Psychological testing in psychiatric practice

Drs. C. Don Morgan and John Bober addressed the important topic of psychological testing in psychiatric practice (“Psychological testing: Use do-it-yourself tools or refer?,” Current Psychiatry, June 2005).

I would like to add some points that were not emphasized in the article:

• Psychological testing should never be used alone to diagnose or rule out a psychiatric disorder.
  
• Psychological testing can help screen for occult psychiatric disorders and confirm psychiatric diagnoses.
  
• Some psychological tests, such as the Minnesota Multiphasic Personality Inventory (MMPI-2), are vulnerable to practice effects and require time between subsequent administrations for results to be valid.
  
• Psychological tests should only be given, scored, and interpreted by properly trained individuals.
  

Michael Menaster, MD
San Francisco, CA

I, too, would like to add the following in reference to the article by Drs. Morgan and Bober:

While this article refers to use of board-certified neuropsychologists, most psychologists who offer neuropsychological testing are not certified by a recognized credentialing organization. The current definition of a clinical neuropsychologist, published by the National Academy of Neuropsychology, does not require psychologists to be board-certified to offer neuropsychological testing. Practitioners, however, must meet specific criteria to be called a clinical neuropsychologist.

Forensic assessment, which Drs. Morgan and Bober mention in passing, is another important application of psychological tests. Numerous well-standardized screening instruments and in-depth measures can be used to assess criminal responsibility or adjudicative competence and to gauge other features.¹

Few psychologists are competent to test patients across a broad age range. In general, children and adolescents should be referred to pediatric psychologists, and patients age >18 should see psychologists with expertise in adult testing. Many pediatric psychologists limit their practice to school-age children, so when referring a preschool-age child, look for practitioners who routinely test this age group.

Also, many psychologists who evaluate adults have little or no experience or training in testing elderly patients, so psychiatrists should seek clinicians who are well-versed in geriatric assessment.

Managed care companies usually authorize psychological testing when a known or suspected medical cause contributes to mental status change. However, authorization requests for other cases are sometimes denied, or the approved assessment period is limited. In these cases, the psychiatrist and testing psychologist must collaborate closely to provide clear rationales for the proposed assessment.

Jerrold Pollak, PhD
Coordinator, program in medical and forensic neuropsychology
Seacoast Mental Health Center, Portsmouth, NH

Drs. Morgan and Bober respond

While tests of cognitive functions such as memory, intelligence, and achievement are susceptible to practice effects, the MMPI-2 is so lengthy (567 items) that it would be difficult to remember how one responded to individual items. The test, however, is state-dependent, meaning that situational stressors can influence test results.

These points aside, we agree with Dr. Menaster’s comments. We also thank Dr. Pollak for his useful and important thoughts.

C. Don Morgan, PhD
Associate professor
John F. Bober, MD
Assistant professor and residency program director
Department of psychiatry and behavioral sciences
University of Kansas School of Medicine
Wichita

Drs. C. Don Morgan and John Bober addressed the important topic of psychological testing in psychiatric practice (“Psychological testing: Use do-it-yourself tools or refer?,” Current Psychiatry, June 2005).

I would like to add some points that were not emphasized in the article:

• Psychological testing should never be used alone to diagnose or rule out a psychiatric disorder.
  
• Psychological testing can help screen for occult psychiatric disorders and confirm psychiatric diagnoses.
  
• Some psychological tests, such as the Minnesota Multiphasic Personality Inventory (MMPI-2), are vulnerable to practice effects and require time between subsequent administrations for results to be valid.
  
• Psychological tests should only be given, scored, and interpreted by properly trained individuals.
  

Michael Menaster, MD
San Francisco, CA

I, too, would like to add the following in reference to the article by Drs. Morgan and Bober:

While this article refers to use of board-certified neuropsychologists, most psychologists who offer neuropsychological testing are not certified by a recognized credentialing organization. The current definition of a clinical neuropsychologist, published by the National Academy of Neuropsychology, does not require psychologists to be board-certified to offer neuropsychological testing. Practitioners, however, must meet specific criteria to be called a clinical neuropsychologist.

