Neuropsychology

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Hi all,

I have been solely set on adult clinical psych all through undergrad, but recently started looking into neuropsychology a little bit. From what I've found online neuropsychological assessment seems very interesting. However, I wasn't sure if neuropsychologists typically do any sort of therapy with their patients and/or their families? And if they can do therapy with psychiatric patients, not just neuropsych patients?

Thanks!
 
There are no "neuropsych patients", just patients who have had or who need neuropsychological assessment. Many times emotional or psychiatric disturbance is part of, or underlying, the cognitive disturbance.

Whether they do therapy or not depends on setting, need, and personal preference. All are trained in it since they are clinical psychologists with added specialty training in neuropsychology.
 
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There have been a ton of threads on here about neuropsych related practice, so a search on the topic should yield a bunch of different threads that can answer your questions.
 
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Okay great. Thanks!
 
I know there has been many threads, but curious what sort of refferal questions you guys get.
 
Most of the time, the ones I've seen have been some variant of: 1) is there objective cognitive impairment; 2) is this cognitive impairment or depression/other mental health condition; 3) what type of cognitive impairment is this (i.e., differential diagnosis); and 4) does this person have capacity for _____ (medical decision making, financial decision making, independent living, etc.)
 
AcronymAllergy said:
Most of the time, the ones I've seen have been some variant of: 1) is there objective cognitive impairment; 2) is this cognitive impairment or depression/other mental health condition; 3) what type of cognitive impairment is this (i.e., differential diagnosis); and 4) does this person have capacity for _____ (medical decision making, financial decision making, independent living, etc.)
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Very interesting. But I'm sure most people don't understand how a neuropsych's job differers from a neurologist.
 
psych84 said:
Very interesting. But I'm sure most people don't understand how a neuropsych's job differers from a neurologist.
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Correct me if I am wrong, but I think of a neurologist as more focused on physiological manifestations of neurological dysfunction whereas a neuropsychologist places more emphasis on the cognitive aspects of neurological dysfunction.

Also, they use fancy machines like CAT scans, fMRIs, and EEGs, and neuropsychs use fancy tests like Boston Naming, Wisconsin Card Sort, and the Rey-Osterrieth Complex Figure test.
 
Don't both neuropsychologists and neurologists use imaging techniques such as MRI's, CT scans, and EEGs, etc.?
 
Neuropsychologist will take imaging data into consideration during the clinical evaluation sure. And yes, they might order imaging (often prior to an eval).
 
still h0ping said:
Don't both neuropsychologists and neurologists use imaging techniques such as MRI's, CT scans, and EEGs, etc.?
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Yes, if imaging is available, I always review it. It's especially helpful in cases of dementia when you are trying to discriminate between types of dementia and can guide some of your interview questions and test selection.
 
How good are the interventions/therapies in neuropsych?
 
psych84 said:
How good are the interventions/therapies in neuropsych?
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Depends on what you mean by "good," and what it is you're actually trying to treat. It's essentially all symptom management-based for most of the populations and conditions with which we work. So if a person with dementia is having behaviorally-based difficulties, you can work on implementing various behavioral strategies and plans. If someone is having cognitive difficulties, you can either work with them directly on developing compensatory strategies or refer them to someone who will. If they're having difficulty adjusting to their illness or injury, you can assist them with that (or, again, refer as needed). If they're having trouble with sleep, injury-related pain, or medication adherence, again, you can use various targeted therapies to address those issues.

This would be the advantage that a neuropsychologist would have over a neurologist in this case--access to the various therapies that most clinical psychologists will have in their toolbox. Depending on the neurologist and their interests and training, neuropsychologists may also have more exposure to differential diagnosis amongst some of the various dementias. Conversely, a neuropsychologist isn't going to prescribe something like donepezil or memantine, although I don't know that this is necessarily a bad thing given the limited utility of the medications. Also, a neurologist is going to be better at quickly picking up various other neurological conditions (e.g., neuromuscular disorders like myasthenia gravis, neuropathies like CMT, etc.) and will have access to the types of tests you'd need in such situations (e.g., EMGs, muscle biopsies) as well as medically-based treatments (e.g., anticonvulsants, migraine meds, TENS--although that might go through physiatry). They're also of course going to be able to draw on their medical training and use that to inform diagnostic and treatment decision-making.
 
Any clinical psychologist in a medical setting will be able to review some of those tests that Iisted. I can have input on when to do so e I those tests but I typically just communicate the rule outs to the physician on the case who will order the tests. We don't even have a neurologist or neuropsychologist at our rural hospital. Wish we did.
 
So what would you guys describe as the best part of being a neuropsychologist?
 
Also, is the pay slightly better compared to a clinical psychologist? (i do realize that neuropsychology is a sub-speciality of clinical)
 
Im not one, so can answer first one.

Salary surveys reveal higher earning for npsych vs other psychologists in the clinical setting, with an average increase of 10k, I think. Not all that much, really. But thats an average, so some setting its more and some its less. Npsych is very in demand and lucrative in forensic setting/capacities, so obviously the income can sky rocket there.
 
In general, yes, neuropsychologists tend to get paid a bit more. Although you also have to consider the fact that they typically do an extra year of fellowship, so especially with early-career numbers, this is going to affect their average pay rates relative to other psychologists (e.g., newly-minted VA neuropsychologists will generally start as GS13's, whereas other folks coming straight from post-doc will typically start out as a GS12). I think there may also be a greater proportion of neuropsychologists relative to all other psychologist who are involved to some degree with forensic work, which tends to be high-paying.
 
