Клиническая нейропсихология: взаимосвязь мозга и поведения.

Sub field of neuropsychology concerned with the applied science of brain behaviour relationships

Clinical neuropsychology is a sub field of cognitive science and psychology concerned with the applied science of brain behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders. The branch of neuropsychology associated with children and young people is pediatric neuropsychology. Clinical neuropsychology is a specialized form of clinical psychology. Strict rules are in place to maintain evidence as a focal point of treatment and research within clinical neuropsychology. Clinical neuropsychology is a fairly new practice in comparison to other specialty fields in psychology with history going back to the 1960s. The specialty focus of clinical neuropsychology evolved slowly into a more defined whole as interest grew. As a clinician a clinical neuropsychologist offers their services by addressing three steps; assessment, diagnosis, and treatment. There are two subdivisions of clinical neuropsychology which draw much focus; organic and environmental natures. Luria developed the 'combined motor method' to measure thought processes based on the reaction times when three simultaneous tasks are appointed that require a verbal response. On the other side, environmental nature of clinical neuropsychology did not appear until more recently and is characterized by treatments such as behavior therapy. There are three main variations in which a clinical neuropsychologist may work at a hospital; as an employee, consultant, or independent practitioner. Physical evidence is not always readily visible so clinical neuropsychologists must rely on assessments to tell them the extent of the damage. To conduct a comprehensive assessment will typically take several hours and may need to be conducted over more than a single visit. Even the use of a screening battery covering several cognitive domains may take 1.5–2 hours. At the commencement of the assessment it is important to establish a good rapport with the patient and ensure they understand the nature and aims of the assessment. Neuropsychological assessment can be carried out from two basic perspectives, depending on the purpose of assessment. These methods are normative or individual. Normative assessment, involves the comparison of the patient's performance against a representative population. This method may be appropriate in investigation of an adult onset brain insult such as traumatic brain injury or stroke. Individual assessment may involve serial assessment, to establish whether declines beyond those which are expected to occur with normal aging, as with dementia or another neurodegenerative condition. It is only within the context of a patient's history that an accurate interpretation of their test data and thus a diagnosis can be made.

Following a neuropsychological assessment it is important to complete a comprehensive report based on the assessment conducted. The report is for other clinicians, as well as the patient and their family, so it is important to avoid jargon or the use of language which has different clinical and lay meanings (e. g. intellectually disabled as the correct clinical term for an IQ below 70, but offensive in lay language).

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 other countries offer clinical neuropsychology courses to students who have completed 4 years of psychology studies. All clinical neuropsychologists require a postgraduate qualification, whether it be a Masters or Doctorate (PhD, PsyD or D. Psych).

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 research thesis. Masters and D. Psych courses involve the same amount of coursework units, but differ in the amount of supervised placements undertaken and length of research thesis. 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.

To become a clinical neuropsychologist in Canada requires the completion of a 4 year honours degree in psychology and a 4 year doctoral degree in clinical neuropsychology. Often a 2 year master's degree is required before commencing the doctoral degree. The doctoral degree involves coursework and practical experience (practicum and internship). Practicum is between 600 and 1,000 hours of practical application of skills acquired in the program. At least 300 hours must be supervised, face to face client contact. The practicum is intended to prepare students for the internship/residency. Internships/residencies are a year long experience in which the student functions as a neuropsychologist, under supervision. Currently, there are 3 CPA accredited Clinical Neuropsychology internships/residencies in Canada, although other unaccredited ones exist. Prior to commencing the internship students must have completed all doctoral coursework, received approval for their thesis proposal (if not completed the thesis) and the 600 hours of practicum.

To become a clinical neuropsychologist in the UK, requires prior qualification as a clinical or educational psychologist as recognised by the Health Professions Council, followed by further postgraduate study in clinical neuropsychology. In its entirety, education to become a clinical neuropsychologist in the UK consists of the completion of a 3 year British Psychological Society accredited undergraduate degree in psychology, 3 year Doctorate in clinical (usually D. Clin. Psy.) or educational psychology (D. Ed. Psy. ), followed by a 1 year Masters (MSc) or 9 month Postgraduate Diploma (PgDip) in Clinical Neuropsychology. The British Psychological Division of Counselling Psychology are also currently offering training to its members in order to ensure that they can apply to be registered Neuropsychologists also.

In order to become a clinical neuropsychologist in the US and be compliant with Houston Conference Guidelines, the completion of a 4 year undergraduate degree in psychology and a 4 to 5 year doctoral degree (PsyD or PhD) must be completed. After the completion of the doctoral coursework, training and dissertation, students must complete a 1 year internship, followed by an additional 2 years of supervised residency. The doctoral degree, internship and residency must all be undertaken at American Psychological Association approved institutions. After the completion of all training, students must apply to become licensed in their state to practice psychology. 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 reviewing the neuropsychologist's training, experience, submitted case samples, and successfully completing both written and oral examinations. Although these requirements are standard according to Houston Conference Guidelines, even these guidelines have stated that the completion of all of these requirements is still aspirational, and other ways of achieving clinical neuropsychologist status are possible.