The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample.

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.

Predictors of medication compliance after hospital discharge in adolescent psychiatric patients.

Failure in medication compliance in adult psychiatric patients is often found to be due to side effects or associated with unawareness of illness. Little research has been conducted on medication compliance in adolescent psychiatric patients. In this study, 97 adolescent psychiatric patients, including 46 with substance abuse, were followed up an average of 14 months after their discharge from inpatient psychiatric care. Compliance with prescribed medications was examined and the association between several potential predictors and compliance was examined. The overall rate of medication compliance was only 38% at 14-month follow-up, whereas the rate of patients stopping their medications because of side effects was only 23%. Significant predictors of compliance failures were general noncompliance with the discharge plan, followed by postdischarge substance abuse. Side effects did not contribute any additional variance when these factors were considered. These data suggest that medication compliance may be adversely impacted by general tendencies toward noncompliance with treatment, which may be mediated by several possible factors. Interventions to increase awareness of the need for psychotropic medications as well as careful monitoring for substance abuse relapse in this population are suggested.

Learning and memory in adolescent psychiatric inpatients with major depression: a normative study of the California Verbal Learning Test.

Depressed adults have deficits in memory functions, especially on demanding tasks, but few studies of depressed adolescents have been published. In order to examine the extent of memory impairment and its diagnostic specificity, adolescent inpatients with DSM-III-R diagnoses of Major Depression (n = 56), Conduct Disorder (n = 42), or mixed Depression and Conduct Disorder (n = 22) were tested on the California Verbal Learning Test (CVLT) and compared to each other, to CVLT norms, and to previously published CVLT norms for adults with Major Depression. Adolescents with Major Depression performed below normative standards on all aspects of the CVLT, but did not have a specific profile of memory impairments that was different from the two comparison samples. Relative to norms for adult patients with Major Depression, adolescent females under performed across all CVLT measures, but males did not differ from adults Depression in adolescence is not associated with specific memory impairments, but adolescent females with depression may have more severe deficits than depressed adults.

Empirical evaluation of the factorial structure of attention in adolescent psychiatric patients.

Adolescent psychiatric inpatients (N = 278) were examined with a structured battery of measures of attentional functioning. The factorial structure of the attentional performance was then examined through confirmatory factor analysis (CFA). Two conceptually related models of attentional functioning were compared to null and unifactorial comparison models. One of the conceptual models, previously described in a series of studies by Mirsky, separates attentional functions into four factors and the other conceptual model, developed by the present authors, collapses two of Mirsky's factors into one. Both of the substantive models fit the data with the four-factor model failing to improve substantially on the simpler three-factor model. These data provide support for the validity of the Mirsky model of attention and suggest that these factors merit further research to validate the brain localization hypotheses that underlie them.