Psychometry – Rating Scales – AR notes

The science of measuring Mental Faculties and is the branch of psychology that deals with
• the design, administration, and interpretation of quantitative and qualitative
tests
• for the measurement of psychological variables such as intelligence, aptitude, and
personality traits and
• clinical disorders such as anxiety, depression, mania, obsessions & compulsions,
psychosis, somatic symptoms, functional impairment etc.….

Properties of good Psychometric tests

• It should have a proper objective with measurable content
• It should be standardized with properly defined norms

• It should be reliable i.e., have consistency of outcome

• It should be validated i.e., should check what is supposed to be checked

• It should be sensitive i.e., ability to check true positives

• It should be specific i.e., ability to check true negatives.
Types of Tests (?)
◼ Objective tests
o Are structured, standardized measurement devices having self-report nature.
o Tendency to use straight forward testing such as direct questions about
person’s opinions of themselves and unambiguous instructions about
completing the test
◼ Projective Tests
o Focus on latent unconscious aspect of personality
o They are designed not to measure one particular personality characteristic but
personality as a whole
o Are unstructured having indirect approach with general instructions for the
patient to express their fantasies
o Responses to projective stimuli are inkblots, pictures, drawing a picture etc.
o Examples of projective tests
▪ Rorschach (Row-shak) ink blot test
▪ Holtzman Inkblot test
▪
▪ Draw a person and House tree person
▪ Human figure drawing
▪ Make a picture story
▪ Thematic apperception test (TAT)

▪ Sentence completion (SCT)

▪ Word association technique (WAT)
Thematic Apperception Test
Important scales to be discussed
Depression and Anxiety
◼ Beck Depression Inventory (BDI)
◼ Beck Anxiety Inventory (BAI)
◼ Beck Suicidal Intent
◼ Hamilton rating scale for depression (HAM-D)
◼ Hamilton rating scale for anxiety (HAM-A)
◼ Hospital Anxiety and Depression Scale (HADS)
◼ Montgomery and Asberg depression rating scale (MADRS)
◼ Edinburgh postnatal depression scale (EPNDS)
◼ Bradford Somatic Inventory
Bipolar Disorder
◼ Young Mania Rating Scale (YMRS)
OCD
◼ Yale Brown Obsessive compulsive Scale (YBOCS)
Schizophrenia
◼ Scale for the assessment of positive symptoms (SAPS)
◼ Scale for the assessment of negative symptoms (SANS)
◼ Positive and negative syndrome scale (PANSS)
◼ Abnormal Involuntary movements scale (AIMS)
◼ Brief Psychiatric Rating Scale (BPRS)
Functional Level
◼ Quality of Life scale (QOLs)
◼ Sheehan Disability Scale
Substance Abuse
◼ AUDIT alcohol screening questionnaire
◼ Severity of Alcohol dependence Questionnaire
◼ Clinical Institute Alcohol Withdrawal
◼ Short Alcohol Withdrawal Scale
◼ CAGE questionnaire
◼ Objective Opioid Withdrawal Scale (OOWS)
◼ Subjective Opiate Withdrawal Scale (SOWS)
◼ Clinical Opiate Withdrawal Scale
Personality
◼ Minnesota Multiphasic Personality Inventory (MMPI)
◼ Draw a person/House Tree Person Test (DAP/HTP)
◼ Thematic apperception test and children apperception test (TAT and CAT)
◼ Rorschach inkblot test (pronounced Raw-shak)
Cognition and Intelligence
◼ MMSE
◼ MoCA
◼ Wechsler (Pronounced weks-ler) Adult Intelligence Test (WAIS III R)
◼ Wechsler Intelligence scale for children (WISC III R)
◼ Stanford Binet Test
◼ Raven Progressive Matrices
◼ Bender (Visual Motor) Gestalt Test
General
◼ General Health Questionnaire (GHQ-12)

