Charles E. Drebing

Personality Change in Head Trauma: A Validity Study of the Neuropsychology Behavior and Affect Profile

This study represents the first attempt to cross validate and report on the Neuropsychology Behavior and Affect Profile (NBAP) using closed head injury (CHI) participants. The NBAP is designed to measure emotional functioning before and following a brain event. Two CHI samples, differing primarily by method of ascertainment, were compared to a group of normal controls. Results provided support for concurrent and predictive validity of the NBAP across both CHI samples. Significantly higher levels of postinjury emotional functioning in clinic-referred CHI patients compared to CHI individuals not seeking treatment (strictly research participants) was demonstrated. A surprising finding was that pre-injury emotional levels of clinic-referred subjects were rated as less severe than that of controls. Based on this finding, the possibility of a gradient effect was discussed in which raters appeared to place selectively greater weight on current condition, while simultaneously making premorbid levels less severe than they really were. Results were discussed in the context of study limitations and directions for further research.

Professional caregivers for patients with dementia: Predictors of job and career commitment

The purpose of this study is to identify what factors predict job and career commitment among professional caregivers working with patients with dementia. A secondary analysis was completed using data collected from 77 professional caregivers working in residential dementia special care programs. The findings suggest that professional caregivers’ commitment to their jobs and careers is most closely related to their level of involvement in the interpersonal aspects of the work, the degree to which they feel personal growth or benefit, and the level of burden that their work generates. Strategies are suggested for improving job and career longevity among professional caregivers by enhancing attachment to patients and families, fostering professional identity and personal growth, and monitoring and managing professional caregiver burden.

Exploring professional caregivers' perceptions. Balancing self-care with care for patients with Alzheimer's disease.

With the are hundreds of studies about caregiver burden related to family caregivers that exist, little has been written about caregiver burden as it pertains to professional caregivers. The purpose of this study was to explore professional caregivers perception and meaning associated with their caring for patients with Alzheimers disease (AD). Twenty-two professional caregivers were interviewed. Content analysis was used to clarify respondents interview data. Several themes emerged from the data related to beliefs about choosing and maintaining AD caregiving role, beliefs about self-efficacy, commitment and self-satisfaction, nature of family interaction of individuals with AD, grieving responses, and ability to maintain self-care through social support as well as solitary time. Implications include AD professional burden measurement; study related to recruitment, orientation, and staffing patterns; and effect on the quality of care provided to patients and their families.

Documenting pathways to dementia care: Relative validity of questionnaire, interview, and medical record formats

One of the shortcomings of the pathways-to-care literature is the lack of empirical support for the validity of the data collection methods. This study uses three common formats to collect retrospective pathways-to-care data for adults who have been diagnosed with possible or probable Alzheimers disease (AD) and compares indicators to evaluate their relative validity. Forty family caregivers of adults diagnosed with possible or probable AD were recruited from the caregiver registry of the Boston University Alzheimers Disease Core Center (BU ADCC). In each of three formats (questionnaire, structured interview, and medical record review), data were collected regarding four key events in the pathway to dementia care: first appearance of symptoms, first verbalized recognition of symptoms, first effort to seek professional help, and first diagnosis by a professional. In addition to the dates of these events, researchers attempted to determine: the first verbalized concern about the symptoms, who first sought professional help, what professional was first approached, and what professional made the first diagnosis. In a consensus meeting, data collected in all three formats were reviewed, and a consensus on the most likely answers to all questions was recorded and compared to data collected in each format. The results suggest that the three formats are not equivalent in terms of concurrent validity. While substantial agreement is found among data collection methods, the validity of the structured interview format and the medical record review is most consistently supported by the data in this study. Questionnaire data resulted in underestimates of delays and correlated poorly with other data sources, including the consensus judgment.

Burden and professional caregivers: tracking the impact.

The objective of this study was to establish the validity and reliability of the Professional Caregivers’ Burden Index (PCBI), a new measure of burden for professionals who work with patients with Alzheimer’s disease. In phase 1, content validity was examined; in phase 2, the 24-item instrument was administered to professional caregivers on specialty dementia care units at a long-term care facility in New England. In phase 3, mean staff PCBI scores were found to increase significantly at 3 and 9 months following a reduction of approximately 5% in staffing levels at a dementia care program. These initial data on the PCBI suggest that it may be used as a valid and reliable measure of burden among professional caregivers of patients with Alzheimer’s disease.

Affect identification bias demonstrated with individual chimeric faces.

