Physical and Mental Disability Test

PHYSICAL AND
MENTAL
DISABILITY TEST
CLINICAL ASSESSMENT
For purposes of this article, we can define clinical assessment as the evaluation of a person’s
physical, medical, cognitive, psychological (personality, emotions, beliefs, and attitudes), and
behavioural history and current condition in order to determine the presence of any mental
health disorder. The assessment process is typically initiated by a referral either from a
physician, mental health worker, or other person, or it can be directly initiated by the
individual.
When people come into an assessment, they have some set of presenting issues or problems
that they, or some other party, wish to address, understand, and change, if possible. The
clinical assessment process is aimed at making a specific diagnostic determination that will
help with understanding these issues, conceptualizing them into an organized and meaningful
format, and developing a formal intervention strategy to assist the individual.
There are a number of assessment techniques and formal tests that can be used during the
clinical assessment process. Assessment techniques and formal tests are tools used to gather
information. A person is not defined by a score on a test. The score or performance on a test
helps the clinician understand something about the person, and during the assessment
process, it contributes to understanding what the potential diagnostic issues may be.
PSYCHOMETRIC TESTING
Psychometric tests or psychological tests consist of a number of formalized tests that tap
nearly every domain of psychological, personality, emotional, behavioral, and cognitive
functioning. These tests can be extremely useful in assisting in the diagnosis of mental health
disorders; however, these tests require special training to assess, score, and interpret properly.
There are literally thousands of psychological tests in use. The basic domains that
psychological tests cover include:
 Personality tests are formal psychological tests that measure aspects of an

individual’s personality or measure specific personality variables. There are literally
hundreds of these tests available. In general, these tests can be divided into two major
categories:
o Projective personality tests are tests that provide some sort of ambiguous
stimulus or task, and the individual is required to give a subjective opinion of the
stimulus or to complete the task, such as a drawing task. There are no right or wrong
answers to these tests; the data gleaned from these tests consists of the individual’s
interpretation and expression to the stimulus or task. These tests are designed to tap
personality variables that individuals are not overtly aware of (in the unconscious
mind). The most well-known of these tests is the Rorschach or ink blot test.
o Objective personality tests have a specific type of question-and-answer format
that may consist of choosing an appropriate answer from several choices that relates
to the individual’s self-perception, rating appropriate feeling on a scale, or some other
concrete response. There is also an option for individuals who know the patient to
take certain types of objective personality tests and rate the patient on specific
personality indices. Perhaps the most used of the objective personality tests is
the Minnesota Multi-Phasic Personality Inventory (MMPI) that is used to rate
individuals on personality, psychological, and emotional variables.
 Intelligence tests are used to rate the individual’s level of overall intellect compared
to others in their peer group. Intelligence tests are important in determining various cognitive
strengths and weaknesses in individuals that may be associated with certain types of mental
health disorders. There are a number of different formal intelligence tests. The most utilized
intelligence tests are the Wechsler Intelligence Scales. These tests are separately developed
for both adults and children, and give a number of different IQ scores (intelligence quotient
scores) for different intellectual domains (e.g., full scale IQ, verbal IQ, nonverbal IQ, and so
forth).
 Neuropsychological tests are specialized tests administered by psychologists trained
in brain behavior relationships (neuropsychologists). These tests can be used to determine the
presence of cognitive strengths and weaknesses that may be the result of brain damage, a
psychological disorder, a neurological disorder, or a developmental disorder. There are
literally thousands of different neuropsychological tests that can be administered to cover
these domains. Neuropsychological functioning generally covers issues such as intelligence,
language abilities (expressive and receptive language abilities), attention, learning and
memory, visual perception, planning and judgment, abstract thinking, motor functioning,
personality, and other psychological domains.
 A number of other tests are specifically designed to measure aspects of an
individual’s mood (e.g., the presence of depression), other emotional states and psychological
states such as the presence of anxiety or psychosis, and to measure a person’s adaptive
abilities.
PHYSICAL AND LABORATORY TESTING
An important part of the assessment process is to ensure that the individual has a full physical
workup to rule out any physical causes/associations that may be related to the presenting
psychological problem. Although there are no laboratory or medical tests that can determine
the presence of the vast majority of psychological or psychiatric disorders, there are a number
of physical conditions and diseases that either present very similarly to certain psychological
disorders or produce side effects that are similar to the symptoms of certain psychological
disorders.
For instance, individuals with certain cardiovascular issues often experience panic attacks.
Not assessing the individual for these cardiac issues could lead to the misdiagnosis of panic
disorder in the person and result in a treatment approach that would be relatively ineffective
in addressing that person’s panic attacks. Individuals with hypothyroidism will often present
with the symptoms of severe depression. Attempting to treat their depression with therapy or
by other means will not fully address the issue and certainly will not treat the thyroid
condition. Only treating the hypothyroidism will fully address the issue in this case.
A number of different physical and laboratory techniques are available. Some of the more
relevant ones in the assessment of mental health issues include the following:
 A full physical examination performed by a physician can help to ascertain any

