The non-credible score of the Rey Auditory Verbal Learning Test: is it better at predicting non-credible neuropsychological test performance than the RAVLT recognition score?

The ability of both the non-credible score of the Rey Auditory Verbal Learning Test (RAVLT NC) and the recognition score of the RAVLT (RAVLT Recog) to predict credible versus non-credible neuropsychological test performance was examined. Credible versus non-credible group membership was determined according to diagnostic criteria with consideration of performance on two stand-alone performance validity tests. Findings from this retrospective data analysis of outpatients seen for neuropsychological testing within a Veterans Affairs Medical Center (N = 175) showed that RAVLT Recog demonstrated better classification accuracy than RAVLT NC in predicting credible versus non-credible neuropsychological test performance. Specifically, an RAVLT Recog cutoff of ≤9 resulted in reasonable sensitivity (48%) and acceptable specificity (91%) in predicting non-credible neuropsychological test performance. Implications for clinical practice are discussed. Note: The views contained here within are those of the authors and not representative of the institutions with which they are associated.

Predicting test of memory malingering and medical symptom validity test failure within a Veterans Affairs Medical Center: use of the Response Bias Scale and the Henry-Heilbronner Index.

The ability of the Response Bias Scale (RBS) and the Henry-Heilbronner Index (HHI), along with several other MMPI-2 validity scales, to predict performance on two separate stand-alone symptom validity tests, the Test of Memory Malingering (TOMM) and the Medical Symptom Validity Test (MSVT), was examined. Findings from this retrospective data analysis of outpatients seen within a Veterans Affairs medical center (N = 194) showed that group differences between those passing and failing the TOMM were largest for the RBS (d = 0.79), HHI (d = 0.75), and Infrequency (F; d = 0.72). The largest group differences for those passing versus failing the MSVT were greatest on the HHI (d = 0.83), RBS (d = 0.80), and F (d = 0.78). Regression analyses showed that the RBS accounted for the most variance in TOMM scores (20%), whereas the HHI accounted for the most variance in MSVT scores (26%). Nonetheless, due to unacceptably low positive and negative predictive values, caution is warranted in using either one of these indices in isolation to predict performance invalidity.

WAIS-IV Digit Span variables: are they valuable for use in predicting TOMM and MSVT failure?

The Digit Span (DS) task in the Wechsler Adult Intelligence Scale-Fourth Edition differs substantially from earlier versions of the measure, with one of the major changes being the addition of a sequencing component. In the present investigation, the usefulness of the new sequencing task and other DS variables (i.e., DS Age-Scaled Score, DS Forward Total, DS Backward Total, and Reliable DS) was investigated with regard to the ability of these variables to predict negative response bias. Negative response bias was first defined and examined using below-cutoff performance on the Test of Memory Malingering (TOMM) (N = 99). Then, for comparison purposes, negative response bias was examined using below-cutoff performance on the Medical Symptom Validity Test (MSVT; N = 95). Study participants included primarily middle-aged outpatients at a Veterans Affairs medical center. Findings from this retrospective analysis showed that, regardless of whether the TOMM or the MSVT was used as the negative response bias criterion, of all the DS variables examined, DS Sequencing Total showed the best classification accuracy. Yet, due to its relatively low positive and negative predictive power, DS Sequencing Total is not recommended for use in isolation to identify negative response bias.

Derivation and clinical validation of consistency indices on the test of memory malingering.

Response consistency (CNS) is considered in free-standing performance validity measures like the Medical Symptom Validity Test (MSVT). This study examined the utility of CNS scores on the Test of Memory Malingering (TOMM). CNS indices were derived in a non-clinical undergraduate sample randomized to control (n = 73), naïve simulator (n = 73), and coached simulator (n = 73) groups. Two of the three TOMM CNS measures showed higher classification rates identifying naïve simulators than the standard TOMM criteria; CNS measures classified coached simulators better than the standard TOMM criteria. Coached simulators outperformed naïve simulators on the standard TOMM scores, but not on CNS measures, suggesting their resilience to coaching. In a separate clinical sample of veterans (N = 92), TOMM CNS scores exhibited comparable classification rates with the standard TOMM scoring using the MSVT as the performance validity criterion. Overall, findings support TOMM CNS scores, especially in settings in which examinee coaching is likely.

Is the montreal cognitive assessment superior to the mini-mental state examination in detecting subtle cognitive impairment among middle-aged outpatient U.S. Military veterans?

