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Psych Reads Basics 1 Neuro Cognitive Function Assessment — Transcript

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0:02hello everyone welcome to today's
0:04lecture the this is the first lecture in
0:07the series and in the course that is
0:10this I create scores one basics of
0:12clinical learning I am Dr Manish Roshan
0:15thakur I have done my empty Psychiatry
0:16from Department of Psychiatry at Ames
0:18New Delhi so in today's lecture we will
0:21be mostly focusing on one aspect of the
0:23course that is a neurocognitive function
0:25the various headings of the
0:26neurocognitive function how to do the
0:28test the
0:30referenced definition of each and every
0:33heading how to rate judgment and insight
0:35and various scales of insight mostly
0:37we'll be looking into the definitions
0:39from CTP and from scrub and black so
0:42let's begin with the first and uh
0:44heading that is in the neurocognitive
0:46function and the first setting is of
0:48orientation so if you look into the
0:50orientation the orientation is defined
0:52as the state of awareness of oneself and
0:55of surrounding
0:57with respect to time
1:00place
1:01and person
1:03so this is the standard definition in
1:06CTP 10th edition it has been given as
1:08and states that it is the state of
1:11awareness of oneself under surrounding
1:13with respect to time decent person so
1:16on assessing the orientation we have to
1:18look into time place in person so when
1:21looking into the time we can ask the
1:23patient regarding what time of day it is
1:25you can also ask the patient that
1:29if he or she can tell the approximate
1:31time
1:32don't uh use or give the cue to the
1:35patient that it is day or night let the
1:37patient answer by himself let him or her
1:42answer if he or she is able to answer
1:44that it is day or night then you switch
1:47forward and do us to tell the
1:50approximate time
1:51similarly if we look into the second
1:54component of orientation that is the
1:55place we can definitely ask them to uh
2:00tell regarding the current place of stay
2:02regarding the ward number regarding the
2:06floor in which they are staying and
2:07regarding the bed number so by this we
2:10can get a fair enough idea regarding the
2:12orientation towards the place with
2:14respect to the person you can ask about
2:16the nearby attendant
2:18the nursing staff tgr of the SR that has
2:21been looking after the patient so once
2:24you are done with the assessment of
2:25orientation you can definitely give the
2:27interpretation by saying that the
2:30patient is oriented to time place in
2:32person if by chance patient is not
2:35oriented time so how to report you can
2:38report by saying that the patient is
2:41oriented to place in person and it is
2:43not oriented to time so this is the
2:46complete interpretation of orientation
2:47looking into the second component of
2:50neurocognitive function that is
2:52attention
2:55and
2:57concentration
3:02so first we should know the definition
3:04of attention
3:06and concentration so if you look into
3:08the definition that has been given in
3:10straw and black
3:17so stubborn black fourth edition
3:21so what is the definition of attention
3:22in stubborn black so it is the
3:26ability
3:32of an individual
3:38who
3:40Focus
3:43on a specific
3:50stimulus
3:54this is the first part of the definition
3:56that is ability of the individual to
3:58focus on a specific stimulus
4:00and
4:03in continuation to that only
4:05without
4:10getting
4:18distracted
4:21by
4:26external
4:28or internal
4:31stimuli
4:35so this is the definition of attention
4:38similarly if you look into the
4:40definition of concentration
4:42so how it has been defined concentration
4:45according to strub and black the same
4:47textbook it is a very standard textbook
4:50for neural cognitive function so
4:51definitely do refer to it how the
4:54concentration has been defined so it is
4:56defined as the ability
4:59to maintain
5:05attention
5:10for a specific
5:17stimuli
5:25for an
5:27extended
5:30period of time
5:37so let's revise and look into the
5:40important
5:41parts of it so first is the attention so
5:44it is defined as the ability
5:47to focus on a specific stimulus
5:53without getting distracted
5:58looking into the concentration it is the
6:01ability to maintain attention
6:04for a specific stimuli
6:09for an extended period of time
6:12so attention is first defined and on top
6:16of that in easier terms we can say that
6:19sustained attention is concentration so
6:21consent uh so
6:45so this is the concept box that we can
6:48definitely get into okay so that
6:51concentration is the sustained attention
6:53so one more important thing that comes
6:55into the place then what is Vigilance we
6:58all should be able to uh differentiate
7:01concentration from vigilance it is one
7:03of the important
7:07terms
7:11so
7:12defining vigilance is
7:15you have to keep a distinction between
7:19vigilance attention and concentration so
7:22let's write down the important points in
7:24definition of vigilance this is also
7:27according to this turban black book
7:29notice the sense of alertness
7:49basic referring to basic
7:52arousal
7:54process
8:04in which the
8:06awake
8:09person
8:11can
8:12respond
8:16to
8:24any stimuli
8:29in the environment
8:41so let's focus on the important part it
8:44is the sense of alertness
8:47statistic basic arousal process
8:51in which the away person can respond to
8:54any stimuli as opposed to specific
8:57stimuli and concentration it refers to
9:00any stimuli that you can focus in the
9:02environment and it is the basic arousal
9:05process so these three terms that is
9:07attention concentration and vigilance
9:10are important
9:19so this is for attention
9:26this is the concentration definition and
9:29the third one is the vigilance okay
9:34so we are clear with the concepts and
9:36the definition let's now focus on two
9:41the testing of attention and
9:43concentration so how to test for
9:46attention
9:52and concentration
9:58so the first is the
10:01serial subtraction test
10:13so there are three serial subtraction
10:15tests that you can actually employ but
10:17first is the 100 minus 7 that is the
10:19standard one
10:21so you can ask the patient I'll
10:24definitely give the instructions let me
10:26first write all the tests
10:30so what is the important instructions
10:32that has to be given to the patient
10:34first of all you have to demonstrate
10:39by
10:40giving an example
10:48this is the first thing that you have to
10:50do you just give an example like 50
10:52minus 5 is 45 and then you keep on doing
10:56the subtraction by yourself and make the
11:00patient familiar with the test that if
11:02you start doing uh subtracting 5 out of
11:0550 it will be 45 and if you keep on
11:08doing it it will be 40 35
11:1130 25 20 and so on so first and foremost
11:17you have to give an example
11:19second
11:22don't
11:24nod
11:26or say yes
11:31or whether or indicate
11:36whether the answer
11:43correct
11:44or not
11:47don't do it like if for example the
11:49patient starts doing 100 minus 7 93 86
11:5379 instead of 79 if he says 78 don't
11:57look at him don't frown at him don't say
12:00yes don't say no don't say whether he or
12:03she is correct or not just ask him to
12:05continue and complete the test
12:08okay so these are the general
12:10instruction that you should follow while
12:12conducting a serious abstraction test
12:14and regarding the interpretation
12:17what you can do is maximum
12:22two mistakes are allowed
12:31more than two the patient has failed the
12:34test
12:39so for example if the individual is not
12:41able to do 100 minus 7 you can
12:43definitely uh drive with other simpler
12:46versions of them 40 minus 3 or 20 minus
12:491.
