Descriptive Psychopathology: The Signs and Symptoms of ...

317 Chapter 13: Testing and psychopathology of cognitive dysfunctionSegues into specific assessmentThe reason for cognitive assessment is to help alleviate the patient’s problems, notthe examiner’s. Thus introductions such as “I need to ask you questions you mayfind silly” have no place in the evaluation. More helpful opening comments are:“You were telling me about the problems you’ve been having with (concentration, memory,thinking, etc.). How troublesome are they? For example, have you ...?”“With all the things that have been happening to you, have they affected your (concentration,memory, thinking, etc.)?”“Are the problems with your (concentration, memory, thinking, etc.) the kind where you getconfused about the date or the day of the week?”“Is your concentration difficulty the type where when you are reading or watching TVyou realize you really aren’t paying attention or you don’t remember what you’ve just reador seen?”“Let me check your concentration, just to be sure. What I would like you to do for me is ...”.Testing concentration follows.“Let me check your memory and thinking a bit ...”. The rest of the formal cognitiveexamination follows.Assessing for general brain “power”: IQThe patient’s present general intelligence influences the response to illness, andthe acceptance of treatments and behavioral strategies in long-term management.Signs of cognitive decline also provide needed information. Although performanceon standard IQ tests is influenced by education, aspects of such batteries areused at the bedside in assessing general intelligence. Unless impacted by injury ordisease, general intelligence remains fairly constant over adult life.Previous levels of employment functioning and present vocabulary and wordusage are associated with pre-morbid IQ. For example, a college professor withhepatic encephalopathy was able to name only 8 animals in one minute (15 ormore is normal). His choices of “Aardvark” and “hippopotamus”, however, wereconsistent with his past high level of function. A construction worker with a highschool education performed poorly on frontal lobe tasks while he was in anacute mania, but despite his frequent periods of flight-of-ideas, he correctly usedsuch words as “persistent”, “theology”, and “transient”, indicating a pre-morbidIQ level beyond his schooling, and a potential strength to rely on during hislong-term care.Present intellectual functioning is assessed with many of the bedside testsdescribed below. In addition to the actual level of performance, general intelligencelevel is suggested by the speed at which the patient grasps the instructionsand the efficiency with which the patient performs the task.