1. PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’
CHAIRPERSON- Dr Prabhat K Chand
CO- CHAIRPERSON- Dr Manoj Kumar Sharma
PRESENTOR- Dr Virupakshappa Irappa Bagewadi
PSYCHODIAGNOSTICS: ‘CRUTCHES FOR CLINICIANS’

2. Outline INTRODUCTION TESTS COMMONLY USED EVIDENCE FOR SUPPORT
INDIAN PERSPECTIVE
CLINICIAN’S PERSPECTIVE
LIMITATIONS
CONCLUSION

3. Introduction

4. Introduction
Like other branches of medicine, PSYCHIATRIC practice, needs diagnostic tests to supplement anamnesis and clinical examination.
In clinical psychiatry, even more than elsewhere in medicine, differential diagnosis is safer, if several tests are available than if only one test is at our disposal.
Attempts at developing and clinically exploring psycho diagnostic procedures can be a potent tool in exploring organization and disorder of the personality.
[David Rapaport,1950]
Anamnesis;1. recollection.2. a medical or psychiatric patient case history, particularly using the patient's recollections

5. Introduction Medical diagnosis Framework of physiology
Psycho diagnosis
Framework of psychology.
Psychodiagnositcs is a branch of psychology concerned with the use of tests in the evaluation of personality and determination of factors underlying human behavior
[David Rapaport,1950]

6. Psychometry
Psychometry has now evolved as study on theory & technique of psychological measurements.
Includes measurement of knowledge, skills , abilities, aptitudes, attitudes, intelligence, memory, creativity, adjustment & personality.
Field uses – questionnaires, schedules, rating scales, inventories & tests
[Venkatesan S. 2010]

7. Psychometric Approaches
Relies on Normative approaches to psychological assessments.
Comparisons with a norm group enabled statistically based diagnostic decisions .
In criterion referenced testing the scores relate directly to individual competencies .
Behavioral assessments look into contemporary behaviors in individuals and are directly linked to planning / implementing for there remediation .
In recent times idiometric approaches to assessments is gaining momentum based on search for underline common denominators for overt behavioral deficits .
Comparision to the normative data
[Venkatesan S. 2010]

8. Psychometry For Clinician: CLINIMETRICS
Introduced by Alvan R. Feinstein in 1982.
The purpose is to provide an intellectual home for a number of distinct clinical phenomenon .
It includes
Types ,severity and sequence of symptoms;
Rate of progression of illness ,
Severity of comorbidity ;
Problems of functional capacity ;reasons for medical decisions and many other aspects of daily life ,such as well being and distress
Example : Apgar’s score
[Venkatesan S. 2010]

9. Psychometry To Clinimetry
TRADITIONAL PSYCHOMETRY
Less sensitive to symptom change
Less clinically coherent
Homogeneity of components were given importance
More subjective
Cross sectional
CLINIMETRICS
Sensitive to symptom change
Clinically coherent –assess sx based on their prevalence
Assess sx based on importance of those sx to define severity (weighting of sx)
More objective
Consider longitudinal course of illness
[Venkatesan S. 2010]

10. Psychological Tests

11. Psychological Test Clinical relevance
It elicits, in a scientifically standardized manner, responses which reveal psychological characteristics in the patient being tested with a high degree of statistical reliability and validity.
It includes obtaining samples of behaviour, relevant to cognitive or affective functioning, and for scoring and evaluation [Essentials of behavioral science]

12. Why Are Assessments Done?
Screening & diagnosing
Treatment Planning
Functional Impairment/Severity
Subjective Distress
Social Support and Attachment Style
Reactant/Resistance Tendencies
Coping Style
Monitoring of Treatment Progress
Prognostic Indicators