Purpose of Rating Scales

◼ For confirmation of diagnosis
◼ For detection of severity of illness
◼ For assessing effect of treatment
◼ For assessing recovery
◼ For assessing prognosis
Depression and
Anxiety
 Beck Depression Inventory
◼ Devised by Dr. Aron T. Beck (original BDI published in 1961)
◼ Widely used to see the severity of depression
◼ Total 21 items
◼ Maximum score 63
◼ 3 versions are (BDI, BDI-1A, BDI-II)
◼ BDI II was published in 1996
Construct measured: This scale measures the existence and severity of symptoms of
depression. Generic vs. disease specific: Generic.
Means of administration: Self-administered.
Intended respondent: Self-Report.
Number of items: 21 items.
Number of subscales and names of sub-scales: 2 subscales: Affective and Somatic
subscales.
Number of items per sub-scale: 8 for affective; 13 for somatic
Standard Cut-offs in BDI II
◼ 0-13 – Indicates minimal depression
◼ 14-19 – Indicates mild depression
◼ 20-28 – Indicates moderate depression
◼ 29-63 – Indicates severe depression

Reliability (Alpha = 0.92)

Sensitivity and specificity: At cut off of 17 points for depressive-related disorder, there is
80.9% sensitivity and 76.4% specificity.
(https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02934/full)
 Beck Anxiety Inventory
• Devised by Aron T. Beck
• Used to assess severity of anxiety
• Total 21 items
• Maximum score is 63
• Cut-off is 36
• Standard Cut-off
o 0-21 → mild
o 22-35 → moderate
o >36 → severe
• Multiple-choice self-report inventory
Reliability – Cronbach’s alpha – 0.92

Beck Suicidal Intent Scale

• Devised by Aron T. Beck and colleagues
• Used to assess the severity of suicidal attempts and risk of future suicide/suicidal
attempts
• Beck suicide intent scale
o 15 items
o Scored from 0-2
o Maximum score is 30
o 0-10 – Low risk – May be sent home with advice to see community mental
health team or GP
o 11-20 – Medium risk – Assessment by Community mental health team or
psychiatrist is advisable. If treatment refused, community mental health team
follow-up should be arranged.
o 20-30 – High – Immediate assessment by Psychiatrist or Community mental
health team. Psychiatric admission recommended. Involuntary admission may
be required.
• Beck scale for suicide ideation (1979) is also available as Urdu translation
o 19 items
o Each with 3 response choices ranging from 0 to 2 that measure the intensity,
duration and specificity of plans and wishes to commit suicide.
o Total score range is from 0 to 38 with higher score indicating increased
severity of suicide ideation.
o Shown to have strong internal consistency and validity with significant
correlations to self-harm questions from Beck Depression Inventory and the
Beck Hopelessness Scale.
Hamilton Rating scale for Depression (HAM-D)
• Developed by Dr. Max Hamilton
• Used to see the severity of depression and effects of treatment
• Total items are 17 (usually first 17 are considered)
• Maximum score is 76
• Cut off is 20
The Hamilton rating Scale for depression is a clinician-rated scale to assess severity
of, and change in, depressive symptoms.
There are 17 items in the scale. For the 17-item version, scores can range from 0 to 54. the
cut-off score is 7.
The original HAM-D included 21 items, but Hamilton pointed out that the last four items
(diurnal variation, depersonalization/derealization, paranoid symptoms, and obsessive-
compulsive symptoms) should not be counted toward the total score because these
symptoms are either uncommon or do not reflect depression severity
0 – 7→not depressed
8 – 13 →mild
14 – 18 → moderate.
19 – 22 → severe.
> 23→ very severe
Limitations
(1) the failure to include all symptom domains of major depressive disorder
(MDD), in particular, reverse neurovegetative symptoms, (2) the presence of items
measuring different constructs (e.g., irritability and anxiety, loss of interest and
hopelessness), and (3) the uneven weight attributed to different symptom domains
(e.g., insomnia may be rated up to 6 points, while fatigue only up to 2).
Internal consistency
HAM-D-17 – 0.83, HAM D-24 – 0.88
Interrater reliability has been reported to be very high for HAM-D total scores (0.8-0.98)
Test-retest reliability for the HAM-D using the Structured Interview Guide has been reported
to be as high as 0.81.
Validity of HAM-D has been reported to range from 0.65 to 0.9 with global measures of
depression severity.