The Montreal Cognitive Assessment (MoCA) is a relatively newly designed test that was developed as a tool to screen patients with mild cognitive problems that are not typically detected by the Mini-Mental State Exam (MMSE). While early research suggests that the MoCA is more sensitive to subtle cognitive impairment than the MMSE, there is concern about potential decreased specificity when using the MoCA. The aim of the present study was to examine the comparative utility of using the MoCA and the MMSE to detect subtle cognitive impairment among a group of 82 middle-aged U.S. military veterans referred for outpatient neuropsychological testing. Using receiver operating characteristic analyses, the MoCA was shown to be a better predictor of subtle cognitive impairment on neuropsychological testing than the MMSE. When using an adjusted cutoff, the MoCA was shown to be more sensitive (i.e., 0.72 vs. 0.52) and nearly as specific as the MMSE (0.75 vs. 0.77).

Evidence of carry-over in memory test batteries using RBANS and screening measures.

When testing memory and cognitive abilities, clinicians often administer batteries including multiple tests with similar content. Care must be taken so that such similarities do not unduly impact test performance. This brief report reviews findings from our own clinic, where administration of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in tandem with other screening instruments has led to apparent carry-over at an overall rate of more than one third of cases. Specific combinations of RBANS plus three other instruments are reported, along with cautions and caveats for appropriate interpretation.

Dimensional versus categorical use of the PHQ-9 depression scale among persons with non-small-cell lung cancer: a pilot study including quality-of-life comparisons.

The debate over the relative usefulness of categorical (yes/no) versus dimensional (continuous scales) assessments for determining mental illness has been running strong for nearly a half century. In order to address the utility of each of these assessment methods within the cancer population, in the present study, the dimensional and categorical scoring systems of the nine-item Patient Health Questionnaire (PHQ-9) for depression were compared among patients (n = 14) in the pretreatment stages for locally advanced non-small-cell lung cancer (NSCLC). Also included in the study was an additional dimensional measure of depression, the Beck Depression Inventory-II (BDI-II). As predicted, dimensional assessments resulted in higher estimates of depression than did the categorical assessment. As predicted, the dimensional depression assessments, including the PHQ-9 and the BDI-II, which showed depression prevalence rates of 43% and 36%, respectively, produced higher estimates of depression than did the categorical system of the PHQ-9, whose use did not result in any patients being diagnosed with major depression or other depression. Also, as predicted, in terms of quality of life, patients found to be depressed by both the BDI-II and the dimensional PHQ-9 reported significantly worse physical, functional, and emotional well-being than did their nondepressed counterparts. Study findings suggest a need for further investigation into the possibility that patients who score highly on the dimensional scoring system of the PHQ-9 but at values below threshold on the more commonly accepted categorical scoring system of the same measure would benefit from consideration for psychotherapeutic treatment.

Validity of the Wechsler Test of Adult Reading (WTAR): effort considered in a clinical sample of U.S. military veterans.

The current study represents an examination of the construct validity of the Wechsler Test of Adult Reading (WTAR) among a sample of U.S. military veterans referred for outpatient neuropsychological evaluation that included a measure of negative response bias, namely, the Test of Memory Malingering (TOMM). This retrospective data analysis examined the relationship between the WTAR and measures of current verbal general intellectual function and current cognitive skills. Findings showed that, among patients passing the TOMM (N = 98), WTAR scores were most highly correlated with current verbal IQ but also showed significant correlations with verbal memory and lesser, but still significant, correlations with measures of visual-spatial memory. Discriminant validity for the WTAR was also shown among the group passing the TOMM in the sense that the WTAR, which is designed to measure verbal premorbid general intellectual skill, was not as highly correlated with measures of learning and memory as was a measure of current verbal general intellectual skill. Whereas scores on most study measures did significantly differ between the groups that passed versus failed the TOMM (N = 26), scores on the WTAR did not, suggesting that the WTAR may remain robust even in the face of suboptimal effort.

Using grip strength force curves to detect simulation: a preliminary investigation.

Analysis of grip strength force curves has successfully detected suboptimal effort in industrial rehabilitation research. This study examined force curve analysis as an effort measure when grip strength was administered according to standardized neuropsychological procedures in a sample without reported neurologic and upper extremity injury. Eighty-two undergraduates were randomized to control (n = 26), naïve simulator (n = 28), and coached simulator (n = 28) conditions. Outcome measures included grip strength in kilograms, variables calculated from grip strength force curves, and the Word Memory Test (WMT). While average force in kilograms was not significantly different between groups, significant differences were found on the average to peak force ratio as calculated from grip strength force curves. The classification accuracy of average to peak force ratio was lower than the WMT, but comparable to other effort measures. Force curve analysis may warrant further study in a clinical sample.

Digit span age scaled score in middle-aged military veterans: is it more closely associated with TOMM failure than reliable digit span?

The relative usefulness of two digit span (DS) variables in detecting negative response bias, as defined by below cut-off performance on the Test of Memory Malingering (TOMM), was examined among primarily middle-aged military veteran outpatients who were judged clinically to be at increased risk for displaying negative response bias on cognitive testing. Digit span variables included DS Age Scaled Score (DS Age SS) and Reliable DS. Findings from this retrospective data analysis (N = 46) suggest that DS Age SS is preferable for use over Reliable DS in predicting TOMM failure. Results of the current study suggest that, particularly if the Wechsler scales are an existing part of the neuropsychological assessment, examination of DS Age SS is an efficient means of detecting negative response bias.

