Let's lower the floor: Clinical utility of the D-KEFS TMT with a forensic psychiatric inpatient population.

Trail-making tests are widely used as part of neuropsychological assessments, although the prevalence of processing speed deficits in schizophrenia spectrum disorders may limit their utility when administered to this population. In response, our study sought to explore D-KEFS TMT performance among a forensic-oriented schizophrenia spectrum sample, with the goal of generating normative data to enhance the utility of the TMT with this population. Archival data was collected from a sample of patients admitted to a forensic maximum-security psychiatric facility. Analyses revealed a large percentage of individuals achieved an "impaired" result across D-KEFS TMT trials, ranging from 20% to more than 60%. The most noteworthy finding was for Number-Letter Switching, in which approximately 48% of participants performed at the floor level. Following reclassification of performance, 36% of our sample were identified as "below average," while greater than 60% of individuals were captured as average to above average. The current analyses revealed a problematic skew in TMT performance among schizophrenia spectrum patients, in turn complicating interpretation of cognitive status as well as the ability to compare performance between patients and over time. The present adjustments account for this skew and yield more variability in standardized scoring.

Executive function, impulsivity, and risky behaviors in young adults.

OBJECTIVE: Among patients with brain damage, executive function deficits and impulsivity correspond with propensity to engage in risky behaviors. Less research has addressed this issue in healthy adults, and fewer still have simultaneously evaluated the importance of executive function and impulsive personality. Additionally, most research has focused exclusively on substance use while ignoring other domains of risky behavior such as sexual activity and antisocial practices. Toward this end, we examined the association of risky behaviors with executive function and self-reported impulsivity. METHOD: Healthy undergraduates (n = 56) were administered the Iowa Gambling Task (IGT), Wisconsin Card Sorting Test (WCST), and UPPS-P impulsivity questionnaire. A self-report questionnaire assessed risky sexual activities, drug use, and antisocial behaviors over a 2-month interval. RESULTS: After accounting for social desirability and performance effort, multiple regression analyses revealed a robust relationship between executive function and risk-taking. Specifically, WCST performance correlated with risky sexual and substance use behavior, whereas the IGT was uniquely linked with antisocial acts. Trait impulsivity was positively associated with sexual behavior. CONCLUSIONS: Extending previous research, executive function accounted for more variance in risky behaviors than self-reported impulsivity, but this was mediated by facet of executive function. Decision-making under risk seemed to better account for antisocial acts, whereas perseveration was more strongly linked to sexual activity and substance misuse. These data imply that poor executive function increases the likelihood that healthy young adults will engage in risky and potentially dangerous acts, extending the ecological validity of the WCST and IGT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).