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The impact of psychiatric symptoms on the capacity of patients to give informed consent
12. Psychology, Cognitive
171
USE OF THE STEREOTYPY TEST APPARATUS WITH SEVERE JUVENILE OFFENDERS E. Hoffmann,* L. Servais, S. Campanella, E. Stillemans,
can be used to guide interventions to assist the informed consent process.
E Lewi, E Janssen
NEUROPSYCHOLOGICAL SCREENING IN SCHIZOPHRENIA: PSYCHOMETRIC PROPERTIES OF THE REPEATABLE BATTERY FOR THE ASSESSMENT OF NEUROPSYCHOLOGICAL STATUS (RBANS)
Unitd de recherche, Centre Hospitalier Jean Titeca, Brussels, Brussels, Belgium (a)This study evaluates the computarized fast assessment of Stereotypy Test Apparatus (STA), a new neuropsychological test for use in schizophrenia assessment. The task consists in pressing 9 buttons, 200 consecutive times, with one-second intervals as randomly as posible. The computer calculates Redundancy of Context (RC), wieh measures the lack of randomness in a series of 200 entries, wich gives the number of Zero (Z) and Multiple (M) entries within intervals. (b)Thirty severe conduct disordered boys (CD), thirty-three with learning problems (LP) and eighteen matched controls (C) were administered a neuropsychological battery including attention and inhibitory control tests (WAIS, codes, D2, Trail Making Test, Stroop). Non-parametric statistical analyses were performed. (c)As in attention and inhibitory control tests, analysis of variance indicated group effect for each STA parameter (RC:p<.005;Z:p<.012;M:p<.001) with the most extreme results in CD and intermediate outcomes in LP. Considering the whole sample, RC was positively correlated with inhibitory deficit (D2%:p<.026) and irregularity (D2SB:p<.036). M but not Z was strongly and negatively correlated with the attention and inhibitory control performances. (d)STA quikly gives precious neuropsychological data. Mainly, RC and M seem to be partially related to sustained attention and inhibitory control. Their exact specificity and sensitivity need further research.
THE IMPACT OF PSYCHIATRIC SYMPTOMS ON THE CAPACITY OF PATIENTS TO GIVE INFORMED CONSENT V. Howe,* K. M. Foister, K. Jenkins, D. Copolov, N. Keks Clinical Research, Mental Health Research Institute, Melbourne, VIC, Australia This investigation was designed to determine which areas of the consent process are likely to be affected by psychiatric symptoms. 109 participants, 54 male and 56 female with a mean age of 37.2 years (SD=12.3 years), from two acute psychiatric inpatient units were included in the investigation. Each patient completed the MacArthur Competence Assessment Tool - Treatment (MacCAT-T). This tool assesses the four key areas considered central to capacity to consent: understanding information, appreciating the relevance of the information, reasoning and expressing a choice. Patients were also administered the Positive and Negative Syndrome Scale (PANSS) by their treating psychiatrist, who was blind to MacCAT-T results. Pearson correlations were performed between the PANSS index scores and the indices measured on the MacCAT-T. Results indicated specific and significant relationships between the MacCAT-T understanding disorder and positive symptoms (r=-0.393, p<0,000) general symptoms (r=-0.300, p=0.002) thought disturbance (r=-0.345, p<0.000), activation (r=-0.309, p=0.001), paranoid/belligerence (r=-0.370, p<0.000) and PANSS total symptoms (r=-0.364, p<0.000). The results indicate specific inverse relationships between positive symptomology and the level of patient understanding regarding their disorder. None of the other key components of capacity to give informed consent demonstrated this relationship with symptomology. Clearly the patient's understanding of their disorder is most likely to be compromised when psychiatric symptoms are prominent. These results
K. Humber,* C. M. Wilk, E B. Dickerson, R. W. Buchanan, J. M. Gold
Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, MD, USA Cognitive impairment is widely recognized as a central feature of schizophrenia. However, the field has lacked a brief assessment approach with demonstrated validity that is suitable for clinical and research applications. We have previously demonstrated that the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has promising psychometric properties, including testretest reliability and construct validity. This presentation will provide an overview of additional RBANS data, drawn from several independent studies, addressing issues of test sensitivity, reliability, and clinical validity. Normative RBANS data are presented on a sample of 564 patients with schizophrenia (383 male, 181 female) drawn from two independent mental health treatment systems. Remarkably, the two patient groups demonstrated nearly identical levels and patterns of performance, with RBANS Total Scaled scores of 70.0 and 71.3 in the MPRC and Sheppard Pratt cohorts respectively. Both scores are approximately 2 SDs below the normal mean, and both group profiles are distinguished by a relative preservation of language and visuospatial skills relative to attention and memory. We found no evidence of increasing intellectual impairment over the age range studied, and minimal differences between the genders, consistent with results obtained on large neuropsychological batteries. Evidence of adequate test-retest reliability was observed in a sample of 181 patients (ICC=.84) and 99 controls(ICC=.77). Additional clinical validity data include the demonstration that the RBANS is related to decisional capacity (N=70), and is predictive of the number of hours worked over the following 24 months in a vocational rehabilitation setting (N=40). Results replicated our prior finding that patients with schizophrenia (n=74) demonstrate more severe RBANS impairment than patients with Bipolar disorder (n=26). These results provide strong evidence that the RBANS has: 1) sensitivity to the level and pattern of impairment expected in schizophrenia, 2) adequate reliability to assess treatment effects, and 3) a relationship to important aspects of functional outcome such as decisional capacity and employment.
DEVELOPMENTAL MARKERS IN CHILDHOOD AND ADOLESCENCE AND RISK FOR SCHIZOPHRENIA IN ADULT LIFE: A THIRTY ONE-YEAR FOLLOW-UP OF THE NORTH FINLAND 1966 BIRTH COHORT M. K. Isohanni,* E B. Jones, J. Jokelainen, T. Croudace, G. Murray
Psychiatry, University Cambridge, Cambridge, CB2 2QQ, United Kingdom Development may go awry long before schizophrenia begins. Our aim was to analyse the relation between early development and adult
International Congress on Schizophrenia Research 2003
171
USE OF THE STEREOTYPY TEST APPARATUS WITH SEVERE JUVENILE OFFENDERS E. Hoffmann,* L. Servais, S. Campanella, E. Stillemans,
can be used to guide interventions to assist the informed consent process.
E Lewi, E Janssen
NEUROPSYCHOLOGICAL SCREENING IN SCHIZOPHRENIA: PSYCHOMETRIC PROPERTIES OF THE REPEATABLE BATTERY FOR THE ASSESSMENT OF NEUROPSYCHOLOGICAL STATUS (RBANS)
Unitd de recherche, Centre Hospitalier Jean Titeca, Brussels, Brussels, Belgium (a)This study evaluates the computarized fast assessment of Stereotypy Test Apparatus (STA), a new neuropsychological test for use in schizophrenia assessment. The task consists in pressing 9 buttons, 200 consecutive times, with one-second intervals as randomly as posible. The computer calculates Redundancy of Context (RC), wieh measures the lack of randomness in a series of 200 entries, wich gives the number of Zero (Z) and Multiple (M) entries within intervals. (b)Thirty severe conduct disordered boys (CD), thirty-three with learning problems (LP) and eighteen matched controls (C) were administered a neuropsychological battery including attention and inhibitory control tests (WAIS, codes, D2, Trail Making Test, Stroop). Non-parametric statistical analyses were performed. (c)As in attention and inhibitory control tests, analysis of variance indicated group effect for each STA parameter (RC:p<.005;Z:p<.012;M:p<.001) with the most extreme results in CD and intermediate outcomes in LP. Considering the whole sample, RC was positively correlated with inhibitory deficit (D2%:p<.026) and irregularity (D2SB:p<.036). M but not Z was strongly and negatively correlated with the attention and inhibitory control performances. (d)STA quikly gives precious neuropsychological data. Mainly, RC and M seem to be partially related to sustained attention and inhibitory control. Their exact specificity and sensitivity need further research.
