Descriptive Psychopathology: The Signs and Symptoms of ...

315 Chapter 13: Testing and psychopathology of cognitive dysfunctionPatient 13.3A 20-year-old student was hospitalized with an acute psychosis secondary toillicit hallucinogen drug intoxication. He had a long history of such use as wellas the abuse of other types of drugs.His psychosis quickly resolved and he was seen by the unit’s staff as anintelligent, highly verbal, pleasant person whose major problem was hissubstance abuse. A disposition plan centered on psychotherapy was proposed.The unit psychiatrist, however, noted that in brief conversations abouttopics the patient had studied in school, the patient’s comprehension appearedlimited and his thinking vague. A WAIS revealed the patient’s full-scale IQ tobe 88, although his vocabulary indicated a much higher pre-illness score. 14The patient’s test performance made it likely that he would have been unableto successfully participate in the proposed psychotherapy program that reliedon high-level comprehension and abstract thinking. A more modest dispositionwas then planned that included the recognition that the patient hadsuffered brain damage from his drug use.Cognitive assessment is also used to monitor treatment. For example, as adepressive illness resolves in a geriatric patient cognition should improve; ifnot, dementia is considered. Cognitive assessment is regularly done throughoutthe acute course of ECT to determine the presence and degree of anterogradeamnesia and the best frequency of treatments (twice or three times weekly).Cognitive testing is repeated after the treatment course to determine when theanterograde amnestic process has resolved and the patient can continue normalresponsibilities.Assessment methodsTable 13.3 displays guidelines for cognitive assessment.Cognitive assessment must be done systematically and precisely so the resultsare reproducible. Instructions should be clearly stated and the assessment settingnon-distracting. The goal is to obtain the patient’s best performance. Encouragementis often needed, particularly for depressed patients and those with apatheticsyndromes. Knowing the patient’s capacity encourages the best prognostic plans.When psychomotor retardation is substantial or the patient has significantperipheral handicaps, timed tests are still done, but the patient is permitted toproceed past the time limit to see if the function being assessed is adequate tocomplete the task. Aphasic patients are mostly assessed with non-verbal tasks.The patient’s education and abilities in the language of the test are consideredin the choice of tasks and their interpretation. One of us successfully treated an