Psychodiagnostics procedure and techniques.

1. EP: 311 ASSIGNMENT.
PSYCHODIAGNOSTICS:
PROCEDURE AND TECHNIQUES.
By-
Saurabh Chavan ; Marzuka Shaikh ;
Lalbiakzuala Chhakchhuak ; Umesh Sasane & Amar
Rathod.

2. INTRODUCTION
-Saurabh Chavan-

3. THE MENTAL STATUS
EXAMINATION
Original MSE was the Mini - Mental State
Examination (Folstein, Folstein, &
McHugh, 1975).

4. MMSE
THE MMSE IS A SCREENING TOOL..
A BRIEF MEASURE OF AMNESTIC AND COGNITIVE
PROCESSING FUNCTIONS.
PURPOSE:
To provide a quantitative evaluation of cognitive
impairment and to record cognitive changes over time.

5. • MMSE is a short 30 point screening tool
extensively used in clinical and research settings to
measure cognitive impairment.
• MMSE is the most widely used standardized
instrument for cognitive impairment in the world.
• It has been cited for more than 14000 occasions.
• It is used globally and is translated in many
languages.
• Note: It does not help in diagnosis of dementia.

6. COMPONENTS:
• Assess short-term changes in mental functioning in
hospitals
• Assess changes in cognitive functioning in
emergencies (e.g., injuries on the baseball field)
• Assess progressive changes in cognitive functioning
in long term care settings
• Obtain a “snapshot” of client’s functioning in
outpatient mental health settings

7. COMPONENTS (Contd.):
• Assesses general quality of:
• amnestic functions.
• cognitive processing and intellectual functions.
• form and content of thought.
• nature, expression, and appropriateness of affect.
• adaptive and maladaptive behaviors.
• symptoms of psychopathology.

8. FEATURES OF MMSE
-Marzuka Sheikh-

9. • THE QUESTIONS ARE GROUPED INTO SEVEN
CATEGORIES, EACH REPRESENTING A
DIFFERENT COGNITIVE DOMAIN OR
FUNCTION AS FOLLOWS:
1) Orientation to time (5 points).
- It measures temporal functions of an individual.
2) Orientation to place (5 points).
- It measures geographical cognitive functions.
3) Registration of three words (3 points).
- It measures the cognitive function to repeat words.

10. (Contd.)
4) Attention and calculation (5 points).
- It measures awareness and calculation.
5) Recall of three words (3 points).
- It measures first and second recall
6) Language (8 points).
- It measures reading, comprehension and writing.
7) Visual construction (1 point).
- It measures construction praxis (visio-spatial function)

11. Patient’s Name: ……………..
Date:.........
Instructions: Ask the questions in the order listed.
Score one point for each correct response within
each question or activity.
Maximum
Score
Patient’s
Score Questions
5 “What is the year? Season? Date? Day of the week? Month?”
5 “Where are we now: State? County? Town/city? Hospital?
Floor?”
3
The examiner names three unrelated objects clearly and slowly,
then asks the patient to name all three of them. The patient’s
response is used for scoring. The examiner repeats them until
patient learns all of them, if possible. Number of trials: ……...
5
“I would like you to count backward from 100 by sevens.” (93, 86,
79, 72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)

12. 5
“I would like you to count backward from 100 by sevens.” (93, 86, 79,
72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
3
“Earlier I told you the names of three things. Can you tell me what those
were?”
2
Show the patient two simple objects, such as a wristwatch and a pencil,
and ask the patient to name them.
1 “Repeat the phrase: ‘No ifs, ands, or buts.’”
3
“Take the paper in your right hand, fold it in half, and put it on the floor.”
(The examiner gives the patient a piece of blank paper.)
1
“Please read this and do what it says.” (Written instruction is “Close your
eyes.”)
1
“Make up and write a sentence about anything.” (This sentence must
contain a noun and a verb.)
1
“Please copy this picture.” (The examiner gives the patient a blank piece
of paper and asks him/her to draw the symbol below. All 10 angles must
be present and two must intersect.)
30 TOTAL

13. PSYCHOMETRIC PROPERTIES,
USES & CONDUCTION
-Lalbiakzuala Chhakchhuak -

14. RELIABILITY, VALIDITY &
NORMS
• Folstein et al. (1975) administered the MMSE to
206 patients with dementia syndromes, affective
disorder, affective disorder with cognitive
impairment, mania, schizophrenia, personality
disorders, and to 63 healthy controls.
• The test satisfies the test-retest reliability, with a
Pearson correlation of r = 0.99.
• The test satisfies concurrent validity.