12:50but if
12:52the person is able to give two or more
12:54than two incorrect answers then
12:55definitely the test has failed there is
12:59also another criteria for failing or if
13:03the to rate whether the individual has
13:05passed or failed the particular test
13:06that is the time criteria what is the
13:09time criteria for it so if you look into
13:11the time criteria
13:14for the serial subtraction test
13:16it is as follows like for example 100
13:19minus 7 the total time duration given is
13:212 minutes
13:23440 minus 3 the time duration given is
13:27one minute
13:33and for 20 minus 1 the total time
13:35duration given is 15 seconds so suppose
13:38if an individual is not able to do a
13:40complete series subtraction test in a
13:43period of two minute then definitely the
13:45individual is said to have failed that
13:46particular test
13:48accordingly the time frame has been
13:50given for each and every three of the
13:52tests fine so let's look into the
13:55another uh what are the other tests uh
13:58in attention and concentration so the
14:00second test in this list is the digit
14:02forward and the digit backward test so
14:04digit forward test and digit backward
14:07test
14:08so
14:09with an example that has already been
14:11given in stubborn black I'll I would be
14:14demonstrating the particular test C
14:30so this is the test that I am talking
14:33about the digit forward and the digit
14:35barcode test the sequence is given in
14:37such a form so
14:39what you have to do is
14:43first and foremost you have to give an
14:46example that you say that I am I'll be
14:49demonstrating the test first so first is
14:51to demonstrate the test
15:02example you can do is like
15:05you give two
15:07five and you say by digit forward I mean
15:10that I have to repeat again two and five
15:14similarly if you are giving the example
15:17for digit backward test you say that if
15:18you say 2 and 5 the answer should be
15:225 followed by 2.
15:25make the patient familiar with the test
15:28second
15:29the speed
15:32you have to say the digit at one digit
15:35per second
15:38that is the speed so you don't have to
15:41say 2 5 7 9 you have to say 2 5 7 9 that
15:47is one digit per second third
15:50don't say digit in pair
15:53that is paired digits are not allowed
15:59so this is not allowed where digits are
16:01not at all Allowed by Payette digits I
16:04mean that don't say for example if you
16:06are giving five digits 2 9
16:11847 don't say 2 9
16:148 4 7.
16:16nothing uh it means that you're clubbing
16:18the first two and clubbing the last
16:20three don't say it like that just follow
16:22this uh the speed technique that is one
16:25digit per second avoid clubbing what is
16:27the next most important thing don't give
16:30a particular sequence
16:32so it means that 2 4 6 8 it is a
16:36sequence of even numbers similarly one
16:38three five seven it is a sequence of odd
16:41numbers similarly other sequence like
16:43Fibonacci
16:45sequence that should be given
16:48so avoid sequence these are the four
16:51important rules that you have to follow
16:53while doing the digit forward test or
16:56digit backward test
16:58so how to do the test for example if you
17:00have demonstrated the test you just
17:01start by saying three seven the patient
17:04will be giving the answer three seven
17:06suppose the patient is making mistake in
17:09two nine six eight three this line two
17:13uh two nine
17:14six eight three so what will you do is
17:17like
17:18you again give this same patient like
17:20for example if the mistake has been made
17:22you just repeat another sequence with
17:25the same number of digits suppose here
17:26you can give
17:29another five digit sequence and if the
17:33patient again makes a mistake you stop
17:35there
17:38so if the patient is making mistake on
17:41first sequence in a five digit
17:43uh sequence
17:46give another that is the second time if
17:48also in the second time the patient is
17:50making mistake stop there and start
17:53rating by just subtracting one digit
17:56from the total number of digits so the
17:58patient is unable to recall five digits
18:01so the digit forward test is four digit
18:03means that up to four digits the patient
18:05was giving correct answer similarly you
18:08can also do for the backward digits also
18:10so now as we have seen that these are
18:13the various rules and this is how you do
18:16this uh digit forward digit backward
18:19let's look into the interpretation of
18:21this so digit forward and digit backward
18:23the interpretations are as follows
18:29so according to Stubborn black it has
18:31been said that 5 plus minus 2
18:34it means the patient has passed the test
18:37so how to write or interpret attention
18:40and concentration
18:42so it is defined as aroused
18:45and sustained
18:56so this is how you report arouse and
18:59sustained for attention concentration
19:01third important heading is memory
19:08so what is memory again it has been
19:10defined in scrub and black
19:12see all these definitions are very
19:14important because these forms are part
19:16of your NSE definition and it has been
19:18asked again repeatedly on a number of
19:21occasions by your Viva in your examiner
19:23buy your examiner and also in your grand
19:26rounds or in your word rounds also so be
19:29aware of these definitions
19:35what is your definition it is defined as
19:37the
19:39mental process
19:47which helps
19:49person
19:52who
19:56store information
20:00for
20:01later recall
20:09it involves three component
20:15immediate
20:17recent
20:20and remote
20:25so immediate is the again how to Define
20:28immediate
20:29immediate is defined as ability
20:34to
20:36recall
20:37registered information
20:51after and
20:54interval of
20:56few seconds
20:58so this is the definition according to
21:01strub in Black
21:03so it is defined as the ability to
21:05recall that is recall is there
21:07the registered information so first of
21:10all you have to do the registration of
21:12the information and then you have to
21:13make the patient recall that particular
21:15information that is why this uh test for
21:19immediate memory involves two process
21:21first is the registration and second is
21:24the recall
