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Psychological evaluation in the psychiatric context generally refers to measurements from psychological testing (in addition to the utilization of information from the history and traditional mental status examination), made for the purpose of helping delineate and clarify a patient's psychopathology. Psychological testing is frequently requested to address specific clinical issues such as the patient's need for hospitalization, personality factors complicating Axis I symptoms, the possible presence of malingering, identification of major therapeutic issues, the patient's potential for suicide, his or her primary defense mechanisms and coping style, and the most appropriate discharge options. The child psychiatrist may need to rule out neurodevelopmental disorders such as mental retardation with cognitive testing. Questions a psychiatrist may ask in a neuropsychological referral are typically related to the role of possible central nervous system dysfunction in a patient's pathology and its impact on daily functioning. For example, does a patient have dementia or pseudodementia, is a patient's behavioral or emotional dyscontrol the result of personality factors or impaired central nervous system mechanisms that modulate such reactions, and what is the extent of organic damage and associated cognitive impairment? In addition to clarifying the diagnosis and assisting in treatment planning, psychological testing can play an important role in outcome assessment by helping to document the effectiveness of the treatment provided to a given patient.
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The psychiatrist's ability to call upon and utilize psychological consultation on complex clinical cases in the course of practice leads to many diagnostic advantages over relying upon interview and observations alone, particularly in today's health care environment that emphasizes documentation. Further, having an understanding of a patient's personality structure, amenability to treatment, and verbal skills, for example, are extremely useful in deciding whether psychosocial treatments or pharmacological treatment alone would be the preferred treatment modality. The demonstration of treatment effectiveness by measurably positive changes on symptom report scales is important documentation for insurance companies, managed care corporations, and patient consumers. The measurement of a patient's tendency to deliberately exaggerate or to experience somatoform symptoms is often critical in the medicolegal context. Similarly, the measurement of cognitive skills and deficits adds a dimension to the psychiatrist's understanding of the patient's abilities, whether it be the identification of precocity in a preschooler or dementia in an aged professional who is reluctant to retire despite complaints from clients and business partners.
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The selection of tests to address given referral questions is determined according to whether they satisfactorily meet key psychometric standards. Psychological tests are typically norm-referenced, that is, the score of an individual patient is compared to the average of the standardization sample, the group of persons to whom the test was initially administered, and who were carefully chosen as being representative of the population of interest (e.g., patients with a diagnosis of bipolar I disorder). The test procedures themselves are also standardized. While informal bedside testing can be adapted to one's personal style and has the flexibility of ...