physical issues that may be contributing to symptoms.
 Neurological evaluations are useful in determining specific types of neurological
disorders that may be presenting as psychological issues. Neurological evaluations typically
include such techniques as neuroimaging and psychophysiological assessment (see below).
 Neuroimaging techniques that look at the structure or functioning of the brain can be
useful. There are two basic categories of neuroimaging techniques: structural
neuroimaging (e.g. magnetic resonance imaging [MRI]) that focuses on changes in the
structure of the brain and functional neuroimaging (e.g., positron emission tomography
[PET]) that focuses on blood flow and areas of activation in the brain during specific
physical, cognitive, and emotional states. Neurologists and psychiatrist can choose the
specific neuroimaging test they feel is most appropriate for the particular case.
 Psychophysiological assessment techniques can be useful, and these include such
procedures as the electroencephalogram (EEG) and evoked potentials that measure changes
in the nervous system. For instance, EEGs are useful in determining if an individual has a
seizure disorder. Often, individuals with chronic seizure disorders experience symptoms
similar to individuals with psychotic disorders such as schizophrenia.
 Laboratory tests, such as blood and urine tests, can help to determine the presence of
any medical conditions, infections, or substance use disorders that contribute to the
individual’s presentation.
Multidisciplinary Assessment
Of course, using medical doctors (e.g., psychiatrists, neurologists, and other physicians) and
psychologists can be useful in ascertaining the exact nature of the presenting issue. However,
in many cases, it is important to broaden the range of assessment services in order to develop
a picture of the whole person. Using assessment techniques and professionals from other
disciplines can widen the assessment process. Professionals that could be utilized include:
 Speech therapists, physical therapists, and occupational therapists to determine

