Proposing a more conservative Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index cutoff score for forensic inpatient populations.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) may be unreliable at its standard recommended cutoff score when used with forensic psychiatric inpatient populations given high rates of genuine cognitive impairment. The present study sought to (a) examine the rate of invalid performance on the RBANS EI using the standard cutoff among incompetent to stand trial (IST) inpatients and (b) investigate the psychometric properties of the RBANS EI at various cutoff scores. This study was conducted using archival assessment data collected at a large forensic psychiatric hospital. Across the entire sample (N = 238, 79% male, Mage = 45 years, 24% primary Spanish-speaking), 79% were diagnosed with a schizophrenia spectrum disorder. Experiment 1 of the study (n = 165) contained IST patients who were classified as having a valid presentation. Experiment 2 contained a valid (n = 46) and invalid (n = 27) presentation group comprised of postadjudication and IST inpatients, respectively. In Experiment 1, over one third (36.4%) of the valid presentation sample scored above the standard recommended EI cutoff. In Experiment 2, applying the standard recommended cutoff score of > 3 was associated with a false positive rate of over 20%. Obtaining < 10% false positive errors was achieved at a cutoff score of > 5. At this cutoff score, the estimated local base rate of invalid responding among IST patients was 28%. Clinical and forensic implications and recommendations for adopting this more conservative RBANS EI cutoff score are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The use of performance validity tests among inpatient forensic monolingual Spanish-speakers.

Performance validity tests (PVTs) are an integral part of neuropsychological assessments. Yet no studies have examined how Spanish-speaking forensic inpatients perform on PVTs, making it difficult to interpret these tests in this population. The present study examined archival data collected from monolingual Spanish-speaking forensic inpatients (n = 55; Mage = 49.6 years, SD = 12.0; 84.9% male; 93.5% diagnosed with a Psychotic Spectrum Disorder) to determine how this population performs on several PVTs. Most participants' scores on the Dot Counting Test (DCT; 82.2%; n = 45), Repeatable Battery for Assessment of Neuropsychological Status-Effort Index (RBANS EI; 84.4%; n = 33), and Test of Memory Malingering (TOMM; 79.1%; n = 43) were indicative of valid performance. Few participants, however, had Rey-15 Item Test (FIT) scores in the valid range (24.5% to 48.0%; Recall n = 50 and Combined n = 49, respectively); although FIT Recall specificity was improved when cutoff scores were lowered. Total years of education, but not other educational factors, were significantly associated with performance on PVTs (r = .33-.40, p = .01-.03). Study results suggest the DCT, TOMM, and RBANS EI may be more appropriate PVTs for Spanish-speaking forensic inpatients compared to the FIT.

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.

Are TOPF and WRAT WR Interchangeable Measures among Psychiatric Inpatients?

OBJECTIVE: To examine whether Test of Premorbid Functioning (TOPF) and Wide Range Achievement Test-Word Reading subtest (WRAT WR) are interchangeable measures, and the relationship between these measures and intelligence, among patients with schizophrenia. METHOD: In this archival study, the authors examined neuropsychology referrals of an inpatient forensic state hospital. Patients with a schizophrenia spectrum disorder (SSD) who received the Wechsler Adult Intelligence Scale-Fourth Edition or the Wechsler Abbreviated Scale of Intelligence-Second Edition and either TOPF or WRAT WR were considered for inclusion. The final sample consisted of 119 individuals (73.1% male). RESULTS: Although there was a linear relationship between most TOPF variables and WRAT WR, their concordance was weak (concordance correlation coefficients [CCC] < 0.90). Poor concordance was also observed between current FSIQ and all standard scores (SS) derived from word reading measures. FSIQ-word reading measure discrepancy scores differed significantly from a hypothesized mean of 0 (mean discrepancy range = -7.42 to -16.60). Discrepancies greater than one standard deviation (>1 SD) were highest among demographics-based SS (i.e. TOPF Predicted and Simple without TOPF). Performance-based SS, particularly TOPF Actual and WRAT4 WR, had the fewest discrepancy scores >1 SD fromFSIQ. CONCLUSIONS: TOPF and WRAT WR should not be used interchangeably among institutionalized patients with SSDs. TOPF and WRAT WR were discrepant from FSIQ, with demographic variables producing higher SS relative to performance-based variables. Future research is needed to determine which of these measures more accurately estimates intelligence among inpatients withSSDs.

Decision making of forensic psychiatric inpatients deemed incompetent to stand trial.

