Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia, II: convergent/discriminant validity and diagnostic group comparisons.
ABSTRACT In a companion article in this issue of the Journal, the authors presented data suggesting that the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is sensitive to the types of impairments observed in schizophrenia, correlates highly with standard measures of intelligence and memory, and is related to employment status in a group of patients with schizophrenia drawn from a tertiary care research center. The objectives of the current study were 1) to determine if evidence of the convergent validity of the RBANS could be replicated in a diagnostically heterogeneous sample drawn from a public mental health system, 2) to examine the relationship of the RBANS to a broad neuropsychological battery, and 3) to compare the performance of patients with schizophrenia and patients with bipolar disorder on a neuropsychological battery and the RBANS.
The RBANS and a standard neuropsychological battery, including the WAIS-III and Wechsler Memory Scale, 3rd ed. (WMS-III), were given to 150 patients drawn from a larger study of vocational rehabilitation.
Correlations of RBANS total scores with WAIS-III and WMS-III variables were highly similar across study groups. The RBANS correlated highly with a composite z score derived from 22 standard measures of IQ, memory, language, motor, attention, and executive function. Principal component analyses of the neuropsychological battery resulted in a six-factor solution: the RBANS correlated most highly with a general ability factor and had limited correlations with measures of motor performance, vigilance, and executive function. Patients with schizophrenia demonstrated greater deficits on the neuropsychological battery and the RBANS than patients with bipolar disorder.
These data suggest that the RBANS is a useful screening instrument for assessing the severity of cognitive impairment in psychiatric populations.
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ABSTRACT: Illicit drug use may influence cognition in non-affective psychosis. Previous studies have shown better cognition in psychosis with illicit drug use as compared to psychosis only. Possibly, illicit drug using patients have more transient drug-related cognitive deficits. Thus, the aim of the present study was to examine cognitive change the first weeks after admission to a psychiatric emergency ward, expecting more cognitive improvement at follow-up in the illicit drug group as compared to psychosis only. Patients with acute non-affective psychosis with (26%) and without illicit drug use were examined at baseline (n=123) and follow-up (n=67), with alternative forms of the Repeatable Battery for the Assessment of Neuropsychological Status. Latent Growth Curve models, controlling for cognition at baseline and age differences between the groups, were used to analyze cognitive change. The illicit drug using patients showed the largest improvement in cognition, especially among the youngest patients. Younger patients with non-affective psychosis and illicit drug use showed more cognitive improvement the first weeks after acute psychosis as compared to psychosis only. This suggests that the illicit drug users constitute a sub-group with less stable cognitive deficits and less cognitive vulnerability.Psychiatry Research 09/2014; · 2.68 Impact Factor
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ABSTRACT: Background Many individuals with schizophrenia experience a profound deficit in global cognitive ability, which is related to poor functional outcomes. Historically, the standard of assessing neurocognitive impairments is one of extensive neuropsychological batteries that are labour-intensive. The present study examined whether a brief neurocognitive assessment (BNA) instrument could effectively estimate global neurocognition and further examined its clinical utility. Methods The validity and clinical utility of a BNA that takes approximately 10 minutes to administer was examined against a full neuropsychological battery that takes approximately 90 minutes to administer in a large and heterogeneous sample of 1303 patients with schizophrenia. Results The BNA explained 76% of the variance in global neurocognition in the total sample and remained consistent in subsamples stratified by clinical characteristics (e.g., severity of psychopathology) and in randomized re-sampling simulations. The two items that comprised the BNA were the letter-number sequencing test, a measure of working memory, and the digit-symbol test, a measure of processing speed. Next, perhaps more importantly, the BNA and full neuropsychological battery were related to symptoms and functional status to a similar degree in both univariate and multivariate regression models; moreover, both instruments were sensitive to longitudinal treatment related change to a similar degree. Conclusions The BNA is able to rapidly, easily, and validly assess global neurocognition in schizophrenia. The BNA was associated with important clinical outcomes to similar degree as a full cognitive battery. This tool provides clinicians and researchers a means to assess global neurocognitive impairments without requiring extensive neuropsychological testing.Journal of Psychiatric Research 05/2014; · 4.09 Impact Factor
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ABSTRACT: Cognitive dysfunction is increasingly recognized as a symptom in mental conditions including schizophrenia, major depressive disorder (MDD), and bipolar disorder (BPD). Despite the many available cognitive assessment instruments, consensus is lacking on their appropriate use in clinical trials. We conducted a systematic literature review in Embase, PubMed/Medline and PsychINFO to identify appropriate cognitive function instruments for use in clinical trials of schizophrenia, MDD, and BPD. Instruments were identified from the articles. Instruments and articles were excluded if they did not address schizophrenia, MDD, or BPD. Instrument appropriateness was further assessed by the criteria of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative: test-retest reliability, utility, relationship to functional status, potential changeability to pharmacological agents, and tolerability and practicality for clinical trials. The database search yielded 173 articles describing 150 instruments used to assess cognitive function. Seventeen additional instruments were identified through Google and clinicaltrials.gov. Among all these, only 30 (18%) were deemed appropriate for use in the diseases of interest. Of these, 27 were studied in schizophrenia, one in MDD and two in BPD. These findings suggest the need for careful selection of appropriate cognitive assessment instruments, as not all may be valid in these disorders.Psychiatry research. 03/2014;