Neuropsychological Assessment for Psychiatrists

PGY-2 Resident Didactics

Joey W. Trampush, Ph.D.

Department of Psychiatry and the Behavioral Sciences
USC Keck School of Medicine

April 9, 2025

Learning Objectives

  • Understand the role of neuropsychological assessment in psychiatric practice
  • Recognize the domains of cognitive functioning assessed in a neuropsychological evaluation
  • Interpret the results of a neuropsychological evaluation in the context of psychiatric diagnosis and treatment planning

Reason for Referral

From you to me

  • Psychodiagnostic clarification ( e.g., poor response to pharmacotherapy)

  • To clarify the presence of cognitive deficits that may be contributing to a patient’s psychopathology

  • Role of neuropsychological assessment in psychiatric differential diagnosis is challenging …

Standard neuropsychological test battery

Behavioral/Emotional/Personality

  • Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), Part I: History
  • Conners’ Adult ADHD Rating Scales–Self-Report: Long Version (CAARS–S:L)
  • Conners’ Adult ADHD Rating Scales–Observer Report: Long Version (CAARS–O:L)
  • Comprehensive Executive Function Inventory Adult (CEFI Adult), Self-Report Form
  • Comprehensive Executive Function Inventory Adult (CEFI Adult), Observer Form
  • Personality Assessment Inventory (PAI)

Neurocognitive Examination

  • Wechsler Adult Intelligence Scale, 4th ed (WAIS-4): Similarities, Matrix Reasoning, Letter-Number Sequencing, Coding
  • Wechsler Individual Achievement Test, 4th ed (WIAT-4): Word Reading, Reading Comprehension, Pseudoword Decoding, Orthographic Fluency, Decoding Fluency
  • Neuropsychological Assessment Battery, Screener (NAB): Attention, Language, Memory, Spatial, and Executive Functions Modules
  • NIH Executive Abilities–Measures and Instruments for Neurobehavioral Evaluation and Research (NIH EXAMINER): Unstructured Task, Verbal Fluency, Behavioral Rating Scale
  • California Verbal Learning Test, 3rd ed (CVLT-3), Brief Form
  • Rey-Osterrieth Complex Figure Test (ROCFT)
  • Trail Making Test (TMT)

Effort/Validity Testing

  • ACS Word Choice Test
  • Dot Counting Test (DCT)

Domains Assessed

How do we measure these domains?

Processing speed and $$$

General cognitive ability “g”

Performance across individual tests correlates strongly among each other

Attention/Executive

Attention

Working Memory

Processing Speed

Executive Functioning

Attention/Executive

Attention

  • attention span
  • attentional fluency

Attention/Executive

Working Memory

  • verbal working memory
  • nonverbal working memory

Attention

Attention/Executive

Processing Speed

  • psychomotor speed
  • cognitive efficiency

Working Memory

Attention

Attention/Executive

Executive Functioning

  • planning
  • judgment

Processing Speed

Working Memory

Attention

Learning Disorders (LD)

Distribution of Scores: Population-level Interpretation

Performance classification of neuropsychological test scores in the general population.

Case Report #1

  • Patient: 20-something yr-old male
  • Referral: ADHD/LD evaluation

Neurocognitive Examination

Behavioral/Emotional/Personality

Effort/Validity Testing

Case Report #2

  • Patient: 20-something yr-old female

  • Referral: ADHD and anxiety for accommodations

Neurocognitive Examination

Behavioral/Emotional/Personality

Effort/Validity Testing

Thank you!