21:25so you have to do the registration and
21:28then you have to do the recall
21:30so how to do the registration definitely
21:33you can give three
21:36items
21:37these items should be non-related
21:43these items should not be present in
21:46your vicinity
21:55and these item
22:06should be
22:13in cultural relations
22:17with patient
22:19so for example if the patient is a
22:22vegetable seller you can't give him a
22:25rocket or a space shuttle so be it in
22:30Realm of the patient so for example if
22:32we can give them uh like for
22:34registration we can give three important
22:36or three of the items like for example
22:38we can give one emotion you can use
22:43one color you can use
22:47and one object you can use
22:49for example the emotion is happiness
22:54in Hindi you can call it as Khushi color
22:57you can give it as yellow
22:59an object you can give as horse
23:02so these are all unrelated items
23:07and various aspects have also been
23:09covered
23:10this you have to ask the patient to
23:12register so you'll be altering these
23:14words and then asking the patient to
23:17repeat it after you so if the patient
23:19rupees 3 out of the three you can say
23:22that registration is three by three
23:24then after some time according to Shrub
23:27and black you have to make the patient
23:28recall these three words
23:31okay so accordingly if the patient is
23:33able to recall 3 out of three you have
23:36rated by three out of three or if the
23:38patient is recalling only two out of
23:40three radiated two or two by three or
23:43one by three accordingly
23:45fine so this is the immediate memory
23:48coming to the recent memory what is the
23:51definition of recent memory
23:54that is also defined as the ability
23:582
23:59register
24:02new information
24:07see the difference it is not the
24:09registered information or recall part
24:12this is just diluted to register the new
24:14information
24:17and
24:19retrieve
24:21after
24:25some periods
24:30it can be day
24:36month
24:40or hours usually we take it for r like
24:45what is the example that we usually ask
24:47is to recall all the events
24:51since morning
24:55so the duration of recall is usually in
24:59form of RS although it's Robin black the
25:02total duration has been referred as
25:03minute hours or days but usually we take
25:07into consideration only the hours so for
25:09example we can ask the patient to record
25:10even since morning
25:15if the patient is able to do so
25:17corroborated with the attendant
25:21so attendance for aberration is
25:23important
25:28so this you have to do whatever
25:30information patient is saying just don't
25:33take it do collaborate it with the
25:35attendant
25:37fine
25:40let's move into the third part of the
25:43memory see I'm get I'm really
25:45completing all these aspects in a
25:48standardized manner but I'm going slow
25:50just because you have to understand the
25:52importance of importance of the
25:54definition and you have to know how to
25:55do these tests
25:57fine I'm into the remote memory it is
26:00defined as
26:02recall
26:05of facts
26:08or events
26:12that
26:13has
26:15occurred
26:18in distant
26:21past
26:25so what are the various
26:27questions that you can ask you can ask
26:30the date of birth you can ask the date
26:31of marriage you can ask the address
26:35you can ask the address of school that
26:40the patient has attended similarly
26:42address of college
26:46you can accordingly
26:47ask them Okay so
26:54once we are done with the immediate
26:55reset and the remote memory how to give
26:58the interpretation as a whole so
27:00interpretation of memory it includes
27:02that memory
27:07is intact
27:10then you name whether the immediate is
27:12intact
27:15remote is intact
27:18or recent designed
27:21so if all are intact definitely say it
27:23that immediate decent and remote memory
27:26are intact if for example limited number
27:28is not intact then what you do by saying
27:31that remote and the recent memories are
27:33entered but immediate memory is not
27:34intact similarly it goes for the remote
27:36and the recent if they are not intact
27:38you can accordingly say that fine now
27:41let's come to another this is the third
27:44in the sequence so we have covered
27:46orientation we have covered attention
27:48and concentration we have covered memory
27:51now let's come to the fourth
27:54heading
28:01the fourth heading is the
28:03intelligence
28:12so what is the definition of
28:14intelligence
28:18so it is defined as the ability
28:22to think
28:26logically
28:31act rationally
28:37deal
28:39effectively
28:44so the components are
28:46think logically
28:50add rationally
28:52and deal effectively
28:58with
29:02the
29:06environments
29:09and
29:11situation
29:16so this is defined as intelligence that
29:18is the ability to think rationally
29:21at think logically act rationally and
29:24deal effectively
29:28okay
29:30now how to do the intelligence testing
29:33so here the testing includes three
29:35components the first is the general fund
29:38of knowledge
29:54the second is the
30:04comprehension and third is the
30:06arithmetic
30:07arithmetic me it includes both in the
30:10simple
30:12and the complex
30:15fine so let's look into the general fund
30:18of knowledge the first is the general
30:19fund of knowledge I request everyone to
30:22make notes of it so that it will be
30:24beneficial for you at the end you don't
30:26have to uh
30:27look around here and there although the
30:30video will be there with you so don't
30:31worry but yeah to make a note of it so
30:33that it get registered with your memory
30:36so general fund of knowledge so what is
30:39the usual question that we asked we ask
30:41regarding so what is the various
30:43instruction that you have to follow the
30:45first is the general fund of knowledge
30:46as the name says that it is the general
30:49fund you don't have to
30:51ask regarding anything specific
30:57it has to be
30:59something that is General to all
31:03so if you ask regarding schizophrenia to
31:06a patient or to a person
31:09he or she might know might also not know
31:12so it is not something which is in
31:14general with the public or known to
31:16public however if you ask regarding
