Detect i on of Bra i n Damage in Psych i at r i c Popu l at i. Anton i o E. Puente. Depar tment of Psycho l ogy

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1 Detect i on of Bra i n Damage in Psych i at r i c Popu l at i Anton i o E. Puente Depar tment of Psycho l ogy Un i vers i ty of Nor th Caro l i na - W i l m i ngton W i l m i ng t on, Nor th Caro l i na Cul l en H i cks Un i vers i ty of Nor th F l or i da Presented at the second annual meet i ng of the Nat i ona l Academy of Neuropsycho l og i sts in A t l an t a, Georg i a on October 30, 1982

2 The ro l e of the c l i n i ca l neuropsycho l og i st has t rad i t i ona l l y been l i m i ted to the detect i on of brain damage in non -psych i at r i c or neuro l og i ca l - l y i mpa i red popu l at i ons. Th i s study exam i ned the re l at i ve ef f ect i veness of common l y used tests in i n-pat i ent menta l hea l th fac i l i t i es in detect i ng bra i n damage and d i f ferent i at i ng between spec i f i c subpopu l at i ons a l ong th i s parameter. For ty- f i ve i n-pat i ents f rom two state hosp i ta l s vo l un teered. Three groups of 15 pat i ents each (sch i zophren i c w i th bra i n - damage, sch i zophren i c w i thout bra i n - damage, and af fect i ve d i sorders w i th bra i n -damage) were ad - m i n i stered the Lur i a- Nebraska Neuropsycho l og i ca l Ba t t ery, Form A of the Wh i taker Index of Sch i zophren i c Th i nk i ng, and Par t A of the Trai l Mak i ng Tes t. D i agnos i s of sch i zophren i a and af fect i ve d i sorder was ascer ta i ned by a c l i n i ca l psycho l og i st and psych i at r i st us i ng DSM. r i l cr i ter i a. Conf i rmed neuro l og i ca l d i agnos i s was made us i ng med i ca l exam i nat i ons by phys i c i ans and / or tests such as CAT Scans or EEGs. Al l par t i c i pants in the bra i n-damaged group exh i b i ted ma l adapt i ve behav i or af ter i ncur r i ng damage. Resu l ts i nd i cated that the Lur i a- Nebraska was more ef fect i ve than the Wh i taker ' i n detect i ng bra i n damage. The Tra i l Mak i ng Test did not re l i ab l y detect damage. Regard i ng d i f ferent i at i on between g roups, af fect i ve d i sorders exh i b i ted less i mpa i rment than non-damaged sch i zophren i cs who exh i b i ted l ess def i c i ts than damaged sch i zophren i cs on the Lur i a- Nebrasks and the Wh i t aker. In order of greatest d i f ferent i a l group e f f ec t s, the fo l l ow i ng sca l es of the Lur i a- Nebraska suppor ted th i s grad i ent de f i c i t ; Mo t o r, Pathognomon i c, Rhy thm, Ar i t hme t i c, Wr i t i ng, V i sua l, Lef t Hem i sphere, and Recept i ve Speech. S i m i l ar d i f ferences were a l so observed for the S i m i l ar i t i es sub t es t, the t i me f ac t or, and the Index of the Wh i taker to a l esser ex t en t. The re l at i ve usefu l ness of these i nst ruments for the psycho l og i st p r ac - t i c i ng in psych i at r i c f ac i l i t i es are e l uc i dated.

