Sociodemographic, cultural, linguistic, and test selection considerations for clinical neuropsychological assessment with Japanese and Japanese-American patients in the United States.

Objective: Japanese-Americans are the sixth largest Asian ethnicity in the United States and represent a highly heterogeneous population. Despite representing a large and diverse group, relatively little attention has been paid to clinical best practices for working with this population in the West, particularly for Japanese speakers and issei (first-generation in the United States). This paper offers guidance for providing competent neuropsychological services to Japanese-Americans. Method: Pertinent facets of Japanese culture are presented within the context of the ECLECTIC framework (education and literacy, culture and acculturation, language, economics, communication, testing situation: comfort and motivation, intelligence conceptualization, and context of immigration; Fujii, 2018). The available literature on clinical neuropsychological tests that are translated into Japanese and normed with Japanese samples was reviewed. Results: Specific recommendations for clinicians providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity (American Educational Research Association et al., 2014). Additional recommendations for the use of teleneuropsychology; working with geriatric, pediatric, and multiracial populations; and providing useful recommendations and feedback from clinical assessment are provided. Measures that are appropriately translated and/or adapted for use with Japanese populations are presented by cognitive domain to assist clinicians with test selection. Conclusions: This paper provides concrete recommendations for Western neuropsychologists working with patients of Japanese descent in order to address the current gap in cultural competence among clinicians when working with this heterogeneous population.

What matters to psychology trainees when making decisions about internship and postdoctoral training sites: Differences between racial/ethnic minority and White VA trainees.

It is projected that by 2045, racial/ethnic minorities in the U.S. will become the majority. Unfortunately, the numbers of racial/ethnic minority psychologists have not kept up with population trends. This discrepancy poses challenges for many psychology training sites, including the Department of Veterans Affairs (VA). There is a lack of data on what factors are important for psychology applicants, including racial/ethnic minority trainees when they are considering internship and postdoctoral training sites. This quality improvement project surveyed 237 VA psychology trainees (59% psychology interns, 32.5% psychology postdoctoral fellows, 69.6% White, 9.3% multiracial, 6.8% Asian American or Pacific Islander, 5.1% Black/African American, 4.2% Latinx American, 0.8% Native American, 0.8% Middle Eastern) to study what factors are important when considering training sites. Results indicated that overall, racial/ethnic minority and White trainees endorsed similar primary factors when considering training programs. Site related factors (e.g., perceived workload, training opportunities) and future work related factors (e.g., ease of licensure, obtaining a first job) were top considerations regardless of race/ethnicity. The groups diverged in secondary factors with racial/ethnic minorities desiring infusion of diversity in training more than White applicants and White applicants considering quality of life factors such as extracurricular opportunities and convenience of daily living more important than racial/ethnic minority applicants. Qualitative data indicated applicants perceived VA training sites to be more welcoming and offer more opportunities for learning about diversity than non-VA sites. Recommendations for recruiting psychology trainees in general, and then specifically for racial/ethnic minority applicants are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cross-cultural considerations for teleneuropsychology with Asian patients.

OBJECTIVE: Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. METHOD: Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. CONCLUSIONS: Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.

Incorporating Intersectionality in Neuropsychology: Moving the Discipline Forward.

OBJECTIVE: Intersectionality is the interface between a person's identities in relation to social systems and institutional discrimination. The concept has generated much interest in psychology for understanding societal inequities and providing culturally informed services to minoritized patients but has yet to be incorporated in clinical neuropsychology. This omission is unfortunate as it is argued that appreciating the impact of institutional discrimination on minoritized groups can enhance our understanding of brain organization and functioning and bolster access to competent neuropsychological services to minoritized patients. The purpose of this article is to illustrate how intersectionality is germane to the discipline of clinical neuropsychology and to make recommendations for infusing it into the practice. METHOD: Theories and findings in cultural neuroscience are summarized to provide a theoretical background for understanding how the environment can impact brain development and organization. The literature on disparities in education, economics, and health disparities between Whites and minoritized groups was reviewed for institutional biases that place minoritized groups at a disadvantage. These topics were selected due to their known impact on brain organization and cognition. This was followed by a similar review for access to competent neuropsychological assessments for minoritized patients. RESULTS: There is a confluence of institutional discriminatory processes that contribute to disparities in education attainment, economic status, health disparities, and accessibility to culturally informed neuropsychological services. Perceived discrimination has significant health and cognitive ramifications. CONCLUSIONS: Intersectionality is germane to appreciating brain functioning and providing competent services to minoritized patients. Recommendations were made to incorporate intersectionality in clinical neuropsychology.

Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness.

OBJECTIVES: Individuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI. DESIGN: A multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project. SETTING AND PARTICIPANTS: Respondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs). MEASURES: The questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs. RESULTS: Respondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff. CONCLUSIONS/IMPLICATIONS: The present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.

Developing a cultural context for conducting a neuropsychological evaluation with a culturally diverse client: the ECLECTIC framework.

OBJECTIVE: With the increasing diversification of the American population, the discipline of neuropsychology is challenged to develop appropriate tools and conceptual models to meet its evolving client base. Thus far, the focus has been on developing appropriate tests and norms to obtain accurate testing data. By contrast, far less attention has been paid to the contextual impact of culture on an evaluation. This paper attempts to address this shortcoming. METHODS: This manuscript introduces the ECLECTIC framework for conceptualizing different facets of culture pertinent for understanding a culturally diverse client when conducting a neuropsychological evaluation. Individual components of the framework (E: education and literacy; C: culture and acculturation; L: language; E: economics; C: communication; T: testing situation: comfort and motivation; I: intelligence conceptualization; and C: context of immigration) are introduced and potential biases to fairness in testing are described. In this manner, the framework specifies how individual facets of culture can impact neuropsychological test performance. CONCLUSIONS: Clinical implementation of the framework will be illustrated with a case sample. Strengths and weaknesses of the framework are discussed as well as recommendations for implementation.

Psychotic disorder caused by traumatic brain injury.

Psychosis is a rare and severe sequela of traumatic brain injury (TBI). This article assists clinicians in differential diagnosis by providing literature-based guidance with regard to use of the Diagnostic and Statistical Manual for Mental Disorders 5 criteria for this condition. This article also describes potential relationships between TBI and the development of a psychosis within the conceptualization of psychosis as a neurobehavioral syndrome.

Psychotic disorder due to traumatic brain injury: analysis of case studies in the literature.

The present study utilized methodology from a previous descriptive study that analyzed case studies of psychotic disorder due to traumatic brain injury (PD-TBI) reported in psychiatry and neurology journals. The purpose was to replicate findings from the PD-TBI literature and to elucidate a pattern of characteristics that would differentiate PD-TBI from schizophrenia. The findings supported both objectives. PD-TBI data were highly consistent with previous studies: PD-TBI differed from schizophrenia in showing more focal frontal and temporal abnormalities on neurological studies and a lower rate of negative symptoms. The authors discuss implications of these findings for conceptualizing psychosis as a neurobiological syndrome.

An exploratory analysis of neurocognition in methamphetamine-induced psychotic disorder and paranoid schizophrenia.

OBJECTIVE: This exploratory study compared the neurocognitive performances of individuals with methamphetamine-induced psychotic disorder (MA psychosis) and paranoid schizophrenia. BACKGROUND: MA psychosis presents very similarly to paranoid schizophrenia and the relationship between the 2 disorders is not well-understood. Neurocognitive functioning is one potential factor for comparison, as deficits are documented in both schizophrenia and methamphetamine dependence. METHOD: Participants were selected through chart review. Neurocognitive test scores for participants with paranoid schizophrenia (n=20) and MA psychosis (n=19) were obtained from hospital records and compared. RESULTS: Results of multivariate analysis of variance found no significant differences between the groups in any neurocognitive domain. CONCLUSIONS: These preliminary findings suggest that similarities between the disorders may extend to neurocognition. Low power and sampling limitations may contribute to the null findings.