31:17fever the patient might be able to ask
31:20answer regarding it so you have to ask
31:23something which is in general to that of
31:26the population
31:28usually it is usually ask also like this
31:31question is also asked in relation to
31:33their occupation
31:38total cultural background
31:47so these things we have to be aware
31:50while
31:51asking the general fund of knowledge so
31:53what questions usually uh are asked to
31:56name five cities
31:59five reverse
32:04so you can ask them to name the five
32:06cities you can ask them to name the five
32:07rivers you can ask them to also to name
32:10the five
32:12props
32:14if the patient belongs to a forward
32:15background or
32:17five different types of pulses
32:21usually what happens that in our College
32:23uh people are like the faculty or the
32:26examiner they usually ask that five
32:28cities whether you have access or not
32:30Five Rivers whether you have asked it or
32:32not so try asking them if for example if
32:35an individual is there who is not able
32:37to ask five cities Five Rivers so what
32:39you do is you keep on asking
32:42in relation to their occupation and also
32:45in relation to their cultural background
32:46so example uh for example like
32:48absolutely I saw a boy he was around 18
32:52uh 13 14 years he was not able to answer
32:55the five rivers and five
32:56cities so I asked him regarding the five
33:00YouTube channel
33:02which he was able to answer the five of
33:05them I asked him regarding five video
33:07games
33:10he was able to answer
33:12I asked him regarding the five subjects
33:14which he is interested in his school he
33:18was able to answer so don't stop by all
33:21those rudimentary questions or the
33:23questions that has been ongoing and were
33:26meant to be asked okay do ask them but
33:29if a patient is not able to answer it
33:31don't stop here only like you shouldn't
33:33be stopping here they take the patient
33:34not able to ask you can move forward and
33:37devise your own set of questions
33:38Instagram and black also they have given
33:41a list of questions and they have also
33:43asked to ask them according to the
33:44specific culture background so for
33:46example if a villager or a person from a
33:48village comes he or she might not be
33:51able to know the various type of
33:53YouTube channel or the name of you can
33:55of the YouTube channel you can ask
33:57regarding five months
34:01you can ask regarding the seasons
34:04you can ask regarding whether he or she
34:07is aware of
34:08the days of the week or not
34:14ask them to name five fruits also so
34:16accordingly it can be uh
34:19it can be
34:21you know like
34:23General front of knowledge can be
34:24assessed accordingly you don't have to
34:26stick into those straightforward
34:28questions which we have been asking
34:30although you should ask but once if the
34:33if the patient is not able to answer you
34:34can definitely look into their
34:36occupation into their cultural
34:37background and move forward and once the
34:40patient is able to answer yes get into
34:42the next question that is your
34:45comprehension
34:49comprehension means to understand in
34:52English terms it means understand
34:56the context
34:59or
35:00the situation
35:02so whether an individual is able to
35:04understand a context of situation or not
35:06that is being tested white while uh we
35:09are testing comprehension you can give
35:11three such
35:13situations
35:16or three such contexts
35:21for example
35:22I can give
35:25rain
35:28Bank
35:30bus
35:33I can give these three situation that if
35:35it is raining and if he or she has to go
35:37go to an important place or an important
35:40work is there what he or she would be
35:42doing in that situation similarly for
35:44the bank you can ask regarding what one
35:49does
35:51in a bank or what is the use of the bank
35:55or what is the bank meant for you can
35:59also answer regarding the
36:01situation
36:03of rain
36:06associated with important work that is a
36:09work has to be done but it is raining
36:10how he or she would be doing in that
36:12situation also for the bus that is the
36:15buses left
36:19and you have to visit an important place
36:27what should be done
36:35so
36:39the patient might answer in a very
36:41different manner again you have to
36:44remember that you have to assess whether
36:46that individual is able to understand
36:48the particular context or not that is
36:50the answers are coming in these contexts
36:53or not the rain the bus the bank
36:55situation or not you don't have to judge
36:57whether the answer are correct or not
36:59you just have to answer look into the
37:01situation that okay fine the the patient
37:03was able to understand I'm asking about
37:05the rain about the rain situation so for
37:08example if you ask regarding the range
37:09which means the patient might say that
37:11I'll stop I'll not go outside I'll
37:13definitely stop roadside and wait for
37:16the rain to stop then I'll be going and
37:17do my work however the work may be of
37:20utmost importance to him another patient
37:22might say that okay if it is raining
37:24I'll go outside I'll I'll not bother
37:27whether I'll get wet or not but I'll
37:29ultimately do the work then and there
37:31only another my some people might say
37:33definitely if it is raining I will book
37:34a cab I'll book a bus or I'll go through
37:37train so situations the answer might
37:40vary but that situation of rain has been
37:43addressed to while answering that is
37:45important so you can give three and
37:47usually
37:48two out of three is the preferred answer
37:52then we can test for arithmetic so the
37:56third in this part is arithmetic
38:03arithmetic the first is the simple one
38:04simple doesn't involve multiple steps
38:08so multiple
38:10step
38:11calculation
38:14usually it is avoided so what you do is
38:17give addition
38:20subtraction multiplication and division
38:24so you can give them and you can ask
38:27them to answer verbally
38:37then regarding the complex
38:39so what you do in complex
38:42complex there is a situation given like
38:44for example you can say a very common
38:47example which we use is like multiple it
38:49involves multiple step so here multiple
