Emotional Functioning

Most assessments of emotional functioning are conducted during the interview with the patient. This information can be gathered in a standardized or nonstandardized format. Tests of emotional functioning ought to be used to generate hypotheses as to the presence of dysfunction with follow-up of these hypotheses occurring during the interview (see Chajpter...3 ). There are two general formats to tests of emotional functioning: objective tests and projective tests. Only objective tests will be presented in this section.

Minnesota Multiphasic Personality Inventory-2 (MMPI^.y This self-report test is an objective measure of personality function composed of 567 true-false questions. The questions were chosen based on their ability to differentiate emotionally impaired individuals from nonimpaired individuals. The MMPI-2 has 10 clinical scales and 4 validity scales. Profiles of the clinical scales can suggest the presence of many different emotional disorders, ranging from mild depression to psychotic conditions. This test has acceptable norms, although the standardization sample was limited in racial diversity. Care needs to be exercised in the interpretation of the MMPI-2 when applied to patients with brain damage, because many of the symptoms elicited by MMPI-2 questions are common to neurological patients.

Beck Depression Inventory.1y This objective self-report measure assesses the presence of depressive symptoms experienced by the patient within the past week. It is composed of 21 questions. Each question is scored on a 4-point scale ranging from no impairment (0) to severe impairment (3). The maximum score is 63; a cutoff score indicative of mild depressive symptoms is greater than 10 and for severe depressive symptoms is greater than 30.

One problem with the use of the Beck Depression Inventory with brain-damaged patients is that many of the items reflect somatic concerns and social changes associated with neurologic damage.

Geriatric Depression Scale.1??' This objective self-report measure of depression was designed for use in elderly patients. The test consists of 30 yes or no questions. A cutoff score of 13 is recommended as an indication of depression.

CLINICAL SITUATIONS FOR TESTS OF EMOTIONAL FUNCTION

The assessment of emotional functioning is important for three reasons. First, emotional disturbance often follows or accompanies CNS damage. Examples include cerebrovascular disease (see Chapter.22 and Chapter...45 ), neurodegenerative disorders (see Chapters.33 , 34 , 35 , and 36 ), and metabolic, nutritional and drug-induced encephalopathies (see Chapters...38 , 39 , 40 , and 55 ). Not only do patients face adjustments to physical function, they also often must make social adjustments that can affect emotional functioning. Second, emotional disturbances can affect cognitive functioning. Although the diagnosis of pseudo-dementia, or dementia related to depression, does not appear to be real dementia, severe depression can cause impairments in attention, vigilance, and motivation, which may affect performance on memory tests. Third, assessment of emotional functioning is required to differentiate functional from neurological disorders.

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