Ethnic differences in prediction of violence risk with the HCR-20 among psychiatric inpatients.

OBJECTIVE: This study examined ethnic differences in assessment of violence risk among psychiatric inpatients by using the Historical Clinical Risk Management-20 (HCR-20). METHODS: The HCR-20 was administered to 169 consecutive psychiatric inpatients. Individual items and total scores on the HCR-20 were compared between patients of Asian-American (N=51), Euro-American (N=46), and Native-Hawaiian (N=38) heritage. Receiver operating characteristic (ROC) and stepwise regressions were calculated for each ethnic group with HCR-20 scores as predictor variables and violent event reports of significant threats and assaults as the outcome measure. RESULTS: Similar rates of overall violence were found between ethnic groups, and the HCR-20 was found to have predictive validity as measured by ROC analysis. Differences in scores on individual HCR-20 items were found, including young age at first incident of violence, psychopathy, early maladjustment, personality disorder, and past supervision failure, as well as total HCR-20 score, with Asian Americans scoring lower (less risk) than Euro-Americans and Native Hawaiians. Stepwise multiple regressions indicated a different pattern of predictor variables for each ethnic group, with impulsivity salient for the Asian-American group, young age at first incident of violence salient for the Euro-American group, and young age at first incident of violence, relationship instability, and risk-management plans' lacking feasibility as salient predictors for the Native-Hawaiian group. CONCLUSIONS: The findings provide preliminary support for the cross-cultural validity of the HCR-20 while at the same time identifying unique ethnic differences in prediction of violence risk among psychiatric inpatients.

Neuropsychological assessment of Asian Americans: demographic factors, cultural diversity, and practical guidelines.

Asian Americans belong to 1 of the most rapidly growing ethnic minority groups in the United States. Clinical neuropsychologists unfamiliar with Asian American peoples and cultures may not be able to perform an adequate evaluation with an individual of Asian descent because of lack of understanding of how cultural variables might affect the assessment. This article attempts to provide some basic knowledge and principles by which to guide neuropsychologists who might work with an Asian American patient by (a) familiarizing the reader with basic information and descriptions of some of the major specific Asian subgroups, (b) providing a context within which neuropsychological test selection and interpretation can be adjusted to account for cultural and linguistic factors, and (c) providing practical suggestions for working with Asian American clients in a neuropsychological setting.

A neuropsychological comparison of psychotic disorder following traumatic brain injury, traumatic brain injury without psychotic disorder, and schizophrenia.

Neuropsychological functioning in individuals with psychotic disorder following traumatic brain injury (PDFTBI), traumatic brain injury without psychosis (TBIWP), and schizophrenia were compared against each other and to the means of normal subjects. It was predicted that the PDFTBI group would be similar to the schizophrenic group in patterns of deficits, but milder in severity. Compared to scores from a normal sample, the PDFTBI group scored significantly lower in intelligence, vocabulary, verbal memory, and executive functioning, while the schizophrenic group scored significantly lower in intelligence, working memory, verbal memory, visual spatial abilities, and executive functioning. No differences were found between normal subjects and the TBIWP group. Implications of our findings for the conceptualization of psychotic disorders are discussed.

Neurocognition and long-term prediction of quality of life in outpatients with severe and persistent mental illness.

The present study examined the predictive validity of neuropsychological measures to quality of life (QOL) indicators in 30 outpatients with severe and persistent mental illness (SPMI), an average of 15 years post-testing. Outcome measures included subscale scores on the Brief Quality of Life Inventory (BQOLI). Results of several stepwise multiple regressions revealed that memory was predictive of income, satisfaction with daily activities, and general health. Executive functioning was predictive of contact with family and financial support. Motor skills were predictive of satisfaction with family contact, and working memory was predictive of victimization and satisfaction with social contacts. Discussion focused on neurocognition as a predictor of QOL, clinical implications, and the potential for improving QOL through cognitive interventions.