38:52steps are allowed
39:03we have the multiple steps were not
39:05allowed that is important so what you
39:08give is like you are having 100 rupees
39:10then you have to buy three pencil
39:14and three bands so this is the first
39:17step of calculation that
39:19you have to say that each pencil cost
39:21around
39:22three rupees each
39:24and each Pen cost around five rupees
39:27each
39:28so what is the
39:30amount of money
39:36he or she will get at the end
39:39so first step was this that he or she
39:43has to multiply it and the second stop
39:45is to divide the total by hundred
39:48okay so the total amount will be
39:51reflected so it involved multiple steps
39:54similarly you can ask them look into
39:56stubborn block they have given specific
39:58questions
39:59although
40:01it has also been mentioned that you can
40:03use your own questions according to the
40:05situation again the occupation the
40:07cultural background takes into the
40:09consideration that if an illiterate
40:11person comes or if he or she is not
40:13aware regarding the pencil and the pen
40:15you can definitely ask them in their
40:18terms what they are aware of for example
40:20if they are aware of sticks bamboo
40:23sticks you can ask them three bamboo
40:24sticks post so much amount of money or
40:27three for cauliflower three cabbage so
40:30ultimately you can devise your questions
40:31according to the situation
40:33fine so we have done three tests one is
40:36the arithmetic
40:41which involves both the simple one
40:44and the complex one
40:50we have done the comprehension
40:55and then we have done the general fund
40:56of knowledge
40:58so these are the three important tests
41:01or sub headings that comes under
41:03intelligence
41:04okay now what we do is we'll look into
41:08the other heading
41:10so till now we have done orientation we
41:13have done attention concentration we
41:15have done memory we have done
41:17intelligence now it is time to
41:21look into the fifth component that is
41:23abstraction
41:30so what is the definition of obstruction
41:32this is according to CTP 10th edition
41:35it is given in chapter number seven
41:39okay look into that definition of
41:41abstraction it means so here I'll be
41:44giving you the important
41:50words or keywords that has been
41:52mentioned in the definition what are
41:54they it is defined as the thinking
41:59which is characterized by
42:02number one
42:05ability
42:07to grasp
42:10d
42:12essential
42:16of a whole
42:36break
42:38a hole
42:40context
42:43into
42:45various
42:47parts
42:52and
42:54two
42:59discern
43:01common
43:05properties
43:12out of it
43:13so this has been given in the text
43:17in the definition what they have
43:19mentioned that is given in the table so
43:22always remember the definition that has
43:24been given in the table
43:26okay this is just for understanding that
43:28the individual should be able to break a
43:30particular context that is a whole
43:32context into small small parts
43:35and to derive and to individually
43:38analyze the small small parts and to
43:40give the answer as per the common
43:42properties with these parts so this is
43:44just for understanding that is the
43:46concept building in the definition that
43:48has been given in the table the
43:50definition says that the process
43:55whereby
43:58parts
44:03or ideas
44:08are generalized that is the first
44:10important thing chain realized
44:20and dissociated
44:27from
44:29particular
44:33concrete
44:37instances
44:42so here also the important terms are
44:45generalization of thoughts
44:50from particular concrete instances
44:53so particular
44:56concrete
44:57instances so these are the three key
44:59terms or three key things that you have
45:02to remember while defining
45:04abstraction it means that for example if
45:06this is a concrete thing that we are
45:08giving to the patient the patient should
45:10be able to
45:11break it into a number of small small
45:13parts to look into the common properties
45:15and then to answer that common property
45:18that is that is common to these
45:20individual parts of the original
45:22material
45:24so with the example you will be able to
45:26understand it in a much more refined
45:28manner so for example we can give
45:31so here the two tests are first is for
45:34similarities
45:37and the secondness of proverbs
45:43so similarities
45:46in stubborn black it has been given that
45:49you can do the scoring by 0 1 2.
45:53according to the response so for example
45:55if I ask what is the similarity between
46:03an airplane
46:09and a Truck
46:13so for example if the individual says
46:15that the airplane flies
46:17and the truck runs on Road
46:20so that becomes wrong it is the
46:22differences it is not the similarity so
46:24always remember that as previously we
46:27have discussed that all the tests should
46:30be made
46:32first you should be doing it in front of
46:34the patient making him or her understand
46:36test later on you'll be giving the
46:39various situations so in this situation
46:41definitely give one of the examples then
46:43you give a particular test so if the
46:50person is not able to find it or if you
46:52say something like that it flies and it
46:55is runs on the road
46:59it is a wrong answer because it is not
47:01showing the similarities so if the
47:03individual says that these are modes
47:08of transport
47:11then this is one of the common answer
47:13which is there in common that it is also
47:15a mode of transport it is also a mode of
47:17transport
47:20he or she can say that it is a mode of
47:22Transport carrying less number of person
47:26it is a mode of Transport in which it
47:28carries more number of person
47:30then again this answer is correct
47:32because mode of Transport is there
47:34although the person has included more
47:37number and less number
47:39similarly you can ask regarding
47:42the famous apple and orange
47:48so in apple and orange if the person
47:50says that is their Foods
47:53it is an accepted answer if they say
47:55these are round in shape
48:00so these are it is also accepted only
48:02that according to stop and black this
48:05can be given as a score of 2 and this
48:07can be given as a score of 1.
