Neurobehavioral approach to classification of psychiatric patients using a competency model.

Abstract

Recent studies of hemisphere functioning among psychiatric patients have revealed an increasing level of impairment from depression to mania to schizophrenia, although clinical observation suggest that degree and type of impairment are substantially independent of psychiatric status. To test these hypotheses, £>-type factor analyses were performed on 25 neuropsychological variables for three samples of right-handed, adult psychiatric patients: an initial sample of 218 subjects; a within-laboratory replication sample of 175 subjects; and a crosslaboratory, cross-national replication sample of 102 subjects. The factor analysis classified 71% of the subjects into six groups with very strong within-and acrosslaboratory replications. Each group had a unique profile of competencies and . deficits that was independent of psychiatric status with the exception of one group comprised primarily of young, poorly educated males with histories of learning disability and drug abuse. It is argued that the development of a classification system with associated treatment interventions based on a patient's profile of competencies and deficits would optimize treatment outcome.Recent studies of hemisphere functioning among psychiatric patients have revealed significant differences in the type and degree of cerebral impairment as a function of diagnosis. Level of impairment has been found to increase from depression to mania to schizophrenia, with schizophrenics showing the greatest degree of generalized impairment (Flor-Henry, 1983;Flor-Henry, Fromm-Auch, & Schopflocher, 1983). In addition, specific types of psychopathology have been associated with specific areas of brain impairment. Tucker (1981) reviewed these data and suggested that schizophrenia is associated with left cerebral hemisphere dysfunction, whereas affective disorders are associated with right cerebral hemisphere dysfunction. The most The authors wish to thank D. Jones and S. Salisbury of Barrow Hospital for their valuable assistance in data collection, John Ernst for his help in data analysis, and Molly Warner for help in proofreading. Appreciation is expressed to Don Tucker for his scholarly advice in the preparation of the manuscript.

Neuropsychiatry: Interfaces between neuropsychology and psychopathology

“…Perhaps the most extensive documentation of this view comes from the study of Townes et al (1985) which identified six subgroups on the basis of Q-type factor analysis of a modified Halstead-Reitan battery, and reported that in five of the subgroups there was no relationship with psychiatric status. In support of comments made above, they state "...support is found for the hypothesis that patients with acute schizophrenic and affective psychoses vary across the entire continuum from no cognitive impairments to profound cognitive impairments.…”

“…Recently, Downloaded by [FU Berlin] at 12:18 06 July 2015 Goldstein and Shelly (1987) have attempted to apply cluster analysis in an attempt to define neuropsychologically based subtypes in a heterogeneous neuropsychiatric patient sample, using the Halstead-Reitan and Luria--Nebraska batteries, as well as the WAIS. Townes et al (1985) also applied an empirical, statistical classification system to categorize a large, international sample of neuropsychiatric patients.…”

Schizophrenia and the brain: Conditions for a neuropsychology of madness.

“…On the other hand, there is evidence that specific cognitive deficits, such as distractibility, are stable in schizophrenia (Harvey, Docherty, Serper, & Rasmussen, 1990). Moreover, psychiatric patients in different settings, and in different countries, evince similar neurocognitive performance patterns (Townes et al, 1985). Besides, fluctuations in effort, motivation, and genera] proficiency may occur in traditional neurological samples.…”

Neuropsychological assessment and the rehabilitation of persons with severe psychiatric disabilities.

“…Fewer think to call upon neuropsychologists to map patients' cognitive strengths and weaknesses and relate them to the challenges of daily living. Clinical applications of those approaches to persons with severe psychiatric disability appear to be most recent (Diamant, 1981(Diamant, , 1985Diamant & Huijsman, 1982;Erickson & Binder, 1986;Spaulding, Storms, Goodrich, & Sullivan, 1986;Townes et al, 1985;Yozawitz, 1986).…”