Hamilton rating scale for Anxiety - HAM-A

• Devised by Dr. Max Hamilton
• Used to see the severity of anxiety and effect of treatment
• Total items are 14
• Maximum score is 56
• Cut-off score is 14
• Standard Cut-offs
o 0-17 → Mild
o 18-25 → moderate
o 26-30 → Severe
o >30 → Very severe
Hospital Anxiety and Depression scale (HADS)
• Devised by Zigmond and Snaith 1983
• Used for diagnosis of both anxiety and depression
• There are 14 items
o 7 items for depression and 7 items for anxiety
• Cut off for anxiety is 8/21
o Anxiety – sensitivity 0.9, specificity 0.78
• Cut off for depression is 8/21
o Depression – sensitivity 0.83, specificity 0.79
• Standard Cut offs
o 0-7 → Normal
o 8-10 → Borderline
o >11 → Case
Montgomery and Asberg Depression Rating Scale
(MADRS)
• Developed by Montgomery and Asberg
• Used to see the severity of depression and effects of treatment
• Consists of definition of both psychological and biological questions of depression
• Total items are 10
• Maximum score is 60
• Cut off is 7
• Standard cut-offs
o <7 → Normal and shows remission
o 8-19 → Mild
o 20-34 → Moderate
o >34 → Severe
 Bradford Somatic inventory (BSI)
• Devised by D.B Mumford et al (1991)
• Used to assess symptoms of anxiety and depression
• It has 46 items.
• In JCPSP a study carried out in Rawalpindi general hospital by Saeed K, Mubashir,
Mumford et al 2001 (Journal of the College of Physicians and Surgeons Pakistan
2001. (4):229-231)
o Comparison of self-reporting questionnaire (SRQ) and Bradford Somatic
Inventory (BSI) as screening instruments for psychiatric morbidity in
community settings in Pakistan
• The results suggested that BSI had a sensitivity value of 82% for women and
specificity was 71%.
Edinburgh Postnatal Depression Scale (EPNDS)
• Devised by J.L Cox et al
• Used as a screening tool for depression in 8 weeks postpartum women
• Total items are 10
• Maximum score is 30
• Standard Cut-offs
o >10 → Possible depression
o Always look at item 10 for suicidal thoughts
o Sensitivity → 0.88
o Reliability → 0.87
Bipolar Disorder
 Young Mania Rating Scale (YMRS)
• Developed by Vincent E Ziegler and popularised by Robert Young
• Used to assess the severity of mania
• It is based on the patient’s subjective report of his or her clinical condition over the
previous 48 hours and additional information is based upon clinical observations made
during the course of clinical interview.
• Total items are 11
o 4 items are rated from 0-8 (irritability, speech, thought content,
disruptive/aggressive behaviour). These four items are given twice the weight
of the others to compensate for poor cooperation from severely ill patients.
o Remaining 7 items are rated from 0-4
• Maximum score is 60
• Cut off is 20
• Standard cut offs
o 0-12 → Normal
o 13-20 → Mild to moderate
o >20 → Severe mania
• Strengths of the YMRS include its brevity, widely accepted use, and ease of
administration. The usefulness of the scale is limited in populations with diagnoses other
than mania.
• The scale is generally done by a clinician or other trained rater with expertise with manic
patients and takes 15–30 minutes to complete.
Obsessive
Compulsive Disorder
Yale Brown obsessive compulsive scale (YBOCS)
• Devised by Wayne Goodman
• There are two types of YBOCS forms
o The YBOCS symptom checklist interview
o YBOCS symptom severity scale
• Used to assess severity of obsessive-compulsive disorder
• The YBOCS has become the gold standard for most recent pharmacological and
behavioural treatment trials because it can be used to measure severity regardless of
the types of obsessions and compulsions the subject exhibits.
• Total items are 10 (5 items for obsessions and 5 items for compulsions)
• Maximum score is 40
• Cut off score of equal to or greater than 16 is the cut off commonly used in
therapeutic trials
• Standard Cut offs
o 0-7 → Borderline/subclinical OCD
o 8-15 → Mild
o 16-23 → Moderate
o 24-31 → Severe
o 32-40 → Profound or extreme
• Inter-rater reliability for the OCD severity score has been estimated at 0.95
and it has been shown to be sensitive to treatment effects.
Schizophrenia
 Scales available internationally
o General symptoms → Gold standard is PANSS
o Psychotic symptoms → Gold standard is PSYRATS (the psychotic symptom rating
scale)
o Social functioning and quality of life → Gold standard is QLS (the quality of life
scale)
o Cognitive functioning in Schizophrenia → The Schizophrenia Cognition Rating Scale
(SCoRS)
o Medication side effects in Schizophrenia → Gold standard is AIMS (Abnormal
Involuntary Movement Scale)