The current study extends previous findings of a left visual-field bias in chimeric face tasks, by using a new procedure which incorporates chimeric stimuli depicting both positive and negative target affects and requires the identification of affect in individually presented faces. This new procedure is more representative of the types of judgements made in daily social interaction. Results with this new procedure are consistent with previous findings, indicating a significant left visual-field bias for both positive and negative affects in the majority of subjects. Handedness was significantly related to lateralization scores, with dextrals showing greater left visual-field biases than sinistrals. Among sinistrals, a left visual-field bias was noted only for happy chimera.

Development and Evaluation of Validity Scales for the Neuropsychology Behavior and Affect Profile: A Dissembling Study.

The Neuropsychology Behavior and Affect Profile (NBAP) is a peer-rated inventory of behavioral and affective changes in brain injured individuals and consists of five Clinical Scales that have demonstrated strong external validity. A potential confound is the NBAPs susceptibility to rater bias. In the present investigation, four validity scales were developed and external validity and psychometric properties were examined through a dissembling paradigm. Study I describes item selection and construction of the validity scales. Study 2 demonstrates that various combinations of both the clinical and validity scales effectively differentiated dissemblers from informants of two groups of traumatic brain injury patients. Although results differed somewhat when dissemblers were grouped according to their level of neuropsychological training, highly trained dissemblers (licensed clinical neuropsychologists) could be detected.

Clinical Care of Gambling Disorders: Training, Experience, and Competence Among VHA Psychologists

Problem gambling is a common, highly destructive disorder which is often overlooked by clinicians. Levels of clinical training, clinical experience, and professional competence for providing clinical services for problem gambling were examined in a survey of 181 clinical psychologists working in the Veterans Healthcare Administration (VHA). The results suggest that the majority of clinical psychologists have little or no formal training and little or no past or current clinical experience in the treatment of disordered gambling, nor do they see themselves as competent to evaluate or treat patients with disordered gambling. Most have not referred patients for treatment of problem gambling and do not know of a competent provider to whom they can refer. There is an identifiable subgroup, representing 9% of respondents, who do have more training, provide services, and see themselves as competent to provide care for patients with problem gambling. The amount of formal training is positively correlated with care provided and self-ratings of competence. Despite the lack of training and experience, most respondents expressed interest in receiving additional training. These data suggest that to improve rates of diagnosis and treatment of patients with problem gambling in mental health settings, additional training needs to be made available for mental health providers as a group, with specialized training for clinicians interested in specializing in this area.

Processing and Recognition of Facial Affect in Schizophrenia

A deficit in the recognition of facial affect has been well documented in people with schizophrenia. Our 1995 research with normal subjects showed that hemispheric bias for processing facial affect is related to accuracy of recognition of facial affect. We tested whether this relationship holds in a sample of 25 people with schizophrenia who completed tasks of identification of facial affect and chimeric facial affect. Subjects with a left visual-field bias were significantly more accurate in identifying one facial emotion (sad) than were other subjects. Individual differences in hemispheric advantage for processing affect appears to be an important variable related to functional br capacity within different populations.

Gambling-related cognitive distortions predict level of function among US veterans seeking treatment for gambling disorders: Gambling-Related Cognitive Distortions and Function

BACKGROUND AND OBJECTIVESnGambling Disorder (GD) is characterized by recurrent gambling behavior that is associated with significant impairment and distress, high psychiatric comorbidities, and high functional disability. The military veteran population appears particularly susceptible to developing the disorder, but relatively little has been studied among this population. The purpose of the present study is to investigate the clinical psychopathologies and comorbidities of veterans seeking treatment for problem gambling and how problem gambling may impact functioning.nnnMETHODSnTreatment-seeking veterans meeting criteria for GD (Nu2009=u200961) underwent a structured clinical interview and completed the South Oaks Gambling Screen (SOGS), the Gambling Symptom Assessment Scale (G-SAS), the Yale-Brown Obsessive-Compulsive Scale for Gambling Disorder (PG-YBOCS), the Gambling Belief Questionnaire (GBQ), the Barratt Impulsiveness Scale (BIS-11), and the Sheehan Disability Scale (SDS).nnnRESULTSnVeterans seeking treatment for GD had high rates of psychiatric and addiction disorder comorbidities. Few veterans had previously sought treatment and most reported substantive challenges in social and occupational functioning. When determining how gambling-related characteristics (ie, severity and cognitive distortions) impact function, severity of cognitive distortions was the strongest statistical predictor of overall functional disability.nnnCONCLUSIONS AND SCIENTIFIC SIGNIFICANCEnThe findings from this study indicate that there is high comorbidity between GD and other psychiatric and addictive disorders, as well as social and occupational functioning. In addition, cognitive distortions related to gambling relate importantly to overall functioning and should be considered in the development of interventions for veterans with GD. (Am J Addict 2018;27:108-115).