48:10and if they are saying that apple is red
48:14and oranges
48:17orangish yellow in color
48:21then these are the differences these are
48:22not the similarities so you can write it
48:24as zero so according to this you can do
48:27five such examples it has been mentioned
48:30in strub in Black
48:32what why do I refer to Shrub and black
48:35is that they have given the five in
48:37increasing order of difficulty so if an
48:40individual is answered is able to answer
48:42the first situation you can give the
48:43second situation third situation fourth
48:46situation or five situation so if by
48:49chance your patient is able to answer
48:51till 3 more or less the abstraction is
48:54there it is not semi concrete or
48:55concrete we'll definitely look into that
48:57when we'll write the impression
49:00so this is how you do the similarities
49:03coming to the Proverbs again
49:06things that you have to keep in mind
49:08while testing proverb is it has to be in
49:10the cultural
49:13boundaries of the patient
49:18it has to be in the local communicable
49:21language
49:28you can take the help of the relatives
49:31and the attendants
49:35in this
49:38also the education status
49:42if you are asking it for a person who
49:44has just passed class six he or she
49:47might not be able to answer the toughest
49:49of the Proverbs but if an individual has
49:51past class 12th or has done a higher
49:54level of Education he or she might be
49:57able to ask the answer the same Proverbs
50:00so take into consideration the cultural
50:02boundaries the local communicable
50:04language and the third is the education
50:06status
50:07and then first demonstrate always and
50:11always remember that while doing the
50:12neurocognitive function this is very
50:15important demonstration always
50:18demonstrate
50:20you just give for an example and you
50:23give the interpretation so as I
50:26I'm currently staying at Delhi and I've
50:29been speaking Hindi along with English
50:31so I can definitely give one proverb in
50:33in the for example
50:44so those of you who are able to
50:46understand in the this it means that
50:49if an individual has been eating around
50:52four to five chapati and two bowl of
50:55rice if I'm just giving him two spoon of
50:58rice and one very small piece of half a
51:00piece of chapati it would be able to
51:01fulfill his hunger so if the individual
51:04is able to explain the proverb
51:08then he has been passing the test you
51:11can similarly to three
51:13such tests if the patient is making
51:16mistake you can continue till five and
51:18then you can score it accordingly out of
51:19five
51:20so at the end how to give the impression
51:28so in the impression how do you write
51:30you can write that
51:35abstraction intact or full abstraction
51:42you can write semi abstract
51:47or you can write
51:50concrete
51:54supposedly if the individual says apple
51:57and orange he says apple apple is apple
52:00and orange is orange and similarly if
52:02you ask five or even if you are seven
52:04all such answers has been given for
52:07example if you ask airplane Network you
52:08say airplanes airplane truck is truck so
52:10the score will be zero the scoring
52:12system is there only in stubborn black
52:14however most of the colleges and
52:16universities they don't follow it they
52:17just look into the total number of
52:19responses out of five how many correct
52:21responses are there and accordingly they
52:23will ask
52:24okay so also in the Provo you can test
52:27for five Proverbs and total number of
52:29correct answers or responses three out
52:31of five means that the individual has
52:33passed it and accordingly in the
52:35similarities one so based on that you
52:38can give if the individual has scored a
52:40zero or has not given at all a correct
52:42answer it is concrete or if the
52:45individual is given correct answer but
52:46the answer is not up to that level for
52:48example if individual has given such an
52:50answer the example if he has given apple
52:52and orange both are round
52:54both are like instead of saying fruit
52:56they have given both a round also like
52:59for example if they are
53:01if you ask regarding p and
53:04uh for example chili so instead of
53:08saying that these are fruit uh that
53:09these are vegetable he says that these
53:12are green elongated objects so the level
53:15of abstraction is not that much all
53:17although it is uh it is also not less to
53:21call it as concrete it is something in
53:23between so you can rate it as semi
53:24abstract
53:26but it all depends on the cultural the
53:29education and also the
53:33local communication language whether he
53:36or she is able to understand the
53:37particular situation or art fine let's
53:40go into the another
53:44heading that is the judgment
53:50so what is defined as judgment judgment
53:52is according to CTP 10th edition
53:56all these definitions are from standard
53:58text
54:01for judgment
54:06so it is defined as the mental Act
54:10of
54:12comparing
54:17and evaluating
54:24choices
54:28Within
54:36the framework
54:38of
54:40given set of values set of
54:45values
54:47so mental X comparing and evaluating
54:49choices within the framework of given
54:51set of values this is the first part of
54:53your definition and in continuation to
54:55that the second part says that okay
54:58for the purpose of
55:05deciding
55:07the course of action
55:16okay so if the course of action is being
55:19chosen according to the reality or
55:22according to the adult standard or the
55:25mutual standard so if the individual is
55:27having schizophrenia or having psychosis
55:29and if you start assessing for the
55:32judgment
55:33so first of all judgment doesn't mean
55:35that uh you will be asking anything
55:37first of all you have to give a
55:39situation we'll look into the various
55:42three type of judgment that or the three
55:44ways in which the Judgment can be
55:47assessed okay so the important thing is
55:51how the individual chooses the course of
55:53action
55:54course of action
55:56and also how the individual is able to
56:01give the answer or the course of action
56:03according to the adult
56:06standards
56:11okay
56:12so for assessing judgment
56:21one is the test judgment
56:23one is the social judgment and one is
56:26the personal judgment
56:30so social judgment is looked upon the
56:32behavior in the world
56:37it is not just the behavior towards the
56:39treating doctors reading team it is it
56:42is also the behavior towards the other
56:44word mates
56:52nursing staff
56:56also it will includes the behavior
56:58towards the treating team
57:03person you'll give a set of situation