Scale for the Assessment of positive symptoms

(SAPS)
o Devised by Nancy C Andreasen
o Used to see severity of positive symptoms of schizophrenia
o SAPS is split into 4 domains, and within each domain separate symptoms are rated
from 0 (absent) to 5 (severe)
o Total items are 35
o Maximum score is 175
Scale for the assessment of negative symptoms
(SANS)
o Devised by Nancy C. Andreasen
o Used to see the severity of negative symptoms in schizophrenia
o SANS splits assessment into five domains. Within each domain it rates separate
symptoms from 0 (absent) to 5 (severe).
o The scale is closely linked to the Scale for the Assessment of Positive Symptoms
(SAPS), which was published a few years later.
o These tools are available for clinicians and for research.
o The SANS is a 24-item clinician-administered questionnaire, which divides symptoms
into five sub-scales (affective flattening or blunting, alogia, avolition-apathy,
anhedonia-asociality, attention), also given global ratings.
o It is therefore comprised of 19 individual symptom ratings and five global
ratings.
o Total items are 24
o Total score is 120
o Cut offs?
Positive and negative Syndrome Scale (PANSS)
o Devised by Stanley Kay, Lewis Opler and Abraham Fiszbein
o Used to assess the severity of schizophrenia symptoms
o Gold standard for assessment of general symptoms in Schizophrenia
o It has 3 subscales
o Positive
o Negative
o General Psychopathology
o There are 30 items
o 7 items for +ve subscale with total score 49 (range 7-49)
o 7 items for -ve subscale with total score of 49 (range 7-49)
o 16 items of general psychopathology with total score 112 (range 16-112)
o Maximum score of PANSS – 210
o Minimum Score – 30
o 101 Schizophrenics showed these mean scores
o Positive scale – 18.20
o Negative scale – 21
o General psychopathology – 37.74
 Brief Psychiatric Rating Scale (BPRS)
o The BPRS was initially developed by John E. Overall and Donald R. Gorham
o Used to measure severity of psychiatric symptoms and effect of treatment in
schizophrenia.
o There are 18-24 items
o Original version -1962 has 18 items while an expanded version of the test was created
in 1993 by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura
o Maximum score is 126-168
o Sensitivity – 85.71
o Specificity – 86.11
o Cut-off ???
o Original BPRS had 18 items
The expanded version has 24 items
 Abnormal involuntary Movements Scale
• Developed by William Guy; National Institute of Mental Health (U.S.).
Psychopharmacology Research Branch.
• Used to assess the level of dyskinesias in patients taking neuroleptic medications
• There are 14 items
• Maximum score is 28 (as only first 7 items are included for scoring)
• The AIMS has 12 items, each of which is rated on a five-point severity scale ranging
from 0 to 4. Ten items assess abnormal movement in specific body regions (orofacial
area, extremities, and trunk) as well as the global severity; two items concern dental
conditions that can complicate the diagnosis of dyskinesia
• The AIMS is a 12-item anchored scale that is clinician administered and scored
o Items 1-10 are rated on a 5-point anchored scale.
o Items 1-4 assess orofacial movements.
o Items 5-7 deal with extremity and truncal dyskinesia.
o Items 8-10 deal with global severity as judged by the examiner, and the
patient’s awareness of the movements and the distress associated with them.
o Items 11-12 are yes-no questions concerning problems with teeth and/or
dentures, because such problems can lead to a mistaken diagnosis of
dyskinesia
• Scoring
o A total score of items 1-7 (Categories I, II, III) can be calculated. These
represent observed movements.
o Item 8 can be used as an overall severity index.
o Items 9 (incapacitation) and 10 (awareness) provide additional information
that may be useful in clinical decision making.
o Items 11 (dental status) and 12 (dentures) provide information that may be
useful in determining lip, jaw and tongue movements.
Standard Cut-offs
• AIMS is positive if there is
o A score of 2 in 2 or more movements
o A score of 3 or more in a single movement
 Quality of Life Scale (QOLS)
