1 / 71

PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’

PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’. CHAIRPERSON- Dr Prabhat K Chand CO- CHAIRPERSON- Dr Manoj Kumar Sharma PRESENTOR- Dr Virupakshappa Irappa Bagewadi. Outline. INTRODUCTION TESTS COMMONLY USED EVIDENCE FOR SUPPORT INDIAN PERSPECTIVE CLINICIAN’S PERSPECTIVE

britain
Download Presentation

PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’ CHAIRPERSON- Dr Prabhat K Chand CO- CHAIRPERSON- Dr Manoj Kumar Sharma PRESENTOR- Dr VirupakshappaIrappaBagewadi

  2. Outline • INTRODUCTION • TESTS COMMONLY USED • EVIDENCE FOR SUPPORT • INDIAN PERSPECTIVE • CLINICIAN’S PERSPECTIVE • LIMITATIONS • CONCLUSION

  3. Introduction

  4. Introduction • Like other branches of medicine, PSYCHIATRIC practice, needs diagnostic tests to supplement anamnesis and clinical examination. • In clinical psychiatry, even more than elsewhere in medicine, differential diagnosis is safer, if several tests are available than if only one test is at our disposal. • Attempts at developing and clinically exploring psycho diagnostic procedures can be a potent tool in exploring organization and disorder of the personality. [David Rapaport,1950]

  5. Introduction [David Rapaport,1950]

  6. Psychometry • Psychometry has now evolved as study on theory & technique of psychological measurements. • Includes measurement of knowledge, skills , abilities, aptitudes, attitudes, intelligence, memory, creativity, adjustment & personality. • Field uses – questionnaires, schedules, rating scales, inventories & tests [Venkatesan S. 2010]

  7. Psychometric Approaches • Relies on Normative approaches to psychological assessments. • Comparisons with a norm group enabled statistically based diagnostic decisions . • In criterion referenced testing the scores relate directly to individual competencies . • Behavioral assessments look into contemporary behaviors in individuals and are directly linked to planning / implementing for there remediation . • In recent times idiometric approaches to assessments is gaining momentum based on search for underline common denominators for overt behavioral deficits . [Venkatesan S. 2010]

  8. Psychometry For Clinician: CLINIMETRICS • Introduced by Alvan R. Feinstein in 1982. • The purpose is to provide an intellectual home for a number of distinct clinical phenomenon . • It includes • Types ,severity and sequence of symptoms; • Rate of progression of illness , • Severity of comorbidity ; • Problems of functional capacity ;reasons for medical decisions and many other aspects of daily life ,such as well being and distress • Example : Apgar’s score [Venkatesan S. 2010]

  9. Psychometry To Clinimetry TRADITIONAL PSYCHOMETRY • Less sensitive to symptom change • Less clinically coherent • Homogeneity of components were given importance • More subjective • Cross sectional CLINIMETRICS • Sensitive to symptom change • Clinically coherent –assess sx based on their prevalence • Assess sx based on importance of those sx to define severity (weighting of sx) • More objective • Consider longitudinal course of illness [Venkatesan S. 2010]

  10. Psychological Tests

  11. Psychological Test Clinical relevance • It elicits, in a scientifically standardized manner, responses which reveal psychological characteristics in the patient being tested with a high degree of statistical reliability and validity. • It includes obtaining samples of behaviour, relevant to cognitive or affective functioning, and for scoring and evaluation. [Essentials of behavioral science]

  12. Why Are Assessments Done? • Screening & diagnosing • Treatment Planning • Functional Impairment/Severity • Subjective Distress • Social Support and Attachment Style • Reactant/Resistance Tendencies • Coping Style • Monitoring of Treatment Progress • Prognostic Indicators

  13. Domains Of Tests

  14. Examples Of Commonly Used Tests In A Clinical Setting

  15. Cognitive Function https://encrypted-tbn2.google.com/images

  16. PGI Memory Scale • Developed by DwarkaPrasad and N.N. Wig (1977) • 10 subtests • Percentile norms for 20 -45 years • Gives profiles for intervention • Indian norms available

  17. Wechsler’s Memory Scale (WMS) • Developed in 1940 at Belleuvehospital,New York • Norms available for 25-50 yrs • 7 subtests • Gives a memory quotient (MQ) which is highly correlated with IQ

