PSYCHOLOGICAL TOOLS IN
ASSESSING ABNORMAL BEHAVIOUR : LECTURE NOTE
Debdulal Dutta Roy
Psychology Research Unit
Indian Statistical Institute
203, B.T. Road
Kolkata – 700 108
In Psychiatry, psychological assessment plays an important role in understanding patient’s strength and weakness, the underlying reasons for the current situation, and the prognosis of the disorder. Thorough evaluation of the test findings provides insights in selection of specific psychiatric medicines, its dosage, specific counseling, specific psychotherapeatutic treatment strategies and possible sessions. Mere knowledge about period of hospitalization or other treatment, discharge or readmission to hospital, length of relationships or employment, the presence of legal trouble are not sufficient to understand the intensity and etiology of diseases. Both intensity and etiology of disease are important to make differential diagnosis. Figure 1 shows steps of Psychological testing in Psychiatric treatment
Case History ---->Mental Status Examination---->Hypotheses framing----->Selection of tests-------> Test administration------->Differential Diagnosis------>Planning for Psychiatric treatment
Fig.1 : Steps of Psychological testing in Psychiatric treatment
ASSESSING ABNORMAL BEHAVIOUR : LECTURE NOTE
Debdulal Dutta Roy
Psychology Research Unit
Indian Statistical Institute
203, B.T. Road
Kolkata – 700 108
In Psychiatry, psychological assessment plays an important role in understanding patient’s strength and weakness, the underlying reasons for the current situation, and the prognosis of the disorder. Thorough evaluation of the test findings provides insights in selection of specific psychiatric medicines, its dosage, specific counseling, specific psychotherapeatutic treatment strategies and possible sessions. Mere knowledge about period of hospitalization or other treatment, discharge or readmission to hospital, length of relationships or employment, the presence of legal trouble are not sufficient to understand the intensity and etiology of diseases. Both intensity and etiology of disease are important to make differential diagnosis. Figure 1 shows steps of Psychological testing in Psychiatric treatment
Case History ---->Mental Status Examination---->Hypotheses framing----->Selection of tests-------> Test administration------->Differential Diagnosis------>Planning for Psychiatric treatment
Fig.1 : Steps of Psychological testing in Psychiatric treatment
Assessment is usually made by Psychological tests. The tests are classified into different types.
CLASSIFICATION OF TESTS
In general tests used for psychiatric purposes are classified broadly from two perspectives- (a) mode of administration and (b) subjectivity (Fig. 2).
Individual and objective tests:
- STAI,
- EPQ,
- 16PF,
- EPQ,
- BDI,
- HAS,
- HRSD
- WAIS/ WISC
Group and objective tests:
- STAI,
- EPQ,
- 16PF,
- EPQ,
Individual and Projective tests
- Rorschach
- TAT/CAT
- SCT
- DAP/HTP
Group and Projective tests
- SCT
Individual VS Group Test
In case of individually administered test, examiner’s constant observation of testee’s behaviour is necessary. But this is not very important in case of group testing..
Projective Test VS Objective Tests
Projective test is a personality test designed to let a person respond to ambiguous stimuli, presumably revealing hidden emotions and internal conflicts. On the other hand, testees interact with universally accepted unambiguous stimuli in objective testing. In projective testing, responses are analyzed using clinical experience of examiners therefore, there is a high possibility of subjective errors in scoring the test findings. On the other hand, in objective test, responses are analyzed according to a universal standard and scoring is least affected by the subjective errors. Besides above, tests are classified in terms of age. Some tests like WISC, CAT, VSMS are applicable for children but WAIS, TAT are for adults. Therefore, one must be very careful about the selection of tests. Besides selection, examiner must be very careful about the administration, scoring, and interpretation of the test findings.