13. Tests of Cognitive Functions Tests for Diagnostic Clarification
Domains Of Tests
Tests of Cognitive Functions
Norm referenced tests of memory, intelligence, perceptual-motor functions, Neuropsychological tests, etc.
Tests for Diagnostic Clarification
Tests of concept formation (thought deviance and psychosis), projective tests, inventories and rating scales
Tests of Personality
Projective tests and self report inventories
Other Tests
Developmental tests, Aptitude tests, Psycho-educational tests and Behavioral procedures

14. Examples Of Commonly Used Tests In A Clinical Setting
Memory-PGIMS,WMS
Intelligence-BKT ,WAPIS, Bhatia, SPM, VSMS
Cognitive Functions
Projective –Rorschach IBT, draw a man test, SCT, TAT
Objective-16PF,MMPI
Personality & Inter personality
RIBT ,MPQ, OST,TAT
Diagnostic
Halstead –Reitan
Luria
Indian Batteries – PGI BBD,NIMHANS
Neuropsychological assessment
Wechsler’s Memory scale (WMS), Vineland social maturity scale, Bhatia battery of performance tests of intelligence, Standard progressive matrices, WAPIS-Wechsler Adult Performance Intelligence Scale, Minnesota Multiphasic Personality Inventory (MMPI-2, 16Personality Factor Test

15. Cognitive Function

16. PGI Memory Scale Developed by Dwarka Prasad and N.N. Wig (1977)
10 subtests
Percentile norms for years
Gives profiles for intervention
Indian norms available
Remote ,Recent memory, Mental balance,Attention and concentration,Delayed recall,Immediate recall,Retention for similar pairs ,Retention for dissimilar pairs, visual retention, Recognition
In at least 5 subsets
Organics
Below 20th percentile
Psychotics
Below 40th percentile
Controls
Between percentile

17. Wechsler’s Memory Scale (WMS)
Developed in 1940 at Belleuve hospital,New York
Norms available for yrs
7 subtests
Gives a memory quotient (MQ) which is highly correlated with IQ
Personal and current information ,Orientation,Mental control,Logical memory,Digit span,Visual reproduction,Associate learning,
Developed in 1940 at Belleuve hospital,New York

18. Binet-Kamat Test Includes both verbal and performance tests
3 -22 yrs, age level
Pattern analysis
Language
Reasoning
Conceptual thinking Memory
Social Intelligence
Visuo-motor…….etc.
Verbally loaded , difficult to assess if verbal function is impaired
Indian adaptation of the 1934 version of Stanford-Binet Scale of Intelligence

19. WAPIS-Wechsler Adult Performance Intelligence Scale
WAPIS Indian adaptation of WAIS
[Ramalingaswamy, 1975]
Age: 15-45
Edu : min 5th std
; 15-19; 20-24; 25-34;35-44Verbal Comprehension Index (VCI) Perceptual Reasoning Index (PRI) Working Memory Index (WMI) Processing Speed Index (PSI)

20. Bhatia battery of performance tests of intelligence
C.M. Bhatia sub-tests
Kohs Block Design- discrimination of patterns
Alexander’s Pass along test- discrimination of movement of concrete material
Pattern drawing test- analysis in terms of lines
Immediate memory- verbal memory
Picture construction- discrimination of picture parts
Norms- 11 to 16 yrs, literate and illiterate
PQ (performance quotient)
IQ (intelligence quotient)
Can not be used to assess MR
Kohs Block Design- discrimination of patterns
Alexander’s Pass along test- discrimination of movement of concrete material
Pattern drawing test- analysis in terms of lines
Immediate memory- verbal memory
Picture construction- discrimination of picture parts
Exercise the powers of analysis and synthesis to the max
Analysis- capacity for observing/discovering parts or differences in objects/qualities which for themselves seem unitary
Synthesis- capacity to construct out of mental elements and fragmentary experiences, concepts and notions of higher order.

