Psychometric Tests
MRCPsych Paper 1
Dr A Davies
ST4 General Adult Psychiatry
Aims
• Overview of psychometric tests
• FAR too many to cover in
one lecture…
focus on common ones
• Past paper questions
Hundreds of psychometric tests…
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Mood
Psychosis
Cognitive impairment
Perinatal
Eating disorders
Side effects
Neuropsychiatric
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Beck’s Depression Inventory
• Self rated 21 multiple-choice questions
• Measures severity of depression
• Each answer scored on a scale value of 0 to 3
• Higher scores = more severe depressive symptoms
0-13
14–19
20–28
29–63
Minimal
Mild
Moderate
Severe
PHQ-9
• Patient Health Questionnaire – 9
• Used to monitor severity of depression and
response to treatment
• Self-administered
• 9 questions (!) score 0-3, total 27
Depression Severity:
0-4 none
5-9 mild
10-14 moderate
15-19 mod/severe
20-27 severe
HAM-D
• Hamilton Rating Scale for Depression
• Assess severity, mostly biological sx
• Clinical interview
• 17 - 21 items, scored on 3 or 5 point scale
• 0-7 = normal
• 20 + or higher indicate moderate, severe, or
very severe depression
Zung SRDS
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Zung Self Rating Depression Scale
Assesses severity of depression
20 items self rated
Affective, psychological & somatic symptoms
Scored 1-4, total 80
20-44
45-59
60-69
70+
Normal
Mildly depressed
Moderately depressed
Severely depressed
MADRS
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Montgomery Asberg Depression rating scale
10 items
Most sensitive to change
Requires clinical interview like HDRS
VAS
• Visual Analogue Scale
• Easy
• 10cm line, indicate where mood lies
GDS
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Geriatric Depression Scale
30-items, “yes, no” answers
Self report assessment
Assess severity, monitor Rx
Not diagnostic
0-9
normal
10-19 mildly depressed
20-30 severely depressed
EPDS
• Edinburgh Postnatal Depression Scale
• Screen for depression (not diagnostic) postnatally (up to 8 wks)
• Self-rated scale, mood over past week
• 10 questions, scored 0-3
wks
0-9 :
Mild distress
10-12 : Moderate distress - repeat in 2
13 +: Referral to psychiatry/ology
Y-BOCS
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Yale-Brown Obsessive Compulsive Scale
Assess severity and monitor improvement of OCD symptoms
Clinician-rated, 10-item scale
Each item rated from 0 (no symptoms) to 4 (extreme
symptoms)
0–7
8–15
16–23
24–31
32–40
sub-clinical
mild
moderate
severe
extreme
(Self rated version has been developed)
ACE-R
• Brief bedside screening for cognitive problems
• Maximum score of 100 weighted as follows:
Orientation
Attention
Memory
Verbal fluency
Language
Visuospatial
10
8
35
14
28
5
• High sensitivity in detecting dementia
• 79% with cut-off score of 83 and 93% with cut-off 88.
SCI-D
• Structured Clinical Interview for DSM-IV
• Diagnostic, clinician rated interview
• SCID-I - Axis I Disorders;
major mental disorders
• SCID-II - Axis II disorders;
personality disorders
Eating Disorder Inventory
• EDI-3 – standardised clinical evaluation of
symptoms associated with eating disorders
• 91 items organized into 12 primary scales+:
Drive for Thinness
Body Dissatisfaction
Personal Alienation
Interpersonal Alienation
Emotional Dysregulation
Asceticism
Bulimia
Low Self-Esteem
Interpersonal Insecurity
Interoceptive Deficits
Perfectionism
Maturity Fears
SCOFF
• Screening questionnaire for anorexia/bulimia
Do you make yourself Sick because you feel
uncomfortably full?
Do you worry you have lost Control over how
much you eat?
Have you recently lost more than One stone in
a 3 month period?
Do you believe yourself to be Fat when others
say you are too thin?