ADMINISTRATION OF TESTS
Tests are used to validate possible hypotheses which are framed based on case history. Case history provides insights about possible hypotheses, selection of tests and how to administer the tests. During administration, one must be very careful about current state of the patient, his socio cultural economic and educational condition. If the patient is non- cooperative, it is better to observe patient’s behavior to different stimulation using structured checklist. Test items may be modified based on socio cultural economic and educational condition of the patient. There are some tests where in strict instruction should be carefully followed and there are some tests where in examiner can maintain some flexibility. For example, in case of Rorschach test, one may use half test as odd-even reliability and two halves reliability of Rorschach is highly correlated in significant manner. Again, one may use one or two cards of TAT instead of all. But such flexibility is not possible in case of STAI, HAS, HRSD, BDI, EPQ etc. Above all, test administrator must have expertise in personality theories and in clinical or abnormal psychology.
INTERPRETATION
After administration of tests, it must be scored following specific scoring strategy. Objective tests follow standardized scoring procedure but projective tests are more flexible in scoring. Both qualitative and quantitative scoring techniques can be used in projective tests. Long term clinical experience and expertise in abnormal psychology are important in qualitative scoring. Using specific norms, the findings can be interpreted in objective testing.
It is advisable to make correspondence map with different test data. This will give clear outline about the pattern of relationship among the variables. In correspondence map, one should integrate the case history, test behavior, intellectual and personality functioning (reality testing ability, impulse control, manifest depression and guilt, manifestation of major dysfunctions, major defenses, overt symptoms, interpersonal conflicts, self concepts, affects). Since, test administration and interpretation are test specific, it is important to understand description of psychological tests. Below are description of few tests used in assessing different abnormal behavior.
WECHSLER ADULT INTELLIGENCE SCALE
Wechsler Adult Intelligence Scale or WAIS is a general test of intelligence (IQ), published in February 1955 as a revision of the Wechsler-Bellevue test (1939), standardised for use with adults over the age of 16. Intelligence is quantified as the global capacity of the individual to act purposefully, to think rationally, and to deal effectively with the environment.
Description
The full scale IQ is broken down into 14 subtests, comprising the verbal (7 subtests) and performance scales (7 subtests). Wechsler's tests provide three scores: verbal IQ, performance IQ , composite, single full-scale IQ score based on the combined scores.
WAIS-R was standardised in 1981 on a sample of 1,880 US subjects, ranging from 16 to 74 years of age, broken down into 9 different age groups. It is considered to have very strong reliability. The current version is WAIS-III (1997). The average full-scale IQ is 100, with a standard deviation of 15 (above and below the mean). This is the average IQ range where most adults would fall.
Test variants
The WAIS-III measure is appropriate throughout adulthood and for use with those individuals over 74 years of age. For persons under 16, the Wechsler Intelligence Scale for Children (WISC, 7-16 yrs) and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI, 2 1/2-7 yrs) are used. An IQ score can be obtained without administering the verbal section of the test since each section yields its own score. Neuropsychologists use the technique on people suffering brain damage as it leads to links with which part of the brain has been affected, or use specific subtests in order to get an idea of the extent of the brain damage. For example, digit span may be used to get a sense of attentional difficulties. However, this is usually done with a separate version of the WAIS, known as the WAIS-R NI (Wechsler Adult Intelligence Scale-Revised as a Neuropsychological Instrument). Each subtest score is tallied and calculated with respect to non-normal or brain-damaged norms. As the WAIS is developed for the average, non-injured individual, separate norms were developed for appropriate comparison among similar functioning individuals. A short, four-subtest, version of the battery has recently been released, allowing clinicians to form a validated estimate of verbal, performance and full scale IQ in a shorter amount of time. The Wechsler Abbreviated Scale of Intelligence (WASI) uses the vocabulary, similarities, block design and matrix reasoning subtests of the WAIS to provide an estimate of the full IQ scores.
Subtests of the WAIS-III
Verbal Subtests
· Information : Degree of general information acquired from culture (e.g. Who is the premier of Victoria?)
· Comprehension : Ability to deal with abstract social conventions, rules and expressions (e.g. What does - Kill 2 birds with 1 stone metaphorically mean?)
· Arithmetic : Concentration while manipulating mental mathematical problems (e.g. How many 45c. stamps can you buy for a dollar?)
· Similarities/Differences : Abstract verbal reasoning (e.g. In what way are an apple and a pear alike and/or unalike?)
· Vocabulary: The degree to which one has learned, been able to comprehend and verbally express vocabulary (e.g. What is a guitar?)
