Recently published practice standards recommend that multiple effort indicators be interspersed throughout neuropsychological evaluations to assess for response bias, which is most efficiently accomplished through use of effort indicators from standard cognitive tests already included in test batteries. The present study examined the utility of a timed recognition trial added to standard administration of the WAIS-III Digit Symbol subtest in a large sample of "real world" noncredible patients (n=82) as compared with credible neuropsychology clinic patients (n=89). Scores from the recognition trial were more sensitive in identifying poor effort than were standard Digit Symbol scores, and use of an equation incorporating Digit Symbol Age-Corrected Scaled Scores plus accuracy and time scores from the recognition trial was associated with nearly 80% sensitivity at 88.7% specificity. Thus, inclusion of a brief recognition trial to Digit Symbol administration has the potential to provide accurate assessment of response bias.
The influence of the quality of care that patients receive during the course of their illness has been the subject of special scrutiny in the area of mental health. The concept of "expressed emotion" (EE) evolved in an effort to understand the impact of family and social environment on the vulnerability to relapse of schizophrenic patients. A semistructured interview, the Camberwell Family Interview, was developed to assess expressed emotion. This article examines the historical context, generalizability, methodological strengths and limitations of the construct of EE and the Camberwell Family Interview, as well as the nature and effects of treatment intervention programs designed to neutralize adverse effects of patient caretaker attitudes.The quality of the care to which patients are exposed has long been recognized in medicine as a factor that influences the course of their illness. Brown and his colleagues (Brown, Carstairs, 8z Topping, 1958) coined the term "expressed emotion" in an effort to measure the impact of family and social life on the vulnerability to relapse of schizophrenic patients. The concept that family interactions or communication patterns influence the development of psychopathology or the recurrence of psychiatric disorders, in particular, schizophrenia, is not new. Early psychoanalytic theory emphasized disturbances in the mother-child relationship and the role of the "schizophrenogenic" mother in the pathogenesis of the schizophrenic process (Fromm-Reichmann, 1948). Later studies (Bateson, 1973;Sullivan, 1974;Wynne, Singer, & Barko, 1977) focused on the impact of disruptions in familial communication on the onset of schizophrenia.
A comparison of psychiatric admissions (1978-1980), from two Irish representative rural and urban communities, indicated no significant intercommunity difference in incidence rates for alcoholism and schizophrenia but significantly higher urban first admissions for neuroses. Total admissions data indicated significantly higher urban readmission rates for alcoholism and neuroses. In contrast to earlier research, readmission rates for schizophrenia were equivalent in the rural and urban community. Several methodological issues were examined to clarify this divergent finding. A demographic comparison indicated rural schizophrenics were admitted at a later age and were more frequently readmitted. The implications of these findings and directions for future research on hospital utilization were discussed.
The role of community factors in psychiatric hospital utilization in rural and urban Ireland was evaluated using Hollingshead & Redlich's conceptual model. Rural and urban differences in identification of psychiatric disorders, attitude to psychiatric facilities and social isolation were assessed using a community survey (N = 200). No difference was found in the recognition of schizophrenic behavior. Rural residents tended to normalize neurotic behavior and significantly fewer recognized it as deviant. The two communities did not differ in the identification of alcoholism or neuroses as mental illness. Rural individuals had a more negative attitude to psychiatric facilities, and sought help more frequently from relatives who were less accessible than their urban counterparts.
Rural Ireland has been characterised by various studies as having high rural rates of schizophrenia. This paper tested the hypothesis that these anomalously high rates resulted from overutilisation of psychiatric hospitals, reflecting community differences in risk for readmission. A comparison of first and total admission (1978-1981), in two broadly matched rural counties showed no significant difference in treated incidence but significant differences in treated prevalence. A demographic comparison of admittants indicated higher risk for readmission for individuals who were older and had previous hospitalisations. The implications for these findings for rural psychiatric care delivery are discussed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.