The prediction of schizophrenic patients' proficiency in psycho-educational treatment by indicators of cognitive modifiability assessed with the Wisconsin Card Sorting Test

Abstract

Introduction: Recent research has demonstrated relationships between neurocognitive dysfunctions in schizophrenic patients and different aspects of everyday functioning. Target variables of the present study are indicators of competency in dealing with medication problems and the modification of these competencies with the help of a psychoeducational program. The research question is, whether the prediction of the respective indicators can be improved by applying principles of Dynamic Assessment to neuropsychological testing. Dynamic Assessment is characterized by the integration of specific interventions into the testing process. Changes of performance are considered to be indicators of `cognitive modifiability'. Method: The Wisconsin Card Sorting Test (WCST, concept formation), which is often used with schizophrenic subjects, was applied within a test-training-test paradigm with specific instructions and trial-by-trial feedback constituting the intervention. WCST pre- and posttest scores were then compared with the help of correlational and linear regression analysis for their predictive power with regard to the patients' level of competence and training proficiency (medication knowledge, problem solving). Results: Clearly increased amount of explained variance is proved for the (dynamic) WCST-posttest scores. Comparison of the explained variance of the criterion variables assessed before and after the clinical training does not yield significant differences, however. Discussion: Results demonstrate that Dynamic Testing can contribute to improve predictive validity in clinical settings. Issues of further research, especially the selection and design of adequate criteria (training) for validating dynamic tests are discussed. The use of the approach in clinical practice for treatment indication is addressed.