Psychiatric testing?

[Jack223]

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I hope you guys don't mind a lowly undergrad posting on here. I was just wondering if you guys ever using any sort of tests to help diagnose your patients? I know that that's one thing psychologists do, but do you guys have your own psychiatric tests, or do you rely on an interview to diagnose or something else? What is the process that you go through when you get a new patient and don't know what disorder they're suffering from? I'm trying to get a feel for both psychology and psychiatry. I shadowed a psychiatrist this summer and it was interesting, although he didn't do any psychotherapy which I would definitely want to do (in addition to meds if I did do psychiatry). If I went to med school I would be going into it knowing I was seriously considering psychiatry, however I'd keep an open mind too. Thanks for your help.

 

[solumanculver]

Yeah, are Rohrschach tests still part of the arsenal...?

 

[nitemagi]

My experience is that it depends quite a bit. Most psychiatrists I've worked under use almost exclusively the interview to diagnose. The benefit of a psychology Ph.D. is heavily in research, such as understanding the SCID, Ham-D (Hamilton Depression), etc. Psychiatrists don't get much training in psychometrics, and so rely on psychologists for intensive standardized psychological testing. This only usually becomes a factor in research studies though, and occasionally in court trials as additional tools for evaluating an individual.

As for Rohrschachs, I think the last I heard was that anyone can use them, but interpretation of them is basically operator dependent. There is no proper answer, but often just serves as a springboard for something like psychoanalysis-- the idea being that the patient's interpretation of the image is always an indication of their underlying psychological struggles. I've never seen anyone actually use them, but I hear that some do in private practice.

 

[Psyduck]

There is no real answer to Rorschachs although there is a big manual for therapists on how to interpret them. The decline of this test is probably linked to the decline in psychoanalysts in the U.S. (although it's still the most popular orientation worldwide). But anyway, psychoanalysis tends to be long term and isn't really used by psychiatrists, only psychologists

 

[Anasazi23]

There is no real answer to Rorschachs although there is a big manual for therapists on how to interpret them. The decline of this test is probably linked to the decline in psychoanalyists in the U.S. (although it's still the most popular orientation worldwide). But anyway, psychoanalysis tends to be long term and isn't really used by psychiatrists, only psychologists

I'm not sure if this is true. Every officer of the NY Psychoanalytic institute is an M.D., while the majority of their active members are physicians, with a small percentage being psychologists. I'm not sure if it is much different (I suspect it's not) nationwide.

http://www.psychoanalysis.org/about-roster.html

 

[Psyduck]

then i would assume that they are private practice psychiatrists who have the time to do more interpretive tests, but i can't say i'm an expert on that topic

 

[outofhere]

When a psychiatrist does 'neuropsch testing' during a patient hour, the psychiatrist uses a code that equates more compensation. Psychiatrists tend to use these tests as confirmative, or using it to track a patient's progress. I have used Beck Depression Scale, Ham-A and Ham-D extensively. It is quick, and patients generally like having a number that they can track.
Check out
www.neurotransmitter.net

 

[50960]

LOL...that👎 is NOT testing....Ham-D?? SCID etc...these are check-lists for primary care etc....

 

[outofhere]

LOL...that👎 is NOT testing....Ham-D?? SCID etc...these are check-lists for primary care etc....

It is testing per insurance companies. It is up to you if you want to claim extra $20 per hour. I would. Say I do this thrice a day, times fives days a week, times 40 weeks year. Hmm, that amounts to $12,000. Who is LOL now?

 

[nitemagi]

LOL...that is NOT testing....Ham-D?? SCID etc...these are check-lists for primary care etc....

Actually it is testing- a standardized question set in an interview that yields a quantitative score that can then be tracked for changes in future sessions, whether in research or therapy. That's one way to document progress, and one of the ways we use in my research.

Out of curiosity, what in your mind is testing then??

 

[50960]

Hmmm stuff that is standardized, with reliability and validy, has stuff like standard deviations etc...