21. Raven’s Progressive Matrices Test
Has three versions
Advanced, Standard , Coloured.
Standard Progressive Matrices (SPM), 60 problems divided into five sets of A,B,C,D and E. Each 12 items in the order of progressive difficulty.
It does not give IQ
It can be used in everyone irrespective of culture, nationality, age, education, physical condition

22. VSMS-Vineland Social Maturity Scale
DR. Edgar A. Doll- 1935
Assesses 8 areas of development
Self-help general , Eating , Dressing , Direction
Occupation, Communication ,Locomotion ,Socialization .
0-25 yrs age level items
Done with the informants

23. Projective
Objective
[downloaded from

24. Personality & Inter Personality
Projective Techniques
Purpose is to gain insight into the individual personality as a system
Rely to some degree on ambiguous stimuli and opaque directions as catalysts for creating data.
The projective hypothesis
Ambiguous stimulus will reveal important aspects of his or her personality
[Frank, 1939]
General proposition stating that whatever an individual does when exposed to an ambiguous stimulus will reveal important aspects of his or her personality

25. Rorschach Inkblot Test
Hermann Rorschach
The test consists of ten ambiguous, symmetrical inkblots, card appears as if a blot of ink was poured onto a piece of paper and folded over—hence, the symmetrical appearance.
These 6½ × 9½–inch inkblot cards are the standard stimuli
Are referred by Roman numerals I to X.
Scoring
Location , Determinants ,Content , Popular, Form level

26. Rorschach Inkblot Test
Scoring Systems
Beck (1937) , Klopfer (1937),Pitrowski ,
Hertz ,Rapapport, Exner (1969)
Pathognomic Signs
Colour shock, Shading shock, Perseveration.
Contamination, Confabulation, Number responses
Behavioral responses like rejection , perplexity, automatic phrasing etc.
Colour shock indicative of anxiety and emotional disturbance
Shading shock- problems in handling affectional needs
Perseveration- suspect organic brain damage, underdeveloped reality testing and deep regression

27. Uses Of Rorschach
Main use differential diagnosis and detecting early schizophrenics
Other uses –
Detecting organicity : Pitrowsky’s signs
Measuring hostility : Elizur’s hostility scores
Screening psychopathology
Studying personality patterns
Evaluating treatment outcomes
Prognosis indication
Pitrowsky’s ;confabulation, cognitive impotence, perseveration etc

28. Ups And Down Of Rorschach
At one time it was most commonly used test for various conditions including child dispute, divorce etc
Validity of the result has been questioned
Critically reviewed by psychologists
Number of psychology school have stopped using the test
James M. Wood (El Paso, TX) is Associate Professor, Department of Psychology, at the University of Texas at El Paso. What's Wrong With the Rorschach? offers a provocative critique of one of the most widely applied and influential - and still intensely controversial - psychological tests in the world today. Surveying more than fifty years of clinical and scholarly research, the authors provide compelling scientific evidence that the Rorschach has relatively little value for diagnosing mental illness, assessing personality, predicting behavior, or uncovering sexual abuse or other trauma. In this highly engaging, novelistic account of the Rorschach's origins and history, the authors detail the wealth of scientific evidence that the test is of questionable utility for real-world decision making.

29. Thematic Apperception Test
Developed by Morgan and Murray
A narrative projective device
21 Black & White cards of individuals in classic human situation
Indian Adaptation by Uma Choudary- 10 cards & a blank card
Murray’s scoring (need aggression, affiliation, affection)
Bellack’s Scoring

30. Sentence Completion Test
Semi projective technique by Sacks and Levy-1950
60 item test that assesses adjustment through 4 subscales
family, sex, interpersonal relationships and self concept
My father seldom…….(family)
When I see a man and woman together…..(sex area)

31. Object sorting test Kurt Goldstein , Martin Scheerer -1941
Consists of 30 objects like ribbon, bottle , needle, cloth etc
2 phases- active and passive phase,
Responses -Common, Impoverished, Peculiar
Measures thought deviance
in active phase S has to make sorts with one stimulus object and explain the principle used. In passive phase S has to tell if sort compatible/incompatible.
eg overlapping conceptual boundaries, concrete thinking, idiosyncratic associations etc.

