This study delineated patterns of alcohol use 1 year after traumatic brain injury (TBI) in a large, population-based, epidemiological, nonclinical sample, and identified predictors of heavy alcohol use in these individuals. Participants were 1,606 adults identified by review of a South Carolina statewide hospital discharge data set, on the basis of satisfying the Centers for Disease Control case definition of TBI, and were interviewed by telephone 1 year after TBI-related discharge. Alcohol use in the month prior to interview was classified according to categories from the Quantity-Frequency-Variability Index; heavy drinking was defined as nearly daily use with > or = 5 drinks at least occasionally, or at least three occasions with > or = 5 drinks. A polychotomous logistic regression with 3 response levels (heavy, moderate, and abstinent/infrequent/light drinking) was used to identify predictors of heavy drinking. Heavy drinking in the month prior to interview was reported by 15.4% of participants, while 14.3% reported moderate drinking and 70.3% reported abstinence or light/infrequent drinking. Risk factors for heavy drinking included male gender, younger age, history of substance abuse prior to TBI, diagnosis of depression since TBI, fair/moderate mental health, and better physical functioning. There was no association between drinking patterns and TBI severity.

The assessment of decision-making capacity is an essential element of competency determinations. As experts in the assessment of human cognitive abilities, neuropsychologists may be the best adjudicators of competency. However, to maximize the contribution of neuropsychology to the courts in the determination of competency, clinicians must be aware of the professional controversies and ethical challenges inherent in the assessment of decision-making capacity and the determination of competence. Professional controversies include the lack of established methodological and procedural guidelines for capacity evaluations and the application of variable criteria to establish impairment. Ethical challenges include balancing the need to respect the individual's freedom of choice and self-determination with the need to promote the individual's safety; attaining professional competence; and selecting, using, and interpreting assessment methods appropriately. The purpose of this article is to examine these issues in the context of neuropsychological practice.

Early intervention in schizophrenia is an emerging goal of research investigating the earliest phases of the illness, which occur predominantly in adolescence and young adulthood. In order to develop strategies for early intervention, individuals at highest risk for the development of psychosis must be accurately identified. Here we briefly review the historical approaches to the assessment of risk for schizophrenia and highlight the more recently developed interview-based methods for the assessment of incipient psychosis, with particular attention paid to their applicability in adolescence. We present a prototypical assessment battery that includes an integration of historical assessment approaches to form a comprehensive assessment of threshold and subthreshold psychopathology, and other assessment procedures targeted specifically at adolescents. This battery may assist in unraveling the complex presentation of prodromal symptoms during the adolescent developmental period.

Sleep disturbance is a common complaint among perimenopausal women and is hypothesized to contribute to compromises in their quality of life (QoL). We investigated the degree to which sleep disturbance and QoL were related and whether dysfunctional beliefs and attitudes about sleep were significantly associated with QoL ratings among a community sample of 168 perimenopausal women (88% return rate). Questionnaires included measures of subjective sleep quality, beliefs and attitudes about sleep, and QoL. Subjective sleep quality accounted for a significant amount of variance in both the physical and mental health aspects of QoL. Dysfunctional beliefs and attitudes about sleep significantly accounted for the physical components of QoL but not mental components. The interplay among sleep quality, dysfunctional beliefs and attitudes about sleep, and QoL is discussed, as well as potential clinical implications and ideas for future investigations specific to perimenopausal women.

The application of writing exercises and the relevance of stage-matching is discussed in the context of the stage of change model.