Rey-Osterrieth complex figure normative data for the psychiatric population.

Objective: Appropriate normative data are crucial for competent neuropsychological assessment. Although individuals with psychiatric illness often perform more poorly than healthy adults on neuropsychological testing, data that reflect the psychiatric population are often lacking. We present a normative dataset and calculation tools for the Rey-Osterrieth Complex Figure Test (RCFT) derived from the psychiatric inpatient population. Method: A sample of 301 psychiatric inpatients completed the RCFT and the Test of Memory Malingering (TOMM) between 1999 and 2018. Participants were 59.5% male, 82.1% Caucasian, 13.3% black, and 4.6% identified as another racial demographic, largely consistent with recent Substance Abuse and Mental Health Services Administration (2018) data for inpatients in U.S. psychiatric facilities. Scores for RCFT Copy, Short-Delay Free Recall, Long-Delay Free Recall, Total Recognition, and Percent Retained were modeled via multiple regression with age and education as predictors. Base rates were computed for subscores comprising Total Recognition to aid clinical decision making. Results: Age and education served as significant individual predictors for all models except one model predicting percent retained across delay that included only age. Regression equations and regression standard errors were used to produce a score calculator using a commonly available spreadsheet software package. Healthy adult norms under-estimated performance in our sample, underscoring the importance of these normative data. Conclusions: These normative data for the RCFT represent a large cohort of psychiatric inpatients. For clinical practice and research, both the data and the tools provided are likely to be of particular usefulness among individuals with serious mental illness.

Cognitive functioning and adjudicative competence: defendants referred for neuropsychological evaluation in a psychiatric inpatient setting.

OBJECTIVE: A paucity of peer-reviewed research exists regarding the relation between cognitive functioning and adjudicative competence, despite increasing awareness of cognitive deficits associated with serious mental illness. This retrospective study sought to add to and expand upon existing research by considering performance validity and court determinations of competence, when available. METHOD: We compared demographic and cognitive variables of a group of defendants with presumed valid testing admitted to an inpatient psychiatric facility for evaluation of adjudicative competence and referred for neuropsychological evaluation (n = 45) and compared individuals determined by the evaluator and/or the court to be competent (n = 30) and incompetent (n = 15). RESULTS: Defendants who were incompetent were more likely to be diagnosed with a cognitive disorder, with a medium effect size. There was a difference in tests of immediate and delayed memory as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with medium to large effects, and high delayed memory scores were helpful in ruling out incompetence (Negative predictive power = 85.71%). CONCLUSIONS: These results provide support for the relationship between cognitive functioning and trial competence, particularly at high and low levels of performance.

Referring Providers' Preferences and Satisfaction with Neuropsychological Services.

OBJECTIVE: This study aims to expand upon previous research by characterizing the attitudes/preferences of referring providers who utilize neuropsychological services. METHOD: A 31-question survey link, along with a description of the rationale, was disseminated across several professional listservs and email lists, and data was collected over a 6-month period from individuals who refer for neuropsychological services (N = 81). Survey questions included referring provider preferences (e.g., ideal time frame for receiving the neuropsychological report, preferred length/format of the report, sections of the report they read and consider essential, comfort level with recommendations, and open responses regarding other general preferences) as well as narrative details about useful aspects of neuropsychological services versus areas of desired change. RESULTS: The represented referring providers included epileptologists (18), neurologists (12), psychologists (11), other various physician specialties (10), social workers (9), non-physician medical providers (9), psychiatrists (8), and legal services (4). Most referring providers prefer shorter reports (2-4 pages), in bullet-point/table format for ease of readability, and receipt of the completed report within 2 weeks. Approximately half of the respondents reported reading the entire neuropsychological report, with the background, developmental/medical, and educational histories being the least frequently read sections. Nearly all respondents indicated they are satisfied with neuropsychological services overall and agree that the referral question is satisfactorily answered, the findings are communicated clearly, and the diagnostic impressions are logical. Referring providers appreciate most recommendations by neuropsychologists, with the exception of those regarding laboratory work, medications, and other medical procedures. The most useful aspects of neuropsychological services included the thoroughness and integration of the evaluation/report, along with the impressions, diagnoses, and recommendations. Recommendations for future practice included shorter reports, increased availability of neuropsychological services, and more concise impressions and recommendations. Generally speaking, few differences in preferences and satisfaction were noted across provider specialties, patient populations, or practice settings. CONCLUSION: These findings are generally consistent with prior literature that referring providers are satisfied with neuropsychological services overall. The current findings also expand upon the previous research, specifically, that referring providers prefer reports to include bullet-point/table format due to ease of reading and do not read some sections of the report, most likely due to already having an adequate understanding of their patients' background. Illuminating aspects of neuropsychological services perceived to be the most and least useful by consumers of these services provides valuable information to practitioners, particularly in the context of rapidly changing institutional and healthcare demands.