32. Minnesota Multiphasic Personality Inventory
Hathaway& Mckinley -1942
566 items, T /F, Cannot Say
10 Clinical scales
Hypochondriasis, Depression, Hysteria, Psychopathic deviation, Paranoia..etc
4 Validity Scales (?, L, F, K)
Additional Scales – Ego Strength, Alcohol Scale

33. 16 Personality Factor Test
Cattell-trait theory of personality
Measures 16 functionally independent dimensions
Age 16 & above
Form standardized and used in India
Form A, B, C, D- for literate group equivalent to high school
Form E and F for education and reading deficits

34. Neuropsychological Assessment
Halstesd –Reitan Battery(1940)
Frontal lobe lesion
10subtests
Criticized being not theoretical
Luria’s neuropsychological investigation
More comprehensive
Based on theoretical principles
11 major cortical functions
Luria-Nebraska Neuropsychological Battery
Standardized luria’s test by Golden
NIMHANS NEUROPSYCHOLOGY BATTERY Adult
Child
OLD BATTERY >65YRS
PGI NEUROPSYCHOLOGY BATTERY
HRB--WIS,Category test ,critical flicker fusion t,tactile performance test ,rhythm t,speech sounds perception t, finger –oscillation t &time sense t.trail making t,aphasia screening t.LURIA—motor, rhythmic,tactile, visual,raceptive speech,expressive speech,writing ,reading ,arithmetic,memory,intellectual function

35. Neuropsychological Assessment
INDIAN TEST BATTTERIES
PGI Battery of Brain Dysfunction(PGI BBD)- 5 subtests
PGI memory scale
WAIS Verbal scale
Bhatia’s short revised scale
Bender –Gestalt scale
Nehor & Benson scale
Gives a profile of 19 variables
NIMHANS Neuropsychological Battery
19 tests

36. Wisconsin Card Sorting Test
David A. Grant and Esta A. Berg 1948
Used to test “set-shifting”
“Frontal" lobe functions
Executive function
Abstract thinking

37. Rating Scales
Help in diagnosis, functioning, symptom severity and side effects
Domain
Scales
Functional status/
impairment
GAF, IDEAS
MOSSF 36
Side effect
AIMS,SAS
Psychiatric diagnosis
SCID,MINI,CIDI
Psychotic disorder
PANSS, BPRS
Mood disorders
HDRS,YMRS
Anxiety disorders
BAI
Medical outcome study short form 36,, GAF –global assessment of functioning scale;; IDEAS. (INDIAN DISABILITY AND ASSESSMENT SCALE). Simpson-Angus Scale (SAS). Extrapyramidal side effects;; Structured Clinical Interview for DSM-IV (scid), MINI—mini international neuropsychiatry interview ;;PANSS- +ve &-ve syndrome scale ,BPRS-brief psychiatry rating scale ;;CIDI—Composite international diagnostic interview ;;
BAI- beck anxiety inventory.

