The terms neuropsychological, psychological, and psychiatric evaluations are often misused in the mental health field, often even by mental health professionals.
Many people believe that any evaluation that includes cognitive testing is a neuropsychological evaluation. This is not the case. Some professionals, including therapists, may use these terms interchangeably. Our goal in this article is to help clarify the differences between a neuropsychological evaluation, a psychological evaluation, and a psychiatric evaluation and how each can achieve a different goal.
The three types of evaluations we will discuss are:
- Psychiatric Evaluation: An MD psychiatrist conducts a psychiatric evaluation, assesses psychiatric disorders, and prescribes appropriate therapeutic modalities and medications.
- Psychological Evaluation: Conducted by a Ph.D. Psychologist, a psychological evaluation focuses on diagnosing mental health and cognitive disorders.
- Neuropsychological Evaluation: Conducted by a Ph.D. Neuropsychologist who has a specialization in neuropsychology. Neuropsychologists specialize in understanding discrete aspects of brain functioning.
Psychiatric Evaluation
A typical psychiatric evaluation is about 60 minutes long, and it includes the psychiatrist interviewing the patient and asking a series of structured and unstructured questions. In layman’s terms, the psychiatric evaluation primarily focuses on medication management. At Bridge House, our approach to the psychiatric evaluation varies substantially depending on the client’s needs, and we often spend considerably more time gathering the information required for the evaluation. The goal is to gather enough information about a resident’s background and symptoms to formulate an initial diagnostic impression and to be able to proceed with medication management. At Bridge House, that might mean changing medication doses, discontinuing medications, and/or starting new medications that are more appropriate. Psychiatrists have training in therapy and medication management, and at Bridge House, our psychiatrists are more involved in the therapeutic process than generally any other mental health setting. By being involved in a resident’s therapeutic process, the psychiatrist can include information in the evaluation gathered during these interactions. This, among other sources of information, helps us complete a full diagnostic picture far beyond determining the need for integrating medications.
Psychological Evaluation
A psychological evaluation is a comprehensive background and history assessment that includes everything in a client’s life and history, starting from pregnancy and early development. It includes family, social, and medical history, substance use history, and many other aspects of the client’s life. A psychological evaluation will consist of personality testing to understand how the client navigates through the world and relationships. It will give insight into issues related to mental illness and can create an understanding of the client’s coping skills and social skills. Cognitive testing is focused on understanding the client’s intellectual level, strengths, weaknesses, thinking, and reasoning in general. This type of evaluation will result in a 20 to 40-page write-up of the history, test results, and a formal diagnosis based on those results.
At Bridge House, the Psychological Evaluation summarizes all that we have learned about a resident in their time at Bridge House. Contrasting the 4-8 hours spent in typical outpatient or hospital settings on a psychological evaluation, our team of Psychologists meets with the treatment teams of each resident weekly over the course of several months, and they spend multiple days for several weeks conducting interviews and administering batteries directly with our residents. A relationship is formed, and trust is built through this process. Information will include insights collected from the psychiatrist, the therapist, and the Bridge House residential staff. We want to gather as many sources of information as we can for a thorough evaluation. The psychological evaluation at Bridge House will come with recommendations for treatment, level of care, academic support, family therapy recommendations, and if needed, substance abuse treatment, and much more. The time spent building a relationship and a true understanding allows for the Bridge House team to accurately identify what is going on, and why, and most importantly, what to do about it next. We can present this information to our residents from a place of trust and rapport, resulting in greater integration of this information into the lives of our residents far beyond discharge from Bridge House.
Neuropsychological Evaluation
A neuropsychological evaluation is geared towards understanding deficits in brain functioning beyond what might be found in a psychological evaluation. These deficits may have been caused by birth trauma, substance abuse, concussions, head traumas, genetic anomalies, genetic disorders, or other insults to the brain that need to be better understood. A client’s history might point to a need for a neuropsychological evaluation, but most often, the psychological evaluation would point out the need for further testing of this type. This can include speech problems, movement problems, hearing or vision differences, visual and spatial differences, and executive functioning that are beyond what psychological evaluations look at.
A Neuropsychological evaluation might include tests such as an MRI, CT scan, or other different brain functioning tests. Bridge House does not conduct neuropsychological evaluations onsite because it requires specific medical equipment and a specific professional to complete the assessment. If we find that a current client needs this type of specialty test, we will not hesitate to outsource this need to a local neuropsychologist to ensure that we are getting the full picture and leaving no stone unturned.
