Exploratory analysis of CVLT-II forced-choice recognition and RBANS El base rates for forensically-committed, psychotic-disordered inpatients: Implications on clinical decision-making

摘要

Within the inpatient forensic setting, requests for a neuropsychoiogical evaluation are common to determine cognitive strengths and weaknesses. However, variable effort proves to be a prominent issue in this setting. Thus, assessment of effort becomes an essential component of a neuropsychoiogical evaluation. The California Verbal Learning Test, 2nd Edition (CVLT-II) and the Repeatable Battery for the Assessment of Neuropsychoiogical Status (RBANS) are widely utilized cognitive measures in the inpatient setting. The purpose of this study is to establish the local base rates and predictive abilities of the CVLT-II Forced-Choice Recognition (FCR) measure and RBANS Effort Index (El). Participants included 56 and 595 forensically-committed, psychotic-disordered inpatients who completed the CVLT-II FCR and RBANS El, respectively. Results indicated that the estimated local base rate for a positive CVLT-II FCR score was 8%, which resulted in 97% negative predictive power and 50% positive predictive power. The estimated local base rate for a positive RBANS El score was 16%, which resulted in 91.7% negative predictive power and 57.1% positive predictive power. Given their low sensitivity and predictive power, the results suggest that much more confidence can be placed in negative FCR and El results as opposed to positive findings.