38. Evidence For Support

39. Description Of Clinical Symptomatology & DD
Test
Domain
Evidence
Neuropsychological test
Differentiating Dementia
R-0.68
Brief neuropsychological tests
Screening brain dysfunction
WAIS
Predicting a range of criterion measures
R-0.57
MMPI
Descriptor of personality
R--0.42
MMPI & MCMI -2
Depression
Schizophrenia
Good positive & negative predictive power.
Good negative predictive power
Neuropsychological Tests
were effective in differentiating the normal elderly person from patients with mild, moderate,or severe dementia. i.e., produced very large effect sizes; r = .68
( Meta-analysis of 77 studies, Christensen, Hadzi-Pavlovic,and Jacomb 1991)
Wechsler Adult Intelligence Scale (WAIS)had strong validity (r = .57) for predicting a range of criterion measures.
(meta-analysis of 39 studies, Parker, Hanson, and Hunsley ,1988)
Utility of brief neuropsychological tests to screen clients for a .wide range of brain dysfunction was documented
(meta-analysis of 67 studies, Chouinard and Braun ,1993)
Self-Report Measures
Minnesota Multiphasic Personality Inventory (MMPI) had strong validity (mean r ~ .42) as a descriptor of personality
(Atkinson,1986; Parker et al., 1988)
MMPI could effectively differentiate among various disorders when a configural approach to the MMPI data was used.
(i.e., neurotic vs. psychotic disorders, depression vs. anxiety disorder, schizophrenia vs. affective disorder, and nonpatient vs. Psychiatric patient).
(Zalewski & Gottesman, 1991)
Similar findings have been reported for the revised test, the MMPI-2
(Ben-Porath, Butcher, & Graham, 1991).
Diagnosis of Depression
MMPI and Millon Clinical Multiaxial Inventory-II (MCMI-II) had good positive predictive power and good negative predictive power.
Diagnosis of schizophrenia
Both tests had strong values for negative predictive power, but more moderate positive predictive value particularly for the MMPI
Ganellen (1996)

40. Description of Clinical Symptomatology & DD
Test
Domain
Evidence
Rorschach
Description of symptomatology
R-0.37
Ego deficits
Impairment in social and occupational functioning
Rorschach Schizophrenia Index
Diagnosing psychotic disorders
Excellent Positive predictive power
Rorschach & TAT
Problematic interpersonal relationships
Strong association with clinical ratings
Interviews or informal observation
Low accuracy
Performance Measures of Personality
Several meta-analytic reviews have demonstrated the utility of the Rorschach to describe symptomatology with large validity coefficients (i.e., r ).
(Atkinson, 1986; Atkinson,Quarrlngton, Alp, & Cyr, 1986; Parker et al.,1983,1988).
Rorschach Schizophrenia Index had excellent positivepredictive power for diagnosing psychotic disorders and moderate-to-good negative predictive power.
Hilsenroth et al. (1998)
Many studies have demonstrated the ability of the Rorschach or the TAT
(a) to differentiate among Axis II conditions and Axis I conditions
(b) to also identify non-DSM conditions, such as differentiating patients who have experienced physical or sexual trauma from those who have not
(e.g; Gartner et al., 1989; Hilsenroth et al, 1998; 1997; Leifer et al 1991; Nigg et al 1992).
Rorschach measure of problematic interpersonal relationships was strongly associated with clinician ratings (r ~ )
(adults (Urist, 1977) and adolescents (Urist &Shill) 1982)
a strong relationship (r = .42) between ego deficits as measured by the Rorschach and general impairment in social and occupational functioning was found
Perry, Moore, and Braff (1995)
similar positive associations found using Rorschach or TAT measures with children
(e.g., Cramer, 1996; Tuber,1992).
Rorschach measure of interpersonal relatedness predict social functioning over and above other variables such as education , intelligence, age, income, and use of psychiatric medication in a nonclinical sample.
Bums and Viglione (1996)

41. Description and Prediction of Functional Behaviour
Psychological assessments will predict functional behaviours which have an effect on diagnosis, treatment and prognosis.
[Moras, 1997]
Tests of Cognitive Ability
Highly predictive of proficiency on the job and success in job training
Strong utility as descriptors and predictors of academic achievement [Gottfredson, 1997]
Self-Report Personality Measures
Multi method assessment batteries better than single method approaches to assessment.
[Robertson & Kinder, 1993]
Tests of Cognitive Ability
Are highly predictive of proficiency on the job and success in job training, particularly when job functioning requires complex skills (uncorrected r ;)
( Gottfredson, 1997; Hunter, 1986; Hunter & Hunter, 1984; Kaufman, 1990; Schmitt et al,1984).
Have strong utility as descriptors and predictors of academic achievement (r )
( Gottfredson, 1997, or Kaufman, 1990).
Self-Report Personality Measures
Meta-analytic reviews have documented the validity and utility of these tests as indicators . These associations are in the small-to-moderate range (uncorrected r ),
(e.g., Barrick & Mount, 1991; Hough, 1992; Hunter & Hunter, 1984; Schmitt et al., 1984; Tett, Jackson,& Rothstein, 1991).
Best to use both personality and cognitive tests to predict these behaviors, suggesting that multimethod assessment batteries > single method approaches to assessment.
(Robertson & Kinder, 1993 , Heaton et al., 1978; Newnan et al.,1978),

