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PSYC31H3 (100)
Chapter 1

PSYC31 Chapter 1.docx

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University of Toronto Scarborough
Konstantine Zakzanis

CHAPTER 1 – THE PRACTICE OF NEUROPSYCHOLOGICAL ASSESSMENT pg. 3-14  Clinical neuropsychology: an applied science concerned with the behavioral expression of brain dysfunction  19th century – controlled observations accepted - Neuroscientists laid out basic brain-behavior relationships  20 century – war-damaged brains  need for screening and diagnosis of brain injured and behaviorally disturbed and for rehab  development of clinical neuropsychology  Clinical neurosciences directly led to clinical neuropsych, but psychology also gave two domains of knowledge: - Educational psychology: developed tests of intelligence: educational testing  large-scale, statistics-dependent testing programs  more reliable measurement technique and standardization, analysis, validation - Experimental studies of cognitive functions: esp gained from studies of brain injured persons with localized lesions  21 century – functional neuroimaging to view brain structures  gives psychological constructs the neurological bases to understand  In assessments  address both neurological- and psychological-based questions  Neuropsych assessment used to assist in clinicians’ practical problems of identification, assessment, care and treatment of brain injured patients  Neuropsychological assistance used by many including: psychologists/psychiatrists/counsellors, neurologists/neurosurgeons, rehab specialists, child neuropsychology, adults w/ cognitive/behavioral problems Examination Purposes pg. 4-11  Any of following purposes would require neuropsych exam, each calling for diffs in assessment strategies: 1. Diagnosis.  Assessment useful for: - For discriminating b/w psychiatric and neurological symptoms - identifying possible neurological disorder - distinguishing b/w diff neurological conditions - providing behavioural data for localizing lesion site  role as diagnostic tool has lessened, partly due to neuroimaging  useful when even most sensitive methods can’t diagnose (e.g. dementing processes - Alzheimer’s)  also, imaging doesn’t identify nature of behavioral strengths and deficits nor account for individual differences  can document abilities inconsistent with anatomic findings  can aid in early detection and prediction of dementing disorders and outcome  to assist in predicting best treatments in mood disorders  screening – identify persons most likely at risk for some condition or in need of further diagnosis 2. Patient care and planning.  many referred for descriptive evaluations about cognitive status, behavioral alterations, and personality characteristics  to determine how condition has affected their behaviour - used in care and treatment of brain injured patients  exam can answer questions regarding capacity for self-care, reliability in following therapeutic regimen, ability to handle certain situations, ability to appreciate and handle financial situation  examiner can tell how to best compensate for deficits and whether retraining could be done  plays key role in monitoring cognitive and neurobehavioural status following a TBI (traumatic brain injury)  repeated testing can indicate whether neurological condition is changing, how rapidly, in what ways  impairment may diminish capacity to understand/recognize their deficits  leads to self-distrust – confusion about habits, etc that now feel different and from tendencies to make errors  perplexity  must give factual info about their functioning to understand themselves and set realistic goals  dispel anxiety and confusion - also to family, in order to be able to respond appropriately 3. Treatment-1: Treatment planning and remediation.  sensitive, broad, accurate assessment needed to determine most appropriate treatment for each rehab candidate  include both description of problems, strengths, and potential for rehab  repeated assessments done to adapt programs and goals to changing needs and abilities 4. Treatment-2: Treatment evaluation.  assessment can answer whether a rehab/retraining service can produce behavioural changes of psychological/social value and that are maintained long enough to warrant costs  neuropsych evaluation can best demonstrate neurobehavioral response to surgical interventions or brain stimulation  testing for drug efficacy and side effects – requires neuropsychol
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