Human Behavioral Development & Problems: Psychological Assessment Gary L. Davis, Ph.D. Dept. of Behavioral Sciences

Learning Objectives Students will have a general understanding of the structure and organization of the psychological interview and assessment process. Students will be familiar with some specific psychological tests that physicians can use in their practice to help answer psychological diagnostic questions. Students will have a rudimentary understanding of the MMPI-2, the role tests play in the assessment process, and when to consider making a referral for psychological assessment.

Psychological Assessment Examples of roles of psychological assessment in medicine Neurology-cognitive, motor, perceptual deficits; surgical readiness Organ transplant-adjustment; coping resources; status Cardiology-panic and anxiety disorders; rehabilitation adjustment PM+R-somatoform disorder; chronic pain evaluation; adjustment and coping resources

Psychological Assessment Examples of roles of psychological assessment in medicine Oncology-depression and anxiety; adjustment and coping resources Pediatrics-cognitive and developmental status; family relationships Family Practice-CD, depression, suicide, somatosizing, anxiety

Interview Current problems B – behavior A – affect S – sensations I – imagery C – cognitions I – interpersonal D – drugs/health

Typical Symptoms in Depressive Disorders Behavioral Withdrawal Insomnia Agitation or retardation Overeat, undereat Inefficient “Going through the motions” Suicide attempts Affect Sad Guilty Regretful Hopeless Helpless Bored Lonely Apathy

Typical Symptoms in Depressive Disorders Sensations Fatigue Pain Don’t like being touched Absence of sensations (deadness) No energy Anhedonic Images Failing Helpless Alone Unlovable Unattractive Empty future

Typical Symptoms in Depressive Disorders Cognitive Concentration difficulties “Empty head” Suicide thoughts Negative focus on self, experiences and future Dysfunctional thinking I am worthless I can’t do anything right No one loves me Other people are happier than I am It’s all my fault Interpersonal Few relationships Excessive sense of responsibility in relationships Dependency, vulnerability Sabotage Drugs, Health Alcohol Absence of Exercise Vague physical complaints Poor eating habits

Interview Current symptoms/status Developmental history Family history School/work experiences Mental health history Legal problems

Review of records Medical Mental health Legal School/work

Psychological tests Reasons for use Unanswered questions Only way to get the information Multi-method validity Objective measurement Normative comparison Monitor treatment effectiveness ? malingering

Psychological Tests Types of tests Intellectual (WAIS-III, WISC-III) Neuropsychological Visual-motor Memory Manual dexterity Perceptual organization etc.

Psychological Tests Types of tests (cont’d) Forensic Tests Rogers Criminal Responsibility Scales, Comprehension of Miranda Rights Test of Memory Malingering, MacArthur Competence Assessment Tool-Criminal Adjudication

Psychological Tests Types of tests (cont’d) Personality/psychopathology Projective Disguise of purpose Freedom of response Ambiguous stimuli Ex: Rorschach, Thematic Apperception Test

Psychological Tests Types of tests (cont’d) Personality/psychopathology Self-report/objective e.g. MMPI-2 (Global), Beck Depression Inv., Alcohol Use Disorders Identification Test, PHQ-9, GAD-7

MMPI-2 Overview History First published in booklet form as the MMPI in 1943 Contained 566 items originally intended to efficiently and objectively identify discrete psychiatric diagnostic groups Developed at the University of Minnesota Hospital by Hathaway (psychologist) and McKinley (psychiatrist)

MMPI-2 Overview Test characteristics Empirically keyed criterion validated scales supplemented by content scales Validity scales 567 items in True/False format Cost effective Over 12,000 published works on the MMPI/MMPI-2; over 80% of the published research on self-report personality tests is on the MMPI The best validated personality test in the world; translated into more than 70 languages

Sample MMPI-2 Items Item # Scale Item 29 L-Lie At times I feel like swearing (F) 24 F-Infrequency Evil Spirits possess me at times (T) 247 Hs-Hypochondriasis I have numbness in one or more places on my skin (T) 260 D-Depression Once in a while, I laugh at a dirty joke (F) 219 Pd-Psychopathic Deviate I have been disappointed in love (T) 220 Pa-Paranoia I tend to be on my guard with people who are somewhat more friendly than I had expected (F) 140 Pt-Psychasthenia Most nights I go to sleep without thoughts or ideas bothering me (F) 316 Schizophrenia I have strange and peculiar thoughts (T) 87 Ma-Hypomania I have met problems so full of possibilities that I have been unable to make up my mind about them (T)

Sample MMPI-2 Items Item # Scale Item 106 Si-Social Introversion My speech is the same as always (not faster or slower, no slurring or hoarseness) (F) 43 APS-Addiction Potential Scale My judgment is better than it ever was (F) 489 AAS-Addiction Admission Scale I have a drug or alcohol problem (T) 82 MAC-R MacAndrew Alcoholism Scale-Revised I do many things which I regret afterwards (I regret more things than others seem to) (T)

MMPI-2 Overview MMPI-2 interpretation Test-taking attitudes (e.g. cooperative candid, exaggerated, defense, faking) Self concept--Self-esteem--Body image Symptomatic complaints and behavioral problems Self-control or acting-out Quality of interpersonal relationships Addiction problems Suicide risk Strengths, resources, coping capacity Diagnostic possibilities Accessibility to treatment