42. Mental Health Outcomes
In children Baseline self reports of negative emotionality predict behavior problems & subsequent clinical outcomes [Mattison et al1990]
In adults, baseline testing has determined that self-reported neuroticism is a better predictor of long-term clinical outcome in depression [Hirschfeld et al1986]
In general, elevated baseline neuroticism scores predispose people to negative outcomes in individual and marital therapy [Luborsky et al1993]
Baseline assessment of hopelessness is the best predictor of subsequent suicide [Stewart, & Steer,1990]

43. Assisting In Treatment
Patients with externalizing symptoms do better in treatment that is more structured or directed by the therapist
Patients with internalizing symptoms do better in treatments where they set the pace and determine the structure
[Engle & Mohr, 1993]
(acting out, projecting,avoidance defenses) , (self-punishment, anxiousness, worry)

44. Assessment As A Treatment
Patients receiving a 2-hour MMPI-2 assessment with feedback reported symptomatic improvement compared who did not.
[Finn and Tonsager 1992]
Personality testing can assist the formation of a "therapeutic community" among men in inpatient treatment for severe substance dependence.
[Moffett et al. 1996]
Personality testing also help to analyze and resolve interpersonal difficulties that arise between difficult patients and their therapists or treatment teams
[Berg 1988]
It was not only statistically significant but also clinically meaningful (at follow-up, m
ean r = .35).
Similar findings replicated in an Australina study by Newman and Greenway (1997)

45. Indian Perspective

46. Scene In India Clinimetrics is of a recent origin in the country.
It is still in the process of establishing
Economical, cultural, educational, language & gender differences contribute to the scenario of poor understanding or acceptance of psychometry .
Despite these limitations and challenges ,the field of clinimetrics has witnessed a periodic although unsteady or patchy growth in mental health practice in the country.
[Venkatesan S. 2010]

47. Distribution Of Research Articles In India [1958-2009]
Year
Total
Personality
Cognitive/organic
Diagnostic
General
<1970
339 6 1 2 10
521 14 3 30
705 16 22
546 5 21 29
2001>
471
2582 24 13 35 33
105
[Venkatesan S. 2010]

48. Scales & Inventories Used In India [1958-2009]
PERSONALITY
COGNITIVE
DIAGNOSTIC
SOCIAL
RIBT
Luria nebraska NPA
Middlesex hospital Q
Family interaction patterns scale
Draw a person
Wisconsin card s
PGI health Q
SES Scale
Eysenck PI
BGT
Beck depression I
Parental handling
Maudsley PQ
PGI Memory
General health Q
Sex knowledge and attitude scale
MMPI
Cattell’s infant IS
Hamilton depression scale
Brief addiction rating scale
Bortner rating scale for type A peronality
Suicidal intent Q
Burden assessment schedule...
16 PF Q
SANS
BPRS....