· Digit span: attention/concentration (e.g. Digits forward: 123, Digits backward 321.)
· Letter-Number Sequencing : attention and working memory (e.g. Given Q1B3J2, place the numbers in numerical order and then the letters in alphabetical order)
Performance Subtests
· Picture Completion Ability to quickly perceive visual details
· Digit Symbol - Coding
· Visual-motor coordination, motor and mental speed
· Block Design : Spatial perception, visual abstract processing & problem solving
· Matrix Reasoning : Nonverbal abstract problem solving, inductive reasoning, spatial reasoning
· Picture Arrangement : Logical/sequential reasoning, social insight
· Symbol Search : Visual perception, speed
· Object Assembly : Visual analysis, synthesis, and construction
· Optional post-tests include Digit Symbol - Incidental Learning and Digit Symbol - Free Recall.
RORSCHACH INKBLOT TEST
Rorschach Psychodiagnostic Test is the most widely used projective psychological test. The Rorschach is used to assess personality structure and identify emotional problems. Like other projective techniques, it is based on the principle that subjects viewing neutral, ambiguous stimuli will project their own personalities onto them, thereby revealing a variety of unconscious conflicts and motivations. Administered to both adolescents and adults, the Rorschach can also be used with children as young as three years old. The test provides information about a person's thought processes, perceptions, motivations, and attitude toward his or her environment, and it can detect internal and external pressures and conflicts as well as illogical or psychotic thought patterns.
The Rorschach technique is named for Swiss psychiatrist Hermann Rorschach (1884-1922), who developed it. Rorschach, whose primary interest was in Jungian analysis, began experimenting with inkblots as early as 1911 as a means of determining introversion and extroversion. The Rorschach technique is administered using 10 cards, each containing a complicated inkblot pattern, five in color and five in black and white. Subjects look at the cards one at a time and describe what each inkblot resembles. After the subject has viewed all 10 cards, the examiner usually goes back over the responses for additional information. The subject may be asked to clarify some responses or to describe which features of each inkblot prompted the responses.
SCORING & INTERPRETATIONS
Test scores are based on several factors. One is location, or what part of the blot a person focuses on: the whole blot (W), sections of it (D), or only specific details (Dd). Another is whether the response is based on factors such as form, color, movement, or shading (referred to as determinants). For example, people who tend to see movement in Rorschach blots are thought to be intellectual and introspective; those who see mostly stationary objects or patterns are described as practical and action-oriented. Finally, content refers to which objects, persons, or situations the person sees in the blot (categories include humans, animals, clothing, and nature). Most examiners also assess responses based on the frequency of certain responses as given by previous test takers. Many psychologists interpret the test freely according to their subjective impressions, including their impression of the subject's demeanor while taking the test (cooperative, anxious, defensive, and so forth). Such interpretations, especially when combined with clinical observation and knowledge of a client's personal history, can help a therapist arrive at a more expansive, in-depth understanding of the client's personality.
PRECAUTIONS
While the Rorschach technique is still widely used, its popularity has decreased somewhat in recent decades. Unlike objective personality inventories, which can be administered to a group, the Rorschach test must be given individually. A skilled examiner is required, and the test can take several hours to complete and interpret. Like other projective tests, it has been criticized for lack of validity and reliability. Interpretation of responses is highly dependent on an examiner's individual judgment: two different testers may interpret the same responses quite differently. In addition, treatment procedures at mental health facilities often require more specific, objective types of personality description than those provided by the Rorschach technique.
THEMATIC APPERCEPTION TEST
Thematic Apperception Test or TAT was developed by the American psychologists Henry A. Murray and Christiana D. Morgan at Harvard during the 1930s to explore the underlying dynamics of personality, such as internal conflicts, dominant drives, interests, and motives. After World War II, the TAT was adopted more broadly by psychoanalysts and clinicians to evaluate emotionally disturbed patients. Later, in the 1970s, the Human Potential Movement encouraged psychologists to use the TAT to help their clients understand themselves better and stimulate personal growth. Thematic Apperception Test or TAT is the most widely used, researched projective psychological tests. Its adherents claim that it taps a subject's unconscious to reveal repressed aspects of personality, motives and needs for achievement, power and intimacy, and problem-solving abilities.