57:05that after the discharge or after uh
57:09the treatment is done what is the
57:11further course of action which he or she
57:14plans to take then accordingly if the
57:17answer it matches according to the
57:19standard of the patient that is why it
57:21has been mentioning the adult set of
57:23Standards then only you can say that the
57:25personal judgment is intact
57:28if the patient is still suspicious in
57:31the world even though the behavior is uh
57:34you can say that the behavior is
57:35improved if the patient is having
57:37Psychopathology active Psychopathology
57:39and the behavior somehow he is able to
57:42uh like the interaction is improved the
57:44behavior is improved still in
57:46persistence with the active
57:47Psychopathology social judgment remains
57:50impaired because he or she would not be
57:53able to carry out the acts that an
57:55individual does in Social Realms with
57:57the existing Psychopathology in test you
58:00can give three situations again
58:03these three situations can be the later
58:05situation
58:06the child situation
58:09and the fire situation
58:11so for example if you ask regarding the
58:13letter you can say that for example
58:15there is a letter there in the road what
58:17would we be doing so if he says that
58:20he'll be taking up the letter and
58:21keeping it
58:22that is also fine if he says that he'll
58:26be not looking at the letter somebody
58:27might have done some black magic why to
58:29touch the letter that is also fine with
58:31the answer it depends upon the current
58:33status of the patient so you won't be
58:35expecting to get a particular answer
58:37don't expect the patient to answer in
58:41your understanding let him or her answer
58:44according to the standard of the current
58:46situation current standard of the
58:49patient okay
58:51similarly can we asked regarding the
58:53child so if a child is there in the road
58:55he or she has been injured and is alone
58:58what will the person do so similarly you
59:01can answer Also regarding the fire if
59:04there is fire situation in the world
59:06what he or she will be planning to
59:07intend so this these are specific
59:09situation based things so it is called
59:12as test for example if the individual is
59:15able to give
59:16is having social judgment and test
59:19judgment intact but personal judgment is
59:21not intact what will be the
59:23interpretation as we have seen that most
59:25of the above we have taken the majority
59:27but in the Judgment always remember
59:31this is very important
59:36this is not something to be rated on
59:39gradation
59:41it means that
59:43grading
59:52is not done
59:57if the patient is
59:59wrong in any of these three
1:00:02be it the person create the personal be
1:00:05it the social
1:00:18or build the test
1:00:21if the individual has failed in any of
1:00:24these three you have to label as
1:00:26impaired judgment okay remember this
1:00:39if
1:00:41any situation
1:00:46is not
1:00:50answered
1:00:53according to
1:00:56the
1:00:58adult
1:01:01standards
1:01:03so this you have to practice a number of
1:01:06times whenever you are doing your mental
1:01:07status examination and neurocognitive
1:01:09function
1:01:10so by this we come to the last part of
1:01:13it of the discussion of today that is
1:01:15insight
1:01:16this is something which is very
1:01:18important and this is a much threat
1:01:20topic individual questions also do come
1:01:22regarding Insight okay so whenever you
1:01:25are reading inside do read what are the
1:01:28definitions for insight
1:01:31what is the classification of insight
1:01:33which currently is there
1:01:36in CTP how the insight has been
1:01:38classified So currently as we know that
1:01:41the insight has been classified uh like
1:01:44previously it was zero to six now the
1:01:4610th edition of CTP has been rating it
1:01:48as
1:01:500 to 5 so the situation has been
1:01:54changing and as the upgradation of the
1:01:56books are done then you have to code the
1:01:58latest reference so today I'll be
1:02:01looking into the definition of inside
1:02:02we'll also be looking at the various
1:02:04gradations of insights okay so first we
1:02:07should be looking into the definition of
1:02:08insight
1:02:13so Insight is defined as the
1:02:16conscious
1:02:19awareness
1:02:23and
1:02:26understanding
1:02:31so it is defined as the conscious
1:02:34awareness and understanding of
1:02:37number one
1:02:41's own
1:02:45physiological psychological State sorry
1:02:47for logical state
1:02:54number two
1:02:59symptoms
1:03:01of
1:03:03null productive Behavior
1:03:17and number three it is Need for
1:03:21treatment
1:03:29so this is definition according to CTP
1:03:33entitation
1:03:39now we would look into the
1:03:42degrees of insight
1:03:51according to CTP 10th edition
1:03:55page number 967
1:04:01now the level of insight is from 1 to 5.
1:04:06all those previous
1:04:08ly like I have been seeing a number of
1:04:10presentations a number of
1:04:12uh like seminars in which they are
1:04:14labeling at zero to six or one to six
1:04:16now though those are obsolete what the
1:04:18current CTP says is one to five now
1:04:21we'll look into each one of them level
1:04:23one
1:04:24complete denial of illness
1:04:27so that is complete denial of illness by
1:04:30the patient
1:04:32the patient
1:04:34completely fails to admit that he or she
1:04:36is ill second
1:04:39slight awareness
1:04:44often being ill
1:04:48being sick
1:04:52and needing help
1:04:58but denying at the same time
1:05:06so the patient says that he might be ill
1:05:09and might need help but he doesn't think
1:05:11that uh
1:05:13he's
1:05:14needing any sort of help so the
1:05:17situation will be something like at
1:05:20times
1:05:21he or she might admit that something is
1:05:25wrong but
1:05:28will be mostly denying that there is no
1:05:31need for the treatment for the same and
1:05:33another time if you ask them they'll
1:05:36totally uh deny that they are having
1:05:38sick so these two important terms are
1:05:42like the two important components are
1:05:44slight awareness of being sick and
1:05:46needing help this is the first component
1:05:48and the second is but denying at the
1:05:50same time that if you ask
1:05:52in deep they'll definitely deny the need
1:05:55for treatment so this is a very dicey
1:05:58situation in three yes
1:06:03the patient is aware regarding the
1:06:05sequence uh
1:06:06aware
1:06:08regarding
1:06:09being sick
1:06:13this is important that the patient is
1:06:16aware regarding being sick but
1:06:21blaming
1:06:26the cause
1:06:30on others
1:06:33number one number two blaming on
1:06:38external factors
