Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 5: Examination and Diagnosis of the Psychiatric Patient

if so, assesses frequency, severity, and associated caregiver dis- tress. The instrument has demonstrated reliability and validity and is useful to screen for problem behaviors in both clinical and research settings. Because of the detailed frequency and severity ratings, it is also useful to monitor change with treatment. Scored General Intelligence Test (SGIT).  This test was developed and validated by N. D. C. Lewis at the New York State Psychiatric Institute in the 1930s. It is one of the few tests that attempts to measure general intelligence that can be administered by the clinician during the psychiatric interview. A decline in general intelligence will be seen in cognitive dis- orders, and the SGIT can alert the clinician to begin a workup for disease states that interfere with cognition. This test deserves more widespread use (Table 5.3-7). Personality Disorders and Personality Traits Personality may be conceptualized categorically as personality disorders or dimensionally as personality traits, which may be

viewed as normal or pathological. The focus here is on personal- ity disorders and the maladaptive traits generally viewed as their milder forms. There are ten personality disorders that are divided into three clusters. Patients tend not to fall neatly into DSM per- sonality categories; instead, most patients who meet the criteria for one personality disorder also meet the criteria for at least one other, particularly within the same cluster. This and other limitations in the validity of the constructs themselves make it difficult to achieve validity in personality measures. Personality measures include both interviews and self-report instruments. Self-report measures are appealing in that they require less time and may appear less threatening to the patient. However, they tend to overdiagnose personality disorders. Because many of the symptoms suggesting personality problems are socially undesir- able and because patients’ insight tends to be limited, clinician- administered instruments, which allow for probing and patient observation, may provide more accurate data. Personality Disorder Questionnaire (PDQ).  The PDQ was developed in the late 1980s as a simple self-report

Table 5.3-7 Scored General Intelligence Test (SGIT)

Indications: When a cognitive disorder is suspected because of apparent intellectual defects, impairment in the ability to make general- izations, the ability to maintain a trend of thought, or to show good judgment, a scored test can be of value. Directions: Ask the following questions as part of the mental status examination. A conversational manner should be used and the ques- tions may be adapted to cultural differences. Scoring: If the patient obtains a score of 25 or under (out of a maximum of 40), it is indicative of a cognitive problem and further exami- nation should follow. Questions: There are 13 questions that follow.  1. What are houses made of? (Any material you can think of)........................................................................................................... 1–4 One point for each item, up to four.  2. What is sand used for? ..........................................................................................................................................................1, 2, or 4 Four points for manufacture of glass. Two points for mixing with concrete, road building, or other constructive use. One point for  play or sandboxes. Credit not cumulative.  3. If the flag floats to the south, from what direction is the wind? ..........................................................................................................3 Three points for north, no partial credits. It is permissible to say: “Which way is the wind coming from?”  4. Tell me the names of some fish...................................................................................................................................................... 1–4 One point for each, up to four. If the subject stops with one, encourage him or her to go on.  5. At what time of day is your shadow shortest? ....................................................................................................................................3 Noon, three points. If correct response is suspected of being a guess, inquire why.  6. Give the names of some large cities. ............................................................................................................................................. 1–4 One point for each, up to four. When any state is named as a city, no credit, that is, New York unless specified as New York City. No  credit for hometown, except when it is an outstanding city.  7. Why does the moon look larger than the stars? .....................................................................................................................2, 3, or 4 Make it clear that the question refers to any particular star, and give assurance that the moon is actually smaller than any star. .......... Encourage the subject to guess. Two points for “Moon is lower down.” Three points for nearer or closer. Four points for generalized  statement that nearer objects look larger than more distant objects.  8. What metal is attracted by a magnet? .........................................................................................................................................2 or 4 Four points for iron, two for steel.  9. If your shadow points to the northeast, where is the sun? ..................................................................................................................4 Four points for southwest, no partial credits. 10. How many stripes are in the American flag? .....................................................................................................................................2 Thirteen, two points. A subject who responds 50 may be permitted to correct the mistake. Explain, if necessary, that the white stripes  are included as well as the red ones. 11. What does ice become when it melts? ..............................................................................................................................................1 Water, one point. 12. How many minutes in an hour? ........................................................................................................................................................1 60, one point. 13. Why is it colder at night than in the daytime? ............................................................................................................................... 1–2 Two points for “sun goes down,” or any recognition of direct rays of sun as source of heat. Question may be reversed: “What makes  it warmer in the daytime than at night?” Only one point for answer to reverse question.

This test was developed and validated by N. D. C. Lewis, MD. (From Sadock BJ, Sadock VA. Pocket Handbook of Clinical Psychiatry . 5 th ed. Philadelphia: Lippincott Williams & Wilkins, 2010, with permission.)