My goal is to do Forensic Psychology (Masters) at John Jay. And if I ended up doing a Phd, it def be in Neuropsychology. How good are the instruments we currently have at picking up malingering?
 
psych84 said:
My goal is to do Forensic Psychology (Masters) at John Jay. And if I ended up doing a Phd, it def be in Neuropsychology. How good are the instruments we currently have at picking up malingering?
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There are literally hundreds if not thousands of journal articles related to validity testing at this point. Short answer: it depends on a variety of factors, including validity type in question, patient population, assessment setting, numbers and types of instruments used, etc.

Edit: And as erg pointed out below, determination of malingering isn't handled by the tests, it's a judgment made by the clinician after reviewing multiple pieces of information.
 
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psych84 said:
My goal is to do Forensic Psychology (Masters) at John Jay. And if I ended up doing a Phd, it def be in Neuropsychology. How good are the instruments we currently have at picking up malingering?
Click to expand...

Malingering, by definition, is a transcient behavioral state. Thus, instruments/tests dont conclude malinger. You do....using tests as ONE piece of evidence.
 
Right. I do remember reading something about how a decision on malingering in the past was totally based on clinical judgement before some instruments/tests were introduced.
 
A good case of a forensic exam detecting malingering can be found in the Kenneth Bianchi Hillside Strangler case where he was trying to feign multiple personalities. From what my forensic friends have told me, many of the tests for malingering can be of limited usefulness because a sophisticated malinger can see through them and respond accordingly. I had a case once with a very intelligent patient with severe Bipolar Disorder with psychotic features who had a technically valid MMPI profile that indicated he was completely within normal limits. The patient wasn't even malingering, they said they just didn't want me to think they were crazy even though they had already told me all of their symptoms!
 
Do you guys deal with CFS patients? Research seems split here, if this is a psychological or physical issue.
What is done for these patients?
 
WisNeuro said:
Essentially malingering. Every time I've seen CFS in a chart, the person has been involved in litigation/SC and they have failed both symptom and performance validity tests.
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Interesting. So in your view people are lying about having this?

And what does it mean to fail symptom part of the test?
 
Discussion of the in's and out's of PVT/SVT testing should be saved for training settings, etc.

As for lying about CFS.....a very large % of ppl who identify with CFS also fail the measures in question.

I had a guy today score a 0% on one of the tests. It actually took quite a bit of effort to do that poorly. 😀
 
Not necessarily. In my view, some people will lie about having this. Especially since we have no good diagnostic test for it other than subjective self-report. As such, it happens to be a common "diagnosis." There may be something to it, as there may be something to fibromylagia. But, until there is a good diagnostic test for either that relies on objective rather than subjective findings, it's ripe for fraud.

Never seen a 0 before. I had someone answer "C" on the TOMM before.
 
But I assume since these patients complain about cognitive deficits, objective testing is done, and these guys score rather way too high (which makes CFS unlikely) or way too low (that would suggest lying)?
 
I think this convo could get dicey fast . I agree. Save it for training.
 
WKS would get you a failing but still above chance profile. If you were purely guessing you would get a 0 about 1 in 10+ billion chances. When you get below statistical chance, you can pretty much conclude intentional feigning with no reservation.
 
I've evaluated a couple folks with full-blown Wernicke-Korsakoff; horrible condition, although I suppose you could say it's "fortunate" in a way that insight is generally non-existent at that point. These end up being the types of situations where folks genuinely do end up going things like forgetting to eat. Conversely, if you don't probe too deeply, folks with WKS can present surprisingly well during a brief interview or casual conversation (at least the ones I've seen).
 
AcronymAllergy said:
Depends on what you mean by "good," and what it is you're actually trying to treat. It's essentially all symptom management-based for most of the populations and conditions with which we work. So if a person with dementia is having behaviorally-based difficulties, you can work on implementing various behavioral strategies and plans. If someone is having cognitive difficulties, you can either work with them directly on developing compensatory strategies or refer them to someone who will. If they're having difficulty adjusting to their illness or injury, you can assist them with that (or, again, refer as needed). If they're having trouble with sleep, injury-related pain, or medication adherence, again, you can use various targeted therapies to address those issues.

This would be the advantage that a neuropsychologist would have over a neurologist in this case--access to the various therapies that most clinical psychologists will have in their toolbox. Depending on the neurologist and their interests and training, neuropsychologists may also have more exposure to differential diagnosis amongst some of the various dementias. Conversely, a neuropsychologist isn't going to prescribe something like donepezil or memantine, although I don't know that this is necessarily a bad thing given the limited utility of the medications. Also, a neurologist is going to be better at quickly picking up various other neurological conditions (e.g., neuromuscular disorders like myasthenia gravis, neuropathies like CMT, etc.) and will have access to the types of tests you'd need in such situations (e.g., EMGs, muscle biopsies) as well as medically-based treatments (e.g., anticonvulsants, migraine meds, TENS--although that might go through physiatry). They're also of course going to be able to draw on their medical training and use that to inform diagnostic and treatment decision-making.
Click to expand...

I'll guess it might differ from institution to institution, but when and how do OTs fit in, in terms of treatment planning? How closely (or not) do you work with them?
 
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