THE IMPACT OF PSYCHIATRIC SYMPTOMS ON THE CAPACITY OF PATIENTS TO GIVE INFORMED CONSENT V. Howe,* K. M. Foister, K. Jenkins, D. Copolov, N. Keks Clinical Research, Mental Health Research Institute, Melbourne, VIC, Australia This investigation was designed to determine which areas of the consent process are likely to be affected by psychiatric symptoms. 109 participants, 54 male and 56 female with a mean age of 37.2 years (SD=12.3 years), from two acute psychiatric inpatient units were included in the investigation. Each patient completed the MacArthur Competence Assessment Tool - Treatment (MacCAT-T). This tool assesses the four key areas considered central to capacity to consent: understanding information, appreciating the relevance of the information, reasoning and expressing a choice. Patients were also administered the Positive and Negative Syndrome Scale (PANSS) by their treating psychiatrist, who was blind to MacCAT-T results. Pearson correlations were performed between the PANSS index scores and the indices measured on the MacCAT-T. Results indicated specific and significant relationships between the MacCAT-T understanding disorder and positive symptoms (r=-0.393, p<0,000) general symptoms (r=-0.300, p=0.002) thought disturbance (r=-0.345, p<0.000), activation (r=-0.309, p=0.001), paranoid/belligerence (r=-0.370, p<0.000) and PANSS total symptoms (r=-0.364, p<0.000). The results indicate specific inverse relationships between positive symptomology and the level of patient understanding regarding their disorder. None of the other key components of capacity to give informed consent demonstrated this relationship with symptomology. Clearly the patient's understanding of their disorder is most likely to be compromised when psychiatric symptoms are prominent. These results
K. Humber,* C. M. Wilk, E B. Dickerson, R. W. Buchanan, J. M. Gold
Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, MD, USA Cognitive impairment is widely recognized as a central feature of schizophrenia. However, the field has lacked a brief assessment approach with demonstrated validity that is suitable for clinical and research applications. We have previously demonstrated that the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has promising psychometric properties, including testretest reliability and construct validity. This presentation will provide an overview of additional RBANS data, drawn from several independent studies, addressing issues of test sensitivity, reliability, and clinical validity. Normative RBANS data are presented on a sample of 564 patients with schizophrenia (383 male, 181 female) drawn from two independent mental health treatment systems. Remarkably, the two patient groups demonstrated nearly identical levels and patterns of performance, with RBANS Total Scaled scores of 70.0 and 71.3 in the MPRC and Sheppard Pratt cohorts respectively. Both scores are approximately 2 SDs below the normal mean, and both group profiles are distinguished by a relative preservation of language and visuospatial skills relative to attention and memory. We found no evidence of increasing intellectual impairment over the age range studied, and minimal differences between the genders, consistent with results obtained on large neuropsychological batteries. Evidence of adequate test-retest reliability was observed in a sample of 181 patients (ICC=.84) and 99 controls(ICC=.77). Additional clinical validity data include the demonstration that the RBANS is related to decisional capacity (N=70), and is predictive of the number of hours worked over the following 24 months in a vocational rehabilitation setting (N=40). Results replicated our prior finding that patients with schizophrenia (n=74) demonstrate more severe RBANS impairment than patients with Bipolar disorder (n=26). These results provide strong evidence that the RBANS has: 1) sensitivity to the level and pattern of impairment expected in schizophrenia, 2) adequate reliability to assess treatment effects, and 3) a relationship to important aspects of functional outcome such as decisional capacity and employment.
DEVELOPMENTAL MARKERS IN CHILDHOOD AND ADOLESCENCE AND RISK FOR SCHIZOPHRENIA IN ADULT LIFE: A THIRTY ONE-YEAR FOLLOW-UP OF THE NORTH FINLAND 1966 BIRTH COHORT M. K. Isohanni,* E B. Jones, J. Jokelainen, T. Croudace, G. Murray
Psychiatry, University Cambridge, Cambridge, CB2 2QQ, United Kingdom Development may go awry long before schizophrenia begins. Our aim was to analyse the relation between early development and adult
International Congress on Schizophrenia Research 2003