functional issues
 Social workers, case managers, and vocational rehabilitation specialists for lifestyle
and practical issues
 Other specialists, such as audiologists, other medical specialists, religious and
spiritual influences, and so forth
MENTAL STATUS EXAMINATION
A synopsis of the four MSE sections is presented below. In following pages, there are
elaborations of each section, with sample descriptors.
1. General Observations
1. Appearance
2. Speech
3. Behavior
4. Cooperativeness
2. Thinking
1. Thought Process
2. Thought Content
3. Perceptions
3. Emotion
1. Mood
2. Affect
4. Cognition
1. Orientation/Attention
2. Memory
3. Insight
4. Judgment
MSE Components in greater detail: these adjectives and descriptors may be helpful in
describing your mental status exam findings. Usually some apply more than others and you
may find your own descriptors that fit your patient best.
General Observations
Appearance
 Hygiene: clean, body odor, shaven, grooming
 Dress: clean, dirty, neat, ragged, climate appropriate — anything unusual?
 Jewelry: rings, earrings — anything unusual?
 Makeup: lipstick, nail polish, eye makeup — anything unusual?
 Other: prominent scars, tattoos
Speech
 General: accent, clarity, stuttering, lisp
 Rate: fast (push of speech) or slow
 Latency (pauses between questions and answers): increased or decreased
 Volume: whispered, soft, normal, loud
 Intonations: decreased (monotone), normal
Behavior
 General: increased activity (restlessness, agitation), decreased activity
 Eye Contact: decreased, normal, excessive, intrusive
 Mannerisms, stereotypies, posturing
Cooperativeness
 Cooperative, friendly, reluctant, hostile
Thinking
Thought Processes
 Tight, logical, goal directed, loosened, circumstantial, tangential, flight of ideas, word
salad
Thought Content
 Future oriented, suicidal ideation, homicidal ideation, fears, ruminative ideas
Perceptions
 Hallucinations (auditory, visual, olfactory)
 Delusions (paranoid, grandiose, bizarre)
Emotion
Mood
 (Patient describes in own words and rates on a scale 1-10)
Affect
 (You describe)
 Type: depressed/sad, anxious, euphoric, angry
 Range: full range, labile, restricted, blunted/flattened
 Appropriateness to content and congruence with stated mood
Cognition
Memory
 Immediate recall, three and five minute delayed recall of three unrelated words
Orientation/Attention
 Day, date, month, year, place, president; Serial 7's (or 3's), WORLD — DLROW,
digit span
Insight/Judgment
 Good, limited or poor (based on actions, awareness of illness, plans for the future)
Psychiatric Review of Systems
Signs and symptoms of psychiatric illness are often described in the history of present illness.
The ROS in psychiatry "covers all the bases" and queries for important signs and symptoms
that have not been discussed during the first part of the history. Similar to the ROS in other
fields of medicine, the ROS in psychiatry is a systematic inquiry, searching for pertinent
positives and negatives over a period of time preceding the time of interviews.
1. Cognitive: memory or concentration changes
2. Psychosis
3. Substance Abuse
4. Mood: depression, mania, suicidal ideation, guilt
5. Neurovegetative: sleep, appetite, libido, interests, energy
6. Anxiety: anxiety symptoms, panic/agoraphobia, obsessions/compulsions,

flashbacks/hypervigilance
7. Eating Disorder: anorexia, bulimia
8. Violence: rages, assaults, homicidal ideation
9. Impulse Control: pathological gambling, trichotillomania, kleptomania

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PHYSICAL AND

 Personality tests are formal psychological tests that measure aspects of an

PHYSICAL AND LABORATORY TESTING

 A full physical examination performed by a physician can help to ascertain any

 Speech therapists, physical therapists, and occupational therapists to determine

 Hygiene: clean, body odor, shaven, grooming

 Dress: clean, dirty, neat, ragged, climate appropriate — anything unusual?

 Jewelry: rings, earrings — anything unusual?

 Makeup: lipstick, nail polish, eye makeup — anything unusual?

 Other: prominent scars, tattoos

 General: accent, clarity, stuttering, lisp

 Rate: fast (push of speech) or slow

 Latency (pauses between questions and answers): increased or decreased

 Volume: whispered, soft, normal, loud

 Intonations: decreased (monotone), normal

 General: increased activity (restlessness, agitation), decreased activity

 Eye Contact: decreased, normal, excessive, intrusive

 Mannerisms, stereotypies, posturing

 Cooperative, friendly, reluctant, hostile

 Hallucinations (auditory, visual, olfactory)

 Delusions (paranoid, grandiose, bizarre)

 (Patient describes in own words and rates on a scale 1-10)

 Type: depressed/sad, anxious, euphoric, angry

 Range: full range, labile, restricted, blunted/flattened

 Appropriateness to content and congruence with stated mood

Psychiatric Review of Systems

1. Cognitive: memory or concentration changes

4. Mood: depression, mania, suicidal ideation, guilt

5. Neurovegetative: sleep, appetite, libido, interests, energy

6. Anxiety: anxiety symptoms, panic/agoraphobia, obsessions/compulsions,

7. Eating Disorder: anorexia, bulimia

8. Violence: rages, assaults, homicidal ideation

9. Impulse Control: pathological gambling, trichotillomania, kleptomania

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