Psychometric Tests

MRCPsych Paper 1 Dr A Davies ST4 General Adult Psychiatry

Aims

• Overview of psychometric tests • FAR too many to cover in one lecture… focus on common ones • Past paper questions

Hundreds of psychometric tests…

• • • • • • • • Mood Psychosis Cognitive impairment Perinatal Eating disorders Side effects Neuropsychiatric …..

Beck’s Depression Inventory

• • • • Self rated 21 multiple-choice questions Measures severity of depression Each answer scored on a scale value of 0 to 3 Higher scores = more severe depressive symptoms 0-13 14–19 20–28 29–63 Minimal Mild Moderate Severe

PHQ-9

• • Patient Health Questionnaire – 9 • • Used to monitor severity of depression and response to treatment Self-administered 9 questions (!) score 0-3, total 27 Depression Severity: 0-4 none 5-9 mild 10-14 moderate 15-19 mod/severe 20-27 severe

HAM-D

• Hamilton Rating Scale for Depression • Assess severity, mostly biological sx • Clinical interview • 17 - 21 items, scored on 3 or 5 point scale • 0-7 = normal • 20 + or higher indicate moderate, severe, or very severe depression

Zung SRDS

• • • • • Zung Self Rating Depression Scale Assesses severity of depression 20 items self rated Affective, psychological & somatic symptoms Scored 1-4, total 80 20-44 45-59 60-69 70+ Normal Mildly depressed Moderately depressed Severely depressed

MADRS

• • • • Montgomery Asberg Depression rating scale 10 items Most sensitive to change Requires clinical interview like HDRS

VAS

• • • Visual Analogue Scale Easy 10cm line, indicate where mood lies

GDS

• • • • • Geriatric Depression Scale 30-items, “yes, no” answers Self report assessment Assess severity, monitor Rx Not diagnostic 0-9 10-19 20-30 normal mildly depressed severely depressed

EPDS

• Edinburgh Postnatal Depression Scale • Screen for depression (not diagnostic) post natally (up to 8 wks) • Self-rated scale, mood over past week • 10 questions, scored 0-3 wks 0-9 : Mild distress 10-12 : Moderate distress - repeat in 2 13 +: Referral to psychiatry/ology

Y-BOCS

• • • • Yale-Brown Obsessive Compulsive Scale Assess severity and monitor improvement of OCD symptoms Clinician-rated, 10-item scale Each item rated from 0 (no symptoms) to 4 (extreme symptoms) 0–7 8–15 16–23 24–31 32–40 sub-clinical mild moderate severe extreme (Self rated version has been developed)

ACE-R

• • Brief bedside screening for cognitive problems Maximum score of 100 weighted as follows: Orientation Attention Memory Verbal fluency Language Visuospatial 10 8 35 14 28 5 • • High sensitivity in detecting dementia 79% with cut-off score of 83 and 93% with cut-off 88.

SCI-D

• •

Structured Clinical Interview for DSM-IV

Diagnostic, clinician rated interview • •

SCID-I

- Axis I Disorders; major mental disorders

SCID-II

- Axis II disorders; personality disorders

Eating Disorder Inventory

• EDI-3 – standardised clinical evaluation of symptoms associated with eating disorders • 91 items organized into 12 primary scales+: Drive for Thinness Body Dissatisfaction Personal Alienation Interpersonal Alienation Emotional Dysregulation Asceticism Bulimia Low Self-Esteem Interpersonal Insecurity Interoceptive Deficits Perfectionism Maturity Fears

SCOFF

• Screening questionnaire for anorexia/bulimia Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a 3 month period?

Do you believe yourself to be Fat say you are too thin?

when others Would you say that Food dominates your life?

One point for every “yes” A score of ≥2 indicates a likely case of anorexia nervosa or bulimia

Alcohol Scales

CAGE – score 2+ indicates problem AUDIT – Alcohol Use Disorders Identification Test MAST – Michigan Alcohol Screening Test CIWA – Clinical Institute Withdrawal Assessment for Alcohol

MMSE

• Screening tool of cognitive function Points per section: • Orientation Registration Attention & calculation Recall Language Copying 10 3 5 3 8 1 Scores: 25-30 normal, 21-24 mild, 10-20 moderate, <10 severe impairment

CIDI

• • • WHO Composite International Diagnostic Interview Structured interview for psychiatric disorders Designed for epidemiological studies • Allows the investigator to: - Measure prevalence of mental disorders - Measure severity of disorders - Determine the burden of these disorders - Assess service use - Assess the use of medications - Assess who is treated, who remains untreated, and what are the barriers to treatment

GHQ

• • • • General Health Questionnaire Screening tool to identify minor psychiatric disorders in general population - “

caseness

” Several versions, GHQ28 most popular 28 item assesses somatic symptoms, anxiety & insomnia, social dysfunction & severe depression

HoNoS

• • • • • Health of the Nation Outcome Scale Routine clinical outcome measure 12 items measuring behaviour, impairment, symptoms and social functioning Completed after routine clinical assessments in any setting Variety of uses for clinicians, researchers and administrators, in particular health care commissioners and providers

Neuropsychometry

Reliability

Extent to which a test produces results consistent across various raters (inter-rater) or various instances with same rater (test-retest)

Validity

Extent to which a test measures what its supposed to

Validity

Construct

– performance fit with theory

Predictive

– extent to which a score on a scale/test predicts scores on some criterion measure

Incremental

– used to determine whether a new test will increase the predictive ability beyond that provided by an existing test

Criterion

– how well variables predict an outcome based on information from other variables (concurrent if applied at same time)