  18. Binet-Kamat Test • Includes both verbal and performance tests • 3 -22 yrs, age level • Pattern analysis • Language • Reasoning • Conceptual thinking Memory • Social Intelligence • Visuo-motor…….etc. • Verbally loaded , difficult to assess if verbal function is impaired

  19. WAPIS-Wechsler Adult Performance Intelligence Scale • WAPIS Indian adaptation of WAIS [Ramalingaswamy, 1975] • Age: 15-45 • Edu : min 5th std

  20. Bhatia battery of performance tests of intelligence • C.M. Bhatia-1942 -5 sub-tests • KohsBlock Design- discrimination of patterns • Alexander’s Pass along test- discrimination of movement of concrete material • Pattern drawing test- analysis in terms of lines • Immediate memory- verbal memory • Picture construction- discrimination of picture parts • Norms- 11 to 16 yrs, literate and illiterate • PQ (performance quotient) • IQ (intelligence quotient) • Can not be used to assess MR

  21. Raven’s Progressive Matrices Test • Has three versions • Advanced, Standard , Coloured. • Standard Progressive Matrices (SPM), 60 problems divided into five sets of A,B,C,D and E. Each 12 items in the order of progressive difficulty. • It does not give IQ • It can be used in everyone irrespective of culture, nationality, age, education, physical condition

  22. VSMS-Vineland Social Maturity Scale • DR. Edgar A. Doll- 1935 • Assesses 8 areas of development • Self-help general , Eating , Dressing , Direction • Occupation, Communication ,Locomotion ,Socialization . • 0-25 yrs age level items • Done with the informants

  23. Projective Objective [downloaded from https://encrypted-tbn2.google.com/images]

  24. Personality & Inter Personality • Projective Techniques • Purpose is to gain insight into the individual personality as a system • Rely to some degree on ambiguous stimuli and opaque directions as catalysts for creating data. • The projective hypothesis • Ambiguous stimulus will reveal important aspects of his or her personality [Frank, 1939]

  25. Rorschach Inkblot Test • Hermann Rorschach- 1910. • The test consists of ten ambiguous, symmetrical inkblots, card appears as if a blot of ink was poured onto a piece of paper and folded over—hence, the symmetrical appearance. • These 6½ × 9½–inch inkblot cards are the standard stimuli • Are referred by Roman numerals I to X. • Scoring • Location , Determinants ,Content , Popular, Form level

  26. Rorschach Inkblot Test • Scoring Systems • Beck (1937) , Klopfer (1937),Pitrowski , • Hertz ,Rapapport, Exner (1969) • Pathognomic Signs • Colour shock, Shading shock, Perseveration. • Contamination, Confabulation, Number responses • Behavioral responses like rejection , perplexity, automatic phrasing etc.

  27. Uses Of Rorschach • Main use differential diagnosis and detecting early schizophrenics • Other uses – • Detecting organicity : Pitrowsky’s signs • Measuring hostility : Elizur’s hostility scores • Screening psychopathology • Studying personality patterns • Evaluating treatment outcomes • Prognosis indication

  28. Ups And Down Of Rorschach • At one time it was most commonly used test for various conditions including child dispute, divorce etc • Validity of the result has been questioned • Critically reviewed by psychologists • Number of psychology school have stopped using the test

  29. Thematic Apperception Test • Developed by Morgan and Murray -1935 • A narrative projective device • 21 Black & White cards of individuals in classic human situation • Indian Adaptation by Uma Choudary-10 cards & a blank card • Murray’s scoring (need aggression, affiliation, affection) • Bellack’s Scoring

  30. Sentence Completion Test • Semi projective technique by Sacks and Levy-1950 • 60 item test that assesses adjustment through 4 subscales • family, sex, interpersonal relationships and self concept • My father seldom…….(family) • When I see a man and woman together…..(sex area)

  31. Object sorting test • Kurt Goldstein , Martin Scheerer -1941 • Consists of 30 objects like ribbon, bottle , needle, cloth etc • 2 phases- active and passive phase, • Responses -Common, Impoverished, Peculiar • Measures thought deviance

