Comprehensive Psychiatry

Contents continued

2010-03-01

Masthead

2010-03-01

Clinical characteristics of depressed outpatients previously overdiagnosed with bipolar disorder

Mark Zimmerman, Camilo J. Ruggero, Iwona Chelminski, Diane Young — 2009-07-10

Abstract: The diagnosis of bipolar disorder in depressed patients requires the ascertainment of prior episodes of mania and hypomania. Several research reports and commentaries have suggested that bipolar disorder is underrecognized and that many patients with nonbipolar major depressive disorder have, in fact, bipolar disorder. In a previous article from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we reported the opposite phenomenon—that bipolar disorder is often overdiagnosed in psychiatric outpatients. An important question that has not been previously examined is whether there is a particular clinical or demographic profile associated with bipolar disorder overdiagnosis among depressed patients. Forty psychiatric outpatients with current major depressive disorder reported having been previously diagnosed with bipolar disorder, which was not confirmed when interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). Psychiatric diagnoses, clinical and demographic variables were compared in these 40 patients and 233 depressed patients who were not diagnosed with bipolar disorder. Patients were interviewed by a highly trained diagnostic rater who administered the SCID for DSM-IV Axis I disorders, the Structured Interview for DSM-IV Personality for DSM-IV Axis II disorders, and the Schedule for Affective Disorders and Schizophrenia for clinical features of depression. The depressed patients who were overdiagnosed with bipolar disorder were diagnosed with a significantly higher number of Axis I disorders and were more likely to be diagnosed with specific phobia, posttraumatic stress disorder, and drug abuse/dependence. The patients overdiagnosed with bipolar disorder were also significantly more likely to be diagnosed with a current personality disorder and were more chronically ill with greater psychosocial impairment. Thus, the results suggest that depressed outpatients who had previously been overdiagnosed with bipolar disorder were more chronically and severely ill than depressed outpatients who had not been overdiagnosed.

Prenatal exposure to tobacco and risk for schizophrenia: a retrospective epidemiological study

Audrey Baguelin-Pinaud, Sylvie Robert, Jean-François Ménard, Florence Thibaut — 2009-05-06

Abstract: Introduction: In animal studies, long-term prenatal nicotinic exposure alters the development of dopaminergic neurons. To determine whether prenatal smoking exposure was associated with schizophrenia, using a retrospective design study, we compared the prevalence of tobacco use during pregnancy in mothers of subjects with and without schizophrenia.Methods: One hundred patients with schizophrenia, 100 nonschizophrenic-matched subjects, and their respective mothers were interviewed. The prevalence of smoking was measured in these individuals as well as in their respective mothers during the pregnancy.Results: Patients with schizophrenia smoked more often compared with controls (73% vs 57%). In contrast, the prevalence of smoking during pregnancy did not differ between the groups of mothers. Indeed, the amount of tobacco used was significantly lower in mothers of patients with schizophrenia vs mothers of nonpsychotic subjects.Conclusion: This study did not show any association between prenatal tobacco exposure and further development of schizophrenia.

Impact of binge eating disorder in the psychopathological profile of obese women

2009-07-10

Abstract: Objective: Our objective was to evaluate the psychopathological profile of obese women with binge eating disorder (BED) using the Symptom Checklist-90 (SCL-90).Methods: Two hundred twelve obese women who seek for weight loss treatment were sequentially selected to participate in the study. Binge eating disorder was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binge eating disorder severity was assessed using Binge Eating Scale. Depressive symptoms were assessed using Beck Depression Inventory. The psychopathological profile was assessed using the SCL-90.Results: Binge eating disorder was diagnosed in 54 patients (26.6%). Obese patients with BED presented significant higher scores in all domains of SCL-90 (P < .05 for all) in comparison with obese patients without BED. A significant relationship was found among Binge Eating Scale, Beck Depression Inventory, and all domains of the SCL-90 (P < .05 for all). After linear regression, obsessivity-compulsivity (P = .03), interpersonal sensitivity (P = .0064), paranoid ideas (P = .03), and psychoticism (P = .01) were independently related to the severity of BED.Conclusion: Obese women with BED presented a more severe psychopathological profile than obese controls. Among all, obsessivity-compulsivity, interpersonal sensitivity, paranoid ideas, and psychoticism seem to be strongly linked to BED severity.