Associations of executive function with concurrent and prospective reports of obsessive-compulsive symptoms in schizophrenia.

Obsessive-compulsive symptoms (OCS) have been widely observed in schizophrenia and linked with concurrent deficits in executive function. Less clear though is whether OCS are prospectively linked with executive function independent of anxiety level. To explore these issues, OCS, state anxiety, and executive function were assessed among 41 participants with schizophrenia spectrum disorders. Measures of OCS and anxiety were then readministered 6 months later. Correlations revealed that a factor score derived from baseline measures of the inhibition domain of executive function was linked to both concurrent and future assessments of OCS even when state anxiety was controlled.

The Medical Symptom Validity Test in the evaluation of Operation Iraqi Freedom/Operation Enduring Freedom soldiers: a preliminary study.

The clinical utility of the Medical Symptom Validity Test (MSVT) for soldiers returning from service in Operation Iraqi Freedom or Operation Enduring Freedom was preliminarily investigated through retrospective chart review. Results showed that 17%, or 4 of 23, Operation Iraqi Freedom/Operation Enduring Freedom patients at a Polytrauma Network Site (Level 2), performed below cut-offs on the MSVT. On "easy" subtests of the MSVT, the group of individuals who failed the MSVT performed significantly worse than the group of individuals who passed. However, there were no significant group differences on the "hard" subtests of the MSVT. When the profiles of individuals who failed the MSVT were examined, none of them met the criteria for the Dementia Profile. These preliminary findings and additional test data supported the conclusion that participants who failed the MSVT were exhibiting diminished symptom validity, suggesting that the specificity of the MSVT was 100%.

Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment.

Literature from the turn of the 20th Century to the present suggests that obsessive-compulsive symptoms occur among persons with schizophrenia at rates that far exceed what is found among persons not suffering from psychoses. Less clear, however, is the significance of those symptoms. Are obsessive-compulsive symptoms, for instance, related to other aspects of schizophrenia or do they represent another isolated dimension of distress? To address this issue, a review of studies is presented that explores the relationships between obsessive-compulsive symptoms; positive, negative and depressive symptoms; psychosocial dysfunction; and neurocognitive deficits. Results are interpreted as indicating that obsessive-compulsive symptoms are linked with graver impairments in psychosocial function. Regarding the relationship between obsessive-compulsive symptoms and neurocognition, results from across a broad range of studies are equivocal. A review of studies of pharmacological treatments for obsessive-compulsive symptoms has also failed to produce consistent results. While some agents have been found to lead to improvement in obsessive-compulsive symptoms, other studies suggest that these medications may exacerbate those same symptoms. In general, it appears that, at best, there are currently few effective treatments. Directions for future research are reviewed. Recommendations include the development of tailored psychological and psychopharmacological interventions, and the implementation of longitudinal studies sensitive to the possibility that there are qualitatively distinct groups of patients with schizophrenia and obsessive-compulsive symptoms.

Is the Rey 15-Item Memory Test II (Rey II) a valid symptom validity test?: comparison with the TOMM.

The Rey 15-Item Memory Test II (Rey II) is a revised version of the original Rey Memory Test and is used as a measure of test-taking effort. In the present study, the concurrent validity of the Rey II was examined by comparing Rey II test scores to a well-established measure of symptom validity, the Test of Memory Malingering (TOMM). Retrospective chart review was conducted using the records of 60 veterans who were referred for outpatient neuropsychological testing and suspected of possible symptom exaggeration. Results of the study suggest that when compared to the TOMM, the Qualitative, as opposed to the Quantitative, scoring method of the Rey II was more discriminative, but showed both positive and negative predictive power that was unacceptably low, falling at .62 and .64, respectively. Clinical implications are discussed.

Is"chemobrain" a transient state? A prospective pilot study among persons with non-small cell lung cancer.

In patients with stage III non-small cell lung cancer (NSCLC), chemotherapy combined with radiation therapy modestly improves survival when compared with radiotherapy alone. In light of the small survival benefit,there is a need to quantify any potential loss of neurocognitive function that may result from chemotherapy in this patient population. The current study examines cognitive functioning in 14 stage III NSCLC patients who received treatment with cisplatin/etoposide/radiotherapy. Patients were assessed before receiving chemotherapy and at 1 and 7 months after treatment. At each time point, participants were administered a comprehensive battery of psychological and neuropsychological tests. In all, 71% of patients demonstrated cognitive impairment prior to any treatment. One month post chemotherapy, the majority of patients (62%) experienced cognitive decline; however, these negative effects apparently dissipated by 7 months post treatment, suggesting that the untoward effects of chemotherapy in these specific patients given this chemotherapy regimen may have been transitory. Cognitive decline did not appear to be associated with age, mood, fatigue, or quality-of-life measures. These findings demonstrated the importance of employing both a pre- and extended post-treatment assessment in chemotherapy research.