ADMINISTRATION
The TAT is popularly known as the picture interpretation technique because it uses a standard series of 30 provocative yet ambiguous pictures about which the subject must tell a story. In the case of adults and adolescents of average intelligence, a subject is asked to tell as dramatic a story as they can for each picture, including:
· what has led up to the event shown
· what is happening at the moment
· what the characters are feeling and thinking, and
· what the outcome of the story was.
For children or individuals of limited cognitive abilities, instructions ask that the subject tell a story including what happened before and what is happening now, what the people are feeling and thinking and how it will come out.
The 30 cards are meant to be divided into two "series" of 15 pictures each, with the pictures of the second series being purposely more unusual, dramatic, and bizarre than those of the first. Suggested administration involves one full hour being devoted to a series, with the two sessions being separated by a day or more. Several cards in the test are present in order to ensure that the subject is able to be provided with cards picturing individuals of the same gender. Eleven cards (including the blank card) have been found suitable for both sexes, by portraying no human figures, an individual of each sex, or an individual of ambiguous gender. Each story created by a subject is carefully analyzed to uncover underlying needs, attitudes, and patterns of reaction. The TAT is a projective test in that, like the Rorschach test, its assessment of the subject is based on what he or she projects onto the ambiguous images.
Scoring Systems
There are several formal scoring systems that have been developed for analyzing TAT stories. Two common methods that are currently used in research are the Defense Mechanisms Manual (Cramer, 1991) and Social Cognition and Object Relations (Westen, 1991)scale.
PRECAUTIONS
Declining adherence to the Freudian principle of repression on which the test is based has caused the TAT to be criticised as false or outdated by many professional psychologists. Their criticisms are that the TAT is unscientific because it cannot be proved to be valid (ie that it actually measures what it claims to measure), or reliable, (ie that gives consistent results over time, due to the challenge of standardising interpretations of the stories produced by subjects).
Rorschach Psychodiagnostic Test is the most widely used projective psychological test. The Rorschach is used to assess personality structure and identify emotional problems. Like other projective techniques, it is based on the principle that subjects viewing neutral, ambiguous stimuli will project their own personalities onto them, thereby revealing a variety of unconscious conflicts and motivations. Administered to both adolescents and adults, the Rorschach can also be used with children as young as three years old. The test provides information about a person's thought processes, perceptions, motivations, and attitude toward his or her environment, and it can detect internal and external pressures and conflicts as well as illogical or psychotic thought patterns.
The Rorschach technique is named for Swiss psychiatrist Hermann Rorschach (1884-1922), who developed it. Rorschach, whose primary interest was in Jungian analysis, began experimenting with inkblots as early as 1911 as a means of determining introversion and extroversion. The Rorschach technique is administered using 10 cards, each containing a complicated inkblot pattern, five in color and five in black and white. Subjects look at the cards one at a time and describe what each inkblot resembles. After the subject has viewed all 10 cards, the examiner usually goes back over the responses for additional information. The subject may be asked to clarify some responses or to describe which features of each inkblot prompted the responses.
SCORING & INTERPRETATIONS
Test scores are based on several factors. One is location, or what part of the blot a person focuses on: the whole blot (W), sections of it (D), or only specific details (Dd). Another is whether the response is based on factors such as form, color, movement, or shading (referred to as determinants). For example, people who tend to see movement in Rorschach blots are thought to be intellectual and introspective; those who see mostly stationary objects or patterns are described as practical and action-oriented. Finally, content refers to which objects, persons, or situations the person sees in the blot (categories include humans, animals, clothing, and nature). Most examiners also assess responses based on the frequency of certain responses as given by previous test takers. Many psychologists interpret the test freely according to their subjective impressions, including their impression of the subject's demeanor while taking the test (cooperative, anxious, defensive, and so forth). Such interpretations, especially when combined with clinical observation and knowledge of a client's personal history, can help a therapist arrive at a more expansive, in-depth understanding of the client's personality.