Pathologic gambling and bankruptcy

Jon E. Grant, Liana Schreiber, Brian L. Odlaug, Suck Won Kim — 2009-07-13

Abstract: Background: Although prior studies have examined rates of bankruptcy in pathologic gambling (PG), there are only limited data regarding the clinical correlates of those with PG who declare bankruptcy because of gambling.Method: Five hundred seventeen consecutive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PG (54.7% females; mean age 47.6 years) were grouped into 2 categories: those who had (n = 93; 18.0%) and had not (n = 424; 82.0%) declared bankruptcy secondary to gambling. Groups were compared on clinical characteristics, gambling severity (using the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, Gambling Symptom Assessment Scale; Clinical Global Impression—severity scale, and time and money spent gambling), and psychiatric comorbidity.Results: Gamblers who had declared bankruptcy were more likely to be single (P = .004); have an earlier age of problem gambling onset (P = .032); and have more financial (P < .001), work-related (P = .006), marital (P < .001), and legal (P < .001) problems secondary to their gambling. They also reported higher rates of depressive disorders (P < .001), substance use disorders (P = .005) and were more likely to be daily users of nicotine (P = .022). Money spent gambling did not differ significantly between groups.Conclusion: These preliminary results suggest that bankruptcy in PG may be associated with specific clinical differences. Treatment strategies may want to assess bankruptcy status to develop more effective treatments that take account of these clinical differences.

Is impulsivity a link between childhood abuse and suicide?

M. Dolores Braquehais, Maria A. Oquendo, Enrique Baca-García, Leo Sher — 2009-08-31

Abstract: Childhood abuse and neglect are known to affect psychological states through behavioral, emotional, and cognitive pathways. They increase the risk of having psychiatric diseases in adulthood and have been considered risk factors for suicidal behavior in all diagnostic categories. Early, prolonged, and severe trauma is also known to increase impulsivity, diminishing the capacity of the brain to inhibit negative actions and to control and modulate emotions. Many neurobiological studies hold that childhood maltreatment may lead to a persistent failure of the inhibitory processes ruled mainly by the frontal cortex over a fear-motivated hyperresponsive limbic system. Multiple neurotransmitters and hormones are involved in the stress response, but, to our knowledge, the two major biological consequences of the chronic exposure to trauma are the hypofunction of the serotonergic system and changes in the hypothalamic-pituitary-adrenal axis function. Some of these findings overlap with the neurobiological features of impulsivity and of suicidal behavior. Impulsivity has also been said to be both a consequence of trauma and a risk factor for the development of a pathological response to trauma. Thus, we suggest that impulsivity could be one of the links between childhood trauma and suicidal behavior. Prevention of childhood abuse could significantly reduce suicidal behavior in adolescents and adults, in part, through a decrease in the frequency of impulsive behaviors in the future.

Monoamine oxidase A genotype is associated with gang membership and weapon use

Kevin M. Beaver, Matt DeLisi, Michael G. Vaughn, J.C. Barnes — 2009-05-06

Abstract: Context: A functional polymorphism in the promoter region of the monoamine oxidase A (MAOA) gene has been found to be associated with a broad range of antisocial phenotypes, including physical violence. At the same time, it is well known that gang members represent some of the most serious violent offenders. Even so, no research has ever examined the association between MAOA and gang membership.Objectives: The aim of this study is to examine the association between MAOA and gang membership and between MAOA and weapon use.Design: We examined the effects of MAOA by using a molecular genetic association research design.Setting: A nonclinical sample was used in this study.Participants: Participants were drawn from the National Longitudinal Study of Adolescent Health (1155 females, 1041 males).Main Outcome Measures: The outcome measures of this study are gang membership and weapon use.Results: The low MAOA activity alleles conferred an increased risk of joining a gang and using a weapon in a fight for males but not for females. Moreover, among male gang members, those who used weapons in a fight were more likely to have a low MAOA activity allele when compared with male gang members who do not use weapons in a fight.Conclusions: Male carriers of low MAOA activity alleles are at risk for becoming a gang member and, once a gang member, are at risk for using weapons in a fight.