  32. Minnesota Multiphasic Personality Inventory • Hathaway& Mckinley -1942 • 566 items, T /F, Cannot Say • 10 Clinical scales • Hypochondriasis, Depression, Hysteria, Psychopathic deviation, Paranoia..etc • 4 Validity Scales (?, L, F, K) • Additional Scales – Ego Strength, Alcohol Scale

  33. 16 Personality Factor Test • Cattell-trait theory of personality • Measures 16 functionally independent dimensions • Age 16 & above • Form standardized and used in India

  34. Neuropsychological Assessment • Halstesd –Reitan Battery(1940) • Frontal lobe lesion • 10subtests • Criticized being not theoretical • Luria’s neuropsychological investigation • More comprehensive • Based on theoretical principles • 11 major cortical functions • Luria-Nebraska Neuropsychological Battery • Standardized luria’s test by Golden

  35. Neuropsychological Assessment • INDIAN TEST BATTTERIES • PGI Battery of Brain Dysfunction(PGI BBD)- 5 subtests • PGI memory scale • WAIS Verbal scale • Bhatia’s short revised scale • Bender –Gestalt scale • Nehor & Benson scale • Gives a profile of 19 variables • NIMHANS Neuropsychological Battery • 19 tests

  36. Wisconsin Card Sorting Test • David A. Grant and Esta A. Berg 1948 • Used to test “set-shifting” • “Frontal" lobe functions • Executive function • Abstract thinking

  37. Rating Scales • Help in diagnosis, functioning, symptom severity and side effects

  38. Evidence For Support

  39. Description Of Clinical Symptomatology & DD

  40. Description of Clinical Symptomatology & DD

  41. Description and Prediction of Functional Behaviour • Psychological assessments will predict functional behaviours which have an effect on diagnosis, treatment and prognosis. [Moras, 1997] • Tests of Cognitive Ability • Highly predictive of proficiency on the job and success in job training • Strong utility as descriptors and predictors of academic achievement [Gottfredson, 1997] • Self-Report Personality Measures • Multi method assessment batteries better than single method approaches to assessment. [Robertson & Kinder, 1993]

  42. Mental Health Outcomes • In children Baseline self reports of negative emotionality predict behavior problems & subsequent clinical outcomes. [Mattison et al1990] • In adults, baseline testing has determined that self-reported neuroticism is a better predictor of long-term clinical outcome in depression [Hirschfeld et al1986] • In general, elevated baseline neuroticism scores predispose people to negative outcomes in individual and marital therapy [Luborsky et al1993] • Baseline assessment of hopelessness is the best predictor of subsequent suicide [Stewart, & Steer,1990]

  43. Assisting In Treatment • Patients with externalizing symptoms do better in treatment that is more structured or directed by the therapist • Patients with internalizing symptoms do better in treatments where they set the pace and determine the structure [Engle & Mohr, 1993]

  44. Assessment As A Treatment • Patients receiving a 2-hour MMPI-2 assessment with feedback reported symptomatic improvement compared who did not. [Finn and Tonsager 1992] • Personality testing can assist the formation of a "therapeutic community" among men in inpatient treatment for severe substance dependence. [Moffett et al. 1996] • Personality testing also help to analyze and resolve interpersonal difficulties that arise between difficult patients and their therapists or treatment teams [Berg 1988]

  45. Indian Perspective

  46. Scene In India • Clinimetrics is of a recent origin in the country. • It is still in the process of establishing • Economical, cultural, educational, language & gender differences contribute to the scenario of poor understanding or acceptance of psychometry . • Despite these limitations and challenges ,the field of clinimetrics has witnessed a periodic although unsteady or patchy growth in mental health practice in the country. [Venkatesan S. 2010]

  47. Distribution Of Research Articles In India [1958-2009] [Venkatesan S. 2010]

  48. Scales & Inventories Used In India [1958-2009]

  49. Advances In Assessment

  50. Computers In Diagnosis • Computer soft wares are also utilized in a variety of ways. • To aid mental health professional in arriving at a psycho diagnostic classification • To define psychiatric symptomatology terms, employ cross-referential diagnostic numbers to diagnostic categories, and even refer the user to a specific page number • Ashton-Tate's dBase lll+ software was utilized and it was found to be user friendly [Stout & Scheramic, 1989]

More Related