 

[Neuro-Dr]

I think the issue of what constitutes a test in psychology/psychiatry is the ability to capture a set of symptoms and allow for predicition. If the Beck scales and Hamilton for that matter have a test-retest reliability of about .60, then they are not predicting a stable construct or are subject to error variable such as question interpretaion, poor quantification based on item score or just the vicissitudes of life. This does not usually lend itself to strong psychometric features considered in psychological testing. Tests that have been well normed for a specific purpose, with adaquate predicitve validity are what is typically referred to here. As for the type and use of testing as always it depends on your referral question. It would be difficult to rule out an LD without testing and even in cases of ADHD where comorbidity can be as high as 50%, there may need to be an additional work-up to rule out other factors.

Testing can also be rather meaningless. In a case of an outpatient, mild, noncomplicated depressive episide, I'm not sure what testing would offer. Likewise, in a case of a floridly psychotic patient, your scores would not likely reflect what you intend to measure. Instruments are most useful in cases of suspected malingering or defensiveness. There have been numerous studies done suggesting that the more experience a clinician has, the more there confidence in their opinion goes up, not their accuracy. Many psych and neuropsych instruments have symptom validity scales and there are several stand alone measures of effort and symptoms validity. You will find excellent uses for testing here. Also, in cases of dementing illnesses np testing is quite valuable. Hope this helps.

 

[Sanman]

Psychological testing consists of much more than checklists. The scales generally used have been extensively normed and researched so as to give practictioners a basis for comparison that is more valid than the interpretations of a practitioner in a clinical interview. Individuals can be tested for personality factors, intelligence, memory, issues of pain, academic standing etc. These tests vary in length, though the most comprehensive take 45 min to 1.5hrs. As for personality testing, the most common test now used is the MMPI, which consists of ~500 m.c. questions and gives profiles on a number of different personality aspects. It is generally the reason the Rorschach is not the predominant test for personailty, since it is easier to administer and score and considered by many to be more empirically valid. Neuropsych testing is a specialized battery of tests generally taking 3+ hours and looking at cognitve function (intelligence, memeory, motor function, etc) to assess for bain injury, dementia, etc. It is still the gold standard of diagnosis for alzheimer's disease (short of an autopsy). That is all the time I can devote to this now. Educate yourselves and make your lives easier.

 

[50960]

Thanks Sanman, that sure shut down the arrogant ignorance. 😀

 

[Anasazi23]

I had something much more scathing written here previously.

Psychiatry residents will learn what they need to know about psychological testing in residency. So, a psychologist telling a medical student (soon-to-be physician) to educate themselves in an oxymoron.

There is a difference between ignorance and not giving a damn.

 

[50960]

As you have told me before Sazi, a little knowledge is dangerous. I teach docs everyday so I must be a hydroxy-***** huh!!

 

[50960]

If you all are not too clear you know what testing is etc.. I am sure a few psychology folks would be happy to carry on a collegial dialogue with you an the subject. Psych-testing is not short-form checklists..if it was we could have the LVn's/MAs doing them. There is alot to it, and alot that you do not learn in psychiatry. I spent 2 hrs yesterday with a psychiatrist I respect alot explaining to him how tests are created, what makes standardization, what is reliability and validity, what are t-scores, and most important what this anal-rententive science of measurement cannot do, or does not do well..... Sazi, you are envited..you may learn something. BTW, Colorado is miles ahead of liberal Ca in how it serves its underserved, and I get to manage patients meds here again. I am writing an article on my last year or 2 experiences with doing so, I am sure you will be happy to read it.

👍

 

[nitemagi]

I never said they were just checklists. Get off your high horses people.
🙄

 

[Therapist4Chnge]

I just wanted to add a few things to Sanman's post....

I believe the common inclusion of the MMPI over something like the Rorschach is two-fold: It has a stronger base of emperical support, and it is more standardized in scoring which contributes to increased reliabilty scores. You will find MMPIs in practically all full battery assessments, and if there was one assessment tool I think everyone should know well...it'd be this one.

The Rorschach is still used, but in a slightly different capacity than it was say 20 years ago. Many people choose to forego a full assessment, and instead use specific cards to look into hypothesized areas of concern. The Rorschach (IMHO) can be very valuable in therapuetic arena, but it has limitations outside of there.

As for scoring, Extner developed a scoring system that is empirically supported, though IMHO it tends to yield similiar results to traditional psychodynamic interpretations (my preferred method of scoring), but takes much longer to complete.

-t