• Devised by American psychologist, John Flanagan.
• Used to assess quality of life in chronic illness group patients
• Measuring quality of life across patient groups and cultures which is conceptually
distinct from health status or other causal indicators of quality of life.
• It is a 16-item scale
• Maximum score is 112.
• Highly validated (0.92) with reliability of 0.84.
 Sheehan Disability Scale (SDS)
• Devised by David V. Sheehan
• It is a Brief self-report tool
• The patient rates the extent to which 3 domains are affected by his or her
symptoms on a 10-point visual analogue scale
o Work/School
o Social life
o Family life
• Rated from 0 to 10
• This 10-point visual analogue scale uses spatiovisual, numeric and verbal
descriptive anchors simultaneously to assess disability.
• Used by researchers and practicing clinicians
• Max score is 30
• There’s no specific cut-off
o Score >5 in any of the three domains indicates significant functional
impairment
• Sensitivity → 83%
• Specificity → 69%
Substance Use
Disorder
Severity of Alcohol Dependence Questionnaire
(SADQ)
• Devised by Stockwell. T et al.
• Used as a screening tool to measure the presence and level of alcohol dependence
• Total items are 20
• Each item is scored on a 4-point scale, giving a possible range of 0 to 60.
• Maximum score is 60
• It is divided into five sections:
o Physical withdrawal symptoms
o Affective withdrawal symptoms
o Craving and relief drinking
o Typical daily consumption
o Reinstatement of dependence after a period of abstinence
• Standard Cut-offs
o <16 → Mild dependence → Target goal can be safe drinking with tightly
monitored alcohol consumption
o 16-30 → Moderate dependence → A period of abstinence will probably be
necessary
o >31 → Severe dependence → Target goal is abstinence
 AUDIT Alcohol Screening tool (AUDIT-II)
• Devised by Thomas F. Babor
• Used to determine Alcohol Consumption, alcohol dependence and alcohol related
problems
• Total items are 10
• Maximum score is 40
• Standard Cut-offs
o 0-7 → Normal
o 8-15 → Possible increasing risk
o 16-19 → Higher risk
o >20 → Possible dependence
 Clinical Institute Withdrawal Assessment for
Alcohol Revised (CIWA-Ar)
• It is an objective scale
• It has 10 items
• All items are scored from 0–7, with the exception of the orientation category, scored
from 0–4.
• Maximum score is 67
• Each item on the scale is scored independently, and the summation of the scores
yields an aggregate value that correlates to the severity of alcohol withdrawal, with
ranges of scores designed to prompt specific management decisions such as the
administration of benzodiazepines.
• Standard cut-offs
o Less than or equal to 10 → Mild withdrawal
o 11-15 → Moderate withdrawal
o Equal to or greater 16→ Severe withdrawal
o Score < 10 doesn’t need additional medication for withdrawal.
 Short Alcohol Withdrawal Scale (SAWS)
• It is a self-reporting scale.
• Administered within 24 hours of alcohol withdrawal
• It has 10 items
• Maximum score is 30
• Score >12 needs treatment.
 CAGE Questionnaire
• Devised by John. A. Ewing.
• It is an extensively used screening tool for identifying “Alcoholism”.
• It has 4 questions.
• Every question is rated 0 or 1
• Score of 2 or greater indicates clinical significance
• It has sensitivity of 93%/76% specificity for identification of “excessive drinking”
and a 91% sensitivity/77% specificity for the identification of alcoholism.
 Objective Opioid Withdrawal Scale
• it provides an objective measure of severity of opiate withdrawal symptoms.
• Devised by Handelsman et al. 1987
• It is clinician scored based on the observation of patient during a 5-minute period.
• It may be used as a part of the initial assessment and for ongoing monitoring to assess
response to medication.
• It is frequently used for monitoring withdrawal using buprenorphine.
• Contains 13 items.
 Subjective Opiate Withdrawal Scale
• Developed by Handelsman et al 1987.
• It is patient scored based on what the patient is feeling at the moment the test is
administered.
• Contains 16 items
• Cut off scores
o 1-10 – Mild, 11-20 – Moderate, 21-30 – Severe