49. Advances In Assessment

50. Computers In Diagnosis
Computer soft wares are also utilized in a variety of ways.
To aid mental health professional in arriving at a psycho diagnostic classification
To define psychiatric symptomatology terms, employ cross- referential diagnostic numbers to diagnostic categories, and even refer the user to a specific page number
Ashton-Tate's dBase lll+ software was utilized and it was found to be user friendly
[Stout & Scheramic, 1989]

51. Quick Psycho Diagnostics Panel [QPD Panel]
Designed for primary care physicians.
It integrates easily into busy medical clinics and provides valid diagnostic information in a user-friendly format.
Fully automated.
Self-administered in 6.2 minutes using portable, hand-held computer tablets.
The test screens for nine common psychiatric disorders.
Physicians immediately receive a computer-generated “lab report”
Product of extensive research into the needs of primary care physicians ; Depression,dysthymia,bpad,gad,panic,ptsd,sud,bulimia,somatisation,ocd
The QPD Panel has been validated against the SCID (Structured Clinical Interview for DSM-IV) diagnostic interview, widely regarded as the “gold standard” for psychiatric diagnosis. The test has high sensitivity and specificity.
17,18 For journal reprints, visit us at
[Shedler Quick PsychoDiagnostics Panel]

52. Evidence For QPD
Criterion validity tested with Structured Clinical Interview for DSM-IV
In 203 patients , not on treatment ,59 core questions, with more than 200 questions
Diagnosis
Sensitivity
Specificity
Kappa
QPD (PRE)
SCID
(PRE)
Major D
0.81
0.96
0.79 30
34.2
Gad
0.90
0.67
26.4
23.9
Panic
0.71
0.97
0.72
12.4
13.4
OCD
0.69
0.64
8.3
7.6
HMO
[Shedler et al 2000]

53. Convergent Validity for QPD
Sample ranging from 113 to 215
The QPD Panel depression scale correlated highly with
Beck Depression Inventory (BDI, r=.80)
Hamilton Depression Inventory (r=.87)
Center for Epidemiological Studies Depression (CES- D) Scale(r=.79)
Zung Self-Rating Depression Scale (r=.78)
[Shedler et al 2000]

54. Convergent Validity For QPD
The QPD Panel anxiety scale correlated highly with
Spielberger State-Trait Anxiety Inventory (r=.67)
Anxiety subscale of the Symptom Checklist-90 (SCL-90) (r=.76).
The QPD Panel somatization scale correlated highly with
somatization subscale of the Symptom Checklist 28 (SCL-28), r=.59.
All correlations are statistically significant (Ps <.001)
[Shedler et al 2000]

55. Utility of QPD Sensitivity to Change Patient Satisfaction
Physician Acceptance
Items % Strongly agree

56. QPD Report-Screening [Shedler Quick PsychoDiagnostics Panel]
Shedler J. The Shedler Quick PsychoDiagnostics Panel (QPD Panel): A psychiatric “lab test”
for primary care. In M. Maruish (Ed.), Handbook of Psychological Assessment in Primary
Care Settings. NY: Erlbaum; 2000.
Shedler J, Beck A, Bensen S. Practical mental health assessment in primary care: validity
and utility of the Quick PsychoDiagnostics Panel. J Fam Pract ;49:
[Shedler Quick PsychoDiagnostics Panel]

57. QPD Report-Monitoring
[Shedler Quick PsychoDiagnostics Panel]

58. Recommendation To Clinicians

59. Evaluating A Psychological Test
Theoretical Orientation
Practical Considerations
Standardisation
Reliability
Validity
Do we adequately understand the theoretical construct the test is supposed to be measuring?
Do the test items correspond to the theoretical description of the construct?

60. Recommendations To Clinicians
Should use comprehensive, structured or at least semi structured approaches to interviewing.
Should not only consider the data that supports their hypotheses, but also carefully consider or even least evidence that does not support their hypotheses.
This will likely reduce the possibility of hindsight and confirmatory bias.
Diagnoses should be criteria based to minimise gender & ethnicity bias
Should avoid relying on memory and refer to careful notes as much as possible.
[Garb1998]
1To avoid missing crucial information, This is especially important in cases where urgent clinical decisions (danger to self or others) may need to occur.

