This document discusses assessment of psychological problems in patients with neurological disorders. It notes that assessment may help with differential diagnosis or identifying treatable psychiatric conditions. Assessing psychological symptoms can be complicated by overlap with neurological symptoms. Clinical interviews and observations can be aided by checklists of psychological symptoms. Self-report instruments and reports from family members can also provide information, especially for patients with cognitive impairments. The document discusses several methods and instruments used to assess conditions like depression, anxiety, apathy, psychosis, and more.

1. MODALITAS TERAPI
PSIKIATRI
SUPERVISOR: dr. Finny
Warouw, M.kees, Sp.N(K)

2. ASSESSMENT OF PSYCHOLOGICAL PROBLEMS, WITH NEUROLOGICAL
DISORDER
Presentation title 2
Assessment may have implications for differential diagnosis (e.g., depression vs. dementia in an
elderly patient), or to identify a psychiatric condition that requires direct treatment
Psychologists will wish to investigate the nature and severity of psychological symptoms as part of a
wider assessment. However, this can be complicated by overlap between the signs and symptoms of
the psychiatric state and those of the brain disorder itself

3. ASSESSMENT OF PSYCHOLOGICAL PROBLEMS, WITH NEUROLOGICAL
DISORDER
Presentation title 3
Clinical Interview and Observation
This process can be aided by a checklist of signs and symptoms that may indicate the presence of
psychological disorder, either as a diagnosable condition
The test situation is highly artificial and can be threatening or a cause of great concern to patients
Self-report Instruments
An alternative or supplement to self-report is information from another individual who knows the
patient well, typically another family member or professional carer. This may be the only method
available for patients with significant dementia or where there are cognitive deficits, such as aphasia
or lack of insight, that preclude other assessment methods

4. ASSESSMENT OF PSYCHOLOGICAL PROBLEMS, WITH NEUROLOGICAL
DISORDER
Presentation title 4
Clinical Interview and Observation
This process can be aided by a checklist of signs and symptoms that may indicate the presence of
psychological disorder, either as a diagnosable condition
The test situation is highly artificial and can be threatening or a cause of great concern to patients
Self-report Instruments
An alternative or supplement to self-report is information from another individual who knows the
patient well, typically another family member or professional carer. This may be the only method
available for patients with significant dementia or where there are cognitive deficits, such as aphasia
or lack of insight, that preclude other assessment methods

5. METHODS AND INSTRUMENT FOR CLINICAL CONDITIONS
Presentation title 5
Depression
the presence of depression may lead to secondary problems with testing that do not necessarily reflect an
underlying cognitive impairment
Anxiety
patients with an anxiety disorder may well be receiving pharmacological treatment for the condition. The
impact of benzodiazepines on memory and psychomotor function are well documented. as in depression,
anxious individuals may indulge in off-task ruminations about their performance, the perceptions of others, etc.
or just indulge in more general worry, also associated with poor test performance
Apathy
apathetic patients may appear relatively normal when performing routine tasks or when responding to external
cues or triggers, but will show a marked deficit in conditions of novelty or when required to self-initiate
behaviour. In these situations they tend to show an absence of spontaneous emotion, cognition and overt
behaviour
Psychosis, Mania and Disorders of Positive Affect

6. METHODS AND INSTRUMENT FOR CLINICAL CONDITIONS
Presentation title 6
Depression
the presence of depression may lead to secondary problems with testing that do not necessarily reflect an
underlying cognitive impairment
Anxiety
patients with an anxiety disorder may well be receiving pharmacological treatment for the condition. The
impact of benzodiazepines on memory and psychomotor function are well documented. as in depression,
anxious individuals may indulge in off-task ruminations about their performance, the perceptions of others, etc.
or just indulge in more general worry, also associated with poor test performance
Apathy
apathetic patients may appear relatively normal when performing routine tasks or when responding to external
cues or triggers, but will show a marked deficit in conditions of novelty or when required to self-initiate
behaviour. In these situations they tend to show an absence of spontaneous emotion, cognition and overt
behaviour
Psychosis, Mania and Disorders of Positive Affect

7. METHODS AND INSTRUMENT FOR CLINICAL CONDITIONS
Presentation title 7
Depression
the presence of depression may lead to secondary problems with testing that do not necessarily reflect an
underlying cognitive impairment
Anxiety
patients with an anxiety disorder may well be receiving pharmacological treatment for the condition. The
impact of benzodiazepines on memory and psychomotor function are well documented. as in depression,
anxious individuals may indulge in off-task ruminations about their performance, the perceptions of others, etc.
or just indulge in more general worry, also associated with poor test performance
Apathy
apathetic patients may appear relatively normal when performing routine tasks or when responding to external
cues or triggers, but will show a marked deficit in conditions of novelty or when required to self-initiate
behaviour. In these situations they tend to show an absence of spontaneous emotion, cognition and overt
behaviour
Psychosis, Mania and Disorders of Positive Affect

