Transcript Initial Results From the NAN/D40 Neuropsychological

An Introduction to Clinical
Neuropsychology

New Hanover Regional Medical Center
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
March 6, 2003
Antonio E. Puente
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
Department of Psychology, UNCW
Private Practice, Wilmington
Outline of Presentation
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Defining Clinical Neuropsychology
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Neuropsychological Assessment

Neuropsychological Intervention
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Sample Cases & Resources
Type of Doctoral Degree
(All Doctoral Licensed Clinicians)
Percent
90
80
70
60
50
40
30
20
10
0
PhD (n=1225)
PsyD (n=143)
EdD (n=24)
Field of Doctoral Degree
(All Doctoral Licensed Clinicians)
Percent
70
60
50
40
30
20
10
0
Clinical
Couns.
Neuro.
School
Ed. Psy.
Comb.
Work Setting
(All Doctoral Licensed Clinicians)
Percent
40
35
30
25
20
15
10
5
0
Private
Practice
Institution
Comb.
Other
Board Certification Status
(Doctoral Licensed Clinicians)
Percent
80
70
60
50
40
30
20
10
0
Board Certified
(n=271)
Not Board Certified
(n=1053)
Weekly Professional Activities by Organization
(All Doctoral Licensed Clinicians, exc. Part time)
Percent
80
70
60
50
40
30
20
10
0
Clinical
Pract.
Teach.
NAN
Research
($)
D40
Both
Res.
(No $)
Unknown
Non-Clin
Admin.
Weekly Professional Activities by Organization
(% for All Doctoral Licensed Clinicians, exc. Part time)
Percent
80
70
60
50
40
30
20
10
0
Supervision
Forensic
NAN
D40
Both
Unknown
Hours Per Week Per Clinical Activity
(Full-time and Full-time plus Doctoral Licensed Clinicians)
2.1
3.3
2.1
2.5
0.6
13.7
3.7
4.9
2.2
2.1
0
5
DX Interv
F/Up Ass.
Tx plan
Nbeh Ex
TX (BD)
Superv
10
Npsy Test
TX (No BD)
15
Psy Test
CogReh
Evaluation Time by Evaluation Goal
(Hrs. for All Doctoral Licensed Clinicians; 5th & 95th%ile in parens.)
0
2
4
6
Pre/Post (n=566) (1-10)
Baseline (n=784) (1-10)
Forensic (n=790) (1-20)
10
6.3
Determ DX (n=1022) (1-16)
TX Plan (n=914) (.5-12)
8
4.4
4.2
4.8
9.3
(Except forensic, those using assistants test more hours (e.g., for determination
of diagnosis, 6.6 hrs vs. 5.8 hrs, p=.017.) However, hours billed are similar.
Time-Related Case Activities
(All Doctoral Licensed Clinicians)
Private
Institution
Minutes
350
300
250
200
150
100
50
0
319
260
In
t
ak
e
In
t
Re
Te
Sc
In
Fe
Co
t
o
e
s
ns
c
er
e
t
r
d
R
r
i
b
A
ng
vie
p/
Re
ev
ac
d
m
R
fS
w
*
k
ep
in
o
Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3)
* Only scoring is not significant between groups; covarying
amount of forensic practice did not eradicate group differences
The Purpose of a
Neuropsychological Evaluation

Origin to Disposition

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Educational
Forensic
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Competency
Social Security
Worker’s Compensation
Personal Injury
Capital Felony
Clinical
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
Surgical Interventions
Treatment Decisions
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Psychopharmaceutical
Psychotherapeutic
Cognitive Rehabilitation
Pain Management
Physical Intervention
Medical Compliance
Components of a
Neuropsychological Evaluation

Record Review

Interview (including collateral)
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Neuropsychological Testing
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Summary and Disposition
Sample Neuropsychological Tests

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Attention (Cancellation tests)
Visuomotor (Trail making)
Fluency (FAS)
Communication (Boston)
Problem Solving (Category)
Learning & Memory (WMS)
Intellectual (WAIS)
Academic Achievement (WRAT)
Personality & Affective (MMPI
Tests of Effort (Rey)

(see Camara, Nathan, & Puente, 2000, Professional Psychology, for a complete
list of neuropsychological and psychological tests currently in use)
Components of a
Neuropsychological Intervention

Psychotherapy

Cognitive Rehabilitation

Biofeedback
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Vocational Intervention

Health Behavior Management
Sample Neuropsychological
Interventions

Psychotherapy

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Cognitive Rehabilitation
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
Individual vs Family/Group
Problem-Focused
Time-Limited
Problem-Solving
Learning & Memory
Biofeedback
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EMG
Sample Forensic Cases

Competency

Social Security
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Workers Compensation

Personal Injury
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Capital Felony
Sample Clinical Cases

Pain

Head Injury

Dementia
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Coronary Bypass
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Stroke
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“Degenerative” Disorders
Resources
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web
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www.Clinicalneuropsychology.us
www.uncw.edu/people/puente
www.div40.org.
www.nanonline.org