Health resource utilization among US veterans with psychogenic nonepileptic seizures: A comparison before and after video-EEG monitoring.

OBJECTIVE: Prior to establishing the correct diagnosis, patients with psychogenic nonepileptic seizures (PNES) frequently endure significant costs and morbidities associated with utilization of health care resources. In this study of the US veterans population, we aimed to investigate for potential changes in health resource utilization before versus after video-EEG (VEEG) confirmation and disclosure of the PNES diagnosis. METHODS: We prospectively studied 65 veterans with VEEG confirmed diagnosis of PNES, and followed their health care utilization during the subsequent 3 years after the diagnosis. Primary outcomes entailed comparing the quantities of post-VEEG outpatient visits and diagnostic procedures versus those during the 3-year span prior to the diagnosis. Secondary outcome involved specifically the measures of seizure-related antiepileptic drug (AED) use from time points before and after VEEG. RESULTS: Within the category of non-psychiatric outpatient visits, we observed significant post-diagnostic decrease in the utilization of PNES-related outpatient visits (p < 0.001). Contrastingly, we found significant post-diagnostic increase in the utilization of non-PNES-related outpatient visits (p = 0.004). When examining exclusively for psychiatric outpatient visits, we further observed a trend toward increased attendance of outpatient visits (p = 0.056) after VEEG. Utilization of diagnostic procedures was not significantly different before versus after VEEG (p = 0.293). 52.3% of the patients were prescribed AEDs for seizure-related purpose during the one-year period leading up to VEEG. By comparison, only 7.7%, 12.3%, and 10.8% of the patients were still on AEDs for seizure-related purpose at the one-year, two-year, and three-year time points after VEEG, respectively. CONCLUSION: We demonstrate new evidence that VEEG confirmation of the PNES diagnosis among US veterans can significantly reduce key measures of non-psychiatric/PNES-related resource utilization, while also potentially associating with appropriate enhancement of psychiatric outpatient visits. However, our results suggest that within this patient population, further efforts are necessary to address heightened demands for non-PNES-related outpatient visits after VEEG.

The dangers of failing one or more performance validity tests in individuals claiming mild traumatic brain injury-related postconcussive symptoms.

Evaluating performance validity is important in any neuropsychological assessment, and prior research recommends a threshold for invalid performance of two or more performance validity test (PVT) failures. However, extant findings also indicate that failing a single PVT is associated with significant changes in neuropsychological performance. The current study sought to determine if there is an appreciable difference in neuropsychological testing results between individuals failing different numbers of PVTs. In a sample of veterans with reported histories of mild traumatic brain injury (mTBI; N =178), analyses revealed that individuals failing only one PVT performed significantly worse than individuals failing no PVTs on measures of verbal learning and memory, processing speed, and cognitive flexibility. Additionally, individuals failing one versus two PVTs significantly differed only on delayed free recall scores. The current findings suggest that failure of even one PVT should elicit consideration of performance invalidity, particularly in individuals with histories of mTBI.

College students' conceptualizations of deficits involved in mild intellectual disability.

Precedential rulings in recent capital murder trials may, in some cases, leave it up to a jury to determine whether or not an individual meets criteria for an intellectual disability (ID) and should be spared from the death penalty. Despite the potential for misconceptions about ID to bias decisions, few empirical studies have examined the public's conceptualizations of individuals with ID. This study sought to examine 890 college students' conceptualizations of the deficits involved in mild ID. Students were asked to respond to two online surveys about the cognitive and adaptive behavior deficits that people with mild ID may experience. While most students were correct about basic facts, such as ID is not contagious and not curable, there was no clear consensus regarding beliefs about individuals with ID getting married, having children, or engaging in other mainstream activities of adult living. Students' responses are examined in light of results of studies that identify and examine bona fide deficits and areas of successful mainstreaming among persons with ID. Implications of misconceptions are discussed.

Using the NAART to estimate WRAT-4 reading grade level in a predominantly African American sample.

Tests of word-reading ability, such as the North American Adult Reading Test (NAART) and Wide Range Achievement Test (WRAT) Word Reading subtest, are often used by neuropsychologists to estimate premorbid intelligence. However, despite the fundamental basis in reading, little work has been done to calculate or estimate literacy level from NAART performance. Additionally, few prior studies have evaluated the use of word-reading tests in underrepresented populations such as African Americans or individuals with lower socioeconomic status and educational attainment. Finally, while the correlations between the NAART and older editions of the WRAT are known, no study has yet examined the relationship between the NAART and WRAT-Fourth Edition (WRAT-4). The purpose of the current study, then, was to replicate and extend prior research in these areas. NAART and WRAT-4 Word Reading (WRAT4WR) performances were examined in a sample of 173 primarily African American individuals who were HIV-positive and who had an average of fewer than 12 years of education. Analyses revealed a strong correlation between NAART error scores and WRAT4WR raw scores (r = -.866, p < .001). Linear regression was used to establish the predictive equation to estimate WRAT4WR scores from NAART errors. This information allows for determining reading grade-level equivalents based on NAART error scores.

Assessment and rehabilitation of acquired visuospatial and proprioceptive deficits associated with visuospatial neglect.

Visuoperceptual disruptions are among the most common, and most debilitating, of the aftereffects following stroke or head injury. Visuospatial neglect in particular, which frequently occurs as a result of insult to the right cerebral hemisphere, has a variety of implications for patient welfare and outcome. And while there exists a great deal of useful information in the area of visual neglect, it is spread out amongst near-countless journal articles, book chapters, and workshop summaries. Thus, it is the purpose of this paper to provide an overview of various topics relating to visuospatial disturbances. Areas covered include theories on sequelae and neuropathology, common direct and indirect complications, rates and types of recovery, past and current trends in assessment and rehabilitation techniques, and thoughts on directions for future research.