WHAT IS A NEUROPSYCHOLOGICAL EVALUATION?

A neuropsychological evaluation involves testing that is sensitive to problems in brain functioning. Unlike CT or MRI scan, which show what the structure of the brain looks like, neuropsychological testing examines how well the brain is working when it performs certain functions (for example, remembering). The types of tests that the examinee will take depend upon the questions the examinee and his/her doctor have. The tests may assess the following areas: attention and memory, reasoning and problem-solving, visual-spatial functions, language functions, sensory-perceptual functions, motor functions, academic skills, and emotional functioning.

The tests are not invasive - that is, they do not involve attaching you to machines or using X-rays. Most of the tests will involve questions and answers, or working with materials on a table. Some tests may use a computer. The testing may be performed by the neuropsychologist or by a trained staff member. The neuropsychologist or a staff member will also spend some time talking with the examinee about their medical, personal, and school history. The total time involved in the evaluation will depend upon the questions the examinee and his/her doctor or attorney have. A comprehensive neuropsychological evaluation requires approximately eight to ten hours.

WHAT IS A CLINICAL PSYCHOLOGIST?

A clinical psychologist is a doctor who is specially trained in psychology to examine human behavior. They work with clients who have nervous, emotional and mental disorders, difficulties adjusting to life, and the psychological aspects of disease and injury.

A licensed psychologist must have a doctoral degree, (Ph.D. or Psy.D.) in psychology from an approved university or professional school of psychology. In addition, they must have completed 3,000 hours of supervised clinical internship in a hospital, clinic, or other health care facility. Also, a psychologist must pass a written and oral state examination given by the Psychology Examining Committee.

Clinical psychologists have widely diversified specialties, depending upon their training and experience, from psychoanalysis to behavior modification, hypnosis, and biofeedback. A clinical psychologist administers psychological tests, interviews clients, and usees psychological methods to treat mental, emotional, and behavioral disorders. These range from short-term crises, such as difficulties resulting from adolescent rebellion, to more severe, chronic conditions, such as schizophrenia.

Some clinical psychologists specialize in helping clients with behavioral problems, such as anger, shyness, depression, or marital discord. Their aim is to promote well-being. Some clinical psychologists treat specific problems exclusively, such as phobias or clinical anxiety and/or depression. Others focus on specific populations: youngsters, ethnic minority groups, gays and lesbians, and the elderly, for example. Clinical psychologists work either in private practice or at a hospital, mental institution, or mental health service agency. Some clinical psychologists specialize in forensic psychology and/or neuropsychology.

WHAT IS THE DIFFERENCE BETWEEN A CLINICAL PSYCHOLOGIST AND A PSYCHIATRIST?

Clinical psychologists have a doctoral degree (Ph.D. or Psy.D.) in clinical psychology. They view behavior and emotions from a psychological perspective. Because of their psychological training, they have more extensive training in psychological assessment, research, and psychological treatment of emotional problems than psychiatrists do.

Psychiatrists are physicians (M.D.) who specialize in the treatment of mental illness. Because of their medical training, they can prescribe drugs and can admit patients for hospitalization. They use a medical approach. Psychiatry is a medical specialty which focuses primarily on mental disorders.

Clinical psychologists and psychiatrists often see a similar mix of clients and sometimes work together as part of a mental health team. The two professions frequently deal with similar problems of mental health - one from a psychological approach, the other from a medical approach. However, clinical psychology is a health profession broadly concerned with improving the effectiveness of human behavior in many settings.

In addition to treating nervous and mental disorders, clinical psychologists, as well as some psychiatrists, focus on the prevention and treatment of numerous other health disorders. They also develop programs which focus on promoting and maintaining health. Further, clinical psychologists may work with persons who are concerned with personal growth or who are dealing with developmental, life or situational crises. They can help individuals learn to relax and handle stresses more effectively.

WHAT IS A FORENSIC PSYCHOLOGIST?

Forensic psychologists focus on legal issues, the court, and correctional systems. They apply psychological principles to legal issues. Their expertise is often essential in court. They can, for example, help a judge decide which parent should have custody of a child, or evaluate a defendant's mental competence to stand trial. They often work with the courts in evaluating whether an inmate is ready for parole, or whether a specific rehabilitation program is achieving its goals. Some forensic psychologists are trained in both psychology and the law. They do forensic psychological evaluations to address various forensic mental health issues arising in criminal and delinquency proceedings, including competence to plead guilty, competence to stand trail, and criminal responsibility or diminished capacity defenses. They also appear in court as expert witnesses.