 Clinical Opiate Withdrawal scale (COWS)
• This scale comprises 11 topics, each comprising 4-5 symptoms experienced by a
patient undergoing opioid withdrawal.
• It can be used to measure opioid withdrawal symptoms in both in patients and
outpatients.
• Cut-offs.
o 5-12 points – mild.
o 13-24 points – moderate.
o 25-36 points – moderately severe.
o Greater than 36 points – severe.
Personality Tests
 Rorschach Test (row-shak test)
• Devised by Swiss Psychiatrist Herman Rorschach in 1921
• Most frequently used projective personality test
• Very useful in eliciting psychodynamic formulations, defence mechanisms and subtle
disorder of thinking
• Consists of 10 ambiguous inkblots 5 coloured and 5 black and white inkblots.
• It has two phases
o Free association
o Inquiry phase
• After free association phase, examiner inquires for important aspects of each response
which is crucial to scoring.
• Psychologists keep record of patients’ verbatim responses along with initial reaction
time and time spent on each card
• Response in schizophrenia → It could be a predator? Lots of ink predators?
• Response in anxiety → I have to think about it. It may be a tree
• In depression → It could be a leaf
Draw a person test (DAP) and House tree Person
(HTP)
• Devised by Florence Goodenough in 1926
• It was initially used to measure intelligence in children but now in adolescents as well
o This test is used to measure nonverbal intelligence or to screen for emotional
or behaviour disorders
• As a screening tool to detect organicity
• Easily administered by asking the subject to draw a picture of a man, a woman and
themselves.
• Interpretation is that drawing a person represents self-image in the drawing. The aim
of the test is to assess how the child perceives the people around them including the
family and other psychological activities on, interpersonal and cognitive setting.
• Psychologist interrogate during drawing about what the person is doing?
• Draw a House-Tree-Person (HTP) is a modification of Draw a Person (DAP)
o HTP was designed by John Buck and was originally based on the Goodenough
scale of intellectual functioning.
o First phase is done with a crayon. During the second phase of HTP, the test-
taker draws the same pictures with a pencil or pen. Again, the test-giver asks
similar questions about the drawings.
• Examples of follow up questions:
o After the House: Who lives here? Is the occupant happy? What goes on
inside the house? What's it like at night? Do people visit the house? What else
do the people in the house want to add to the drawing? [2]
o After the Tree: What kind of tree is this? How old is the tree? What season is
it? Has anyone tried to cut it down? What else grows nearby? Who waters this
tree? Trees need sunshine to live so does it get enough sunshine?[1]
o After the Person is drawn: who is the person? How old is the person? What
do they like and dislike doing? Has anyone tried to hurt them? Who looks out
for them?
Minnesota Multiphasic personality Inventory
(MMPI)
• Devised by Starke R. Hathaway and J.C McKinley
• Most commonly used objective personality test.
• MMPI-1 has 567 items.
• MMPI-A has 350-478 items
• It is a self-report questionnaire consisting of 567 questions covering the following
components
• It gives scores on 10 clinical scales to separate medical and psychiatric patients from
normal controls.
• The original MMPI had the following components
o Scale 1: Hypochondriasis – Concern with body symptoms
o Scale 2: Depression – Depressive symptoms
o Scale 3: Hysteria – Awareness of problems and vulnerabilities
o Scale 4: Psychopathic deviate – Conflict, struggle, anger and respect for
society rules
o Scale 5: Masculinity/Femininity – Stereotypical masculine or feminine
interests or behaviours
o Scale 6: Paranoia – Level of trust, suspiciousness and sensitivity
o Scale 7: Psychasthenia – Worry, anxiety, tension, doubt and obsessiveness
o Scale 8: Schizophrenia – Odd thinking and social alienation
 o Scale 9: Hypomania – Level of excitability
o Scale 0: Social introversion – People orientation
