IGDA.5: Supplementary assessment procedures psychopathological, neuropsychological and physical aspects
IGDA WORKGROUP, WPA
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5.1
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Supplementary assessment procedures may be used to complement the
psychiatric diagnostic interview. These include procedures for the
comprehensive evaluation of the mental and physical state of the patient
(psychosocial procedures are considered in part 6
(IGDA Workgroup, WPA 2003, this
suppl.)). Psychopathological assessment instruments, biological tests and
procedures and neuropsychological tests are among those used to enrich or
refine data collected in a clinical interview in order to arrive at the
standardised multi-axial diagnostic formulation.
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5.2
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The purposes of these supplementary assessments are:
- to accurately identify and describe signs and symptoms in terms of their
type, extent and severity;
- to increase the reliability and validity of clinical diagnoses, to aid in
the process of differential diagnosis, and to identify potential aetiological
factors;
- to document patients' cognitive skills and limitations for the purposes of
estimating capacity for self-care, treatment adherence, and ability to carry
out activities of daily living;
- to identify particular targets and goals for treatment and rehabilitation
and to measure change over time and treatment outcome;
- to document psychological and behavioural injuries, rehabilitation
potential, and need for treatment; capacity pertinent to legal
proceedings;
- to support research into mental disorder evaluation, treatment and
aetiology.
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5.3
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Various types of supplementary assessment procedures should be considered
for use, including self-rated and observer-rated scales, screening tests and
scales, symptom and diagnostic checklists, semi-structured and fully
structured diagnostic interviews, neuropsychological tests, and biological
tests and procedures.
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5.4
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Choice of a supplementary assessment procedure should be based on a number
of criteria, including the specific purpose intended (e.g. syndrome
identification, symptom severity, clinical change over time); pathological
domain (e.g. depression, dementia, personality functioning); characteristics
of the patient to be tested (e.g. age, educational level, cognitive status);
characteristics of the setting in which the procedure will be used (e.g.
primary care practice, psychiatric hospital, community survey); qualifications
and training of user (e.g. psychiatrist, general medical professional, lay
interviewer); culture of the patient and the evaluator (e.g. first language,
translations, concepts of health and illness); psychometric properties of the
instrument or procedure (e.g. reliability, validity); cultural validation in
the population of interest; and other characteristics (e.g. time frame of
interest, time and cost of administration, training required).
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5.5
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Diagnostic checklists and interviews are useful for trained clinicians to
ensure that adequate information has been gathered from the patient,
informants or other sources, so that a differential nosological diagnosis
according to specified diagnostic criteria (as set out in one of the
international classifications of mental disorders) can be made.
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5.6
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Brief screening scales or instruments that include exploratory questions
and symptom or diagnostic checklists are useful when large numbers of patients
or community residents are to be examined for possible mental or physical
disorders, with positive cases referred for more extensive evaluation.
Instruments that can be administered by a primary care physician or a
less-qualified health worker are useful when a mental health clinician is not
available. Rating scales for psychopathological symptoms or syndromes
identified with Likert or visual analogue scales of frequency or severity are
useful to ascertain initial levels of symptom severity and to measure change
over time.
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5.7
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The assessment of psychodynamic and cognitivebehavioural
perspectives on psychopathology should be considered, through systematic
procedures, especially when these assessments are contributory to a better
understanding of the clinical condition or to treatment planning.
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5.8
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Neuropsychological assessment helps to ascertain mental and neurological
factors and causes of symptoms and disorders and to localise sites of lesions.
Neuropsychological tests also appraise cognitive strengths and weaknesses and
other behavioural capacities of the patient for the purpose of planning
treatment and rehabilitation.
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5.9
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Physical examination and laboratory tests (e.g. of blood or urine) are
useful to rule in or out general medical conditions or substances of misuse as
a case of mental disorders, and also aid in the diagnosis of other physical
conditions or disorders that might affect treatment or clinical management.
Brain imaging such as computed tomography or magnetic resonance imaging is
helpful in documenting structural and functional brain abnormalities.
Electrophysiological tests such as electroencephalography can identify
abnormal brainwave activity. All of these procedures help in formulating a
more definitive clinical diagnosis.
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5.10
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The effective use of supplementary psychopathological, neuropsychological
and biological assessment procedures requires appropriate training in their
application. The competent interpretation of the results requires training in
and familiarity with indications for use, applications to particular patient
groups and settings, and strengths and weaknesses of the procedures
involved.
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FURTHER READING
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American Psychiatric Association (2000)
Handbook of Psychiatric Measures. Washington, DC:
APA.
Bech, P. (1993) Rating Scales for
Psychopathology. Health Status and Quality of Life: A Compendium on
Documentation in Accordance with the DSMIIIR and WHO
Systems. Berlin: Springer.
IGDA Working Group, WPA (2003) IGDA. 6:
Supplementary assessment procedures functioning, social context,
cultural framework and quality of life. British Journal of
Psychiatry, 182 (suppl. 45),
s50-s51.[Free Full Text]
Mezzich, J. E., Jorge M. R. & Salloum, I. M.
(1994) Psychiatric Epidemiology: Assessment
Methods. Baltimore, MD: Johns Hopkins University
Press.
Robin, L. N., Wing, J., Wittchen, H.-U., et al
(1988) The Composite International Diagnostic Interview. An
epidemiologic instrument suitable for use in conjunction with different
diagnostic systems and in different cultures. Archives of General
Psychiatry, 45,
1069-1077.[Abstract]
Sartorius, N. & Jança, A. (1996)
Psychiatric assessment instruments developed by the World Health Organization.
Social Psychiatry and Psychiatric Epidemiology,
31, 55-69.[Medline]