Wechsler Adult Intelligence Scale WAIS

• Most widely used IQ test (WISC for children)

WAIS

Hold tests:

measure stored knowledge & skills Eg) vocab, picture completion, NART

Non hold tests:

Eg) block design, digit span Deterioration quotient derived from difference between ‘don’t hold’ and ‘hold’ scores  Hold tests supposed to be resistant to age related decline, so sensitive to organic brain disease such as dementia (refuted)

Raven’s Progressive Matrices

• • • Quick IQ test of current performance Independent of education & cultural influence General intelligence with visuospatial problem solving

Wisconsin Card Sorting

• • • Wisconsin card sorting test Stimulus cards of different colour, form and number Patient has to sort into a group according to single principle, eg) colour, but not told which just told if right or wrong • Difficult if frontal lobe or caudate damage and some people with schizophrenia

Wechsler Memory Scale Revised

• WMS-R • Most widely used memory test battery for adults • Yields a memory quotient MQ, corrected for age and generally approximates to WAIS IQ • Amnesic conditions – disproportionately low MQ but relatively preserved IQ

Others

•

NART National Adult Reading Test

• Previous work knowledge before becoming ill – premorbid IQ estimate

Stroop Test

Measures set shifting abilities and response inhibition Test frontal function and selective attention

Questions

In MMSE intersecting pentagons primarily assesses which of the following functions?

A. Copying skills B. Visual retention C. Constructional praxis D. Language E. Orientation

MCQ

On mini-mental examination, a 74 year old man loses all points on orientation to time and recall while other faculties are intact. How many points has he lost?

A. Thirteen B. Eight C. Sixteen D. Six E. Five

MCQ

Which one of the following questionnaires can be used to identify psychiatric 'caseness' in general population?

a. Structured clinical interview DSM-IV b. GHQ General Health Questionnaire c. PSE Present state examination d. HAM-D e. BDI Beck‟s depression inventory

MCQ

Serial sevens test is most useful to test one’s?

a. Inattention b. Concentration c. Working memory d. Short term memory e. IQ

MCQ

The Clifton Assessment procedure is used in which of the following situations?

a. Care homes for the learning disabled b. Children in foster care c. Schizophrenia rehabilitation units d. Residential care for the elderly e. Prisons with high mental health burden

MCQ

Considering Beck’s depression inventory, which of the following is true?

a. It has 21 items b. Refers to symptoms over the last 5 days.

c. Maximum score is 42 d. Strictly clinician rated scale e. Has no item on suicidal ideas

MCQ

Which of the following is NOT a component of clock drawing test?

a. Placing the hands of the clock correctly b. Indicating the hour correctly according to instructions c. Indicating the minutes correctly according to instructions d. Using numbers 1 to 12 to create the face of a clock e. Being aware of the current time when the test is administered

MCQ

Which of the following will you use to assess orientation in a hospitalised patient?

a. Ability to remember his/her own address b. Ability to repeat a phone number immediately after reading out c. Ability to correctly identify the doctor when asked to point out d. Ability to recognise pictures of famous personalities e. Tap the table once whenever the examiner reads letter „E‟ from a random list of alphabets

MCQ

Copying intersecting polygons in MMSE tests then functions of?

a. Temporal lobes b. Cerebellum c. Frontal lobes d. Hippocampus e. Parietal lobes

MCQ

Which of the following is not an alcohol assessment tool?

a. AUDIT b. CAGE c. SCOFF d. MAST e. CIWA

EMI – Assessment Instruments

1. A 34 year old woman complains of loss of weight and appetite for last 2 months. She has poor sleep and has multiple somatic complaints that started when she and her husband separated 3 months ago. She denies using alcohol.

B – Beck’s depression scale

EMI – Assessment Instruments

2. A researcher is interested in finding out the degree of self rated psychiatric symptoms in a sample of 125 diabetic outpatients attending an insulin clinic.

D – General Health Questionnaire

EMI – Assessment Instruments

3. As a part of a new World Mental Health initiative, it is planned to conduct a nationwide survey of mental health burden. It is planned to administer a fully structured instrument through trained non-clinical research workers to ascertain lifetime diagnosis of mental illness.

F – Diagnostic Interview Scale

EMI – Assessment Instruments

4. A newly constituted mental health trust wants to adopt a common scale for monitoring clinical recovery on discharge across different adult units.

H - HONOS

EMI – Neuropsychological Tests

A 54 year man presents with a year’s history of steadily progressive personality change. He has become increasingly apathetic and appears depressed but his main complaint is of increasing frontal headaches. On examination he has word finding difficulties. EEG shows frontal slowing, greater on the left. You are concerned that he may have an intracranial space occupying lesion.

EMI – Neuropsychological Tests

Which test would you use to obtain a quick estimate of his current performance IQ?

F – Raven’s progressive matrices

The test indicates that his current performance IQ is in the low average range. Which test would enable you to estimate his IQ before any brain damage he may have sustained in recent months/years?

E - NART

EMI – Neuropsychological Tests

The estimate of his premorbid IQ is 15 points higher than his current performance IQ. It is recommended that he has a full WAIS IQ assessment to measure both performance and verbal IQ. On the WAIS his verbal IQ is found to be impaired over and above his performance IQ. Which test is part of the WAIS verbal subtests?

B – Digit Span

EMI – Neuropsychological Tests

An MRI scan shows a large meningioma compressing dorsolateral prefrontal cortex on the left. Which test result is most likely to be impaired?

J – Wisconsin Card Sorting Test