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Psychometric Tests

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Psychometric Tests MRCPsych Paper 1 Dr A Davies ST4 General Adult Psychiatry MCQ On mini-mental examination, a 74 year old man loses all points on orientation to time ... – PowerPoint PPT presentation

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Title: Psychometric Tests


1
Psychometric Tests
  • MRCPsych Paper 1
  • Dr A Davies
  • ST4 General Adult Psychiatry

2
Aims
  • Overview of psychometric tests
  • FAR too many to cover in
  • one lecture
  • focus on common ones
  • Past paper questions

3
Hundreds of psychometric tests
  • Mood
  • Psychosis
  • Cognitive impairment
  • Perinatal
  • Eating disorders
  • Side effects
  • Neuropsychiatric
  • ..

4
Becks 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 Minimal
  • 1419 Mild
  • 2028 Moderate
  • 2963 Severe

5
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

6
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

7
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 Normal
  • 45-59 Mildly depressed
  • 60-69 Moderately depressed
  • 70 Severely depressed

8
MADRS
  • Montgomery Asberg Depression rating scale
  • 10 items
  • Most sensitive to change
  • Requires clinical interview like HDRS

9
VAS
  • Visual Analogue Scale
  • Easy
  • 10cm line, indicate where mood lies

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

11
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
  • 0-9 Mild distress
  • 10-12 Moderate distress - repeat in 2 wks
    13 Referral to psychiatry/ology

12
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)
  • 07 sub-clinical
  • 815 mild
  • 1623 moderate
  • 2431 severe
  • 3240 extreme
  • (Self rated version has been developed)

13
ACE-R
  • Brief bedside screening for cognitive problems
  • Maximum score of 100 weighted as follows
  • Orientation 10 Attention 8 Memory
    35 Verbal fluency 14 Language
    28 Visuospatial 5
  • High sensitivity in detecting dementia
  • 79 with cut-off score of 83 and 93 with cut-off
    88.

14
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

15
Eating Disorder Inventory
  • EDI-3 standardised clinical evaluation of
    symptoms associated with eating disorders
  • 91 items organized into 12 primary scales
  • Drive for Thinness Bulimia
  • Body Dissatisfaction Low Self-Esteem
  • Personal Alienation Interpersonal Insecurity
  • Interpersonal Alienation Interoceptive Deficits
  • Emotional Dysregulation Perfectionism
  • Asceticism Maturity Fears

16
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 when others
  • say you are too thin?
  • 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

17
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

18
MMSE
  • Screening tool of cognitive function
  • Points per section
  • Orientation 10
  • Registration 3
  • Attention calculation 5
  • Recall 3
  • Language 8
  • Copying 1
  • Scores 25-30 normal, 21-24 mild, 10-20
    moderate, lt10 severe impairment

19
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

20
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

21
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

22
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

23
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)

24
Wechsler Adult Intelligence Scale WAIS
  • Most widely used IQ test (WISC for children)

25
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 dont hold and
  • hold scores
  • Hold tests supposed to be resistant to age
    related decline, so sensitive to organic brain
    disease such as dementia (refuted)

26
Ravens Progressive Matrices
  • Quick IQ test of current performance
  • Independent of education cultural influence
  • General intelligence with visuospatial problem
    solving

27
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

28
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

29
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

30
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33
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

34
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

35
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

36
MCQ
  • Serial sevens test is most useful to test ones?
  •  
  • a. Inattention
  • b. Concentration
  • c. Working memory
  • d. Short term memory
  • e. IQ

37
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

38
MCQ
  • Considering Becks 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

39
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

40
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

41
MCQ
  • Copying intersecting polygons in MMSE tests then
    functions of?
  • a. Temporal lobes
  • b. Cerebellum
  • c. Frontal lobes
  • d. Hippocampus
  • e. Parietal lobes

42
MCQ
  • Which of the following is not an alcohol
    assessment tool?
  • a. AUDIT
  • b. CAGE
  • c. SCOFF
  • d. MAST
  • e. CIWA

43
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 Becks depression scale

44
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

45
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

46
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

47
EMI Neuropsychological Tests
  • A 54 year man presents with a years 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.

48
EMI Neuropsychological Tests
  • Which test would you use to obtain a quick
    estimate of his current performance IQ?
  • F Ravens 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

49
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

50
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

51
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