1. Psychological testing
Aws Khasawneh, MD.

2. Overview:
Psychological test: Is a measurement instrument that consists of a sample of behavior obtained under standardized conditions and evaluated using established scoring rules.
psychological tests are used to assess intelligence, achievement, personality and psychopathology.
It must meet the requirements of any good instrument:
– Validity (the extent to which a test measures what it is intended to measure)
– Reliability (An instrument is reliable to the extent that repeated measurements of the same thing under the same conditions agree.)
– Accuracy (A measure is accurate to the extent that its results agree with a known standard.)

3. Types of Tests
Most psychological tests can be sorted into 3 general categories:
Tests in which the subject performs a task. (designed to uncover what an individual can do, given the specific test conditions) ex. Intelligence Tests, language proficiency
2. Tests that involve observations of the subject’s behavior within a particular context. (the subject does not have a single, well defined task.)
3. Self-report measures. (Participant is asked to report his or her feelings, attitudes, beliefs, values.) ex. Many personality inventories such as the MMPI

4. Intelligence Tests -1 the possession of knowledge
Intelligence: the Capacity to learn.
Intelligence:. the ability to understand abstract concepts, reason, assimilate, recall, analyze, and organize information, and meet the special needs of new situations
Robert Sternberg (1985) defined intelligence in terms of three characteristics:
-1 the possession of knowledge
-2 the ability to efficiently use knowledge to reason about the world
-3 the ability to employ that reasoning adaptively in different environments.

5. Mental age: the person’s level of intellectual functioning.
Chronological age: the person’s actual age
Intelligence Quotient ( IQ ): It is the ratio of mental age to chronological age times 100
IQ= MA / CA x 100
* The highest chronological age used to determine IQ is 15 years.
* IQ is relatively stable throughout life. In the absence of brain pathology IQ is essentially the same.

6. Intelligence: Heredity or Environment?
Family and twin studies
Heritability estimates
Environment
Adoption studies
Cumulative deprivation hypothesis
The Flynn effect
Interaction
Reaction Range: Children reared in high quality environments score near the top of their potential IQ range (20-25 points difference)

7. Twin studies provide evidence regarding the role of genetic factors
Twin studies provide evidence regarding the role of genetic factors. The basic rationale is that identical and fraternal twins develop under similar environmental conditions, but identical twins share more genes…if identical twins end up more similar on a given characteristic, it must be genetic.
Adoption studies provide evidence that upbringing plays an important role in mental ability, as adopted children show some resemblance to their foster parents. Also, siblings reared together are more similar in IQ than siblings reared apart. In fact, entirely unrelated children who are reared together show resemblance in IQ.
The cumulative deprivation hypothesis holds that children raised in deprived environments will experience a gradual decline in IQ as they grow older. Conversely, children removed from deprived environments and placed in homes that are more conducive for learning show IQ increases.
The Flynn effect is the trend, all over the developed world, for IQ scores to increase from one generation to the next. Hypotheses for why this occurs focus on environmental variables, as evolution does not operate in a generation.
Clearly, heredity and environment both influence intelligence. Theorists use the term “reaction range” to refer to genetically determined limits on IQ. The environment determines whether a person will fall at the upper or lower end of their genetically determined range.

8. Normal Intelligence
When the Mental age and Chronological ages are approximately the same i.e. IQ = 100
IQ followed the normal distribution pattern( bell shaped )
- mean=median=mood
Standard deviation in IQ scores is 15.
Mental retardation: When the IQ is more than two standard deviation below the mean.
Mental giftedness: when the IQ is more than two standard deviation above the mean.

9. Figure 9.7 The normal distribution

10. Extremes of Intelligence: Mental Retardation
Diagnosis based on IQ and adaptive testing
IQ below 70
Adaptive skill deficits
Origination before age 18
4 levels: mild, moderate, severe, profound
Mild most common IQ (50-70)
Moderate (IQ 35-55)
Sever (IQ 20-40)
Profound ( IQ < 20)
Mental retardation is a diagnosis reserved for individuals with subaverage general mental ability accompanied by deficiencies in adaptive skills, originating before age 18.
The vast majority of people with mental retardation have mild mental retardation and are not easily distinguished from the rest of the population.
Origins of mental retardation may include organic syndromes, as 350 biological conditions that can cause mental retardation have been identified. Diagnosticians are, however, only able to pin down an organic cause in <25% of cases.
In fact, cases of mild mental retardation tend to involve unknown origin. Environmental theories hold that unfavorable environmental factors may contribute to the development of mild mental retardation; things like neglect, inadequate nutrition and medical care, and lower quality schooling.