This study examined decision making and its correlates among forensic psychiatric inpatients deemed incompetent to stand trial (IST). This study utilized archival data (n = 41; Mean Age = 44.27, SD = 15.89, 79.1% Male; 34.1% Caucasian). Decision making was measured using the Iowa Gambling Task (IGT), which is purported to simulate real-life decision making. Correlates included cognitive functioning, psychiatric symptom severity, and impulsivity. Participants selected more frequently from disadvantageous decks, which yield larger immediate monetary gains with a larger long-term monetary losses (Mean NET = -9.51, SD = 26.70), but avoided decks yielding frequent monetary losses (Mean GLF = 10.10, SD = 26.70). Consistently, participants selected most frequently from a deck yielding the most immediate monetary gains and the least frequent monetary losses compared to other decks (ps < 0.05). Based upon their selections, participants lost a significant amount of money (M = -$1,493.22, SD = $1,182.26). IGT outcomes were differentially associated with cognitive functioning (rs = -0.26 to 0.47), psychiatric symptom severity (rs = -0.41 to 0.37), and impulsivity (rs = -0.47 to 0.28; all ps = 0.003-0.98). Findings can guide future research, as well as guide competency restoration and decision-making interventions, for this population.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting.

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS. The current study examined the relationship between both the RBANS and NAB Judgment performance as predictors of LOS among 63 individuals diagnosed with schizophrenia spectrum disorders undergoing competency restoration treatment. Additionally, sensitivity analyses were used to determine cutoff scores for individuals requiring additional competency services. Results indicated that the NAB Judgment subtest was more predictive of LOS than the RBANS Total Index Score. Additionally, a raw score of ≤9 on NAB Judgment was indicative of increased LOS. These results highlight the utility of the NAB Judgment subtest within a forensic inpatient setting.

Examining false-positive rates of Wechsler Adult Intelligence Scale (WAIS-IV) processing speed-based embedded validity indicators among individuals with schizophrenia spectrum disorders.

Recent research (Erdodi et al., 2017) indicated that certain Wechsler Adult Intelligence Scale (WAIS-IV) Processing Speed Index (PSI)-based indices may have some utility as embedded validity indicators (EVIs) among a diagnostically diverse sample of neuropsychology referrals. Individuals with schizophrenia spectrum disorders (SSD) are often evaluated in forensic contexts in which there is incentive to exaggerate deficits. Because individuals with SSD often have limitations in processing speed associated with their disorders, the current study sought to evaluate the false-positive (FP) rates of cutoffs identified by Erdodi et al. on WAIS-IV PSI-based EVIs among forensically committed psychiatric inpatients with SSD who had no known incentive to feign because of the nature of their legal commitments. In the current sample, the previously suggested cutoff scores on PSI-based EVIs resulted in FP rates ranging from 2% to 57% among schizophrenia spectrum patients, with unacceptable FP rates for most indices. In the current sample of SSD patients, WAIS-IV PSI-based EVIs that are calculated based on the relative performance between PSI subtests (as opposed to absolute performance on individual indices) demonstrated acceptable FP rates. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Impaired verbal learning in forensic inpatients with Schizophrenia Spectrum Disorder.

The present study aimed to: (a) examine verbal learning performances among forensic inpatients diagnosed with Schizophrenia Spectrum Disorder (SSD); and (b) compare verbal learning performances among forensic SSD inpatients, SSD outpatients, and a small control sample. Participants included forensic SSD inpatients (n = 71), SSD outpatients (n = 305; see Stone et al.), and a control sample from the California Verbal Learning Test-II (CVLT-II) manual (n = 78; see Delis, Kramer, Kaplan, & Ober). Five verbal learning outcomes were measured using the CVLT-II. The average forensic SSD inpatients performed 1 to 1.5 standard deviations below the mean across the five verbal learning outcomes, many of whom (26.8% to 36.6%) performed in the impaired range across the five outcomes. Forensic SSD inpatients performed significantly lower than the SSD outpatients on three verbal learning outcomes and significantly lower than healthy controls on all five verbal learning outcomes. Results indicated forensically committed SSD inpatients have diminished verbal learning performances. Study findings could help define normative verbal learning performances in different types of SSD patients, may guide the development of compensatory strategies for verbal learning deficits, and could subsequently lead to more successful clinical outcomes in this population.

The Use of RBANS among Inpatient Forensic Monolingual Spanish Speakers.

OBJECTIVE: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been shown to be an effective screener for detecting neurocognitive impairments in English speaking forensic psychiatric inpatients, but no studies have examined whether the RBANS would have the same utility among monolingual Spanish speaking inpatients. This study sought to examine RBANS performance, as well as risk factors (i.e., educational, neurological, and medical) influencing RBANS performance, in that particular population. METHOD: The present study examined archival data collected from monolingual Spanish speaking inpatients (n = 34; mean age = 48.71, SD = 11.99; 85.3% men; 93.5% with Schizophrenia Spectrum Disorder). All participants must have RBANS data, and must not have a diagnosis of malingering or major neurocognitive disorder. Medical records of eligible participants were examined. RESULTS: Our findings indicated that most participants (75.8%) performed in the impaired range for the RBANS Total Index; however, the frequency of impaired performances varied on more specific RBANS indices (42.4%-72.7% of the participants). Although neurological and medical risk factors were not associated with RBANS Total Index performance (all p's = .26-.82), years of education appeared to be inversely associated with RBANS Total Index score (all p's = .04-.07). CONCLUSIONS: These findings can serve as the first step in helping to define "normative" cognition among Spanish speaking forensic psychiatric inpatients. Such findings can reduce the likelihood of over-pathologizing performance and increase the likelihood that treatment goals will be better tailored to the patient's cognitive ability.

