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 28406 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
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.
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 28406 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.
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)
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 46.2 30.2 34.2 YEAR OF ONSET 31.5 21.4 29.3 # HOSPITALIZATIONS l.z 5.0 2.3 LENGTH OF CURRENT HOSPITALIZATION 1163.1 113.Z 5Z.5 ( I N DAYS )
LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY SCALE DAMAGED NON-DAMAGED AFFECTIVE DISORDERS MOTOR, 40.3 13.2 10.3 RHYTHM. 13.0 7.6 5.8 TACTILE 13.5: 8.9 4.0 VISUAL. 23.5 10.0 5.5 RECEPTIVE SPEECH. 18.0 12.4 6.9 EXPRESSIVE SPEECH 26.3 15.2 10.1 WRITING. 12.2 7.2 4.3 READING 9.3 6.5 4.8 ARITHMETIC* 1Z.8 9.0 7.7 MEMORY 18.4 13.3 11.5 INTELLECTUAL 38.5 30.0 25.7 PATHOGNOMONIC. 26.0 15.7 9.4 LEFT HEMISPHERE. 11.8 6.4 3.3 RIGHT HEMISPHERE 14.8 6.3 3.1
WHITAKER INDEX. TRAIL MAKING. & DIMASCIO SCALE INSTRUMENT DAMAGED NON-DAMAGED AFFECTIVE DISORDERS WIST SIMILARITIES. 6.3 7.1 2.5 WIST WORD PAIRS 3.0 3.7 1.3 WIST NEW INVENTIONS 5.4 6.9 3.5 WIST TIME, 14.7 9.7 8.2 WIST INDEX. 29.4 27.4 15.5 TRAIL MAKING PART A 125.2'' 90.3" 67.5" DIMASCIO SCALE, 8.7 5.3 4.1
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