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Ask the Mental Health Expert Archives 2001-2004

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Neuropsychological Diagnosis

Q. I assume that neuropsychological testing is used to assist in the determination of a diagnosis. Until testing is done, how does the MD know what the treatment plan should be? Is it just based on symptoms? What's the best method to come to a diagnosis?

A. Neuropsychological testing (NPT) is often a useful adjunctive tool in the diagnosis of mental disorders; however, I don't regard it as essential in the diagnosis or treatment of any specific mental disorder. Indeed, I would go so far as to say that NPT almost never yields a single, specific diagnosis; e.g., "This testing conclusively shows that this patient suffers from schizophrenia."

On the contrary, as Calev et al state in their book, Assessment of Neuropsychological Functions in Psychiatric Disorders (American Psychiatric Press, 1999) "Neuropsychological assessment aims to describe different cognitive functions and to understand the biological and functional causes of [malfunctions] or hyperfunctions, [in order] to improve management and treatment." NPT is not aimed as establishing with certainty a specific diagnosis or disorder. This is the job of a clinician, such as a psychiatrist, who can put together the patient's personal history, family history, mental status exam, brain imaging studies (CT scan, MRI, etc.), laboratory testing, and a myriad of other factors--NPT is merely one piece of the puzzle.

It can be quite helpful in quantifying memory problems, and localizing areas of brain dysfunction. NPT does not allow one to say, however, "This patient definitely suffers from Alzheimer's Disease." Thus, psychiatric diagnosis is based on more than "just symptoms". It is a comprehensive, bio-psychosocial determination that may involve several other professionals and various kinds of tests--but, in the final analysis, diagnosis and treatment still come down to the clinician's judgment and experience.

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June 2001

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