8. Assesment of memory
Presentation title 8

9. Memory Rehabilitation
Presentation title 9

10. ENHANCED LEARNING
Presentation title 10
Attention: Pay more attention to the information to be remembered. Make sure that you are not
distracted by your environment and that you consciously focus on whatever you have to remember. .
Time: Spend more time on encoding. Generally, the more time you spend on encoding the more you
will remember. But spend your time economically—not too long without a pause, but frequently and
little by little.
Repetition: Whatever you have to remember will sink in more easily if you repeat it. There are
several forms of repetition—simple repetition, spaced repetition (with increasing time intervals) and
varied repetition (in several ways and situations).

11. EXECUTIVE DYSFUNCTION TREATMENT MODALITIES
Presentation title 11
A number of tools are available for the clinician to determine the presence of the dysexecutive
syndrome, its principal characteristics, the functional problems it causes and its severity. These
comprise the clinical interview, assessment through questionnaire administration,
neuropsychological tests, and behavioural and functional assessment.
Method 1: Time Administer the greatest number of tests possible in the available time. .
Method 2: Psychometrics Base one’s choice of measures on test-based factors such as ease of use
and cost, psychometric validity, how widely the tests are used, how often they have been used with
a particular client group, etc. .
Method 3: Expectation Base assessment on what one expects to find, given knowledge of medical
history and/or previous assessments. .
Method 4: Observation Base assessment on symptoms already observed by carers or relatives. .
Method 5: Theory Adopt a particular theoretical stance and choose the tests that make most sense
according to it.

12. EXECUTIVE DYSFUNCTION TREATMENT MODALITIES
Presentation title 12
Method 1: Time
traditional tests of executive function
 Wisconsin Card Sorting Test [WCST], Stroop Test
Method 2: Psychometrics
 psychometric tests

13. EXECUTIVE DYSFUNCTION TREATMENT MODALITIES
Presentation title 13
Method 5: Theory
(SINGLE PROCESS THEORIES)
 Hayling Test, Burgess & Shallice
Stroop Test
 CANTAB [Cambridge Neuropsychological Test Automated Battery] spatial working memory test
(CONSTRUCT-LED THEORIES)
Petrides and Milner’s (1982) Self-Ordered Pointing Test
Fair Test
the Six Element Test of the Behavioural Assessment of the Dysexecutive Syndrome

14. NEUROPSYCHOLOGICAL ASSESSMENT
Presentation title 14
The Halstead– Reitan Battery (Halstead, 1947; Reitan & Davison, 1974) is such an approach, and was
originally used to discriminate between patients with frontal lobe lesions and normal control
subjects
models of reading (Coltheart, 1985; Patterson, 1994) have led to systematic and careful assessment
of the ability to read parts of speech, words of different length, nonsense words, irregular versus
regular words, words acquired at different ages, and highly imageable versus abstract words.

15. BEHAVIOURAL ASSESSMENT
Presentation title 15

16. RECOVERY FROM BRAIN INJURY
Presentation title 16
Wessex Head Injury Matrix (WHIM)
The WHIM was developed as a behavioural assessment to monitor recovery and response to
rehabilitation after severe brain injury
The WHIM is administered regularly—if patients are changing rapidly it is administered daily; for
patients who do not change for more than 3 days it is administered twice weekly; for patients who
do not change for a week it is administered weekly; and for patients who do not change for a
month it is administered monthly. If rate of change alters, the assessment schedule is revised as
appropriate
Sensory Modality Assessment and Rehabilitation Technique (SMART)
The SMART records patients’ responses to sensory and environmental stimulation and evaluates
these in a 5-point hierarchy from no response to a consistent purposeful response. It is used as an
assessment tool and a treatment tool simultaneously, and depending on scores, patients are
classified as being vegetative or minimally conscious

17. BEHAVIOURAL APPROACHES FOR DECREASING OR
ELIMINATING INAPPROPRIATE BEHAVIOURS
Presentation title 17
Strategies that have proved useful in teaching new skills or improving existing skills include
prompting, chaining, shaping, expanding rehearsal, positive reinforcement, and goal planning

18. THANK YOU
Presentation title 18