Psychometry – 2

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48 Psychometry – 2

Salbu Krishnan, Deborah McCartney

	T	F
1. The Bannister-Fransella Grid is a personality test.
2. The Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (Ham-D) are used differently.
3. The Camberwell Assessment of Need (CAN) is used in the general population.
4. The likelihood of Alzheimer’s disease over vascular dementia can be confirmed by a defective clock face drawing.
5. The ‘draw a person’ test is used to distinguish between dementia and depressive pseudodementia.
6. The GHQ is frequently used for psychiatric diagnosis.
7. Hare’s Psychopathy Checklist is validated for use in the general population.
8. The Halstead–Reitan Battery is used for bedside cognitive function assessment.
9. The Ham-D has more cognitive items than the MADRS.
10. Hayling’s test assesses spatial accommodation.
11. Kendrick Assessment Scales help to distinguish between dementia and depressive pseudodementia.
12. The McCollough effect always includes a visual percept.
13. A Mini Mental State Examination (MMSE) score of below 24 is 60% specific for dementia in the over-65 age group.
14. The reverse calendar test is a semi-quantitative test of cognitive function.
15. Compared to patients with dementia, patients with depressive pseudodementia do less well on the Paired Associated Learning Test.
16. The General Health Questionnaire (GHQ) is used to assess premorbid personality.
17. The Raven’s Progressive Matrices test gives a percentile score.
18. In assessment of cognitive function, registration is tested by asking the patient to give their telephone number.
19. The Rorschach test is used to measure attitudes.
20. The Stanford–Binet scale is used to assess people with learning disabilities.
21. Sternberg defined the meta-components of intelligence.
22. The Thematic Apperception Test is used to assess personality.
23. The Wechsler Adult Intelligence Scale (WAIS-III) has five verbal and six performance components.
24. In dementia there is a differential drop in verbal and performance IQ.
25. The Wisconsin Card Sorting Test (WCST) is a test for planning.

ANSWERS

1. The Bannister-Fransella Grid is a personality test.

False: The Bannister-Fransella Grid is a test of schizophrenic thought disorder, not personality.

2. The Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (Ham-D) are used differently.

True: The interviewer completes the Ham-D based on an unstructured interview, using his own observations and information from the patient. It measures the severity of the depressive syndrome. The BDI has 21 items, with 4 statements each. The patients complete them themselves by choosing the statements that best apply to their feelings in the previous week (Gelder et al 2006, p. 66).

3. The Camberwell Assessment of Need (CAN) is used in the general population.

False: CAN is used to assess the health and social needs of people with severe mental health problems. It is not for use in the general population. CANE is the version for the elderly mentally ill (Gelder et al 2006, p. 625).

4. The likelihood of Alzheimer’s disease over vascular dementia can be confirmed by a defective clock face drawing.

False: In the clock drawing test the patient is asked to draw a clock face, marking the hours, and then to draw the hands to indicate a particular time, e.g. 10 minutes past 11. It tests comprehension, motor function, visuospatial integrity, numerical knowledge and executive function. It is simple to administer, requires no special equipment, is non-threatening and takes only 2 minutes to administer. Common errors in Alzheimer’s disease include perseveration, counter-clockwise numbering, absence of numbers and irrelevant spatial arrangement. Errors in vascular dementia may reflect spatial neglect, hemianopsia, sensory loss and cognitive dysfunction. Patients with Alzheimer’s disease may do better on copying compared to those with vascular dementia. As a screening test for dementia, it has a sensitivity and specificity of 85%. It cannot differentiate between dementias, and it may be affected by delirium, dysphasia and neglect (Mitchell 2004, p. 86; Sadock & Sadock 2005, p. 872).

5. The ‘draw a person’ test is used to distinguish between dementia and depressive pseudodementia.

False: The ‘draw a person’ test is a projective personality measure. Normative data for ages 4–89 years is available. The subject is asked to draw people of both genders. The picture is then analysed to gain insight into the subject’s personality and emotional state. Egodystonic unacceptable impulses are often drawn in association with the opposite sex figure whilst the converse is true of acceptable impulses. Some features are held to be more specific, e.g. large eyelashes may be a feature of hysteria. Some features have been correlated with non-verbal intelligence and visuomotor and cognitive functions. Some clinicians use the drawings primarily as a screening technique, particularly to detect brain damage. It is not used to distinguish dementia from depressive pseudodementia (Aiken 2000, p. 334; Sadock & Sadock 2002, p. 185; Sadock & Sadock 2005, p. 3068).

