Goals of Neuropsychiatric Evaluation Paper
An older male patient reports urinary frequency, back pain, and nocturia. A dipstick urinalysis reveals hematuria. What will the provider do next to evaluate this condition? 2) An older male patient has a screening PSA which is 12 ng/ml. What does this value indicate? 3) A male patient reports nocturia and daytime urinary frequency and urgency without changes in the force of the urine stream. What is the likely cause of this? 4) A 70-year-old male reports urinary hesitancy, post void dribbling, and a diminished urine stream. A digital rectal exam reveals an enlarged prostate gland that feels rubbery and smooth. Which tests will the primary care provider order based on these findings? 5) The provider orders the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction in a 65-year-old male patient. What will be included when teaching this patient about taking this medication? Select all that apply. Goals of Neuropsychiatric Evaluation Paper 6) Which is true about hypoactive sexual desire in older men? 7) A young adult male reports a dull pain in the scrotum and the provider notes a bluish color showing through the skin on the affected side.
Palpation reveals a “bag of worms” on the proximal spermatic cord. What is an important next step in managing this patient? 8) An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention? 9) A high school athlete is brought to the emergency department after collapsing during outdoor practice on a hot day. The patient is weak, irritable, and confused. Serum Na is 152 mEq/ml and has dry mucous membranes and tachycardia. What is the initial approach for rehydration in this patient? 10) An elderly patient who is taking thiazide diuretic has been ill with nausea and vomiting and is brought into the emergency department for evaluation. An assessment reveals oliguria, hypotension, and tachycardia and serum sodium is 118 mEq/ml. What is the treatment. 11) Which thyroid stimulating hormone level indicates hyperthyroidism? 12) A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? 13) What are some common goals of neuropsychiatric evaluation?Goals of Neuropsychiatric Evaluation Paper 14) A patient exhibits visual field defect, ataxia, and dysarthria and complains of a mild headache. A family member reports that the symptoms began several hours prior. An examination reveals normal range of motion in the neck. What type of cerebrovascular event is most likely? 15) An elderly patient is brought to the emergency department after being found on the floor after a fall. The patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. The patient’s blood pressure is 220/190 mm Hg. What is the likely treatment for this patient? 16) What are initial approaches when managing delirium in a hospitalized patient who is agitated and confused? (select all that apply) 17) A previously lucid patient with early-stage Alzheimer’s disease is hospitalized after a surgical procedure and exhibits distractibility and perceptual disturbances that occur only in the late afternoon. 18) An elderly patient has symptoms of depression and the patient’s daughter ask about possible Alzheimer’s disease since there is a family history this disease. A screening evaluation shows no memory loss. What is the itinal step in managing this patient? 19) A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with subsequent worsening of symptoms. Based on this response what is the likely cause of the patient’s symptoms? 20) Which medication maybe useful in treating tension-type headache? Goals of Neuropsychiatric Evaluation Paper
Neuropsychology is concerned with relationships between the brain and behavior. Neuropsychologists conduct evaluations to characterize behavioral and cognitive changes resulting from central nervous system disease or injury, like Parkinson’s disease or another movement disorder. Some neuropsychologists also focus on remediation of or adaptation to these behavioral and mental changes and other symptoms.
What is a neuropsychological evaluation?
Neuropsychological evaluation is an assessment of how one’s brain functions, which indirectly yields information about the structural and functional integrity of your brain. The neuropsychological evaluation involves an interview and the administration of tests. The tests are typically pencil and paper type tests. Some tasks might be self-reports meaning that they are completed by the patient with assistance from a technician, but the majority of the tests require administration by a neuropsychologist or trained, skilled psychometrist.
Neuropsychological tests (unlike bedside cognitive and behavioral neurologic screens) are standardized, meaning that they are given in the same manner to all patients and scored in a similar manner time after time. An individual’s scores on tests are interpreted by comparing their score to that of healthy individuals of a similar demographic background (i.e., of similar age, education, gender, and/or ethnic background) and to expected levels of functioning. In this way, a neuropsychologist can determine whether one’s performance on any given task represents a strength or weakness. Although individual scores are important, the neuropsychologist looks at all of the data from the evaluation to determine a pattern of cognitive strengths and weaknesses and, in turn, to understand more about how the brain is functioning.Goals of Neuropsychiatric Evaluation Paper
Neuropsychological tests evaluate functioning in a number of areas including: intelligence, executive functions (such as planning, abstraction, conceptualization), attention, memory, language, perception, sensorimotor functions, motivation, mood state and emotion, quality of life, and personality styles. The areas addressed in an individual’s evaluation are determined by the referral question (what the referring doctor and patient wants to know), patient’s complaints and symptoms, and observations made during interview and test administration.
How long does a neuropsychological evaluation take?
