Cognitive Symptom Trajectories among Forensic Inpatients

Diagnosed with Psychotic Disorders

Jennifer Hatch1, Nicolasa Villalobos1, Danielle Burchett, Ph.D.1, & David M. Glassmire, Ph.D. 2
1Department of Psychology, California State University, Monterey Bay; 2Patton State Hospital

Introduction Table 1. Variable Response Inconsistency (VRIN-r) and Cognitive Complaints (COG) Scores for
• Most patients in forensic inpatient settings are diagnosed with psychotic
Younger, Middle, and Older Patients with Psychotic Disorder Diagnoses
disorders; it is imperative clinicians and researchers understand their
symptoms Younger Middle Older
• Psychotic disorders consist of a complex variety of symptoms
categorized as positive, negative, and cognitive1 n M SD n M SD n M SD F g1 g2 g3
• Although much research has been done in regards to cognitive
symptoms, two conflicting models of the trajectory of cognitive
Variable Response
Inconsistency (VRIN-r) 351 59.72 16.21 444 58.17 14.28 190 55.34 13.98 5.29* 0.10 0.20 0.28*
symptoms remain:
Developmental Degenerative Cognitive Complaints
(COG) 208 51.14 11.60 288 49.65 9.91 136 50.57 10.33 1.24 0.14 -0.09 0.05
Over time patients have Over time patients have
reduced cognitive problems2,3 increased cognitive problems4,5 Note. g1 = younger versus middle age; g2 = middle versus older age; g3 = younger versus older age. For Cognitive Complaints (COG) analyses, invalid protocols
(CNS ≥ 18; VRIN-r ≥ 80; TRIN-r ≥ 80; F-r ≥ 120; Fp-r ≥ 100; RBS ≥ 80) were excluded. *p < .05. Bolded Hedges’ g values are practically significant with a small
effect.
Hypotheses
Results & Discussion
This study sought to add to the literature in this area and determine which
trajectory model is more accurate. Based on neuroimaging and For VRIN-r the significant findings we observed occurred in the opposite This study had many strengths:
neuropsychological testing research, we anticipated: direction of our hypotheses: • Studying patients with a range of psychotic disorders
• Younger Adults would show cognitive impairment • Older adults may have significantly less cognitive problems than Young • Large overall sample & subsample sizes
• Middle Aged Adults would show stability in cognitive impairment levels adults • Uncontaminated dataset from a forensic inpatient sample
• Older Adults would show moderately more impairment than younger • Older adults may have significantly less cognitive problems than Middle
and middle adults adults This study also had some notable limitations:
• There were no significant differences between Young and Middle adults. • Unequal group sizes with a smaller older adult group
Method However, for COG analyses, we found no significant differences between • Inability to control for confounds such as medication, education, and
age groups. onset of symptoms due to variable unavailability
Participants • Relies on an indirect measure of cognitive impairment as well as a self-
Conclusions & Implications: reported measure of cognitive impairment
• Our sample consisted of 985 forensic inpatients, at least 18 years of age, • Because VRIN-r is associated with cognitive problems, Young and Middle
holding psychotic disorder diagnoses adults may be experiencing more cognitive problems than Older adults Future researchers should:
• Mean age = 40 years (SD = 11.16) and clinicians should consider neuropsychological testing for these age • Consider a longitudinal research design among patients living with
• Based on recent neuropsychological research, we divided patients into groups8 psychotic disorders
the following age groups: Young Adult (18-34 years), Middle Adult (35-49 • Because there were no significant differences on the COG scale, VRIN-r • Utilize direct measures of cognitive impairment as well as clinician
years), and Older Adult (≥ 50 years)5,6 differences could be due to other factors such as differences in reading ratings
abilities or cooperativeness. • Study cognitive symptoms in patients with different severe mental
Measures • However, one of the common issues for patients with psychotic disorders illnesses and in comparison to a non-clinical normative sample
is a lack of insight into their symptoms, which may limit the effectiveness • Control for factors such as medication, education, and onset of psychotic
MMPI-2-RF (Ben-Porath & Tellegen, 2008/2011): A 338-item True/False of the self-report COG scale results symptoms, and patient insight into symptomatology
statement measure that is a shortened version of the MMPI-27. Two MMPI-
2-RF scales were used in this study:
• Variable Response Inconsistency (VRIN-r) Scale: An indirect measure of
cognitive problems; traditionally utilized as a Validity Scale
• Cognitive Complaints (COG) Scale: A scale that assesses self-reported
References & Acknowledgements
memory, attention, and concentration problems 1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC.:
American Psychiatric Association.
2Kurtz, M. M. (2005). Neurocognitive impairment across the lifespan in schizophrenia: an update. Schizophrenia research, 74(1), This research was made possible by support from a grant from the
Procedures 15-26. University of Minnesota Press, Test Division in supporting data
3Heaton, R. K., Gladsjo, J. A., Palmer, B. W., Kuck, J., Marcotte, T. D., & Jeste, D.V. (2001). Stability and course of collection, California State University, Monterey Bay
• ANOVAs and Hedges’ g values were examined to compare mean scores neuropsychological deficits in schizophrenia. Archives of General Psychiatry, 58(1), 24–32. Undergraduate Research Opportunity Center (UROC) for additional
⁴Irani, F., Kalkstein, S., Moberg, E. A., & Moberg, P. J. (2011). Neuropsychological performance in older patients with financial, logistical, and mentorship support. This research was
between Young, Middle, and Older Adult age groups and our measures
schizophrenia: A meta-analysis of cross-sectional and longitudinal studies. Schizophrenia Bulletin, 37, 1318–1326. approved by the CA Department of Mental Health Committee for
of cognitive dysfunction the Protection of Human Subjects. The statements and opinions
⁵Herold, C. J., Schmid, L. A., Lässer, M. M., Seidl, U., & Schröder, J. (2017). Cognitive performance in patients with chronic
• For VRIN-r analyses, we excluded patients without Thought Dysfunction schizophrenia across the lifespan. The Journal of Gerontopsychology and Geriatric Psychiatry, 30(1), 35-44. expressed are those of the authors and do not constitute the
(Psychotic Disorder) diagnoses (included n = 985) ⁶Fucetola, R., Seidman, L. J., Kremen, W. S., Faraone, S. V., Goldstein, J. M., & Tsuang, M. T. (2000). Age and neuropsychologic official views or the official policy of DSH-Patton, The California
Department of State Hospitals, or the State of California. The
• For COG analyses we excluded patients with invalid protocols due to function in schizophrenia: A decline in executive abilities beyond that observed in healthy volunteers. Biological Psychology, 48,
137–146. authors thank Harry Oreol for his support of the research program
random responding, fixed responding, or overreporting (CNS ≥ 18; VRIN-r at Patton State Hospital.
⁷Ben-Porath, Y. S. & Tellegen, A. (2008/2011). MMPI-2-RF Manual for Administration, Scoring, and Interpretation. Minneapolis:
≥ 80; TRIN-r ≥ 80; F-r ≥ 120; Fp-r ≥ 100; RBS ≥ 80) (included n = 632) University of Minnesota Press. photo credit: J.L. Matthews

⁸Ben-Porath, Y.S. (2012). Interpreting the MMPI-2-RF. Minneapolis: University of Minnesota Press.