The Cognitive Difficulties Scale (CDS): Psychometric Characteristics in a Clinical Referral Sample

Objective: To evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS), a 39-item Likert-type self-report instrument that requires a fifth grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline in older persons. Method: Participants were 512 consecutive outpatient referrals (71% women, mean age 60.6, and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was followed by a varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria including demographics, Cronbach’s alpha, Digit Span, and Wechsler Memory Scale-IV Logical Memory (LM) and Visual Reproduction (VR), and Minnesota Multiphasic Personality Inventory (MMPI)-2 measures of depression, anxiety, somatic preoccupations, and thought disturbance. Results: Six dimensions of cognitive complaint emerged accounting for 64% of the variance: attention/concentration, praxis, prospective memory, speech problems, memory for people’s names, and temporal orientation. The factors showed good internal consistency (alphas > .850). Correlations with Digit Span, LM, and VR were all nonsignificant. CDS scores were associated with MMPI-2 measures of anxiety, depression, somatic preoccupation, and thought disturbance. Percentiles and T-scores were derived for raw scores on the CDS and its six component subscales. Conclusion: The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has clinical utility and is a potentially useful tool in research involving age-related cognitive changes and meta-cognition.

Mental Health Problems Among Male Offenders and Youths with Conduct Problems

BackgroundMental health problems among youth, are frequent especially in offenders and as such is very important to identify as early as possible.ObjectivesTo estimate and compare level of some mental health problems between three groups of male youths: juvenile offenders in correctional center, adolescents with conduct problems and university students.MethodIt is cross-sectional quantitative study. The sample consisted of three male groups: 41offenders placed in one correctional center (Mean age = 18.02; SD = 2.20); 41 male students of secondary school with conduct problems (Mean age = 16.97; SD = 61) and 42 male university students randomly selected (Mean age = 19.7; SD = 1.77). They filled questionnaire MAYSI–2. Data processing was done with SPSS 21.0 and Microsoft Excel 2013.ResultsJuvenile offenders in correctional center scored significantly higher than other two groups of youth in alcohol/substance abuse subscale (P = 001), Suicidal ideation subscale (P = 048) and traumatic stress subscale (P = 003) based on Kruskal-Wallis Test. Juvenile offenders in correctional center scored higher but non-significantly in angry/irritable and depression/anxious subscales. Students of secondary school with conduct problems scored higher but non-significantly in thought disturbance and somatic subscales.ConclusionMale juvenile offenders have significantly more mental health difficulties. Mental health needs of youths in Kosovo (especially juvenile offenders) seem to be numerous and is important to be addressed properly.

Relationship of behavioural and symptomatic syndromes in schizophrenia to spatial working memory and attentional set-shifting ability

Background. Behavioural syndromes (thought disturbance, social withdrawal, depressed behaviour and antisocial behaviour) offer a different perspective from that of symptomatic syndromes on the disability that may be associated with schizophrenia. Few studies have assessed their relationship with neuropsychological deficits. We hypothesized that these syndromes may represent behavioural manifestations of frontal-subcortical impairments, previously described in schizophrenia.Method. Long-stay inpatients (n=54) and community patients (n=43) with enduring schizophrenia were assessed, using measures of symptoms and behaviour and tests of executive functioning. The relationship between syndromes and neuropsychological function was assessed using multiple regression and logistic regression analyses.Results. Significant associations were found between performance on the spatial working memory task and the psychomotor poverty symptomatic syndrome, and between attentional set-shifting ability and both disorganization symptoms and the thought disturbance behavioural syndrome. These results were not explained by the effect of premorbid IQ, geographical location, length of illness or antipsychotic medication. Length of illness was an independent predictor of attentional set-shifting ability but not of working memory performance.Conclusion. The specific relationship between negative symptoms and spatial working memory is consistent with involvement of the dorsolateral prefrontal cortex. The associations between difficulty with set-shifting ability and both disorganization symptoms and behaviours may reflect inability to generalize a rule that had been learned and impaired ability to respond flexibly. The specific relationship of illness duration to set-shifting ability may suggest progressive impairment on some executive tasks. The nature of these relationships and their neurobiological and rehabilitation implications are considered.

Hallucinogenic drug induced states resemble acute endogenous psychoses: results of an empirical study

SummaryClinical evidence suggests that hallucinogenic drug-induced altered states of consciousness (ASCs) and the incipient, acute stages of endogenous psychoses share many common phenomenological features. The aim of our study was to assess hallucinogen-like phenomena in endogenous psychotic patients using standardised methods. We examined 93 endogenous psychotic patients, 50 healthy controls and a small group of drug induced psychotic patients (n = 7) with two ASC self-assessment scales (questionnaire APZ = Abnormer Psychischer Zustand = Altered State of Consciousness [Dittrich et al, 1985]; and questionnaire OAV = Abbreviation of the three subscales: Oceanic Boundlessness/Angst = Dread of Ego Dissolution/Visionary Restructuralisation [Bodmer 1989]). Patients were examined shortly after remission of their last acute psychotic episode and they answered the questionnaires referring to the early phase of this episode. Differences in the questionnaire scores were significant between psychotic patients and controls. Drug induced patients had numerically higher scores than endogenous psychotic patients, however these differences were only significant for the APZ total score and the undifferentiated items of the APZ, but not for the three APZ subscale and the OAV scores. More than 50% of the endogenous psychotic patients answered 26% of the APZ-and 43% of the OAV-items with “yes”. The OAV total score and the OSE (Ozeanische Selbstentgrenzung = oceanic boundlessness) scores of both questionnaires correlated significantly with BPRS Factor 3 (thought disturbance). Our results support the hypothesis that hallucinogen-like experiences represent common phenomena during the acute stages of endogenous psychoses. Remarkably, these phenomena include subjectively pleasant experiences of the OSE dimension. In the routine clinical assessment of endogenous psychotic patients experiences of this dimension may be more easily overlooked than the negative experiences of the AIA dimension (AIA: Angst vor der Ich-Auflösung = dread of ego dissolution).

Psychotic Patients' Awareness of Mental Illness: Implications for Legal Defense Proceedings

This study examined the relationship between psychotic patients' insight into their mental illness and current symptoms, competency to stand trial, and willingness to use the insanity defense. Inpatients with psychotic disorders were grouped by whether they exhibited insight into their mental status (n=18) or denied being mentally ill (n=13). The majority of all patients, regardless of insight status, failed at least one item on a 16-item competency exam. However, the majority of insightful subjects (77%) were willing to consider using the insanity defense, while only a minority (31%) of the non-insightful subjects were willing to consider such a defense. Using the Brief Psychiatric Rating Scale (BPRS), univariate analyses indicated that the insightful subjects manifested significantly more Anxiety-Depression and less Thought Disturbance than the non-insightful subjects. Although there was no relationship between insight and performance on the competency exam, there were significant inverse correlations between competency scores and ratings on the BPRS symptom factors.