This is a summary of chapter 3, 5, 13, 15, 18, 19, 21 and 23 from the book Clinical Neuropsychology. ISBN: 9789024456130.
Used for the study Psychology at Radboud University; the second year course Clinical Neuropsychology.
,Chapter 3 – Neuropsychology in clinical practice
A psychologist working in health care is a scientist-practitioner who combines clinical
knowledge and skills with a scientific attitude.
Neuropsychological assessment
- starts with a research question
- various hypotheses are formulated
- data collection (studying the medical file, clinical interview, interview with an informant,
observations,, test results and questionnaires)
- results are integrated
- and a conclusion follows
Areas of expertise
Hospital:
This can be a general, university or categorical hospital. A categorical hospital focuses on a
specific patient group, for example patients with epilepsy or cancer.
Questions that the neuropsychologist in the hospital encounters are often focused on
diagnostics. Besides diagnostic questions, the neuropsychologist within a hospital focuses on
treatments mostly of short duration.
Mental Health Care:
Several psychiatric disorders are known to have an effect on cognitive functioning, or
cognitive impairments are associated with the disorder itself.
The neuropsychologist within a mental health institution makes use of a neuropsychiatric
model, which examines the relationship between brain, cognition, emotion and behaviour.
Treatments in the mental health services often last longer than treatments in a hospital.
Rehabilitation Care:
In rehabilitation, a multidisciplinary approach is taken, with the patient’s treatment team made
up of the neuropsychologist and other disciplines. Treatment can take place in both inpatient
and outpatient settings.
A key theme in rehabilitation is participation; the aim is to enable patients to participate in
activities in society as independently as possible.
Questions within a rehabilitation setting are usually not of a differential diagnostic nature, as
the diagnosis process has often already taken place.
Long-Term Care
Patients who can no longer live independently at home due to cognitive or physical
impairments are eligible for long-term care. This often involves older people with
neurodegenerative diseases, but patients with severe brain injuries who can no longer live at
home are also admitted to specialised units of care institutions.
Their work is usually more focused on mediative treatment and counselling than on
diagnostics.
Forensic Care
The neuropsychologist working in forensic care sees patients with a (suspected) mental
disorder or previously acquired brain injury. Treatment of patients can be voluntary or
imposed. Neuropsychologist in forensic institutions often work within a legal framework, for
example when patients are in detention or have been placed in preventative custody.
, Questions for the neuropsychologist focus on explanatory diagnostics (‘Can the patient’s
behaviour be explained by cognitive disturbances?’) or serve to support a treatment indication
(‘Do the cognitive disturbances interfere with the proposed treatment?’)
The forensic neuropsychologist is also involved in the question of whether statements made
by suspects or victims are reliable.
Neuropsychological experts report
A neuropsychological assessment is usually performed in the context of healthcare. However,
it is also possible that an investigation is conducted within a medicolegal context. This may
concern personal injury cases or questions of liability (e.g. in medical negligence cases).
In a medicolegal report, it is important to provide patients with a detailed explanation of the
procedure prior to the investigation and to point out their rights.
Cross-cultural factors
Neuropsychological tasks have typically been developed for a Western population with most
normative data being based on Nort-American or European studies. This complicates and
limits neuropsychological diagnostics in patients with a non-Western background. Some tests
cannot be presented to patients or test results can be difficult to interpret. Different native
language, illiteracy or a low level education make testing more complex.
Secondary cognitive complaints
There is also a wide range of disorders, neurological and non-neurological, in which the brain
damage is not clearly demonstrated or only very subtle, yet patients still experience cognitive
complaints.
It is the task of the neuropsychologist to provide clear explanations to patients about the
various factors, besides brain damage, that may have a negative impact on cognitive
functioning.
Neuropsychological treatment
Psycho-education is an important first step of neuropsychological treatment. In psycho-
education patients receive information about their disease and concrete advise.
Neuropsychological treatment focuses on learning to cope with cognitive disorders, such as
treatments specifically aimed at coping with memory loss, mental slowness or neglect.
However, patients can also suffer from mood complaints, adjustment problems, relationship
issues or changes in intimacy as a direct or secondary result of brain injury. Therse problems
are part of neuropsychological treatment. Some standard treatment protocols in mental health
care (for example mood complaints) may be of limited use or even unsuitable for individual
patients with brain injury and adjustments are required.
It is the task of the neuropsychologist to adjust the treatment in such a way that it is in line
with the capacities of the patients.
When a patient is affected by brain injury, this not only has an effect on their own functioning,
but also on the lives of significant others. For this reason, family and significant others should
be mostly involved in neuropsychological treatment.
In conclusion
A neuropsychologist is a scientist-practitioner working in different field within health care.
Assessments and treatment are carried out on the basis of a scientific framework. There is
often intensive collaboration with other professional disciplines. The notion that
neuropsychological assessment is equivalent to administering cognitive test is incorrect. To
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