A complete evaluation generally takes between two and five hours to complete, but can take up to eight hours, depending on the complexity of the issues to be addressed by the evaluation and the patient’s condition (for example, fatigue, confusion, and motor slowing can extend the time required for an evaluation). Occasionally, it is necessary to complete the evaluation over two or more sessions. In general, the clinician attempts to elicit the patient’s best possible performance under optimal conditions.
“Assessment” refers to the purposeful gathering of information on an individual, including clinical interview material, psychometric data, formal observations, and past medical records. Generally speaking, the purpose of an assessment is to generate a diagnosis, to provide direction for treatment planning, to assist in patient care, and to advance research efforts (Leon-Carrion, Taffee & Barroso y Martin, 2006).
Neuropsychological assessment is a specific methodological procedure for measuring functional changes due to impairment of specific cognitive or behavioral domains. This assessment is done in order to determine rehabilitation needs based on the measured strengths and weaknesses of the individual in the functional domains assessed. Normally, neuropsychological assessment is carried out through the administration of neuropsychological tests that have proven to be sensitive to the effects of brain injury.
A typical neuropsychological assessment consists of administering tests or tasks that examine a set of functional cognitive, behavioral, emotional and social domains that are controlled by known brain systems. According to the National Academy of Neuropsychology (NAN, 2006), neuropsychological assessment is a neurodiagnostic, consultative service, and not a mental health evaluation or treatment service.
Is it possible to assess only through tests and batteries?
There are two main models for neuropsychological assessment, the quantitative and the qualitative method. Whereas the quantitative neuropsychologist is mainly concerned with the mathematics and statistics of the functional impairment, the qualitative neuropsychologist endeavors to find the procedural breakdowns implicit in the loss of functional integrity.Goals of Neuropsychiatric Evaluation Paper
The quantitative perspective is based on comparing the results obtained from a patient who undergoes a test battery with those of a normal person who undergoes the same tests and observing the deviation from the latter results. Comparisons can also be made between the results of the assessed patient and those of other patients with different cognitive impairment profiles in order to see if the patient fits a certain profile, given that damage to different regions of the brain may result in characteristic patterns of deficit. These patterns may explain the neurological processes involved in the cognitive, emotional, and functional impairment of the patient. Numbers are the product of quantitative assessment. Scores are viewed as having some intrinsic meaning upon which assumptions are made as to the existence of a lesion, its location, and associated deficits. The treatment plan emerging from the test results calls for a return to the pre-morbid level of functioning. Rehabilitation outcome has to also be measurable (Leon-Carrion et al, ibidem).
In contrast, the foundation of qualitative assessment, lies in classic clinical examinations, where the clinical and theoretical knowledge of the neuropsychologist are the most important tools, together with flexibility in choosing the instruments used in examining the patient. This examination is process-oriented rather than data-driven, producing behavioral and cognitive signs and symptoms thought to be meaningful only in a broad context. The patient’s relative strengths and weaknesses must be considered with respect to treatment efforts. Furthermore, the goal of rehabilitation is to assist the patient in achieving an optimal level of cognitive and behavioral coherence and independence, not necessarily a return to normalcy (Leon-Carrion et al. ibidem).
Over the years, American neuropsychologists have seemed most comfortable with tests that have strong psychometric properties and might be categorized as being quantitative in nature (e.g., Halstead-Reitan´s procedures). European neuropsychologists, on the other hand, have appeared to be most comfortable with qualitative clinical examinations (e.g., Luria´s procedures). Currently, the requirement of most scientific journals, quantitative methodology, seems to be the most extended and used method of assessment. Nonetheless, there is some merging of quantitative and qualitative methods, perhaps in an effort to be more universally appealing and comprehensive.Goals of Neuropsychiatric Evaluation Paper
What are the goals of the Neuropsychological Assessment?
There are four main goals of neuropsychological assessment. Firstly, and most importantly, is to understand the nature of cognitive and behavioral problems produced by any brain injury and how this affects an individual’s functional activities. Only a complete neuropsychological assessment can comprehensively explain the changes and impairments produced in behavior, emotion, mood, attention, thinking, language, memory, reasoning, executive functioning, calculation, social relationships, etc. The data obtained from a sound neuropsychological assessment are the best guarantee for designing a sound rehabilitation program. There is no other way to understand and explain functional individual changes than through neuropsychological assessment. Secondly, neuropsychological assessment it is the main contributor to a diagnosis that determines the functional nature of an underlying neurological problem. Thirdly, assessments may be undertaken to control and monitor functional changes over time as a consequence of neuropsychological rehabilitation or treatments using drugs (Leon-Carrion, 1998). And lastly, neuropsychological assessment is the most powerful method to explain changes in an individual’s voluntary activities in a medico-legal case (Leon-Carrion & Leon-Jimenez, 2001), providing important evidence in personal injury litigation or in any other type of court action in which a person with brain damage is seeking compensation.
