Practical and Diagnostic Challenges for the Neuropsychologist

Mapping Intimacies ◽

10.1093/med/9780190265045.003.0009 ◽

2017 ◽

Author(s):

Kim Willment ◽

David Loring

Keyword(s):

Decision Making ◽

Psychological Distress ◽

Neuropsychological Evaluation ◽

Performance Validity ◽

Cognitive Profiles ◽

Therapeutic Goals ◽

Psychogenic Nonepileptic Seizures ◽

Clinical Environments ◽

Nonepileptic Seizures ◽

Neuropsychological Findings

The objective of this chapter is to outline practical and diagnostic challenges in the clinical neuropsychological evaluation of patients with psychogenic nonepileptic seizures (PNES) and to aid neuropsychologists in developing a consistent decision-making protocol. Challenges outlined include responding to performance validity test (PVT) failures, testing in different clinical environments, medications effects, acute psychological distress, and length of evaluations. Diagnostic challenges related to the neuropsychological evaluation in PNES, including the lack of specificity of cognitive profiles and psychopathological heterogeneity, are discussed. The final focus of the chapter is therapeutic goals of the neuropsychological evaluation, particularly the integration of the neuropsychological findings during the delivery of the PNES diagnosis and promoting cognitive self-efficacy.

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Mechanisms of Possible Neurocognitive Dysfunction

10.1093/med/9780190265045.003.0005 ◽

2017 ◽

Author(s):

Daniel L. Drane ◽

Dona E. C. Locke

Keyword(s):

Neuropsychological Testing ◽

Psychological Theory ◽

Future Research ◽

Performance Validity ◽

Post Traumatic Stress ◽

Neurocognitive Dysfunction ◽

Psychogenic Nonepileptic Seizures ◽

Nonepileptic Seizures ◽

Performance Validity Measures ◽

Validity Tests

This chapter covers what is known about the possible mechanisms of neurocognitive dysfunction in patients with psychogenic nonepileptic seizures (PNES). It begins with a review of all research examining possible cognitive deficits in this population. Cognitive research in PNES is often obscured by noise created by a host of comorbid conditions (e.g., depression, post-traumatic stress disorder, chronic pain) and associated issues (e.g., effects of medications and psychological processes that can compromise attention or broader cognition). More recent studies employing performance validity tests raise the possibility that studies finding broad cognitive problems in PNES may be highlighting a more transient phenomenon secondary to these comorbid or secondary factors. Such dysfunction would likely improve with successful management of PNES symptomatology, yet the effects of even transient variability likely compromises daily function until these issues are resolved. Future research must combine the use of neuropsychological testing, performance validity measures, psychological theory, neuroimaging analysis, and a thorough understanding of brain–behavior relationships to address whether there is a focal neuropathological syndrome associated with PNES.

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RBANS Validity Measures and the TOMM in Veterans Undergoing Seizure Monitoring

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa079 ◽

2020 ◽

Author(s):

Laurence Binder ◽

Martin C Salinsky ◽

Daniel Storzbach ◽

Sandy K Tadrous-Furnanz

Keyword(s):

Positive Likelihood Ratio ◽

Epileptic Seizures ◽

Cutoff Score ◽

Performance Validity ◽

Test Of Memory Malingering ◽

Psychogenic Nonepileptic Seizures ◽

Neuropsychological Status ◽

Embedded Measures ◽

Validity Measures ◽

Nonepileptic Seizures

Abstract Objective To assess the validity of embedded measures of performance validity, the effort index (EI) and effort scale (ES) of the repeatable battery for the assessment of neuropsychological status (RBANS), in Veterans with seizures; to compare the frequency of failure on the test of memory malingering (TOMM) in patients with epileptic versus psychogenic nonepileptic seizures (PNES). Methods Seizure diagnosis was established for 309 participants in epilepsy monitoring units using conventional diagnostic criteria who completed both the TOMM and RBANS. The criterion for performance invalidity was failure on any trial of the TOMM. We examined multiple EI and ES cutoffs to establish optimal sensitivity and specificity. Results An RBANS EI cutoff score of greater than three was optimal with specificity of .98, sensitivity of.19, and positive Likelihood Ratio of 10 but was not useful when below this cutoff. Confidence intervals indicate the need for confirmation of a failed EI with another performance validity test (PVT). No ES cutoff had sufficient specificity for clinical use. Invalid TOMM performance but not invalid RBANS performance was significantly more common in persons with PNES than in persons with epileptic seizures. Conclusions In Veterans undergoing seizure monitoring, the RBANS EI was useful as a screen when positive that requires confirmation with another PVT. The RBANS ES was not useful. Invalid performance on the TOMM was more common in persons with PNES than in persons with epileptic seizures.

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