Perpetrators of homicide with schizophrenia: sociodemographic characteristics and clinical factors in the eastern region of Turkey

2009-04-23

Abstract: In this study, we aimed to describe the social and clinical characteristics and offense details in a sample of people with schizophrenia convicted of homicide in the eastern region of Turkey.This study was performed in Elazig Mental Hospital between November 2004 and May 2007. We included 43 men and 6 women with schizophrenia convicted of homicide who were hospitalized in the forensic psychiatry unit for compulsory treatment. Preset data recording forms were used. The first part of the forms contained questions regarding the age, sex, marital status, residence, educational status, and occupation of the patients. The second part of the forms included questions about some clinical features of patients with schizophrenia: the presence of schizophrenia in any family member, duration of the disease, subtype of schizophrenia, previous contact with mental health services, types of antipsychotics (first and last drug used), and adherence to antipsychotic medication. The third part of the forms dealt with alcohol-substance abuse and features of the victim (sex of the victim and whether the victim was a stranger, partner, or an ex-partner in the family or an acquaintance).The mean ± SD age of our patients was 36.98 ± 10.07 years, and 55.1% of the patients were unmarried. In our sample, 42.9% of the patients were primary school graduates and 75.5% were unemployed. Of the perpetrators, 14.3% never had contact with mental health services. However, 85.7% of patients had previous contact with mental health services. We found that 85.7% of the patients were paranoid subtype and 85.7% were not using their medication regularly and that treatment compliance was considerably low. We found that haloperidol and trifluoperazine were the most preferred antipsychotic drugs, particularly being the first drugs used during treatment (haloperidol, 71.4%; trifluoperazine, 10.2%) and the last antipsychotics used before the offence (haloperidol, 46.9%; trifluoperazine, 20.4%). In 38.8% of cases, schizophrenia was present in the first-degree relatives. We also found that 69.4% of victims were one of the family members. In our sample, 24.5% of patients were using alcohol and 4.1% were using cannabis.It is plausible that rendering more effective communication might allow earlier intervention for unrecognized and possibly unrecognizable risk factors of homicidal acts in people with schizophrenia.

Eating disorder psychopathology as a marker of psychosocial distress and suicide risk in female and male adolescent psychiatric inpatients

Shannon L. Zaitsoff, Carlos M. Grilo — 2009-05-04

Abstract: Objective: The aim of this study was to examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (ie, dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically hospitalized adolescent girls and boys.Method: A total of 492 psychiatric inpatients (286 adolescent girls and 206 adolescent boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning, including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores.Results: Among the adolescent boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among adolescent girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among adolescent boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity).Conclusion: In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys, although the nature of the specific associations differs by sex.

Mortality in Kraepelinian schizophrenic patients: a prospective study with a median follow-up of 8.4 years

Gwenolé Loas, Pénélope Descle, Valérie Yon — 2009-07-10

Abstract: Kraepelinian schizophrenia is a subtype of schizophrenia defined by its very poor outcome.Several studies have demonstrated the validity of this distinction, but the expected excess mortality has not been investigated.The aim of the present study was to test the hypothesis that Kraepelinian schizophrenic subjects have a higher mortality rate, notably due to natural causes, than non-Kraepelinian schizophrenic subjects. The results of a prospective study with a median follow-up of 8.4 years are reported. Three hundred ten schizophrenic subjects meeting the International Classification of Diseases, 10th Revision, criteria for schizophrenia were classified on admission as Kraepelinian schizophrenia (n = 31) and non-Kraepelinian schizophrenia (n = 279); 31 deaths (16 from unnatural causes, 13 from natural causes, and 2 from undetermined causes) were observed during follow-up. Univariate and multivariate Cox regression analyses were performed using schizophrenia subtype (Kraepelinian vs non-Kraepelinian), age, and duration of illness as predictors. Schizophrenia subtype was a significant predictor of mortality in univariate analysis only for death from natural causes, and a trend was observed after adjusting for age and duration of illness. A log-rank test was used to compare mortality rates between Kraepelinian and non-Kraepelinian schizophrenic subjects and showed a significantly higher mortality rate from natural causes in Kraepelinian schizophrenia (16.7%) than in non-Kraepelinian schizophrenia (4.1%).