1:06:42number three
1:06:47blaming on medical
1:06:51or
1:06:54unknown
1:06:57organic
1:06:59practice
1:07:02so this is very important that the
1:07:04patient is aware regarding being sick
1:07:06the individual will say that he or she
1:07:08is ill but the cause is
1:07:12that someone has done black magic on
1:07:14them someone from outside is doing
1:07:16something as a result of which he or she
1:07:19is being sick or would be blaming into
1:07:21some unknown organic factors the
1:07:23individual might say that he doesn't
1:07:24know what is causing him to be ill but
1:07:27he is ill as opposed to the second one
1:07:30which is that there is slight awareness
1:07:32of his sickness
1:07:34and he might say that he needs help but
1:07:37upon deeper integration interrogation he
1:07:40might deny he'll deny that there is no
1:07:43need for the treatment regarding the
1:07:45same
1:07:46four is defined as the intellectual
1:07:48insight
1:07:53intellectual Insight it means that
1:07:56first of all
1:07:58the patient admits
1:08:00being ill
1:08:04number two
1:08:08it recognizes
1:08:13that
1:08:18symptoms
1:08:21or failures
1:08:25or failures
1:08:30in Social judgment
1:08:42are due to
1:08:45irrational
1:08:48feelings
1:08:51or disturbances
1:08:58but the important thing which is is that
1:09:03these things
1:09:05the patient
1:09:13is not applying
1:09:20the knowledge
1:09:25that is these knowledge
1:09:27recognizes that the signs and symptoms
1:09:32this particular knowledge the individual
1:09:33is not applying in the
1:09:38future experiences
1:09:44so the individual will admit that he or
1:09:46she is ill and all the disturbances are
1:09:48all the difficulties that he or she had
1:09:50in Social judgment were because of the
1:09:53rational feeling or disturbance that he
1:09:55was having but if asked regarding the
1:09:58future course of action if us regarding
1:10:00the further
1:10:02consequences that he or she can have
1:10:04with the existing or because of the
1:10:07whatever the symptoms had he or she
1:10:09might not be able to apply the knowledge
1:10:11and would not be able to answer the
1:10:13future experience accordingly in the
1:10:15last or five is defined as the true
1:10:17emotional insight
1:10:20this is the fifth one
1:10:23so the true emotional Insight is the
1:10:28the definition says it is the emotional
1:10:30awareness
1:10:34number one that is it is an emotional
1:10:36awareness of
1:10:40motives
1:10:43and of feelings
1:10:47so this is the emotional awareness of
1:10:48motives and the feelings
1:10:55and this awareness of motives and
1:10:57feelings
1:10:59is
1:11:01Within
1:11:06and of
1:11:09underlying
1:11:12meaning of symptoms
1:11:18so the individual is able to uh is
1:11:21having awareness regarding whatever the
1:11:24motives and feelings were there and it
1:11:26with respect to the set of symptoms that
1:11:28he was having
1:11:30is well aware of that
1:11:36and the third component is that the
1:11:39patient is able
1:11:42to apply
1:11:45the knowledge
1:11:51to Future experience
1:11:58so the part that was not covered in uh
1:12:03intellectual Insight that part becomes
1:12:05covered in the true emotional side so
1:12:07these are the five levels or degrees of
1:12:10inside that you have to read
1:12:18forget all the past
1:12:20the classification of one to five or
1:12:23like whatever they used to give zero to
1:12:25six or zero to five so this is the five
1:12:28these are the five degrees of inside
1:12:29which has been mentioned according to
1:12:30CTP 10 tradition
1:12:32so by this we come to the end of the
1:12:35lecture number one in which we have
1:12:37completed the neurocognitive functions
1:12:40we have done the headings we have done
1:12:42how to do the test read the judgment and
1:12:44insight and we have also done the
1:12:45various degrees of insight according to
1:12:47CTP so let's uh so just revise will be
1:12:51revising it in a go that neuro quantity
1:12:53function includes a number of functions
1:12:55that has to be tested first is the
1:12:57orientation followed by attention and
1:12:58concentration in which we'll be looking
1:13:00into the serial subtraction test digit
1:13:03forward digit backwards next is the
1:13:05memory memory is tested under three
1:13:07earnings immediate recent and remote
1:13:09accordingly we have seen how to test the
1:13:11memory next in the line comes
1:13:13intelligence intelligence involved three
1:13:16subheadings
1:13:18so one is the general fund of knowledge
1:13:20comprehension arithmetic arithmetic is
1:13:22simple and complex
1:13:23okay so General front of knowledge could
1:13:26be asked about regarding the uh various
1:13:28specific things but it has to be General
1:13:32to all it shouldn't be specific it has
1:13:33to be according to the occupation
1:13:35according to cultural background of the
1:13:36patient also the second component is the
1:13:39comprehension whether he or she
1:13:40understand the particular context or
1:13:42situation arithmetics you can ask
1:13:44regarding the simple in the complex
1:13:46simple usually involves a single step
1:13:47calculation complex policy multiple
1:13:50steps called calculations in the
1:13:53abstraction again we can do similarities
1:13:55and Proverbs similarities and Provost we
1:13:58have already discuss how to do the
1:13:59similarities and Proverbs and according
1:14:02to the interpretation we can label it as
1:14:04semi abstract full abstraction or
1:14:07abstraction intact or concretors and
1:14:11then we can look into the Judgment
1:14:12judgment accordingly we can judge for
1:14:15the personal the social and the test if
1:14:18any of the judgment is uh not intact you
1:14:21have to label whole judgment as impaired
1:14:23judgment the last one was the inside
1:14:25inside the five degrees you have to
1:14:27write it in like so how to give the
1:14:30interpretation of insight so
1:14:32interpretation is usually given as three
1:14:33by five four by five accordingly you
1:14:37have to label for the situation
1:14:39okay
1:14:41so I hope I was able to make you
1:14:43understand the various subheadings of
1:14:46neurocognitive functions and the various
1:14:48tests that we have to do okay
1:14:52follow me on
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1:14:56doctor Manish it is the only one of its
1:14:59kind for the psychiatric residence in
1:15:01India nobody in India is actually uh
1:15:04providing such level of content from
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1:15:09and from classical articles that is
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1:15:36listening to the video

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