An Explanation of Psychological Tests

Saturday, December 20, 2003 | 0

Explanation of Psychological Tests
Bernard Bauer, Ph.D.
Psychology

Psychological testing in the medical-legal arena is of great importance, and understanding the role tests play in the formation of a medical-legal psychiatric or psychologic opinion is critical to the attorney asked to defend against or support the opinion. A comprehensive psychiatric interview is necessarily incomplete even though it is usually two hours in duration. High confidence in diagnostic impressions and credibility is often difficult to obtain. Maintaining accountability as to how opinions are arrived at is crucial, or else adjusters and attorneys will more vigorously contest highly conflicted areas and request unnecessary supplemental reports or depositions.

In our office, we administer a battery of tests appropriate for the individual patient circumstances. These are self-administered tests taken in our office, at which time examination behavior is also carefully noted for concentration, attention, endurance, tolerance, and motivation of effort.

An MMPI-2 is the baseline test most thoroughly researched and validated against which all the other tests in our battery are correlated for cohesiveness and congruence. The Whaler Physical Symptoms Inventory measures propensity towards somatization, necessary whenever any physical symptoms or conditions are problematic in the diagnostic picture. The Beck Depression Inventory measures the subject's estimation of their depressive symptoms. The Impact of Events Scale measures impairment in self-regulatory processes associated with stressful life events which is of concern in many psychiatric conditions. The State-Trait Anxiety Inventory measures a predisposition to and current experience of anxiety. The Rotter Incomplete Sentences Blank is the sole projective test we use which accesses unconscious themes otherwise not available. Finally, when indicated specifically, the McGill Pain Inventory measures a subject's description of the various parameters of their pain experiences.

In evaluating the test findings, we determine validity and propensity towards exaggeration or distortion on significant indices. This material is then correlated with the clinical data, especially the individual's history and current mental status examination, all of which then deepens confidence about diagnostic impressions and the credibility of the individual's subjective reporting.

The following tests are generally administered. These tests exclude the Neuropsychological exam and testing:

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a 567-item, self-administered True-False instrument that provides data on 10 clinical constructs (e.g. depression anxiety, hypochondriasis, mania); three validity scales, which measure such constructs as malingering, defensiveness and distorting; and numerous subscales, which provide detailed clinical information.

The Whaler Physical Symptoms Inventory is a 42-item, self-administered instrument in which subjects rate, on a five-point scale, the frequency of a variety of physical symptoms. The test yields a decile score that measures the likelihood of somaticization, i.e the tendency to overstate and exaggerate complaints related to pain and physical discomfort.

The Beck Depression Inventory is a 21-item, self-administered instrument in which subjects select one of four statements describing the intensity and / or frequency of thoughts and feelings related to depressive affect. The test yields a score that is compared to normative data for depression.

The Impact of Events Scale (IES) is a 15-item, self-administered instrument in which subjects rate, on a four-point scale, their reactions to stressful life events. The test yields an Avoidance score, which measures levels of stress related to the avoidance of situations and experiences, and an Intrusion score, which measures levels of stress related to an inability to appropriately monitor and block stress-evoking thoughts and feelings from specific anxiety-producing stimuli. The scores are compared to normative data.

The State-Trait Anxiety Inventory (STAID) is a 40-item, self-administered instrument that measures both current and chronic anxiety levels. The test yields a State score and a Trait score, which are normed by gender and age.

The McGill Pain Inventory is a 28-item, self-administered instrument in which the subject selects from a list of adjectives that describe pain symptoms. It is used to help identify somaticizing traits.

The Rotter Incomplete Sentences Blank is a 40-item, self-administered projective instrument that provides the beginning of sentences (e.g. "I feel..."; "My nerves...") that are completed by the subject. The responses are analyzed to provide information about conscious and unconscious thoughts and feelings.

Fees for Psychiatric or Psychological Evaluations

Psychiatric or Psychological Evaluations, Examination and Reporting Fees usual meet the Medical-Fee Schedule of ML103 $750 or ML104 & 200 / hour or $1,000 or more + Psychological testing Fees of $550. The examination itself lasts 2 hours or more while the testing may last 2 hours or more.

Neuropsychological Evaluations, Examination and Reporting Fees plus Testing lasts 6 to 8 hours and may run up to $2500 or more.

Dr. Bauer is represented by MedLink in the San Francisco, CA, area. MedLink represents 35 forensic physicians in Northern California in nearly every forensic specialty. Appointments can be made through MedLink at: www.camedlink.com.

-------------------

The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.