Clinical neuropsychology

Neuropsychology
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Clinical neuropsychology is a sub-field of psychology concerned with the cognitive function of individuals with neurological and psychiatric disorders. Neuropsychological assessment examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status of patients. Assessment is primarily by way of neuropsychological tests, but also includes patient history, qualitative observation and may draw on findings from neuroimaging and other diagnostic medical procedures. Clinical neuropsychology requires knowledge of: neuroanatomy, neurobiology, psychopharmacology and neurological illness or injury.

Assessment

Neuropsychologists use models of brain-behavior relationships to determine whether expected neurobehavioral function is different from normal, or has changed to a degree that is consistent with impairment. Findings may be augmented with neuroimaging (PET, MRI, fMRI etc). Such relationships are demonstrated through the interpretation of performance that is derived from a variety of specialized assessment procedures. An example of one commonly used instruments is the Weschler Adult Intelligence Scale IV, which provides an interpretable Intelligent Quotient (IQ). Thus, the domain of neuropsychologists is expressed brain function: for example, reasoning/problem-solving, learning/recall processes, selective attention/concentration processes, perception, sensation, language processes, controlled/directed movement processes. Serial neuropsychological examinations may be used to monitor deteriorating neurobehavioral performance (as with dementing disorders) or to monitor improving neurobehavioral function (as during the recovery after an acquired brain injury or in response to pharmacological or surgical intervention). Some neuropsychologists, who specialize in childhood neurodevelopmental and acquired disorders, specialize in the differing course of learning, behavioral and social development that results from genetic, congenital, and acquired changes in the brain structure and function of children.

What distinguishes a clinical neuropsychologist from other clinical psychologists is a more extensive knowledge of the brain, including an increased understanding of areas such as:neuroanatomy, neurobiology, psychopharmacology, neurological illness or injury, the use of neuropsychological tests to accurately assess cognitive deficits, and the management, treatment and rehabiliation of brain injured and neurocognitively impaired patients. Clinical neuropsychologists perform a number of tasks, usually within a clinical setting. They are often involved in conducting neuropsychological assessments to assess a person's cognitive skills, usually after some sort of brain injury or neurological impairment. This may be for the purposes of planning treatments, to determine someone's neurocognitive functioning or mental capacity (often done for presentation as evidence in court cases or legal proceedings) or to detect changes over time.

A clinical neuropsychologist's typical caseload may include people with traumatic brain injury (TBI), cerebrovascular accidents (CVA) such as stroke and aneurysm ruptures, brain tumors, encephalitis, epilepsy/seizure disorders, dementias, mental illnesses (e.g. schizophrenia), and a wide range of developmental disorders, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, autism and Tourette's syndrome.

Clinical neuropsychologists' training has included methods of psychotherapy and counseling. They can also provide therapeutic services to patients in need of education and emotional support concerning their neurological injuries or illness. They are frequently active in teaching at the university level and conducting research into a wide range of issues concerning human brain-behavior relationships. Some clinical neuropsychologists are also employed by pharmaceutical companies to help develop and test neuropsychological assessment tools for use in clinical trials.

The practice of cognitive neuropsychology and cognitive neuropsychiatry involves studying the cognitive effects of injury or illness to understand normal psychological function. Because of their day-to-day contact with people with brain impairment, many clinical neuropsychologists are active in these research fields.

Educational requirements of different countries

The educational requirements for becoming a clinical neuropsychologist differ between countries. In some countries it may be necessary to complete a clinical psychology degree, before specialising with further studies in clinical neuropsychology. While some countries offer clinical neuropsychology to students who have completed 4 years of psychology studies. All clinical neuropsychologists require a post graduate qualification, whether it be Masters or Doctorate (Ph.D, Psy.D. or D.Psych).

