Exploratory analysis of CVLT-II forced-choice recognition and RBANS EI base rates for forensically-committed, psychotic-disordered inpatients: Implications on clinical decision-making.

Within the inpatient forensic setting, requests for a neuropsychological evaluation are common to determine cognitive strengths and weaknesses. However, variable effort proves to be a prominent issue in this setting. Thus, assessment of effort becomes an essential component of a neuropsychological evaluation. The California Verbal Learning Test, 2nd Edition (CVLT-II) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) are widely utilized cognitive measures in the inpatient setting. The purpose of this study is to establish the local base rates and predictive abilities of the CVLT-II Forced-Choice Recognition (FCR) measure and RBANS Effort Index (EI). Participants included 56 and 595 forensically-committed, psychotic-disordered inpatients who completed the CVLT-II FCR and RBANS EI, respectively. Results indicated that the estimated local base rate for a positive CVLT-II FCR score was 8%, which resulted in 97% negative predictive power and 50% positive predictive power. The estimated local base rate for a positive RBANS EI score was 16%, which resulted in 91.7% negative predictive power and 57.1% positive predictive power. Given their low sensitivity and predictive power, the results suggest that much more confidence can be placed in negative FCR and EI results as opposed to positive findings.

Locked in and Growing Old: The Psychiatric, Forensic, and Cognitive Correlates of 30 Years of Psychiatric Hospitalization.

OBJECTIVE: As the number of older adults in the United States continues to grow, the population of older adults with severe mental illness in institutional settings (OASIS) is expected to place a significant demand on healthcare resources. This study presents an update to research regarding the clinical characteristics of OASIS inpatients with histories of extensive hospitalization through the use of a newly developed psychiatric measure: the Clinician-Rated Dimension of Psychosis Symptom Severity. METHODS: We investigated an OASIS sample (N = 55) with an average of nearly 30 continuous years of hospitalization at a forensic state psychiatric hospital. RESULTS: The average OASIS patient exhibited the most prominent psychiatric symptoms via delusions and negative symptoms, received psychotropic medications at substantially higher doses than recommended therapeutic levels, rarely committed acts of institutional violence (IV), and performed more than two standard deviations below the normative mean on cognitive testing. More severe hallucination symptoms were associated with higher psychotropic medication dosage, and more severe depressive symptoms were associated with more IV incidents. OASIS inpatients performed moderately worse than general psychiatric inpatients in the areas of overall cognition, immediate memory, and delayed memory; older age was associated with poorer language and attention. No psychiatric or cognitive factors predicted IV incidents. CONCLUSION: These results highlight the continued importance of understanding the psychiatric, forensic, and cognitive factors associated with aging in an institutional setting and how these factors among OASIS inpatients may vary from general psychiatric inpatients.

Sensitivity and specificity of finger tapping test scores for the detection of suspect effort.

Past studies indicate that patients with incentive to fake neuropsychological symptoms are likely to have lower finger tapping scores than credible patients. The present study builds upon past research by investigating finger tapping performance for seven groups: (a) noncredible patients (as determined by failed psychometric and behavioral criteria), and patients with (b) closed head injury, (c) dementia, (d) mental retardation, (e) psychosis, or (f) depression, and (g) healthy older controls. Results showed that men tapped faster than women, requiring that groups be divided by gender. Noncredible male and female patients tapped slower than their comparison group counterparts. Dominant hand score proved to be more sensitive to noncredible performance than other scores (nondominant, sum of both hands, difference between dominant and nondominant), especially for women. Sensitivity, specificity, and positive and negative predictive value tables are presented. With specificity set at 90% for the comparison groups combined, a dominant hand cutoff score of