Would you say that Food dominates your life?
One point for every “yes”
A score of ≥2 indicates a likely case of anorexia nervosa or bulimia
Alcohol Scales
CAGE – score 2+ indicates problem
AUDIT – Alcohol Use Disorders Identification Test
MAST – Michigan Alcohol Screening Test
CIWA – Clinical Institute Withdrawal
Assessment for Alcohol
MMSE
• Screening tool of cognitive function
Points per section:
Orientation
10
Registration
Attention & calculation
Recall
Language
Copying
3
5
3
8
1
• Scores: 25-30 normal, 21-24 mild, 10-20
moderate, <10 severe impairment
CIDI
• WHO Composite International Diagnostic Interview
• Structured interview for psychiatric disorders
• Designed for epidemiological studies
• Allows the investigator to:
- Measure prevalence of mental disorders
- Measure severity of disorders
- Determine the burden of these disorders
- Assess service use
- Assess the use of medications
- Assess who is treated, who remains
untreated, and what are the barriers to treatment
GHQ
• General Health Questionnaire
• Screening tool to identify minor psychiatric
disorders in general population - “caseness”
• Several versions, GHQ28 most popular
• 28 item assesses somatic symptoms, anxiety &
insomnia, social dysfunction & severe
depression
HoNoS
• Health of the Nation Outcome Scale
• Routine clinical outcome measure
• 12 items measuring behaviour, impairment,
symptoms and social functioning
• Completed after routine clinical assessments in
any setting
• Variety of uses for clinicians, researchers and
administrators, in particular health care
commissioners and providers
Neuropsychometry
Reliability
Extent to which a test produces results consistent
across various raters (inter-rater) or various instances
with same rater (test-retest)
Validity
Extent to which a test measures what its supposed to
Validity
Construct – performance fit with theory
Predictive – extent to which a score on a scale/test
predicts scores on some criterion measure
Incremental – used to determine whether a new test
will increase the predictive ability beyond that provided
by an existing test
Criterion – how well variables predict an outcome
based on information from other variables (concurrent
if applied at same time)
Wechsler Adult Intelligence Scale
WAIS
• Most widely used IQ test (WISC for children)
WAIS
Hold tests: measure stored knowledge & skills
Eg) vocab, picture completion, NART
Non hold tests:
Eg) block design, digit span
Deterioration quotient derived from
difference between ‘don’t hold’ and
‘hold’ scores
Hold tests supposed to be resistant to age related decline, so
sensitive to organic brain disease such as dementia (refuted)
Raven’s Progressive Matrices
• Quick IQ test of current performance
• Independent of education & cultural influence
• General intelligence with visuospatial problem
solving
Wisconsin Card Sorting
• Wisconsin card sorting test
• Stimulus cards of different colour, form and number
• Patient has to sort into a group according to single
principle, eg) colour, but not told which just told if
right or wrong
• Difficult if frontal lobe or
caudate damage and some
people with schizophrenia
Wechsler Memory Scale Revised
• WMS-R
• Most widely used memory test battery for adults
• Yields a memory quotient MQ, corrected for age and
generally approximates to WAIS IQ
• Amnesic conditions – disproportionately low MQ but
relatively preserved IQ
Others
• NART National Adult Reading Test
Previous work knowledge before becoming ill –
premorbid IQ estimate
• Stroop Test
Measures set shifting abilities and response inhibition
Test frontal function and selective attention
Questions
In MMSE intersecting pentagons primarily
assesses which of the following functions?
A. Copying skills
B. Visual retention
C. Constructional praxis
D. Language
E. Orientation
MCQ
On mini-mental examination, a 74 year old man
loses all points on orientation to time and
recall while other faculties are intact. How
many points has he lost?
