Cognition and Competency Restoration: Using the RBANS to Predict Length of Stay for Patients Deemed Incompetent to Stand Trial

Abstract

Intact cognition is a foundational component of one's ability to be competent to stand trial. Given the cost of assessing and treating incompetence, it is recommended that clinicians develop efficient methods to identify individuals who are most likely to require intensive competence-related treatment interventions. This study sought to ascertain whether a brief cognitive screening instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), could predict the length of stay required to restore trial competency among 288 forensic psychiatric inpatients undergoing competency restoration treatment. Results indicated that incompetent defendants who were older or demonstrated poorer overall RBANS performance required longer hospitalizations to be deemed restored to trial competence. Interestingly, incompetent defendants scoring in the 51-60 range on the RBANS Total Scale Index were almost three times more likely to require hospitalization beyond the average length of stay. Findings support the use of the RBANS to identify individuals early in the treatment process who may require and benefit from intensive restoration treatment.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting

“…Only individuals who “pass” in-depth performance validity and/or symptom validity assessments are referred for neuropsychological assessment; subsequently, lowering the base rate of malingering behavior present in the current sample and allowing the focus to remain on performance validity. Additionally, Toofanian Ross et al (2015) demonstrated that genuine cognitive impairment due to dementia, did not evidence a significant relationship with hospital LOS. Other studies demonstrated that individuals with dementia were significantly less likely to achieve trial competency (Morris & Parker, 2009), as were individuals with a psychotic disorder (Morris & Parker, 2008).…”

“…Cognition has also been identified as a significant predictor in determining one’s competence to stand trial (Nestor et al, 1999; Toofanian Ross et al, 2015; A. J.…”

“…Thus, brief cognitive screeners are commonly used to assess for cognitive factors that may influence competency restoration (Kirkish & Sreenivasan, 1999). As one example, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998) is a brief screener that measures multiple cognitive domains and has demonstrated a sensitivity to severe cognitive deficits commonly found among individuals with schizophrenia spectrum disorders (Bailie et al, 2012; Dickerson et al, 2004; Gogos et al, 2010; Gold et al, 1999; Hobart et al, 1999; Iverson et al, 2009; King et al, 2012; Toofanian Ross et al, 2015; Wilk et al, 2002, 2004). Specifically, the RBANS Total Scale Index was determined to be the most appropriate RBANS index for assessing individuals with a schizophrenia spectrum diagnosis within a forensic inpatient setting (King et al, 2012) and has further been shown to predict LOS for individuals deemed IST (Toofanian Ross et al, 2015).…”

Examining the repeatable battery for the assessment of neuropsychological status validity indices in people with schizophrenia spectrum disorders

“…Based on previous reports of the RBANS PVTs (Bailie et al, 2012;Bayan et al, 2018;Moore et al, 2013;Morra et al, 2015;Toofanian Ross et al, 2015;Williams et al, 2020), we expect that about 20% of the participants will have scores exceeding the PVTs cutoffs. We assume that BRIEF-A scores suggesting problems with motivation and interest will be comparable (i.e., about 40%) to findings from other studies describing the prevalence of problems with motivation in schizophrenia spectrum disorders (Patel et al, 2015;Rabinowitz et al, 2013;Schennach et al, 2015).…”

“…The RBANS allows for the concurrent assessment of cognitive deficits and motivational problems in patients with schizophrenia spectrum disorders. The frequencies at which patients with schizophrenia exceed cutoffs on RBANS PVTs have been examined for some, but not all, possible PVTs deriving from the battery, and have ranged from 9-24% (Bailie et al, 2012;Bayan et al, 2018;Moore et al, 2013;Morra et al, 2015;Toofanian Ross et al, 2015;Williams et al, 2020). No previous study has reported the frequencies of BRIEF-A scores indicating problems with motivation and interest in patients with schizophrenia disorders.…”