6. The GHQ is frequently used for psychiatric diagnosis.

False: The General Health Questionnaire is a non-specific screening tool for identifying ‘caseness’ in the community, general medical and primary care settings. It is a screening instrument and not a diagnostic instrument. It is a self-rated questionnaire. The original version has 60 items that can be completed in 10 minutes. Shorter versions with 30, 28 and 20 items are available (Gelder et al 2000, p. 1527; Wright et al 2005, p. 127).

7. Hare’s Psychopathy Checklist is validated for use in the general population.

False: The 22-item Hare’s Psychopathy Check List (PCL) and its 20-item revised version (PCL-R) are used to measure traits of psychopathic personality disorder in forensic populations. It has not been validated for use in the general population. It is completed based on a semi-structured interview lasting 90–120 minutes. The items are rated on a 3-point scale: 1= item does not apply, 2 = item applies somewhat, 3 = item definitely applies (Wright et al 2005, p. 476).

8. The Halstead–Reitan Battery is used for bedside cognitive function assessment.

False: The Halstead–Reitan Neuropsychological Test Battery is an extensive battery of tests designed for a comprehensive assessment of brain damage, i.e. to detect brain damage, to indicate whether it is focal, diffuse or lateralized, and whether it is acute and progressive or relatively static. Some of the principal tests are Trail making test, Halstead’s category test, Critical flicker frequency test, Tactual performance test, Rhythm test, Speech sounds perception test, Finger trapping test, Time sense test and H-A aphasia screening test (Hodges 1994, p. 217; Lishman 1997, p. 121).

9. The Ham-D has more cognitive items than the MADRS.

False: The Montgomery-Åsberg Depression Rating Scale (MADRS) has 10 items concerned with psychological aspects of depression. The Ham-D is concerned with somatic and behavioural features, rather than cognitive features, of depression.

10. Hayling’s test assesses spatial accommodation.

False: Hayling’s sentence completion test is designed to assess executive functions such as response initiation and response inhibition (Halligan et al 2003, p. 315).

11. Kendrick Assessment Scales help to distinguish between dementia and depressive pseudodementia.

False: Kendrick Assessment Scales of Cognitive Ageing are intended to test cognitive abilities in people without known neuropsychiatric disturbance. They can act as an early warning signal of dementia, indicating a possible need for further assessment or treatment and to provide a baseline for further assessments. They measure the four areas of cognitive function affected in normal ageing, i.e. short-term memory, speed of information processing, reasoning and visuospatial ability. They take about 15 minutes to complete. They do not help distinguish between dementia and depressive pseudodementia.

12. The McCollough effect always includes a visual percept.

True: The McCollough effect occurs when, following exposure to a grid of lines of different colours, a grid of black lines may subsequently be seen as edged with the previously seen colours. It is a contingent after-effect visual adaptation being created by a combination of colour and orientation.

13. A Mini Mental State Examination (MMSE) score of below 24 is 60% specific for dementia in the over-65 age group.

False: Using a cut-off score of 24 the MMSE has a specificity of greater than 60%. Initial values quoted were a specificity of 82% and a sensitivity of 87%. These figures have been questioned as they were obtained in a group of hospitalized and possibly delirious elderly. Despite this, subsequent series have still shown specificity of better than 60% (Hodges 1994, p. 184; Jacoby & Oppenheimer 2002, p. 621; Lishman 1997, p. 123).

14. The reverse calendar test is a semi-quantitative test of cognitive function.

True: The ability to recite familiar sequences backwards is a test of concentration. This is often disrupted in delirium. If the patient is unable to manage months of the year, days of the week may be attempted. It is in a sense semi-quantitative because the number of errors can be counted (Hodges 1994, p. 111).

15. Compared to patients with dementia, patients with depressive pseudodementia do less well on the Paired Associated Learning Test.

False: The Paired Associated Learning Test is a new word learning task. It gives a quantitative estimate of memory impairment. It is not used to differentiate between dementia and pseudodementia (Lishman 1997, p. 114).

16. The General Health Questionnaire (GHQ) is used to assess premorbid personality.

False: The GHQ is a self-rated questionnaire used to screen for potential psychiatric cases. It gives a measure of current psychiatric health. It does not provide information about premorbid personality (Gelder et al 2006, p. 66).

17. The Raven’s Progressive Matrices test gives a percentile score.

True: The Raven’s Progressive Matrices test was developed as a test of Spearman’s general intelligence factor. It is considered as a ‘culture fair’ test of general intellectual ability. It consists of 60 visually based problem-solving tests arranged in 5 sets of 12 problems of increasing complexity. Each test is a pattern set with a missing piece that the subject must choose from a multiple choice. It initially tests simple pattern matching and moves on to more abstract, complex visuospatial reasoning. The test is simple to administer and takes 20–45 minutes to complete. The raw scores are converted to a percentile. Normative data with percentile scores are available for ages 8 to 65 (Aiken 2000, p. 156; Hodges 1994, p. 207).