PRECAUTIONS
While the Rorschach technique is still widely used, its popularity has decreased somewhat in recent decades. Unlike objective personality inventories, which can be administered to a group, the Rorschach test must be given individually. A skilled examiner is required, and the test can take several hours to complete and interpret. Like other projective tests, it has been criticized for lack of validity and reliability. Interpretation of responses is highly dependent on an examiner's individual judgment: two different testers may interpret the same responses quite differently. In addition, treatment procedures at mental health facilities often require more specific, objective types of personality description than those provided by the Rorschach technique.
THEMATIC APPERCEPTION TEST
Thematic Apperception Test or TAT was developed by the American psychologists Henry A. Murray and Christiana D. Morgan at Harvard during the 1930s to explore the underlying dynamics of personality, such as internal conflicts, dominant drives, interests, and motives. After World War II, the TAT was adopted more broadly by psychoanalysts and clinicians to evaluate emotionally disturbed patients. Later, in the 1970s, the Human Potential Movement encouraged psychologists to use the TAT to help their clients understand themselves better and stimulate personal growth. Thematic Apperception Test or TAT is the most widely used, researched projective psychological tests. Its adherents claim that it taps a subject's unconscious to reveal repressed aspects of personality, motives and needs for achievement, power and intimacy, and problem-solving abilities.
ADMINISTRATION
The TAT is popularly known as the picture interpretation technique because it uses a standard series of 30 provocative yet ambiguous pictures about which the subject must tell a story. In the case of adults and adolescents of average intelligence, a subject is asked to tell as dramatic a story as they can for each picture, including:
· what has led up to the event shown
· what is happening at the moment
· what the characters are feeling and thinking, and
· what the outcome of the story was.
For children or individuals of limited cognitive abilities, instructions ask that the subject tell a story including what happened before and what is happening now, what the people are feeling and thinking and how it will come out.
The 30 cards are meant to be divided into two "series" of 15 pictures each, with the pictures of the second series being purposely more unusual, dramatic, and bizarre than those of the first. Suggested administration involves one full hour being devoted to a series, with the two sessions being separated by a day or more. Several cards in the test are present in order to ensure that the subject is able to be provided with cards picturing individuals of the same gender. Eleven cards (including the blank card) have been found suitable for both sexes, by portraying no human figures, an individual of each sex, or an individual of ambiguous gender. Each story created by a subject is carefully analyzed to uncover underlying needs, attitudes, and patterns of reaction. The TAT is a projective test in that, like the Rorschach test, its assessment of the subject is based on what he or she projects onto the ambiguous images.
Scoring Systems
There are several formal scoring systems that have been developed for analyzing TAT stories. Two common methods that are currently used in research are the Defense Mechanisms Manual (Cramer, 1991) and Social Cognition and Object Relations (Westen, 1991)scale.
PRECAUTIONS
Declining adherence to the Freudian principle of repression on which the test is based has caused the TAT to be criticised as false or outdated by many professional psychologists. Their criticisms are that the TAT is unscientific because it cannot be proved to be valid (ie that it actually measures what it claims to measure), or reliable, (ie that gives consistent results over time, due to the challenge of standardising interpretations of the stories produced by subjects).
HAMILTON ANXIETY RATING SCALE
Description
The Hamilton Anxiety Scale (HAS or HAMA) is a 14-item test measuring the severity of anxiety symptoms. It is also sometimes called the Hamilton Anxiety Rating Scale (HARS). The HAS was developed by Max Hamilton in 1959. It provides measures of overall anxiety, psychic anxiety (mental agitation and psychological distress), and somatic anxiety (physical complaints related to anxiety). Hamilton developed the HAS to be appropriate for adults and children; although it is most often used for younger adults, there has been support for the test's use with older adults as well. Hamilton developed the scale by utilizing the statistical technique of factor analysis. Using this method, he was able to generate a set of symptoms related to anxiety and further determine which symptoms were related to psychic anxiety and which were related to somatic anxiety. The HAS is used to assess the severity of anxiety symptoms present in children and adults. It is also used as an outcome measure when assessing the impact of anti-anxiety medications, therapies, and treatments and is a standard measure of anxiety used in evaluations of psychotropic drugs. The HAS can be administered prior to medication being started and then again during follow-up visits, so that medication dosage can be changed in part based on the patient's test score.