61. Recommendations To Clinicians
In making predictions, clinicians should attend to base rates as much as possible.
Should seek feedback when possible regarding the accuracy and usefulness of their judgments.
Should learn as much as possible regarding the theoretical and empirical material relevant to the person or group they are assessing
Familiarity with the literature on clinical judgment should be used to continually update practitioners on past and emerging trends
[Garb1998]

62. Clinical vs Actuarial Prediction
The clinical approach used clinicians’ judgment,
Actuarial approach used empirically derived formulas, such as single/multiple cut offs and regression equations, to come to decisions regarding a client
Statistical decisions consistently outperformed clinical judgments
When the focus changes from institutional to individual decision making, the relevance of statistical rules becomes less practical
Controlled studies generally favour a statistical approach over a clinical one but, at the same time, that truth is seldom useful to the practitioner involved in the changing and unique world of practice
[Hand book of psychological assessments 4th edition Gary Groth ]

63. Clinical vs Actuarial Prediction
Ideally, clinicians need to be aware of and to use, whenever available, actuarial approaches such as multiple cut offs and regression equations.
Future computer-assisted analysis of assessment results can increasingly provide actuarial predictions especially from multiple sources
Clinicians must recognize possible increases and decreases in test interpretation and clinical judgment resulting from the incremental validity of their instruments
Because more information does not necessarily increase the accuracy of clinically based predictions
While it is unlikely that actuarial prediction rules will replace clinical judgment,
formal prediction rules can and should be used more extensively as a resource to improve the accuracy of clinical decision making
[Hand book of psychological assessments 4th edition Gary Groth ]

64. Limitations

65. Limitations
Although many studies have recommended these assessments, the validity & reliability are low.
The test norms needs to be periodically revised .
Most of assessments are developed in western countries which has to adapted for INDAN setting.
Non availability of well trained & experienced professional limits the use of test.
Cost & time spent on testing may not be feasible for Indian setting

66. Conclusions
Tests can be used for screening, diagnosing, treatment planning, monitoring & as prognostic indicators
Considerable empirical support exists for the validity of psychological assessments
Psychological assessments may be viewed as analogues to lab reports of other medical conditions.
While it is unlikely that actuarial prediction rules will replace clinical judgment
Formal prediction rules can and should be used more extensively as a resource to improve the accuracy of clinical decision making

67. Thank You

68. Case Vignette
Mr P, 38 year old, married male, MBA, HSES, Mumbai (Settled in US for past 16 yrs)
Pre morbidly sensitive & quick to temper with low frustration tolerance,
Personal h/o ongoing marital discord,
Family h/o difficulties in relationship b/w pt & parents,
Past h/o thalassemia minor,
C/O difficulty in establishing emotional connections with people, frequent change in jobs since the past 10 yrs, with h/o intermittent bouts of irritability & withdrawn behavior since the past 8 months in the back ground of severe marital discord. While in US the pt has consulted 3 psychiatrists, at the insistence of his wife, who had variously diagnosed him as adjustment disorder, paranoid schizophrenia & PPD. The pt had come to NIMHANS

69. What would you like to do?
How would you like to proceed this case?
Would you refer this case for psychometry?
What areas would you assess?
What are the tests you would chose?

70. Commonly used neuropsychological tests
Domain
Function
Test
Speed
Motor speed
Finger tapping
Mental speed
Digital Symbol Substitution
Attention
Focussed
Colour trails
Sustained attention
Digit vigilance
Divided attention
Triads test
Executive functions
Verbal fluency
Controlled oral word
Category fluency
Animal names
Design fluency
Design fluency test
Working memory
N Back (verbal& visual)

71. Commonly used neuropsychological tests
Domain
Function
Test
Executive functions
Planning
Tower of london
Set shifting
Wisconsin card sorting
Response inhibition
Stroop
Comprehension
Verblal
Token
Learning & memory
Verbal
Auditory verbal learning
Passages test
Visuo-spatial construction
Complex figure
Learning &memory
Visual
Design learning test