A comparison of life events in patients with unipolar disorder or bipolar disorder and controls

Netta Horesh, Iulian Iancu — 2009-07-13

Abstract: Objective: The present study aimed to explore the association between stressful life events (LEs) and the development of affective psychopathology.Method: Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls in regard to the rate of stressful LEs. Assessment measures included the Beck Depression Inventory, the Adult Life Events Questionnaire, and the Childhood Life Events List.Results: The entire sample of affective patients had more LEs in general, more negative LEs, and more loss-related LEs in the year preceding their first depressive episode as compared with normal controls. Subjects with unipolar disorder had more positive LEs and more achievement LEs, whereas subjects with bipolar disorder had more uncontrollable LEs in the year preceding the first depressive episode. The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode, with subjects with bipolar disorder reporting more LEs in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year before the last depressive and manic episodes in the patient groups with unipolar and bipolar disorder. A significant relationship was found between childhood LEs and the development of affective disorders in adulthood, with patients with unipolar disorder exhibiting less positive and achievement LEs.Conclusions: In both the unipolar and the bipolar groups, the major impact of LEs on the onset of affective disorders was found in the year before the first depressive or manic episodes. This suggests that the accumulation of stressful LEs at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.

The relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia

Jong-Hoon Kim, Jun-Hyung Ann, Min-Jung Kim — 2009-07-10

Abstract: Background: Depressive symptoms are common in schizophrenia and are considered core features of the disorder. The purpose of the present study was to examine the relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia.Methods: Eighty newly admitted patients were comprehensively evaluated for subjective well-being, schizophrenic symptoms, and depressive symptoms using the Subjective Well-Being Under Neuroleptics Scale (SWN), the Positive and Negative Syndrome Scale (PANSS), and the Beck Depression Inventory. Correlation coefficients were obtained between depressive symptoms and subjective well-being while controlling for the influence of the severity of psychotic symptoms, extrapyramidal side effect, and subjective attitude toward antipsychotics, as assessed by the PANSS, the Drug-Induced Extrapyramidal Symptoms Scale, and the Drug Attitude Inventory, respectively.Results: The SWN score had a significant negative correlation with the PANSS depression factor score (P < .001). Correlation analysis also revealed a significant negative correlation between the SWN score and the Beck Depression Inventory score (P < .001).Conclusions: The results of our study suggest that depressive symptoms are significantly associated with a low subjective well-being in newly admitted patients with schizophrenia and that the relationship is significant even after controlling for the influence of potential confounding variables. Detection and appropriate management of depressive symptoms in schizophrenic patients may affect their perceptions of their own well-being.

Current alcohol use and risk for hypomania in male students: generally more or more binging?

Thomas D. Meyer, Larissa Wolkenstein — 2009-07-10

Abstract: Background: Alcohol use disorders and bipolar disorder are highly comorbid. Some studies suggest that alcohol abuse or misuse might even precede the onset of bipolar disorder, but few studies have looked at the daily drinking pattern beyond diagnostic categories. We therefore examined if risk for hypomania is associated with a specific drinking pattern when using a calendar-based interview.Method: A total of 120 students who completed the Hypomanic Personality Scale were independently interviewed with the FORM 90 to assess daily drinking and the Composite Diagnostic Interview to derive Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses.Results: Conducting regression analyses, we found that an alcohol-related disorder was related to the amount and frequency of drinking, as expected. Risk for hypomania was specifically related to an unstable drinking pattern and binge drinking, but not generally higher consumption.Conclusion: Risk for hypomania was associated with unstable alcohol consumption and binge drinking, even after controlling for alcohol-related disorders. This supports the idea that instability in different areas of behavior is characteristic of vulnerability to hypomania.