Can other methodologies be used in place of neuropsychological assessment?
A comprehensive neuropsychological assessment is the only way to obtain a comprehensive understanding of the functional deficits of neurological patients, including those suffering from stroke, traumatic brain injury, dementia, epilepsy, and brain tumors, among others (McKhann et al., 1984; Roman et al., 1993; Leon-Carrion, ibidem; Martelli et al., 2006) Of course, neuropsychologists work in a multidisciplinary setting with primary or consulting physicians such as neurosurgeons, neuroradiologists, and neurorehabilitators. The Social Security Administration has stated that a comprehensive neuropsychological examination, performed by a qualified and specialized neuropsychologist, may be used to establish the existence and extent of compromise of brain function (SSA, 2002). The American Academy of Neurology has rated neuropsychological testing as “Established” with Class II evidence and a Type A recommendation and having ICD diagnoses (National Academy of Neuropsychology, 1996).Goals of Neuropsychiatric Evaluation Paper
Who can perform a neuropsychological assessment?
According to the official position of the Division of Clinical Neuropsychology of the American Psychological Association (APA, 2006), Division 40,the selection of tests, interpretation of those tests, clinical interviewing of patients or family members, and communication of test results and their implications is the sole and exclusive responsibility of the licensed neuropsychologist. Some neuropsychologists elect to use technicians that have a very narrowly defined and highly specific role in the overall process. These technicians are responsible only for the administration and scoring of neuropsychological tests under the supervision of a neuropsychologist who must be a licensed psychologist in that state or province. The ultimate responsibility for testing procedures and training remains with the licensed supervising neuropsychologist. The professional relationship in clinical neuropsychology is between the patient and the licensed neuropsychologist. Fees for service and accountability for the quality of professional work are exclusively the purview of the licensed neuropsychologist.
Is Neuropsychological Assessment reliable and valid?
Most published neuropsychological tests meet the requirements for reliability and validity. Test reliability is defined as the degree to which a test is consistent in measuring a cognitive function, a type of behavior, an emotional characteristic or a mood. A test with optimal reliability is one that gives the same values each time it is administered to a patient (Leon-Carrion, 1995).Goals of Neuropsychiatric Evaluation Paper
In neuropsychological assessment, the most important types of reliability are those of interexaminer and test-retest. Neuropsychological tests require very high reliability. The interexaminer reliability coefficient should be over 0.90, and that of the test-retest should be no lower than 0.85 over a one week period (Rourke & Adams, 1984). Test validity refers to what a test measures and how this is done. Test validity aims to determine if a test actually measures what it claims to measure and if it does so with precision. A test may be valid for measuring a cognitive function such as emotion, for example, but not for measuring reasoning.
The two most important types of validity in neuropsychological assessment are criteria validity and content validity. The validity coefficients should always be over 0.60, and preferably over 0.70. Tests which do not meet this criterion, which must be described in their manuals, should not be applied in neuropsychological assessment. Some neuropsychological tests are very sensitivity and may reveal cognitive or behavioral abnormality in the absence of positive findings in MRI and CT scans. If the tests being used in these cases are considered valid and reliable, then these results should be accepted, for they may indicate the need for further testing using functional neuroimaging, which would explore the cerebral regions associated with the functional deficits found in the neuropsychological assessment. A comprehensive neuropsychological assessment can identify patterns of impairment that are normally not possible to determine through other procedures, thereby indicating the most appropriate treatment recommendations.Goals of Neuropsychiatric Evaluation Paper
Paper-and-pencil neuropsychological-test batteries versus computerized neuropsychological-test batteries
Traditional paper-and-pencil neuropsychological batteries used to explore cognitive deficits in people with acquired brain injury have demonstrated some weaknesses. Traditional tests lack timing precision, making it difficult to accurately measure cognitive and psychomotor slowing in patients. Furthermore, traditional test batteries depend, in large part, on the motor and sensory skills of the examiner, who must take down all the details of the neuropsychological test with precision, particularly that of reaction times or complex and multitask responses. Finally, these traditional batteries may become lengthy and expensive.
Computerized neuropsychological-test batteries improve precision and accuracy, require less administration time, measure response time more precisely, are ideal for rapid screening/triage and most of the people feel comfortable, given that they are accustomed to using their personal computer. The new computerized batteries have been developed with normative data and with the reliability and validity of computerized measures. Both traditional and computerized test batteries identify patients with or without neurocognitive impairment, although computerized batteries seem to increase the accuracy of neuropsychological assessment as well as the accessibility of patients to this kind of testing.Goals of Neuropsychiatric Evaluation Paper