answer 10

• Hamilton Rating Scale for Depression (Ham-D)
• Patient Health Questionnaire (PHQ-9)
• Geriatric Depression Scale (GDS)

Question 11

What office screening assessment techniques can be used for anxiety?

Answer 11

• Hamilton Rating Scale for Anxiety (Ham-A)
• Patient Health Questionnaire (GAD-7)

Question 12

What office screening assessment technique can be used for alcohol use?

Answer 12

Alcohol Use Disorders Identification Test (AUDIT)

Question 13

What screening assessment techniques can be used for ADHD and Childhood Behavior Problems?

Answer 13

• SNAP-IV Rating Scale:
  
  • 90 questions designed to be answered by classroom teachers
  • Also contains items to screen for Oppositional Defiant Disorder
• Vanderbilt ADHD Diagnostic Teacher and Parent rating scale

Question 14

What are the four levels of cognitive and neuropsychological examination measurements with varying degrees of precision and usability?

Answer 14

• Nominal Scales
• Ordinal Scales
• Interval Scales
• Ratio Scales

Question 15

What is a nominal measurement in cognitive and neuropsychological examinations?

Answer 15

• Least precise, assigning numbers or labels to identify categories to which individuals belong
  
  • Ex - diabetic or not diabetic

Question 16

What is an ordinal measurement in cognitive and neuropsychological examinations?

Answer 16

• Arrange or sort individuals in a series ranging from highest to lowest according to an observed characteristic
  
  • Ex - test scores

Question 17

What is an interval measurement in cognitive and neuropsychological examinations?

Answer 17

• Gives numbers for which not only order but also differences between numbers are meaningful
• No absolute zero, assignment of the zero value is arbitrary

Question 18

What is a ratio measurement in cognitive and neuropsychological examinations?

Answer 18

• All arithmetical operations can be used - addition, subtraction, multiplication, and division
  
  • Highest level of measurement
  • True zero point

Question 19

What does reliability refer to in assessment techniques?

Answer 19

Consistency of predictive statements over time, over predictors, over individuals and/or over assessment techniques

Question 20

What does validity refer to in assessment techniques?

Answer 20

• “Truthfullness”
• Degree of accuracy of predictive (concurrent or prospective) statements

Question 21

How are intelligence tests scored today?

Answer 21

Statistically derived most commonly using:

• Wechsler Adult Intelligence Scale (WAIS-IV for ages 17+)
• Wechsler Intelligence Scale for Children (WISC-IV for ages 6-16)

Question 22

What is average IQ classification based on the Wechsler Adult Intelligence Scale?

Answer 22

90-109

Question 23

What are the most common examples of memory screening tests used in cognitive and neuropsychological examination?

Answer 23

• Rey-osterreich Figure
• Rey Auditory-Verbal Learning test
• California Verbal Learning test

(relatively short: 15-30 minutes)

Question 24

What is the most common memory test batteries?

Answer 24

Wechsler Memory Scale (WNS-IV)

(Takes approximately 60-90 minutes to administer)

Question 25

What is the most common neuropsychological test battery?

Answer 25

Halstead-Reitan Neuropsychological Test Battery * contains 10 subtests * abstract reasoning * kinesthetic and sensorimotor ability * attention * auditory perception * sensory-perceptual ability * language

Question 26

How are neuropsychological test batteries useful?

Answer 26

* many types to examine specific brain functioning * some very sensitive and highly accurate in assessing damage * used to help target brain damage before other techniques are used * BUT, they are very expensive to administer and are only available in larger cities and test centers

Question 27

What is the aphasia screening test?

Answer 27

A simple card can be used to simulate various types of aphasia

Question 28

What is the Rey Complex Figure used for?

Answer 28

To assess the individual’s ability to recall complex information presented visually

Question 29

What are the two types of measures in a personality assessment?

Answer 29

Objective measures & Projective measures

Question 30

What do projective tests show in personality assessments?

Answer 30

Reveal hidden emotions and internal conflicts via a subject’s responses to ambiguous stimuli * Rorschach Inkblot tests

Question 31

What do objective tests show in personality assessments?

Answer 31

Determine whether the person taking the test is responding truthfully * restricted response format (T/F) * Ex. Minnesota Multiphasic Personality Inventory (MMPI)

Question 32

What is the MMPI?

Answer 32

* Minnesota Multiphasic Personality Inventory (MMPI) * Most frequently used clinical testing instrument * one of the most researched psychological tests in existence * 567 true-false items