Mr. A, age 38, presents with severe anxiety symptoms that suggest generalized anxiety disorder (GAD). You wish to confirm the diagnosis before starting medication, measure treatment response, and provide documentation to Mr. A’s managed care company.
Miss B, age 73, complains of memory and organization problems. Her history of transient ischemic attacks suggests vascular dementia, but the gradual symptom onset suggests Alzheimer’s dementia. You need to clarify the diagnosis.
Informed use of psychological testing can help you plan treatment by clarifying the causes, diagnosis, and prognosis of patients’ symptoms. With hundreds of instruments available, we offer an overview to help you quickly choose appropriate in-office tools or refer for more-intensive testing.
QUICK BUT IMPERFECT
Checklists and rating scales can quickly gauge a personality trait such as impulsivity or target symptom such as anxiety, using a numerical list of words or statements:
- A checklist’s response format is dichotomous (typically yes/no).
- Rating scales offer greater options, such as a 4-point scale for measuring symptoms as 0 (not present), 1 (mild), 2 (moderate), 3 (severe).
Some checklists/rating scales can assess more than one disorder or target symptom. These wide-band instruments—often called inventories or schedules—tend to be lengthy (1 to 2 hours), often require an interview, and generally require specialized training to administer.1-4
Pros. Two attributes make checklist/rating scales popular in clinical practice: their convenience, and managed care’s quest for documentation of service need, quality of care, cost-effectiveness, and symptom reduction.5 Brief, accurate, efficient checklists/rating scales can help you give managed care firms the documentation they require to authorize continued treatment—whether psychotherapy or medication monitoring.
Cons. Many checklists/rating scales are psychometrically weak, with low reliability and unproven validity. Some are lengthy or have other traits that diminish their clinical value (Table 1).
Table 1
Pros and cons of checklists/rating scales
| Pros |
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| Cons |
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LONGER AND MORE DETAILED
Objective tests typically contain true/false questions for which responses are reported as percentiles or standard scores. Examples are the Minnesota Multiphasic Personality Inventory (MMPI-2), used to clarify axis I diagnoses, and Millon Clinical Multiaxial Inventory (MCMI-III), chiefly used to assess personality disorders. Objective tests’ ability to assess a wide band of psychopathology can help you evaluate patients with complex differential diagnoses.6
Projective tests are unstructured instruments developed to detect covert psychosis and pathologic conflicts/impulses. Patients respond to ambiguous stimuli (inkblots, pictures, incomplete sentences) that are assumed to function as a screen onto which a person projects his or her conflicts and issues.3
Useful projective tests include the Rorschach ink blot test, Thematic Apperception Test (TAT) of interpersonal relationships, and several sentence-completion tests. The Rorschach can take 1 to 2 hours to administer and score and requires years to master. The Rotter Incomplete Sentences Blank (2nd ed) (RISB) is well-constructed; available in high school, college, and adult forms; and can help clarify major conflicts.3
Projective tests’ psychometric properties have been questioned, but the Rorschach is considered useful in detecting subtle psychoses.6
Neuropsychological tests can identify and localize brain injury. Board-certified neuropsychologists (with 2 years’ postdoctoral training) use them to assess traumatic brain injury, evaluate post-stroke syndromes or early dementia, and differentiate dementia and depression.7 These tests also have litigation and forensic applications, such as assessing competence or malingering.
Some neuropsychologists use a comprehensive instrument such as the Halstead-Reitan Neuropsychological Test Battery, which evaluates memory, abstract thought, language, sensory-motor integration, imperception, and motor dexterity. Others may select specific instruments to answer a referring psychiatrist’s question.
CHOOSING AN INSTRUMENT
Medical reference librarians can help research specific instruments and choose useful testing tools. We also recommend Corcoran and Fischer’s Measures for Clinical Practice,8 which provides practical information on administration, advantages, and disadvantages of instruments that:
- are used in clinical practice
- provide data on psychometric properties
- take
- are rapidly scored
- provide information on symptom severity
- can be used to document change.
Table 2
Commonly used checklists/rating scales for adult assessment