• All of the versions of MMPI tests also use validity scales of varying sorts to help
assess the accuracy of each individual's answers. Since these tests can be used for
circumstances like employment screenings and custody hearings, test takers may not
be completely honest in their answers.
• Results are compared with normative data from non-clinical populations.
• Now the interpretation of responses is also done on computer systems.
Thematic Apperception test (TAT) and children
apperception test (CAT)
• Devised by Henry Murray and Christina Morgan
• It is another projective personality test
• The complete version of the test contains 32 picture cards. Some of the cards show
male figures, some female, some both male and female figures, some of ambiguous
gender, some adults, some children, and some show no human figures at all. One card
is completely blank and is used to elicit both a scene and a story about the given scene
from the storyteller. Although the cards were originally designed to be matched to the
subject in terms of age and gender, any card may be used with any subject.
• It consists of series of 20 pictures
• The person is asked to construct the story about the pictures and psychoanalysis is
done on the basis of person’s emotional conflicts, theme of success and failure,
jealousy and competition, relationships, opinion, aggression and sexuality, use of
frequent defence mechanisms etc.
• Child version is called Children Apperception test (CAT)
Cognition and
Intelligence
 Mini Mental State Examination (MMSE)
• First developed by American Psychiatrist, Folstein in 1975, in order to differentiate
organic from functional psychiatric patients.
• Used as a screening tool to assess the severity of cognitive impairment in dementias,
delirium, CVA, Space occupying lesions, disorders of consciousness, psychiatric
disorders and effect of treatment in all these conditions.
• 11 questions
• Total score is 30
• NICE guidelines for MMSE scores in patients with Alzheimer disease
o Mild Alzheimer’s disease – 21 to 26
o Moderate – 10-20
o Moderately severe – 10-14
o Severe – <10
• Tombaugh et al. 1992. The mini mental state examination: A comprehensive review
o 24-30 = no cognitive impairment
o 18-23 = mild cognitive impairment
o 0-17 = severe cognitive impairment.
• Canada
o 25-30 – Questionably significant
o 20-25 – Mild
o 10-20 – Moderate
o 0-10 – Severe
• Errors in MMSE could be due to
o Illiteracy
o Minimal schooling in <8yrs
o In elderly ppl >80yrs age
 Montreal Cognitive Assessment (MoCA)
• This is a widely used screening assessment for detecting cognitive impairment.
• It was created in 1996 by Ziad Nasreddine in Montréal.
o It was validated in the setting of mild cognitive impairment and has
subsequently been adopted in numerous other settings clinically.
• The MoCA test is a one-page, 30-point test administered in approximately 10
minutes.
• It assesses several cognitive domains:
o The short-term memory recall
o Visuospatial abilities
o Attention, concentration, and working memory
o Language.
o Abstract reasoning
o Orientation to time and place
• A score of 26 or over is considered to be normal.
 Wechsler Adult Intelligence Scale IV
• Devised by David Wechsler
• There have been four different versions of the WAIS over the years. These include:
o WAIS (1955)
o WAIS-R (1981)
 o WAIS-III (1997)
o WAIS-IV (2008)
• The current version of the test, the WAIS-IV, which was released in 2008.
• The WAIS-IV was standardized in the United States ranging in age from 16 to 90
years of age.
• It is composed of 10 core subtests and five supplemental subtests with the 10 core
subtests yielding scaled scores that sum to derive the full-scale IQ.
• The verbal/performance IQ scores from previous versions were removed and replaced
by the index scores.
• The General Ability Index was included.
• There are four index scores representing major components of intelligence
o Verbal Comprehension Index (VCI)
o Perceptual Reasoning Index (PRI)
o Working Memory Index (WMI)
o Processing Speed Index (PSI)
• Two broad scores which can be used to summarize general intellectual ability, can
