Self-awareness of traumatically brain injured patients in the acute inpatient rehabilitation setting.

The self-awareness of brain injured patients in an acute inpatient rehabilitation programme was measured using the Functional Self-Appraisal Scale (FSAS), which compares patient and staff ratings of patient performance on tasks relevant for acute rehabilitation and in a format that is easy to administer. There was a significant difference between patients' and staffs ratings near admission, consistent with previous findings in post-acute settings that brain injured patients tend to overestimate their abilities relative to other raters. Patient and staff ratings tended to converge at time of discharge, likely reflecting patients' improvements on rehabilitation tasks rather than increased self-awareness. The average difference between patients' and staffs ratings did not correlate with neuropsychological functioning on admission, supporting evidence that self-awareness early in the recovery process is a unique construct. Future research is outlined, including investigating the relationship of early levels of self-awareness following TBI to functional outcome.

Wechsler Verbal-Performance IQ discrepancies among psychiatric inpatients: implications for subtle neuropsychological dysfunctioning.

One hundred seventy-nine psychiatric inpatients were administered the WAIS-R and several neuropsychological and academic achievement tests. All subjects were assigned to three groups based on their WAIS-R's VIQ-PIQ discrepancy scores: (i) Low Verbal (Verbal IQ < Performance IQ. by at least 13 points); (ii) Low Performance (Performance IQ < Verbal IQ by at least 13 points); and (iii) Equal (Verbal IQ-Performance IQ within 13 points). The Low Verbal group made significantly more errors on the Speech Sounds Perception Test, demonstrated lower spelling scores, evinced more aphasic signs, and had had more special education placements than did the Equal or Low Performance groups. The Low Performance subjects demonstrated significantly more signs of constructional dyspraxia and performed more poorly on the Grooved Pegboard test. The neuropsychiatric patients who had Verbal-Performance IQ discrepancies of at least one standard deviation may be at risk for specific, subtle neuropsychological deficits.

A multifactor model of the Halstead-Reitan Neuropsychological Test Battery and its relationship to cognitive status and psychiatric diagnosis.

An oblique, five-factor model of a modified Halstead-Reitan Neuropsychological Test Battery is presented. One hundred fifty-one neuropsychiatric inpatients (94 men, 57 women) were examined on 44 neuropsychological indices. Five correlated dimensions (r = .25), viz., Verbal Comprehension, Perceptual Organization, Sensory-attention, Primary Motor, and Tactile-spatial abilities, were identified by maximum likelihood factor analyses of this correlation matrix. These findings are quite similar to those reported earlier by Fowler, Richards, Berent, and Boll (1985, 1987) and Royce, Yeudall, and Bock (1976). The factors may be broadly categorized using the distinction made by Lezak (1983) for verbal, nonverbal, and mental activity variables. MANOVAs revealed systematic relationships between simple-weighted factor scores and: (1) the overall level of cognitive functioning (p less than .01), as well as (2) psychiatric diagnosis (p less than .01). Implications of these findings for understanding the impact of neuropsychiatric disorders on the structure of abilities for such patients are developed.

WAIS factor pattern for neuropsychiatric inpatients.

The current study examines the factor pattern of the Wechsler Adult Intelligence Scale for a sample of 151 neuropsychiatric inpatients (97 men, 54 women). As expected, these patients performed less well on all 11 of the subtests and ranged from .60 to 1.54 SD below normative standards. These patients were neither more variable nor were the intercorrelations among the subtests lower than those of the normative group. As in previous research, maximum likelihood factor analyses revealed the presence of a Verbal Comprehension dimension and a Perceptual Organization dimension, factors that were moderately correlated (.60). The stability of a two-factor solution for the WAIS in this population and its implications for the inclusion of the WAIS as a component of a neuropsychological assessment paradigm are discussed.

Relationships between the WAIS and neuropsychological measures for neuropsychiatric inpatients.

The current study examines the sensitivity of the Wechsler Adult Intelligence Scale in predicting performance on a modified Halstead Neuropsychological Test Battery for lower-functioning neuropsychiatric inpatients (97 men, 54 women). Regression analyses support earlier-reported findings that the WAIS's subtests more accurately predict neuropsychological test performance than do the WAIS IQ's alone. The IQ's and scaled scores respectively predicted 27% and 39% of the variance in the Halstead's measures. The overall relationship between neurocognitive and WAIS indices is somewhat greater than previous reports and is apparently due to the fact that the lower the overall level of cognitive ability, the lower is neuropsychological functioning in general. However, since most of the variance in the modified Halstead Battery was not common with the WAIS's indices, these findings continue to support the practice of including both sets of measures as part of a comprehensive neuropsychological assessment paradigm for such patients. The importance of developing instruments and procedures which more precisely measure "fluid" neurocognitive abilities is underscored.