A. Thirteen
B. Eight
C. Sixteen
D. Six
E. Five
MCQ
Which one of the following questionnaires can be
used to identify psychiatric 'caseness' in general
population?
a. Structured clinical interview DSM-IV
b. GHQ General Health Questionnaire
c. PSE Present state examination
d. HAM-D
e. BDI Beck‟s depression inventory
MCQ
Serial sevens test is most useful to test one’s?
a. Inattention
b. Concentration
c. Working memory
d. Short term memory
e. IQ
MCQ
The Clifton Assessment procedure is used in
which of the following situations?
a. Care homes for the learning disabled
b. Children in foster care
c. Schizophrenia rehabilitation units
d. Residential care for the elderly
e. Prisons with high mental health burden
MCQ
Considering Beck’s depression inventory, which
of the following is true?
a. It has 21 items
b. Refers to symptoms over the last 5 days.
c. Maximum score is 42
d. Strictly clinician rated scale
e. Has no item on suicidal ideas
MCQ
Which of the following is NOT a component of clock
drawing test?
a. Placing the hands of the clock correctly
b. Indicating the hour correctly according to instructions
c. Indicating the minutes correctly according to
instructions
d. Using numbers 1 to 12 to create the face of a clock
e. Being aware of the current time when the test is
administered
MCQ
Which of the following will you use to assess orientation
in a hospitalised patient?
a. Ability to remember his/her own address
b. Ability to repeat a phone number immediately after
reading out
c. Ability to correctly identify the doctor when asked to
point out
d. Ability to recognise pictures of famous personalities
e. Tap the table once whenever the examiner reads letter
„E‟ from a random list of alphabets
MCQ
Copying intersecting polygons in MMSE tests
then functions of?
a. Temporal lobes
b. Cerebellum
c. Frontal lobes
d. Hippocampus
e. Parietal lobes
MCQ
Which of the following is not an alcohol
assessment tool?
a. AUDIT
b. CAGE
c. SCOFF
d. MAST
e. CIWA
EMI – Assessment Instruments
1. A 34 year old woman complains of loss of
weight and appetite for last 2 months. She has
poor sleep and has multiple somatic complaints
that started when she and her husband
separated 3 months ago. She denies using
alcohol.
B – Beck’s depression scale
EMI – Assessment Instruments
2. A researcher is interested in finding out the
degree of self rated psychiatric symptoms in a
sample of 125 diabetic outpatients attending an
insulin clinic.
D – General Health Questionnaire
EMI – Assessment Instruments
3. As a part of a new World Mental Health
initiative, it is planned to conduct a nationwide
survey of mental health burden. It is planned to
administer a fully structured instrument through
trained non-clinical research workers to
ascertain lifetime diagnosis of mental illness.
F – Diagnostic Interview Scale
EMI – Assessment Instruments
4. A newly constituted mental health trust wants
to adopt a common scale for monitoring clinical
recovery on discharge across different adult
units.
H - HONOS
EMI – Neuropsychological Tests
A 54 year man presents with a year’s history of steadily
progressive personality change.
He has become increasingly apathetic and appears
depressed but his main complaint is of increasing
frontal headaches. On examination he has word finding
difficulties. EEG shows frontal slowing, greater on the
left.
You are concerned that he may have an intracranial
space occupying lesion.
EMI – Neuropsychological Tests
Which test would you use to obtain a quick
estimate of his current performance IQ?
F – Raven’s progressive matrices
The test indicates that his current performance IQ is
in the low average range. Which test would enable
you to estimate his IQ before any brain damage he
may have sustained in recent months/years?
E - NART
EMI – Neuropsychological Tests
The estimate of his premorbid IQ is 15 points
higher than his current performance IQ. It is
recommended that he has a full WAIS IQ
assessment to measure both performance and
verbal IQ. On the WAIS his verbal IQ is found to
be impaired over and above his performance IQ.
Which test is part of the WAIS verbal subtests?
B – Digit Span
EMI – Neuropsychological Tests
An MRI scan shows a large meningioma
compressing dorsolateral prefrontal cortex on
the left. Which test result is most likely to be
impaired?
J – Wisconsin Card Sorting Test