Administration
The HAS is administered by an interviewer who asks a semi-structured series of questions related to symptoms of anxiety. The interviewer then rates the individuals on a five-point scale for each of the 14 items. Seven of the items specifically address psychic anxiety and the remaining seven items address somatic anxiety. For example, the third item specifically addresses fears related to anxiety, the fifth item addresses insomnia and sleeping difficulties related to anxiety, and the tenth item addresses respiratory symptoms related to anxiety. According to Hamilton, examples of psychic symptoms elicited by the HAS interview include a general anxious mood, heightened fears, feelings of tension, and difficulty concentrating. Examples of somatic symptoms include muscular pain, feelings of weakness, cardiovascular problems, and restlessness.
Precautions
The test has been criticized on the grounds that it does not always discriminate between people with anxiety symptoms and those with depressive symptoms (people with depression also score fairly high on the HAS). Because the HAS is an interviewer-administered and rated measure, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can impact the results. For this reason, some people prefer self-report measures where scores are completely based on the interviewee's responses.
HAMILTON RATING SCALE FOR DEPRESSION
The Hamilton Depression Rating Scale (HAM-D) is a 21-question multiple choice questionnaire measuring severity of a patient’s depression.. It was originally published in 1960 by Max Hamilton, and is presently one of the most commonly used scales for rating depression in medical research. The questionnaire rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight-loss. The examiner must choose the possible responses to each question by interviewing the patient and observing their symptoms. Each question has between 3-5 possible responses which increase in severity. The first 17 questions contribute to the total score and questions 18-21 are recorded to give further information about the depression such as if paranoid symptoms are present.
Sample Items
Activity
Score
Depressed mood Sad, hopeless, helpless, worthless
0 = Absent
1 = Gloomy attitude, pessimism, hopelessness
2 = Occasional weeping
3 = Frequent weeping
4=Patient reports highlight these feelings states in his/her spontaneous verbal and non-verbal communication
YALE-BROWN OBSESSIVE COMPULSIVE SCALE
Yale-Brown Obsessive Compulsive Scale – sometimes referred to as Y-BOCS – is a test to rate the severity of obsessive-compulsive disorder (OCD) symptoms.
The Yale-Brown Obsessive Compulsive Scale was designed newly from the ground up by Dr. Wayne Goodman and colleagues. It is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive-compulsive disorder without being biased towards the type of obsessions or compulsions present.
The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms). The results can be interpreted as follows:
0-7 Subclinical
8-15 Mild
16-23 Moderate
24-31 Severe
32-40 Extreme
Patients scoring in the mild range or higher should consider professional help in alleviating obsessive-compulsive symptoms.
VINELAND SOCIAL MATURITY SCALE
Vineland Social Maturity Scale is designed to measure social competence, defined as a functional composite of human traits that subserve social usefulness and are reflected in self-sufficiency and in service to others, from birth to 30 years of age. It measures eight categories of behaviour:
· self-help general,
· self-help eating,
· self-help dressing,
· locomotion,
· occupation,
· communication,
· self-direction, and
· socialization.
ADMINISTRATION
An interview is conducted with a parent, sibling, or other third party who is familiar with the person being assessed, and scores are assigned according to the behaviours that are reported to be customarily exhibited, the assessment being expressed in terms of social age or social quotient. It was developed by the US psychologist Edgar (Arnold) Doll (1889–1968), originally published in 1936, and discussed in Doll's booklet Your Child Grows Up in 1950.
SCORING
Test specific scoring procedure is to be followed.
The Hamilton Anxiety Scale (HAS or HAMA) is a 14-item test measuring the severity of anxiety symptoms. It is also sometimes called the Hamilton Anxiety Rating Scale (HARS). The HAS was developed by Max Hamilton in 1959. It provides measures of overall anxiety, psychic anxiety (mental agitation and psychological distress), and somatic anxiety (physical complaints related to anxiety). Hamilton developed the HAS to be appropriate for adults and children; although it is most often used for younger adults, there has been support for the test's use with older adults as well. Hamilton developed the scale by utilizing the statistical technique of factor analysis. Using this method, he was able to generate a set of symptoms related to anxiety and further determine which symptoms were related to psychic anxiety and which were related to somatic anxiety. The HAS is used to assess the severity of anxiety symptoms present in children and adults. It is also used as an outcome measure when assessing the impact of anti-anxiety medications, therapies, and treatments and is a standard measure of anxiety used in evaluations of psychotropic drugs. The HAS can be administered prior to medication being started and then again during follow-up visits, so that medication dosage can be changed in part based on the patient's test score.