11. Figure 9.10 The prevalence and severity of mental retardation

12. Figure 9.11 Social class and mental retardation

13. A- Wechsler intelligence test: 3 types
WAIS-R: Wechsler adult intelligence scale- Revised, for adult and the most commonly used includes 11 subsets 6 verbal and 5 performance.
WISC-R: Wechsler intelligence scale for children- Revised. For children years.
WPPSI: Wechsler preschool and primary scale of intelligence. For children years.
B- Vineland social maturity test:
used to evaluate skills for daily living ( dressing, using telephone) in mentally retarded and other challenged people.

14. Achievement Test Uses:
1- evaluate how well an individual has mastered specific areas, such as reading and mathematics.
2- evaluation and career counseling in school and industry.
Examples:
SAT: Scholastic aptitude test( college admission in US)
MCAT: Medical college admission test
USMLE: united state medical licensing examination
WRAT: wide range achievement test. (evaluate arithmetic, reading and spelling skills.)

15. Personality Test
Tests are used to evaluate psychopathology and personality characteristics:
Objective: easily scored questions and statistically analyzed
Projective: subject interpret the questions.( responses based on the subject’s motivational state and defense mechanisms.

16. MMPI-2 Minnesota Multiphasic personality inventory
* The most commonly used objective personality test. No training is required for administration and scoring.
Includes 567 True or false questions.
Clinical scales include; depression, paranoia, schizophrenia and hypochondreasis.

17. Rorschach test The most commonly used projective personality test
Used to identify thought disorders and defense mechanisms
Patient is asked to interpret 10 bilaterally symmetrical ink blot designs

18. Thematic Apperception test
It is a projective test
Evaluate unconscious emotions and conflicts
Patient is asked to create a verbal scenarios based on 30 drawings depicting ambiguous situations.

19. Sentence completion test
Projective test
Identify worries and problems using verbal associations
Patient is asked to complete sentences started by the examiner

20. Psychiatric Assessment
1- psychiatric history: Includes questions about mental illness, drug and alcohol use, sexual activity, current living situation and sources of stress.
2- Mental status/state examination: (MSE) is the psychological equivalent of a physical exam that describes the mental state and behaviors of the person being seen. It includes both objective observations of the clinician and subjective descriptions given by the patient.

21. Component of MSE General presentation Mood Affect Thought process
Thought content
perception
Cognition
Insight/Judgment

22. General presentation
Appearance: Built, posture, dress, grooming, prominent physical abnormalities.
Behavior: Eye contact: ex. poor, good, Psychomotor activity level: ex. retardation or agitation . hand wringing Movements: tremor, abnormal movements i.e.. sterotypies, gait
Attitude toward the examiner: cooperative, uncooperative, friendly, hostile, defensive…etc.
Level of consciousness:
- Normal (Alert, follow command, normal verbal responses)
- clouding of consciousness(cannot respond normally to external events)
- somnolence (abnormal sleepiness)
- stupor ( responds only to shouting ,shaking)
- coma (unresponsive)

23. Mood and Affect
Mood :subjective description of prevalent emotional state: by patient own words
Affect: objective description of patient’s mood, has three components:
1- Type:
- euphoric: strong feeling of elation
- expansive: feeling of self important and generosity
- irritable: easily annoyed
- euthymic: normal, no significant up or down
- dysphoric: unpleasant feeling ( nervous sad)
- anhedonic: inability to feel pleasure
- Labile: alteration between euphoric and dysphoric mood

24. 2- Range: - Restricted: decreased display of emotional response - Blunted: strongly decreased display of emotional response - Flat: complete lack of emotional response. 3- Congruency: whether affect matches mood ( congruent) or not ( incongruent)

25. Thought Process / speech
Describes the rate of thoughts, how they flow and are connected.
Normal: tight, logical and linear, coherent and goal directed
Abnormal: associations are not clear, organized, coherent. Examples include circumstantial, tangential, loose, flight of ideas, word salad, clanging, thought blocking.

26. Thought Content
Refers to the themes that occupy the patients thoughts.
Examples include: preoccupations, fears, obsessions, derealization, depersonalization, delusions.

27. perception
Hallucinations: False sensory perceptions. Can be auditory (AH), visual (VH), tactile or olfactory
Illusions: Misinterpretations of environment
Distortion of sensations.

28. Cognition orientation
Attention and concentration: the ability to focus, sustain and appropriately shift mental attention
Memory: immediate, short and long term
Abstraction: proverb interpretation
Mini-Mental State Exam

29. Insight/Judgment
Insight: awareness of one’s own illness and/or situation
Judgment: the ability to anticipate the consequences of one’s behavior and make decisions to safeguard your well being and that of others

30. Depression rating scales
Hamilton and Raskin in these two scales the examiner rates the patient
Zung and Beck scale in these two scales the patient rates himself