PSYCHOLOGICAL ASSESSMENT

PSYCHOLOGICAL ASSESSMENT

Some tests need the services of a clinical psychologist. The others can be administered and interpreted easily even by a non-professional.

One way of classifying the tests is according to the function sub served by them like intelligence tests, personality tests etc. Another way is depending on the nature of instruments like rating scales (e.g. Hamilton rating scale for anxiety), questionnaires (e.g. Eysenck personality inventory), pen and paper tests (e.g. letter cancellation tests), special apparatus test (e.g. Rorschach inkblot test) and performance tests(e.g. Koh’s block design test).

Instruments for Assessing Symptoms and Symptom Patterns:

1. Psychiatric Symptom Check List (PSCL): Self report with 90 item check list.

2. Brief Psychiatric Rating Scale (BPRS): Clinical interview with 16 items covers positive, negative and affective symptoms including hostility.

3. Structured Clinical Interview for Diagnosis: Semi-structured interview with 3-point rating scale of symptoms.

4. Clinical Global Impression (CGI): Rating instrument to enable the clinician to quantify severity of illness and improvement after treatment in a 7-point scale.

5. Anxiety Self-Rating Scale: Brief self rating questionnaire for phobic patients’ yields information on common phobias, global phobic rating and the target phobia along with associated anxiety depression symptoms.

6. S-R Inventory for Anxiety: Self report with 5 point severity scale.

7. Hamilton Anxiety Scale (HAS): An observer rating scale for “Anxiety Neurosis” as a syndrome (not for rating of individual anxiety symptoms). Rates 13 symptom groups along with a 14 variable –   “behavior during interview”

8. Clinical Anxiety Scale (CAS): Another observer rating scale for anxiety derived from HAS.  But unlike HAS this is confined to anxiety and tension in somatic musculature. It consists of six items like ability to relax, restlessness, etc.

9. Anxiety Disorders Interview Schedule: Semi-structural interview for rating anxiety and depressive disorders

10. Brief Scale for Anxiety: Observer rating scale with 10 items. Assesses mixed states of anxiety with depressive, phobic, obsession and psychotic symptoms and also anxiety occurring in medical and neurological disorders

11. Newcastle Scale for Depression: Self rating scale with 10 items like sudden onset, duration, persistence of depression, reactivity, retardation, delusions, etc.

12. Beck’s Depression Inventory (BDI): One of the longest established self rating scales for depression.  Tests 21 items with 4-point severity scale.  There is a shorter form with 13 items with 0-3 intensity scale.

13. Edinburgh Postnatal Depression Scale (EPDS): Self-rating scale meant to detect mothers with postnatal depression.  It is a 10 item questionnaire with a 0-3 severity scale.

14. Montgomery-As berg Depression Rating Scale (MADRS): Observer rating scale with 10 commonly occurring symptoms like sadness, tension, lassitude, etc. with a 7-point scale.

15. Hamilton Depression Scale (HAMD): Observer rating scale to be used in patients already diagnosed to be suffering from an effective disorder.  There are several versions.  The usual version has 17 variables with 0-2 or 0-4 intensity scale.

16. Young Manic Rating Scale: A scale on the basis of self-report and the clinician’s observations.  It includes 11 items like elevated mood, speech, sleep, etc. on a 5-point scale.

17. Manic State Rating Scale: Another observer rating scale with 26 items.

18. Schedule for Affective Symptoms and Schizophrenia: Semi-structured interview with 7-point rating scales for symptoms like hallucinations, delusions, etc.

19. Yale-Brown Obsessive-Compulsive Scale: Based on the subjective report and the clinician’s judgment, this scale rates the severity and type of symptoms in patients with OCD. Contains 19 items

20. Sandoz Clinical Assessment – Geriatric (SCAG) Scale: Meant to differentiate dementia and pseudo dementia.  It consists of 18 variables on a 7-point scale with a 19th item on the overall impression of patient.

21. Suicide Intent Scale: Self-report with 15 items and 3-point scale rating.

22. Index of Potential Suicide: Self-report with 50 items and 5-point severity scale.

23. Reasons for Living: Self-report with six factors.

24. Nurses Observation Scale for Impatient Evaluation (NOSIE): This is an observer rating scale for the use of nurses.  It rates 80 behavior modes seen in impatient units.  The items are most applicable to schizophrenia.

25. Positive and Negative Symptom Scale (PANSS) for Schizophrenia: PANSS is a 30-item rating scale used in schizophrenia.  It consists of a semi- structured clinical interview and supplementary clinical information.  There are nine clinical domains.  Assessed in  a 7-point severity scale.

26. Scale for Assessment of Positive Symptoms (SAPS): Clinician rating scale with 34 items for schizophrenic patients. Rating is done in a 0 (none) to 5 (severity) intensity scale.  It is usually administered with SANS.

27. Scale for Assessment of Negative Symptoms (SANS): This 25-item scale assesses negative symptom in schizophrenia.  It has an intensity scale of 0-5.  Administered along with SAPS.

28. Abnormal Involuntary Movement Scale (AIMS): A structured examination schedule to assess movements of face, trunk and extremities with 0-4 point scoring on incapacitation and patient’s awareness of abnormal movements.