Utility of the response bias scale (RBS) and other MMPI-2 validity scales in predicting TOMM performance.

The present study represents a replication and extension of the original Response Bias Scale (RBS) validation study. In addition to examining the relationship between the Test of Memory Malingering (TOMM), RBS, and several other well-researched Minnesota Multiphasic Personality Inventory 2 (MMPI-2) validity scales (i.e., F, Fb, Fp, and the Fake Bad Scale), the present study also included the recently developed Infrequency Post-Traumatic Stress Disorder Scale and the Henry-Heilbronner Index (HHI) of the MMPI-2. Findings from this retrospective data analysis (N=46) demonstrated the superiority of the RBS, and to a certain extent the HHI, over other MMPI-2 validity scales in predicting TOMM failure within the outpatient Veterans Affairs population. Results of the current study confirm the clinical utility of the RBS and suggest that, particularly if the MMPI-2 is an existing part of the neuropsychological assessment, examination of RBS scores is an efficient means of detecting negative response bias.

IQ and scores on the Mini-Mental State Examination (MMSE): controlling for effort and education among geriatric inpatients.

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of "impaired" performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.

Awareness of illness in schizophrenia: associations with multiple assessments of executive function.

Though insight in schizophrenia is correlated with flexibility in abstract thought, it is unclear how differing dimensions of executive functions are linked to insight. Accordingly, the authors administered the Scale to Assess Unawareness of Mental Disorder and the Delis-Kaplan Executive Function System to 53 participants with schizophrenia spectrum disorders. Spearman Rho correlations revealed that symptom awareness was significantly related to Verbal Fluency, Color-Word, Tower, and Word Context scores. Awareness of treatment need was related to Color-Word, Tower, and Word Context tasks. Results suggest insight may be related to capacities to shift attention between differing environmental demands, plan ahead, and construct contextual understandings.

Obsessive-compulsive and negative symptoms in schizophrenia: associations with coping preference and hope.

Although agreement exists regarding the high occurrence of obsessive-compulsive (OC) symptoms in schizophrenia, it is less clear how OC symptoms are related to the traditional symptoms of schizophrenia and co-occurring deficits. One possibility is that there may be two distinct groups of persons with schizophrenia who experience OC symptoms: one group with poor and another with relatively good function. In the present study, the relationships between OC symptoms, coping, and hope were examined among 67 persons with schizophrenia spectrum disorders. First, participants with significant levels of OC symptoms were compared with participants without OC symptoms. Then, participants with significant levels of both OC symptoms and negative symptoms were compared with participants with negative symptoms, but no OC symptoms, and to participants with neither OC symptoms nor negative symptoms. Analysis of variance revealed participants with significant levels of OC symptoms were significantly more likely to experience greater levels of hopelessness and endorse a preference for avoidant focused coping strategies relative to participants without significant OC symptoms. Participants with both negative symptoms and OC symptoms also had less hope and greater preferences for ignoring stressors than participants with negative symptoms but no OC symptoms and participants with neither OC symptoms nor negative symptoms. Implications for theory, practice and research are discussed.

Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms.

Executive function deficits are seen in both schizophrenia and obsessive-compulsive disorder (OCD), but research suggests that dorsolateral prefrontal (DLPF) dysfunction is associated with schizophrenia and orbitofrontal (OBF) dysfunction is associated with OCD. As part of a comprehensive neuropsychological assessment, the Bechara Gambling Task (BGT) was used to assess OBF function and the Wisconsin Card Sorting Test (WCST) was used to assess DLPF function among three groups: 26 individuals with schizophrenia/schizoaffective disorder with obsessive-compulsive symptoms (SCZ+), 28 individuals with schizophrenia/schizoaffective disorder without obsessive-compulsive symptoms (SCZ-), and, 11 individuals with OCD. It was predicted that the SCZ+ group and the OCD group would show impairments in OBF function, as compared to the SCZ- group, and that the SCZ+ and SCZ- groups would show impairments in DLPF function, as compared to the OCD group. It was also predicted that the SCZ+ group would perform more poorly than the SCZ- and OCD groups in a number of other cognitive domains. Contrary to expectation, no divergence between groups was seen on tests of executive function. Instead, there was a statistical trend for the SCZ+ and SCZ- groups, when combined, to perform worse than individuals with OCD on the measure of OBF. Although not significant at the designated alpha level, the profile results showed that the SCZ+ group performed slightly below the OCD and SCZ- groups across nearly all neuropsychological domains.