Forensic assessment, which Drs. Morgan and Bober mention in passing, is another important application of psychological tests. Numerous well-standardized screening instruments and in-depth measures can be used to assess criminal responsibility or adjudicative competence and to gauge other features.¹

Few psychologists are competent to test patients across a broad age range. In general, children and adolescents should be referred to pediatric psychologists, and patients age >18 should see psychologists with expertise in adult testing. Many pediatric psychologists limit their practice to school-age children, so when referring a preschool-age child, look for practitioners who routinely test this age group.

Also, many psychologists who evaluate adults have little or no experience or training in testing elderly patients, so psychiatrists should seek clinicians who are well-versed in geriatric assessment.

Managed care companies usually authorize psychological testing when a known or suspected medical cause contributes to mental status change. However, authorization requests for other cases are sometimes denied, or the approved assessment period is limited. In these cases, the psychiatrist and testing psychologist must collaborate closely to provide clear rationales for the proposed assessment.

Jerrold Pollak, PhD
Coordinator, program in medical and forensic neuropsychology
Seacoast Mental Health Center, Portsmouth, NH

Drs. Morgan and Bober respond

While tests of cognitive functions such as memory, intelligence, and achievement are susceptible to practice effects, the MMPI-2 is so lengthy (567 items) that it would be difficult to remember how one responded to individual items. The test, however, is state-dependent, meaning that situational stressors can influence test results.

These points aside, we agree with Dr. Menaster’s comments. We also thank Dr. Pollak for his useful and important thoughts.

C. Don Morgan, PhD
Associate professor
John F. Bober, MD
Assistant professor and residency program director
Department of psychiatry and behavioral sciences
University of Kansas School of Medicine
Wichita

Drs. C. Don Morgan and John Bober addressed the important topic of psychological testing in psychiatric practice (“Psychological testing: Use do-it-yourself tools or refer?,” Current Psychiatry, June 2005).

I would like to add some points that were not emphasized in the article:

• Psychological testing should never be used alone to diagnose or rule out a psychiatric disorder.
  
• Psychological testing can help screen for occult psychiatric disorders and confirm psychiatric diagnoses.
  
• Some psychological tests, such as the Minnesota Multiphasic Personality Inventory (MMPI-2), are vulnerable to practice effects and require time between subsequent administrations for results to be valid.
  
• Psychological tests should only be given, scored, and interpreted by properly trained individuals.
  

Michael Menaster, MD
San Francisco, CA

I, too, would like to add the following in reference to the article by Drs. Morgan and Bober:

While this article refers to use of board-certified neuropsychologists, most psychologists who offer neuropsychological testing are not certified by a recognized credentialing organization. The current definition of a clinical neuropsychologist, published by the National Academy of Neuropsychology, does not require psychologists to be board-certified to offer neuropsychological testing. Practitioners, however, must meet specific criteria to be called a clinical neuropsychologist.

Forensic assessment, which Drs. Morgan and Bober mention in passing, is another important application of psychological tests. Numerous well-standardized screening instruments and in-depth measures can be used to assess criminal responsibility or adjudicative competence and to gauge other features.¹

Few psychologists are competent to test patients across a broad age range. In general, children and adolescents should be referred to pediatric psychologists, and patients age >18 should see psychologists with expertise in adult testing. Many pediatric psychologists limit their practice to school-age children, so when referring a preschool-age child, look for practitioners who routinely test this age group.

Also, many psychologists who evaluate adults have little or no experience or training in testing elderly patients, so psychiatrists should seek clinicians who are well-versed in geriatric assessment.

Managed care companies usually authorize psychological testing when a known or suspected medical cause contributes to mental status change. However, authorization requests for other cases are sometimes denied, or the approved assessment period is limited. In these cases, the psychiatrist and testing psychologist must collaborate closely to provide clear rationales for the proposed assessment.

Jerrold Pollak, PhD
Coordinator, program in medical and forensic neuropsychology
Seacoast Mental Health Center, Portsmouth, NH

Drs. Morgan and Bober respond

While tests of cognitive functions such as memory, intelligence, and achievement are susceptible to practice effects, the MMPI-2 is so lengthy (567 items) that it would be difficult to remember how one responded to individual items. The test, however, is state-dependent, meaning that situational stressors can influence test results.

These points aside, we agree with Dr. Menaster’s comments. We also thank Dr. Pollak for his useful and important thoughts.

C. Don Morgan, PhD
Associate professor
John F. Bober, MD
Assistant professor and residency program director
Department of psychiatry and behavioral sciences
University of Kansas School of Medicine
Wichita