Derivation and Cross-Validation of Cutoff Scores for Patients With Schizophrenia Spectrum Disorders on WAIS-IV Digit Span-Based Performance Validity Measures.

Two studies were conducted to identify and cross-validate cutoff scores on the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span-based embedded performance validity (PV) measures for individuals with schizophrenia spectrum disorders. In Study 1, normative scores were identified on Digit Span-embedded PV measures among a sample of patients (n = 84) with schizophrenia spectrum diagnoses who had no known incentive to perform poorly and who put forth valid effort on external PV tests. Previously identified cutoff scores resulted in unacceptable false positive rates and lower cutoff scores were adopted to maintain specificity levels ≥90%. In Study 2, the revised cutoff scores were cross-validated within a sample of schizophrenia spectrum patients (n = 96) committed as incompetent to stand trial. Performance on Digit Span PV measures was significantly related to Full Scale IQ in both studies, indicating the need to consider the intellectual functioning of examinees with psychotic spectrum disorders when interpreting scores on Digit Span PV measures.

Cognition and competency restoration: using the RBANS to predict length of stay for patients deemed incompetent to stand trial.

Intact cognition is a foundational component of one's ability to be competent to stand trial. Given the cost of assessing and treating incompetence, it is recommended that clinicians develop efficient methods to identify individuals who are most likely to require intensive competence-related treatment interventions. This study sought to ascertain whether a brief cognitive screening instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), could predict the length of stay required to restore trial competency among 288 forensic psychiatric inpatients undergoing competency restoration treatment. Results indicated that incompetent defendants who were older or demonstrated poorer overall RBANS performance required longer hospitalizations to be deemed restored to trial competence. Interestingly, incompetent defendants scoring in the 51-60 range on the RBANS Total Scale Index were almost three times more likely to require hospitalization beyond the average length of stay. Findings support the use of the RBANS to identify individuals early in the treatment process who may require and benefit from intensive restoration treatment.

Is the repeatable battery for the assessment of neuropsychological status factor structure appropriate for inpatient psychiatry? An exploratory and higher-order analysis.

The present study, utilizing a sample of inpatients with schizophrenia or schizoaffective disorder (n = 167), examined the factor structure of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Principal axis exploratory factor analysis, multiple factor extraction criteria, and higher-order factor analysis were used. Results were inconsistent with the five-factor structure of the RBANS purported in the test manual. Factor extraction criteria recommended extraction of one or two factors. Extraction of two factors resulted in a memory dimension and a less homogeneous visual perception and processing speed dimension. Higher-order analysis found that a second-order factor, representing general neurocognitive functioning, accounted for over three times the total and common variance than the two first-order factors combined. It was concluded that although the RBANS appears to be a useful measure of general neurocognitive functioning for inpatients with schizophrenia or schizoaffective disorder, clinical interpretation beyond a general factor (i.e., Total Scale score) should be done with caution in this population. Limitations of the present study and directions for future research are discussed.

The relationship between self-reported neuropsychological risk factors and RBANS test performance among forensically committed psychiatric inpatients.

Patients who are committed to a psychiatric inpatient hospital are at increased risk for neuropsychological compromise. This study investigated a large (n = 260) and diverse sample of patients at a forensic state psychiatric hospital. A substantial proportion (35.8%) of the sample performed two standard deviations below the normative mean on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In addition, 65% of the participants reported a history of developmental delays, less than 12 years of education, or past learning difficulties. Participants who reported these developmental and academic problems performed worse on the RBANS compared with those without such a history. Additionally, the more developmental/educational risk factors a participant reported, the more likely they were to be impaired on the RBANS. Half of the sample reported a history of at least one neurological risk factor (e.g., history of head injury with loss of consciousness). However, in this sample, a history of neurological risk factors did not influence overall performance on the RBANS and did not increase the likelihood of impairment. These results speak to the relevance of neuropsychological services at state psychiatric hospitals and provide some evidence that a history of developmental or academic problems may help identify psychiatric patients with neuropsychological compromise.

Concurrent validity of two observer-rated alexithymia measures.

The purposes of the present study were to evaluate 1) the correspondence between two observer-rated alexithymia measures, the Observer Alexithymia Scale and the modified Beth Israel Hospital Psychosomatic Questionnaire (BIQ) and 2) the psychometric properties of both instruments. Clinical and counseling psychologists (N=131) used the two instruments to rate outpatients with various psychiatric diagnoses. Correspondence was excellent; the correlation between the two scales was 0.69. Moreover, Observer Alexithymia Scale and modified BIQ scores are reliable (total and subscale alphas were within acceptable ranges), and both theoretical structures were confirmed. Both instruments can be recommended for alexithymia studies requiring observer ratings.