Delusional versus nondelusional body dysmorphic disorder

Serafino G. Mancuso, Natalie P. Knoesen, David J. Castle — 2009-07-10

Abstract: This study assessed demographic and clinical features in 65 subjects with body dysmorphic disorder (BDD) and compared the 39 (60%) with the delusional form (receiving an additional diagnosis of delusional disorder, somatic type) with those who did not meet delusionality criteria. Delusional and nondelusional patients did not statistically differ on most demographic and clinical variables. Delusional patients, however, had significantly more severe BDD symptoms at both baseline and follow-up assessments than those of nondelusional patients. Furthermore, poorer insight was significantly associated with more severe BDD symptoms at both baseline and follow-up. Overall improvement in BDD symptom severity was similar for the 2 groups. Our results support other studies in the view that BDD and its delusional variant have more similarities than differences and that the delusional variant may be simply a more severe form of BDD. Implications for the diagnostic classification of BDD and future research directions are discussed.

The prevalence of pathologic skin picking in US adults

2009-07-13

Abstract: Objective: Despite increasing recognition of the potentially severe medical and psychosocial costs of pathologic skin picking (PSP), no large-sample, randomized investigation of its prevalence in a national population has been conducted.Method: Two thousand five hundred and thirteen US adults were interviewed during the spring and summer of 2004 in a random-sample, national household computer-assisted phone survey of PSP phenomenology and associated functional impairment. Respondents were classified for subsequent analysis according to proposed diagnostic criteria.Results: Of all respondents, 16.6% endorsed lifetime PSP with noticeable skin damage; 60.3% of these denied picking secondary to an inflammation or itch from a medical condition. One fifth to one quarter of those with lifetime PSP not related to a medical condition endorsed tension or nervousness before picking, tension or nervousness when attempting to resist picking, and pleasure or relief during or after picking. A total of 1.4% of our entire sample satisfied our criteria of picking with noticeable skin damage not attributable to another condition and with associated distress or psychosocial impairment. Pickers satisfying these latter criteria differed from other respondents in demographics (age, marital status) and both picking phenomenology and frequency.

Distinguishing affective depersonalization from anhedonia in major depression and bipolar disorder

2009-05-06

Abstract: Background: Affective depersonalization has received limited attention in the literature, although its conceptualization may have implications in terms of identification of clinical endophenotypes of mood disorders. Thus, this study aims to test the hypothesis that anhedonia and affective depersonalization represent 2 distinct psychopathological dimensions and to investigate their clinical correlates in patients with major depressive disorder (MDD) and bipolar disorder (BD).Methods: Using a data pool of 258 patients with mood and anxiety disorders, an item response theory–based factor analysis approach was carried out on 16 items derived from 2 clinical instruments developed in the Spectrum Project (the Structured Clinical Interview for Mood Spectrum and the Structured Clinical Interview for Derealization-Depersonalization Spectrum). Clinical correlates of these psychometrically derived dimensions were subsequently investigated in patients with BD or MDD.Results: Using an item response theory–based factor analysis, a 2-factor solution was identified, accounting overall for the 47.0% of the variance. Patients with BD showed statistically significant higher affective depersonalization factor scores than those with MDD (Z = 2.215, P = .027), whereas there was no between-groups difference in anhedonia scores (Z = 0.825 P = .411). In patients with BD, age of onset of the disease correlated with affective depersonalization factor scores (ρ = −0.330, P = .001) but not with anhedonia factor scores (ρ = −0.097, P = .361).Conclusions: Affective depersonalization and anhedonia seem to be 2 distinct psychopathological dimensions, although closely related, bearing the opportunity to identify patients with a specific profile for a better clinical and neurobiological definition.

Clinical predictors of health-related quality of life in obsessive-compulsive disorder

2009-04-17

Abstract: Background: Obsessive-compulsive disorder (OCD) is a serious mental disorder that has severe impact on a person's quality of life and those living with a person with OCD. This study systematically examined the clinical variables that are predictive of several domains of quality of life in a large, well-characterized sample of patients attending a specialized treatment unit in Italy.Methods: The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to 151 patients with OCD and their scores were compared to published Italian norms. A principal component analysis was performed on the 13 major categories of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) Symptom Checklist to derive symptom dimension scores. The association between various domains of quality of life and a wide range of clinical variables, including symptom dimension scores, was examined using multiple regression models.Results: Compared to published Italian norms, patients with OCD showed impairment in most domains of quality of life, particularly social functioning. The principal component analysis of the YBOCS Symptom Checklist yielded 5 symptom dimensions that were identical to those previously identified in the international literature. Fewer years of education, higher depression scores (Hamilton Rating Scale for Depression), higher YBOCS obsessions scores, and higher scores on the contamination/washing symptom dimension independently predicted a poorer score on the physical health component of the SF-36. Higher YBOCS compulsions scores, the presence of a current mood disorder, and higher anxiety scores (Hamilton Rating Scale for Anxiety) predicted a poorer score on the mental health component of the SF-36.Conclusions: Our study confirms that quality of life is severely impaired in patients with OCD. The identification of predictors of quality of life in OCD can help clinicians to adapt their treatment protocols to cater for the individual needs of their patients.