Administration
The HAS is administered by an interviewer who asks a semi-structured series of questions related to symptoms of anxiety. The interviewer then rates the individuals on a five-point scale for each of the 14 items. Seven of the items specifically address psychic anxiety and the remaining seven items address somatic anxiety. For example, the third item specifically addresses fears related to anxiety, the fifth item addresses insomnia and sleeping difficulties related to anxiety, and the tenth item addresses respiratory symptoms related to anxiety. According to Hamilton, examples of psychic symptoms elicited by the HAS interview include a general anxious mood, heightened fears, feelings of tension, and difficulty concentrating. Examples of somatic symptoms include muscular pain, feelings of weakness, cardiovascular problems, and restlessness.
Precautions
The test has been criticized on the grounds that it does not always discriminate between people with anxiety symptoms and those with depressive symptoms (people with depression also score fairly high on the HAS). Because the HAS is an interviewer-administered and rated measure, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can impact the results. For this reason, some people prefer self-report measures where scores are completely based on the interviewee's responses.
HAMILTON RATING SCALE FOR DEPRESSION
The Hamilton Depression Rating Scale (HAM-D) is a 21-question multiple choice questionnaire measuring severity of a patient’s depression.. It was originally published in 1960 by Max Hamilton, and is presently one of the most commonly used scales for rating depression in medical research. The questionnaire rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight-loss. The examiner must choose the possible responses to each question by interviewing the patient and observing their symptoms. Each question has between 3-5 possible responses which increase in severity. The first 17 questions contribute to the total score and questions 18-21 are recorded to give further information about the depression such as if paranoid symptoms are present.
Sample Items
Activity
Score
Depressed mood Sad, hopeless, helpless, worthless
0 = Absent
1 = Gloomy attitude, pessimism, hopelessness
2 = Occasional weeping
3 = Frequent weeping
4=Patient reports highlight these feelings states in his/her spontaneous verbal and non-verbal communication
YALE-BROWN OBSESSIVE COMPULSIVE SCALE
Yale-Brown Obsessive Compulsive Scale – sometimes referred to as Y-BOCS – is a test to rate the severity of obsessive-compulsive disorder (OCD) symptoms.
The Yale-Brown Obsessive Compulsive Scale was designed newly from the ground up by Dr. Wayne Goodman and colleagues. It is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive-compulsive disorder without being biased towards the type of obsessions or compulsions present.
The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms). The results can be interpreted as follows:
0-7 Subclinical
8-15 Mild
16-23 Moderate
24-31 Severe
32-40 Extreme
Patients scoring in the mild range or higher should consider professional help in alleviating obsessive-compulsive symptoms.
VINELAND SOCIAL MATURITY SCALE
Vineland Social Maturity Scale is designed to measure social competence, defined as a functional composite of human traits that subserve social usefulness and are reflected in self-sufficiency and in service to others, from birth to 30 years of age. It measures eight categories of behaviour:
· self-help general,
· self-help eating,
· self-help dressing,
· locomotion,
· occupation,
· communication,
· self-direction, and
· socialization.
ADMINISTRATION
An interview is conducted with a parent, sibling, or other third party who is familiar with the person being assessed, and scores are assigned according to the behaviours that are reported to be customarily exhibited, the assessment being expressed in terms of social age or social quotient. It was developed by the US psychologist Edgar (Arnold) Doll (1889–1968), originally published in 1936, and discussed in Doll's booklet Your Child Grows Up in 1950.
SCORING
Test specific scoring procedure is to be followed.
N.B.: Lecture was given to the professional psychiatric counsellors of the Girindra Shekhar Basu Clinic, Kolkata.