Is psychosis a neurobiological syndrome?

OBJECTIVE: To describe theoretical weaknesses in the DSM-IV criteria for psychotic disorders and to argue that schizophrenia-like psychosis is a neurobiological syndrome similar to aphasia or apraxia. METHOD: We outline the criteria for the concept of neurobiological syndrome and present supporting evidence for schizophrenia-like psychosis as a neurobiological syndrome. RESULTS: There is evidence in the literature to support the hypothesis that schizophrenia-like psychosis is a neurobiological syndrome. CONCLUSION: Conceptualizing schizophrenia-like psychosis as a neurobiological syndrome has important implications for both clinicians and researchers.

Dementia screening: can a second administration reduce the number of false positives?

OBJECTIVE: Early diagnosis of dementia is important for medical treatment and quality-of-life interventions. The authors examine whether administering a second cognitive screening after a poor initial score can improve the accuracy of diagnosis. Of particular interest is reducing false positives that may generate an unnecessary referral for a dementia work-up. METHODS: A group of 389 Japanese men from the Honolulu-Asia Aging Study were administered the Cognitive Assessment Screening Instrument (CASI) twice within a 2-month period. A small sample received a follow-up CASI 3 years later. RESULTS: Administration of a second CASI reduced the false-positive rate by 16.1% in the total sample and 20.2% in those suspected of having mild dementia. The negative predictive value for the second administration was 80% for the entire sample and 82.6% for those suspected of having mild dementia. CONCLUSION: Administration of a second cognitive screening in patients initially scoring in the dementia range can significantly reduce the number of false positives for dementia. This technique may be useful to managed-care companies who aim to reduce unnecessary costs in medical care.

Neurocognition and community outcome in schizophrenia: long-term predictive validity.

The present study examined the predictive validity of neuropsychological measures to functional outcome in 26 schizophrenic patients 15-plus year post-testing. Outcome measures included score on the Resource Associated Functional Level Scale (RAFLS), number of state hospital admissions, and total duration of state hospital inpatient stay. Results of several stepwise multiple regressions revealed that verbal memory significantly predicted RAFLS score, accounting for nearly half of the variance. Trails B significantly predicted duration of state hospital inpatient status. Discussion focused on the utility of these measures for clinicians and system planners.

Are depressive symptoms a risk factor for mortality in elderly Japanese American men?: the Honolulu-Asia Aging Study.

OBJECTIVE: This study determined the influence of depressive symptoms on subsequent mortality of all causes. METHOD: The Honolulu Heart Program, established in 1965, is a prospective, community-based cohort of Japanese American men living in Hawaii. The analysis was based on 3,196 Japanese American men aged 71-93 at the time of the fourth examination in 1991-1993. Depressive symptoms were measured by use of an 11-question version of the Centers for Epidemiologic Studies Depression Scale questionnaire. All-cause mortality data were available for 6 years of follow up. Data were analyzed on the basis of presence or absence of chronic diseases. RESULTS: The overall prevalence of frequent depressive symptoms was 9.9%. Age-adjusted mortality rates at 3 years were 48.0 and 30.3 per 1,000 person-years for the depressed and nondepressed groups, respectively. At 6 years, the rates were 54.1 (depressed) and 41.5 (nondepressed) per 1,000 person-years. After adjustment for age, marital status, and antidepressant use, the relative risk for all-cause mortality associated with depressive symptoms was 1.53 for 3-year and 1.27 for 6-year mortality. Among participants who were healthy (without cognitive impairment, coronary heart disease, stroke, diabetes, or cancer), the association between depressive symptoms and mortality was greater (relative risk of 2.30 and 1.57 for 3- and 6-year mortality, respectively). Among participants with chronic disease, there were no significant associations between depressive symptoms and mortality. CONCLUSIONS: Depressive symptoms are a risk factor for mortality in elderly people, particularly in physically healthy individuals.