15. • Estimate functioning to determine need for further
testing.
• Estimate functioning to determine treatment needs.
• Assess progress when functioning has declined in an
emergency situation.
• Periodically assess insidious decline in functioning
(e.g., dementias).
USES

16. WAYS TO CONDUCT A MMSE
• Rapport - building is important in order to obtain the client’s
cooperation and best effort in responding to the examination.
• These components are assessed while interviewing the client
about her concerns, circumstances, and history:
• Thought form and content.
• Nature, expression, and appropriateness of affect.
• Behavior strengths and weaknesses (or adaptive
behaviors).
• These functions may be assessed informally during the
interview, or formally through specific questions and tasks:
• Amnestic functions.
• Cognitive processing and intellectual functions.

17. NOTE: MMSE IS NOT
• An intelligence test.
• A detailed memory test.
• A fully precise measure of cognition, affect, and behavior.

18. ADVANTAGES, STRENGHTS
LIMITATIONS
-Umesh Sasane-

19. ADVANTAGES
• Could be administered without additional
equipment at patient bedside.
• Requires little critical thinking and interpretation.
• Quick to administer. (10 mins or less)

20. STRENGHTS
• The MMSE is effective as a screening instrument
to separate patients with cognitive impairment
from those without it.
• In addition, when used repeatedly the instrument is
able to measure changes in cognitive status that
may benefit from intervention.
• The MMSE is also one of the most frequently used
screening and outcome measures in cognition
enhancing drug trials for Alzheimer’s disease (AD)

21. LIMITATIONS
• The tool is not able to diagnose the case for
changes in cognitive function and should not
replace a complete clinical assessment of mental
status.
• The instrument relies heavily on verbal response
and reading and writing. Therefore, patients that
are hearing and visually impaired, intubated, have
low English literacy, or those with other
communication disorders may perform poorly even
when cognitively intact.

22. • Ceiling effects are obvious in younger, more intact
individuals.
• Floor effect is also present in advanced stages of
AD.
• Standardization samples are small and not broadly
representative of national population.
• Samples are not fully culture – fair.
LIMITATIONS (Contd.)

23. -Amar Rathod-
SCORING, INTERPRETATION
& VARIATIONS OF MMSE

24. MENTAL STATUS SCORES AND
TIME
• Simple scoring system (point per item).
• Scores range from 0 – 30.
• Scores below 24 indicative of dementia or cognitive deficit.
• Lower scores indicate greater deficits.
• Scores obtained from small sample of Caucasian males and
females from middle US.
• Time: Can be administered in 5-10 minutes.

25. INTERPRETATION
Method Score Interpretation
Single Cutoff <24 Abnormal
Range
<21
>25
Increased odds of dementia
Decreased odds of dementia
Education
21
<23
<24
Abnormal for 8th grade education
Abnormal for high school education
Abnormal for college education
Severity
24-30
18-23
0-17
No cognitive impairment
Mild cognitive impairment
Severe cognitive impairment

26. VARIATIONS OF MMSE
• Extended MMSE (John Ashford, M.D.,&
Associates, 1992).
• St. Louis MMSE (1991).
• Solomon “7 Minute Screen” (2000).
• All these yield standardized scores.

27. VARIATIONS OF MMSE
• Practitioners tend to develop their own versions of
comprehensive mental status examinations.
• As long as the protocol measures the areas typically
assessed by these examinations, a wide range of
specific items will serve the purposes.
• Clinicians should avoid using IQ and memory test
items in their MMSE.

28. THANK YOU.