Australia

To become a clinical neuropsychologist in Australia requires the completion of a 3-year Australian Psychology Accreditation Council (APAC) approved undergraduate degree in psychology, a 1-year psychology honours, followed by a 2-year Masters or 3-year Doctorate of Psychology (D.Psych) in clinical neuropsychology. These courses involve coursework (lectures, tutorials, practicals etc.), supervised practice placements and the completion of a thesis. Masters and D.Psych courses involve the same amount of coursework units, but differ in the amount of supervised placements undertaken. Masters courses require a minimum of 1,000 hours (125 days) and D.Psych courses require a minimum of 1,500 hours (200 days), it is mandatory that these placements expose students to acute neurology/neurosurgery, rehabilitation, psychiatric, geriatric and paediatric populations. The Australian Psychological Society does not specify a minimum word count for the research component of either degree, but this is generally around 15,000 words or more. Entry to these courses is very competitive and is generally decided on the basis of academic merit (a H1 or H2A honours mark), referee reports and an interview process. Australian universities offering a D.Psych or Masters in clinical neuropsychology include: La Trobe University, Macquarie University, Monash University, University of Queensland, University of Sydney and University of Western Australia^[1]. Depending on the university, courses may be offered as Commonwealth supported places (HECS/HELP) or full-fee courses.

Canada

Clinical neuropsychology courses are offered at the following Canadian universities:Université de Montréal, University of Victoria and University of Windsor.^[2]

United States

In the USA, a neuropsychologist is a clinical psychologist who, in addition to completing a Doctoral Degree in Clinical Psychology (with a focus on the neuro-anatomical and neurotransmitter bases of behavior), also completes a Clinical Internship (1 year) and specialized Post-Doctoral training in Clinical Neuropsychology. Such Post-Doctoral training (i.e. Fellowship/Residency) currently ranges from 2 to 4 years. In the US, clinical neuropsychologists who have obtained the training needed to practice in this specialty can be identified by their board certification. The American Board of Clinical Neuropsychology, The American Board of Professional Neuropsychology, and The American Board of Pediatric Neuropsychology all award board certification to neuropsychologists that demonstrate competency in specific areas of neuropsychology, by requiring a review of the neuropsychologist's training, experience, submitted case samples, and both written and oral examinations.

Most American states do not permit clinical neuropsychologists to prescribe medications. However, psychotropic medications can be prescribed by clinical neuropsychologists in New Mexico, Louisiana, Guam or who work for the Department of Defense or the Public Health Service, after the completion of post-doctoral training in clinical psychopharmacology.

Clinical neuropsychology courses are offered at the following US universities: Adler School of Professional Psychology, Ananda Institute, Argosy University (Seattle, Chicago & Atlanta campuses), Binghamton University, Brigham Young University, City University of New York, Drexel University, F. R. Carrick Institute, Florida Institute of Technology, Fordham University, Forest Institute, Illinois School of Professional Psychology, Northwestern University, Nova Southeastern University, Pacific University, San Diego State University-University of California (Joint Doctoral Program), Temple University, University of Cincinnati, University of Connecticut, University of Florida, University of Georgia, University of Houston, University of Kentucky, University of Massachusetts, University of South Florida, University of Utah, University of Wisconsin, Washington State University, Washington University, Wayne State University and Yeshiva University.^[2]

Many clinical neuropsychologists are employed by medical schools and hospitals, especially neurology, psychiatry, and rehabilitation facilities. Some work in private practice.

Clinical neuropsychology journals

The following represents an (incomplete) listing of significant journals in or related to the field of clinical neuropsychology.

Applied Neuropsychology Archives of Clinical Neuropsychology Archives of Neurology Brain Child Neuropsychology The Clinical Neuropsychologist Cognitive Neuropsychology Cortex

Journal of Cognitive Neuroscience Journal of the International Neuropsychological Society Neurocase Neuropsychologia Neuropsychological Rehabilitation Neuropsychology Neuropsychology Review Psychological Assessment

See also

• Abnormal psychology
• cognitive neuropsychology
• Neurolaw

Further reading

• Broks, P. (2003) Into the Silent Land: Travels in Neuropsychology. ISBN
• Halligan, P.W., Kischka, U, & Marshall, J.C. (Eds.) (2003) Handbook of Clinical Neuropsychology. Oxford University Press. ISBN
• Lezak, M.D. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press.
• Snyder, P.J, Nussbaum, P.D., & Robins, D.L. (Eds.) (2005) Clinical Neuropsychology: A Pocket Handbook for Assessment, Second Edition. American Psychological Association. ISBN

References

1. ^ "APAC Accredited Psychology Degrees". APAC. https://www.apac.psychology.org.au/Courses.aspx?ID=1045. Retrieved 1/8/11. 
2. ^ ^{a b} APA approved clinical neuropsychology programs. [www.div40.org/training/index.html "APA Division of Clinical Neuropsychology"]. APA. www.div40.org/training/index.html. Retrieved 24/8/11.