also be derived.
o Full scale IQ, based on the total combined performance of the VCI, PRI,
WMI, and PSI.
o General Ability Index (GAI), based only on the six subtests that the VCI and
PRI comprise.
Wechsler Intelligence Scale for Children Fifth
edition (WISC-V)
• This is the latest version and was published in 2014.
• It can be administered in children from 6 to 16 years 11 months of age (6:0 – 16:11).
• It provides a comprehensive measure of overall intellectual ability as well as five
specific cognitive domains.
• Full Scale IQ comprises five domains.
o Verbal Comprehension
▪ Similarities
▪ Vocabulary
▪ Information
▪ Comprehension
o Visual Spatial
▪ Block Design
▪ Visual Puzzles
o Fluid Reasoning
▪ Matrix Reasoning
▪ Figure Weights
▪ Picture concepts
▪ Arithmetic
o Working Memory
▪ Digit Span
▪ Picture Span
▪ Letter-Number Sequencing
o Processing Speed
▪ Coding
▪ Symbol Search
▪ Cancellation
 Raven Progressive Matrices
• Devised by John C Raven
• Used in 5 years till elderly
• It is a nonverbal test typically used to measure general human intelligence and
abstract reasoning.
• It comprises 60 multiple choice questions listed in order of increasing difficulty.
• It is regarded as a non-verbal estimate of fluid intelligence.
• Spearman thought of general cognitive ability (g) as being made up of two very
different abilities which normally work closely together,
o Eductive ability- meaning-making ability
o Reproductive ability-the ability to reproduce explicit information and learned
skills.
• Raven developed his RPM tests as measures of eductive ability and his Mill Hill Vocabulary
(MHV) tests as measures of reproductive ability.
• Used as an I.Q tool in Autism & Asperger`s Syndrome.
 Stanford Binet Test
• Devised by Alfred Binet and Theodor Simon in 1905 called Binet-Simon scale.
• It was the 1st IQ test.
• Lewis Terman, a psychologist at Standford University, revised the original scale and
it became known as Stanford-Binet Intelligence Scale.
o It is currently in its fifth edition (SB5) and was released in 2003 (author is
Gale Roid).
• The SB5 contains both nonverbal and verbal measures. Each of these contains 5-
factor indices
o Fluid Reasoning (FR)
o Knowledge (KN)
o Quantitative Reasoning (QR)
o Visual-Spatial Processing (VS)
o Working Memory (WM)
• Yields score of mental age and IQ as well.
• Current version can be applied from 2 to 85+ years.
• The IQ score was calculated by dividing the test taker's mental age by his or her
chronological age and then multiplying this number by 100.
o For example, a child with a mental age of 12 and chronological age of 10,
would have an IQ of 120 (12/10 x 100).
 Bender Gestalt Test
• Devised by child psychiatrist Lauretta Bender in 1938
• Used in both children and adults
• Used to assess cognitive disorders, Mental retardation, aphasias, psychosis, neurosis
and malingering
• Most frequently used as screening device in adults for organic dysfunction
• Consists of 9-16 index design cards picturing different geometric designs.
o Original test contains 9 cards
o Bender II contains 16 figures
• The cards are presented individually and test subjects are asked to copy the design
before the next card is shown.
• There’s no time limit.
• Test results are scored based on the accuracy and organization of the reproductions.
• Administration includes copy and recall phase
• Evaluation depends upon the designs produced and relation to one another or whole
spatial background
• Impairment in this test indicates right non-dominant occipitoparietal lobe dysfunction
responsible for visuospatial and perception skills.
General health questionnaire (GHQ-12 and GHQ-
28)
o GHQ-12 a shorter version was devised by Goldberg
o It has 12 items
o GHQ-28 is another version devised by Goldberg and Hillar and has 28 items with a
total score of 84
o More advanced version has 60 items
o Used for the symptoms of somatic, anxiety, depression and social dysfunction
o GHQ is used in primary care, by GPs and community surveys for psychiatrist
judgement of ‘case’ and ‘non-case’
o Score>24 → Indicates distress.

GHQ-12