WHAT IS A NEUROPSYCHOLOGIST?

A neuropsychologist is a licensed psychologist specializing in the area of brain-behavior relations. He/she explores the relationships between brain systems and behavior. For example, neuropsychologists may study the way the brain creates and stores memories, or how various diseases and injuries of the brain affect emotion, perception, and behavior. A neuropsychologist has additional training in the specialty field of clinical neuropsychology. That means a neuropsychologist is educated in brain anatomy, brain function, and brain injury or disease.

The neuropsychologist also has specialized training in administering and interpreting the specific kinds of tests included in the neuropsychological evaluation. As a part of the required education, a neuropsychologist also has years of practical experience working with people who have had problems involving the brain. Neuropsychologists frequently help design tasks to study normal brain functions with new imaging techniques, such as position emission tomography (PET), single photon emission tomography (SPECT), and functional magnetic resonance imaging (FMRI).

Neuropsychologists also assess and treat people. With the dramatic increase in the number of survivors of traumatic brain injury over the past 30 years, neuropsychologists are working with health teams to help brain-injured people resume productive lives.

WHAT IS THE DIFFERENCE BETWEEN NEUROLOGY AND CLINICAL NEUROPSYCHOLOGY?

Neurology	Clinical Neuropsychology
Medical training and Neurology Residency (M.D.)	Clinical Psychology and Neuropsychology training (Ph.D.)
Diagnosis of brain damage and neurological disorders	Identification of emotional and behavioral deficits associated with brain damage and neurological disorders
Work with neurologically impaired populations	Work with neurologically and psychiatrically impaired populations
Neurological exam: qualitative nonstandardized subjectively interpreted relatively brief (approximately 2 hours)	Neuropsychological testing: quantified standardized objective lengthy (8-10 hours)
Emphasis typically focuses on assessing basic motor and sensory abilities. Mental status exam is typically very brief and focuses on orientation to surroundings, attention, recent memory, language, and constructional skills.	Much greater emphasis on assessing patient's higher cognitive functions: attention, perception, language, memory, executive functions, judgment, motor skills, reasoning, abstract thinking, problem solving, intellectual abilities, and personality/emotional functioning.
Little emphasis on psychosocial and psychiatric factors	Considerable emphasis on psychosocial and psychiatric factors
Can prescribe medical diagnostic procedures (e.g., CT scan, MRI, EEG)	Cannot prescribe medical diagnostic procedures, but can review findings of such tests
Treatment with medication	Treatment with psychotherapy and cognitive rehabilitation, biofeedback, and environmental and behavioral modification

WHAT IS PSYCHOTHERAPY?

Psychotherapy is an intervention that uses the principles of psychology in order to treat mental or emotional disorders or otherwise to improve the adjustment and well-being of the person who receives the intervention. Generally, psychotherapy is a set of techniques intended to improve mental health, emotional or behavioral issues in individuals, who are often called 'clients' or 'patients'. These issues often make it hard for people to manage their lives and achieve their goals. Psychotherapy is aimed at these problems, and solves them via a number of different approaches and techniques; commonly psychotherapy involves a therapist and client(s) or patient(s), who discuss their issues in an effort to discover what they are and how they can manage them. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect patient privacy and client confidentiality.

Given that psychotherapy is a kind of treatment restricted mostly to verbal exchanges, practitioners do not have to be medically qualified. In most countries, however, psychotherapists must be trained, certified and licensed with a range of different licensing schemes and qualification requirements in place around the world. Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, psychoanalysts, or professional of other mental health disciplines. Psychiatrists' training focuses on the prescription of medicines, with some training in psychotherapy. Psychologists have special training in mental health assessment and research in addition to psychotherapy. Social workers have special training in mental health assessment and treatment as well as linking patients to community and institutional resources.

Recent trends in drug development to treat chemical imbalances have led to a more wide spread use of pharmaceuticals in conjunction with psychotherapy by medically qualified mental health nurse practitioners, psychiatrists, and in some states prescribing psychologists.