Direct and indirect effects of the temperament and character on alexithymia: a pathway analysis with mood and anxiety

Yu Jin Lee, Seung-Hee Yu, Seong-Jin Cho, In Hee Cho, Seung-Hee Koh, Seog Ju Kim — 2009-07-13

Abstract: Objective: We aimed to assess the pathway from personality to alexithymia through mood and anxiety as mediators.Method: Three hundred thirty-four subjects (130 male), whose psychiatric health was verified by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders, completed the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory, the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression scale (CES-D). The schematic models for the pathway analysis from Temperament and Character Inventory (TCI) to TAS-20 scores were made.Results: Low reward dependence (RD), low self-directedness (S-D), and high cooperativeness (CO) had paths to TAS-20 total (P = .000, P = .000, and P = .042, respectively). S-D had also an indirect path via STAI-state to TAS total. On TAS-20 factor 1, low RD, low S-D, and high self-transcendence (ST) had direct effects (P = .004, P = .000, and P = .000, respectively). S-D had also an indirect path via STAI-state and (CES-D) on TAS-20 factor 1. On TAS factor 2, low novelty seeking (NS), high harm avoidance (HA), low RD, low S-D, and high cooperativeness (CO) had direct effects (P = .005, P = .011, P = .000, P = .000, and P = .004, respectively). On TAS-20 factor 3, low RD and S-D had direct effects (P = .002 and P = .000, respectively).Conclusion: Current results suggest that although alexithymia is affected by the personality, state-dependent mood and anxiety may mediate the relationship between alexithymia and personality.

Normative data for the Tygerberg Cognitive Battery and Mini-Mental Status Examination in a South African population

2009-04-20

Abstract: Background: Normative data for the Tygerberg Cognitive Battery (TCB) and Mini-Mental Status Examination (MMSE) (in South Africa) have not been formally examined before. The TCB was developed for the bedside pen-and-paper screening of cognitive impairment in each of the 6 main cognitive domains, including attention and concentration, speech, memory, praxis, gnosis, and executive functioning. The test is also used to diagnose different neuropsychiatric conditions. The MMSE is an established screen of cognitive status, which is often used as a comparative standard for novel screening tests such as the TCB. The TCB was initially developed in English and Afrikaans, and a Xhosa version was also initiated with this study so that the 3 most common languages of the region could be accommodated.Aims: The first aim of the study was to estimate normative test performance on the TCB and MMSE among controls, and the second aim was to develop a Xhosa version of the TCB.Methods: Assessments of the TCB and MMSE were carried out in a population of healthy individuals (n = 157). In addition, healthy Xhosa-speaking participants (n = 14) were screened using a Xhosa version of the TCB.Results: Reliability scores for all forms of the TCB were satisfactory. Age and education correlated significantly with TCB scores (r = −0.26, P < .01; r = 0.64, P < .01, respectively), whereas only education significantly correlated with MMSE scores (r = 0.32, P < .05). Normative values were calculated accordingly, that is, controlled for the effects of age and education. The TCB scores also correlated significantly with MMSE scores (r = 0.49, P < .05), demonstrating the potential of the TCB to serve as an alternate cognitive assessment tool, along with the MMSE, to focus neuropsychiatric investigations. Scores on the Xhosa version differed significantly on speech, praxis, and gnosis between the Afrikaans and English participant scores.Conclusion: These normative data can be used to increase precision and to provide an impartial evaluation when applying TCB to evaluate the cognitive ability of neuropsychiatrically impaired adult patients. However, age and education effects should be considered when computing the results of cognitive assessment.

Information for Contributors

2010-03-01

Editorial Board

2010-03-01