18. In assessment of cognitive function, registration is tested by asking the patient to give their telephone number.

False: Registration, used in the context of whether facts are being encoded for recall, is usually assessed as part of the MMSE. The examiner names three objects. The patient is asked to repeat the three words. One point is given for each correct answer.

If a patient can recall an already known telephone number, this would suggest that long-term memory may be unaffected, but this does not tell us whether the patient can register new information.

19. The Rorschach test is used to measure attitudes.

True: The Rorschach Ink Blot test is a projective personality test. The subject is shown a series of 10 standard inkblots, one at a time, and asked to describe what they can see. Initially free association is used. Then the clinician may ask questions. Responses are analysed according to the part of the blot talked about, elements of the blots discussed (colour, shape, etc.) and what the blot is held to represent. Though attempts have been made at standardizing interpretations, the validity of these is questionable.

Attitudes are likes and dislikes, i.e. favourable and unfavourable evaluations of and reactions to objects, people, situations or other aspects of the world.

Even though questionnaires are most commonly used to measure attitudes, personality tests such as the Rorschach test, Thematic Apperception Test and Kelly’s Repertory Grid can be used to measure attitudes (Atkinson et al 2000, pp. 466, 658; Fear 2004, p. 18; Wright et al 2005, p. 78).

20. The Stanford–Binet scale is used to assess people with learning disabilities.

True: The Stanford–Binet Intelligence scale consists of pictures, drawings and objects. It gives a mental age score. It provides useful information about people functioning below the standard cut-off score on the Wechsler Intelligence Scales (Gelder et al 2006, p. 659).

22. The Thematic Apperception Test is used to assess personality.

True: The Thematic Apperception Test is a widely used projective test of personality for adults. The subject is shown up to 20 ambiguous pictures of persons and themes and asked to make up a story about what is going on in each picture. The stories are analysed for recurrent themes that may reveal the subject’s ideas, attitudes, needs, motives and characteristic ways of handling interpersonal relationships (Aiken 2000, p. 337; Fear 2004, p. 18).

23. The Wechsler Adult Intelligence Scale (WAIS-III) has five verbal and six performance components.

False: The Wechsler Adult Intelligence Scale (WAIS-III) has a verbal scale with six compulsory and one optional subtests and a performance scale with five compulsory and two optional subtests. Note that this is different from the older WAIS-R.

The six compulsory subtests of the verbal scale include Arithmetic, Comprehension, Digit span, Information, Similarities and Vocabulary. Letter–number sequencing is optional.

The performance scale includes Block design, Digit symbol-coding, Matrix reasoning, Picture arrangement and Picture completion. Symbol search and Object assembly are optional.

By summating the subset scores and adjusting for age, Verbal, Performance and full IQ, scores can be derived. An average person should score 100 with a standard deviation of 15.

It is a quantitative test battery, with careful timing on some subtests. It is designed to measure intelligence. If repeated after a delay of some months or years, it can identify intellectual deterioration.

There is a deterioration index (DI) to compare scores on the WAIS that tend to be preserved in old age (those that ‘hold’) compared to those that are likely to decrease (don’t hold) in the normal population.

A discrepancy of at least 15 IQ points between the Verbal score and the Performance score is considered significant (Hodges 1994, p. 222; Johnstone et al 2004, p. 142; Lishman 1997, p. 110).

24. In dementia there is a differential drop in verbal and performance IQ.

True: Diffuse brain damage tends to disproportionately lower performance IQ.

However, the opposite might occur in 5% of cases. The performance scale is more sensitive to normal ageing than the verbal scale and the verbal scale is more sensitive to education (Lishman 1997, p. 111; Mitchell 2004, p. 58; Sadock & Sadock 2002, p. 180).

25. The Wisconsin Card Sorting Test (WCST) is a test for planning.

False: The WCST was designed to study abstract thinking and set-shifting ability. It may also test non-verbal reasoning. It is not a test of planning.

The test involves cards with different symbols, e.g. stars, circles or triangles. The number of symbols on each card and their colours vary. The first card is placed down and the examiner creates a rule for which further cards should be matched, e.g. shape, number or colour. When the subject puts a subsequent card down the examiner simply says ‘yes’ or ‘no’ until the subject has calculated the rule for matching. Then, the examiner changes the rule. Deficits in motivation, abstract thinking and the verbal regulation of behaviour may contribute to poor performance on WCST (Hodges 1994, p. 226; Lishman 1997, p. 118; Mitchell 2004, p. 78).

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