29. Extrapyramidal Symptom Rating Scale (ESRS): This contains 12 questionnaire items to identify the patient’s symptoms.  Parkinsonian (including akathesia), dystonic and dyskinetic movements are examined in a 7-point scale. Rating is done by a clinician in two modalities – frequency and intensity.

30. Present State Examination – Ninth Edition (PSE-9): Developed for WHO to diagonise major psychiatric illnesses in adults. As a diagnostic instrument for international studies it was used in WHO’s International Pilot Study of Schizophrenia.  It is administered by the clinician during a semi-structured interview. 140 items are rated.

31. Global Assessment of Functioning (GAF) Scale: GAF is part of DSM-IV classification as its axis V and evaluates over all psychological health and illness using a 100 point scale (global functional levels). It is administered by the clinician. Code 100 denotes superior functioning (healthiest) and 1 denotes persistent danger to self or others (sickest).

32. Insight and Treatment Attitude Questionnaire (ITAQ): This 11 item rating scale evaluates the patient’s recognition of the illness and the need for treatment, that is, the patient’s insight.  It is rated in a 3-point scale by the clinician depending on the patient’s self assessment on his awareness of problems and consequences.

33. The CAGE Questionnaire: A widely used instrument for alcohol abuse screening.  Simple to use, it has only four items, self-reported by the patient.

The CAGE Questionnaire:-

Answer “Yes” or “No” to each of the following questions:

1. Have you ever felt that you ought to cut down on your drinking?

2. Have people annoyed you by criticizing your drinking?

3. Have you ever felt bad or guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?

34. Addiction Severity Index (ASI): A scale which provides information about the patient’s life areas which contribute to the addiction problem. There are seven functional life areas like medical status, social status, etc. A 10-point severity rating is done by the clinician on 142 items.

35. Overt Aggression Scale- Modified (DAS-M): This 25 item scale is used to access aggressive behavior in outpatients. It has nine subscales covering aggression, irritability and suicide, measured in a 0-6 point spectrum.

36. Mini Mental State Examination (MMSE): Clinical instrument to assess the cognitive functioning of a patient. It assesses the patient’s attention, orientation and memory in the first section by his verbal responses. In the second section the patient has to read, write and copy a geometric figure (two polygons). The test has 11 items and can be administered by a non professional.

37. Child Behavior Check List (CBCL): CBCL is a 113 item behavioral check list meant to evaluate pathological behavior in the age group 1.½ -18 years. Rating is done by parents, teachers, clinicians or by self in a 3-point scale. The listed behavior does not always correspond with the diagnostic categories of standard classification (ICD/DSM) systems.

Instruments for Assessment of Personality Traits and Disorders

1. Minnesota Multiphasic Personality Inventory (MMPI): Self –report with 560 items.

2. Cattel’s 16 Factor Personality Inventory: Self-report.

3. Eysenck Personality Inventory: Self-report with 57 Yes/No items.

Instruments for Assessment of Cognitive Functioning

1. Seguin Form Board: Performance test of intelligence containing 10 pieces and stacks.

2. Wechsler Adult Intelligence Scale (WAIS): Objective test of intelligence for adults.

3. Wechsler Intelligence Scale for Children.

4. Raven’s Standard Progressive Matrices: Pen and paper test of intelligence for adults.

5. Raven’s coloured progressive Matrices: Pen and paper test of intelligence for children.

6. Binet-Kamath Test of Intelligence: Indian version of Stanford-Binet intelligence test.

7. Bhatia Battery Test of Intelligence with five sub-tests.

8. Bender-Gestalt Test: Visual motor behavior test consisting of nine cards with geometrical designs.

9. Goldstein-Scheerer Tests of Abstract and Concrete Thinking: Battery of five tests to assess abstract thinking.

10. Kasanin and Hanfman Concept Formation Test: Contains 22 blocks in 5 colors, 6 shapes and 2 sizes. Tests concept formation.

11. Luria Nebraska Test: Structured assessment of intellectual, sensory-motor and expressive skills. Has 269 items.

12. PGI Battery of Brain Dysfunction (PGI-BD): Consists of 13 items.

13. PGI Memory Scale: Consists of 10 sub-tests.

14. NIMHANS Neuropsychological Battery of Lobe Dysfunction: Has 31 Sub-tests.

Instruments for Assessment of Psycho-dynamics

1. Rorschach Inkblot Test: Projective test. Have 10 ambiguous inkblots some of which are coloured.

2. Thematic Aperception Test: Projective diagnostic test with 30 ambiguous scenes.

3. Sentence Completion Test: Consists of incomplete sentences (e.g. “My mother …….”. Patient has to complete the sentence.

Instruments for Assessment of Environmental Stressors

1. Social Adjustment Scale: Self-report with 42 questions on a 5-point scale.

2. Marital Satisfaction Inventory: Self-report with 280 items.

Psychological tests have several limitations. Self-reports and observer reports may be biased by subjective factors of the reporter. The subject may falsify his responses intentionally or due to tiredness and lack of motivation. Attention deficits attributable to the illness state, or the medication and environmental conditions causing distraction, may also influence the performance.