3 Detection of B r a i n Damage in Psychiatric Populationa Antonio E. Puente University of N o r t h Carolina - \'?ilraington Wilmingtonf North Carolina Cullen Hicks University of N o r t h Florida The role of t h ec l i n i c a l neuropsychologist has t r a d i t i o n a l l y been limited tot h ed e t e c t i o n o f b r a i n damage i nn o n - p s y c h i a t r i c o r neurologically impaired populations. This study examined ther e l a t i v e effectiveness of commonly used tests ini n p a t i e n t mental health facilities in d e t e c t i n g brain damage and d i f f e r e n t i a t i n g between specific subpopulations along this parameter. Forty-five inpatients from a state hospital^volunteered. Three groups o f 15 p a t i e n t s each (schizophrenic w i t h brain-damage, schizophrenic without brain-damage, and a f f e c t i v e disorders with brain-damage) were administered the Luria-Nebraska Neuropsychological Battery, Form A o f t h e Whitaker Index o f Schizophrenic Thinking, and P a r t A o ft h et r a i l Making Test. Diagnosis o f schizophrenia and a f f e c t i v e disorder was ascertained by a c l i n i c a l psychologist and p s y c h i a t r i s t using DSM I I I c r i t e r i a. Confirmed neurological diagnosis was made using medical examinations by p h y s i c i a n s and/or tests such as CAT Scans or EEGs. A l l p a r t i c i p a n t s i nt h e brain-damaged group exhibited maladaptive behavior after incurring damage. Results indicated that the Luria-Nebraska was more effective thant h e Whitaker in detecting brain damage. The T r a i l Making Test did n o t r e l i a b l y detect damage. Regarding d i f f e r e n t i a t i o n between groups, affective disorders exhibited less impairment than non-damaged schizophrenics who exhibited less deficits than damaged schizophrenics on t h el u r i a - N e b r a s k a and t h e Whitaker.

4 PURPOSE 1) EXAMINATION OF THE RELATIVE EFFECTIVENESS OF COMMONLY USED PSYCHOMETRIC TESTS IN INPATIENT MENTAL HEALTH FACILITIES IN DETECTING BRAIN DAMAGE 2) EXAMINATION OF A HYPOTHESIZED GRADIENT DEFICIT ACROSS THESE POPULATIONS (E.G.. BRAIN DAMAGED INDIVIDUALS EXHIBIT MORE DEFICITS ON THESE TESTS THAN S WITHOUT BRAIN DAMAGE WHICH. IN TURN. EXHIBIT MORE DEFICITS THAN AFFECTIVED DISORDERS)

5 ART!CI P A N T S GENERAL CRITERIA; (1) INPATIENT FROM NORTHEAST FLORIDA STATE HOSPITAL OR CHERRY HOSPITAL VOLUNTEER (2) RIGHT-HANDED (3) MALE (4) SIXTH GRADE EDUCATION MINIMUM VARIABLE DAI^^IAGED NON-DAMAGED AFFECTIVE DISOORDERS AGE YEAR OF ONSET # HOSPITALIZATIONS l.z LENGTH OF CURRENT HOSPITALIZATION Z 5Z.5 ( I N DAYS )

6 LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY SCALE DAMAGED NON-DAMAGED AFFECTIVE DISORDERS MOTOR, RHYTHM TACTILE 13.5: VISUAL RECEPTIVE SPEECH EXPRESSIVE SPEECH WRITING READING ARITHMETIC* 1Z MEMORY INTELLECTUAL PATHOGNOMONIC LEFT HEMISPHERE RIGHT HEMISPHERE

7 WHITAKER INDEX. TRAIL MAKING. & DIMASCIO SCALE INSTRUMENT DAMAGED NON-DAMAGED AFFECTIVE DISORDERS WIST SIMILARITIES WIST WORD PAIRS WIST NEW INVENTIONS WIST TIME, WIST INDEX TRAIL MAKING PART A 125.2'' 90.3" 67.5" DIMASCIO SCALE,

8 USIONS 1) THE LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY WAS MORE EFFECTIVE THAN THE WHITAKER INDEX OF THINKING IN DETECTING BRAIN DAMAGE: THE TRAIL MAKING TEST DID NOT DIFFERENTIATE BETWEEN GROUPS: DIMASCIO SCALE WAS USEFUL IN DETECTION OF BRAIN DAMAGED INPATIENTS 2) AFFECTIVE DISORDERS EXHIBITED LESS IMPAIRMENT'THAN NON-DAMAGED S WHO.EXHIBITED LESS DEFICITS THAN BRAIN-DAMAGED S: ORIGINAL GRADIENT HYPOTHESIS WAS SUPPORTED AS MEASURED BY THE.LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY. THE WHITAKER INDEX OF THINKING. AND. TO A LESSER EXTENT. THE DIMASCIO SCALE

A L A BA M A L A W R E V IE W

A L A BA M A L A W R E V IE W Volume 52 Fall 2000 Number 1 B E F O R E D I S A B I L I T Y C I V I L R I G HT S : C I V I L W A R P E N S I O N S A N D TH E P O L I T I C S O F D I S A B I L I T Y I N