The utility of the Poreh Nonverbal Memory Test (PNMT) for the detection of noncredible performance.

Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and- at times- reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.

Development of normative data for the Five Point Test using the cognitive reliability and time to failure rate theory.

In this study, several theoretically based curve fitting nonlinear models for analyzing the Five Point Test (FPT), a nonverbal fluency test, were examined. One thousand two hundred and one participants from the general population of Germany and the USA completed the FPT. The test scores were analyzed using three process indexes; the number of unique designs, strategy, and repetitions. Participants were stratified by age and level of education, and the resulting data were examined using best-fit nonlinear distribution equations. The study shows that the Weibull Growth three-factor curve fitting model provides equivalent fit as four-factor quadratic or linear curve fitting models for estimates continue normative data the Reliability and Time to Failure Theory of Cognitive Functions. Namely, that neurocognitive abilities remain stable during young adulthood and after reaching a threshold, starts to linearly or exponentially decline. The study also shows that education differentially impacts the asymptote, threshold, and decline rate of the FPT indexes confirming the importance of isolating specific cognitive domains within neuropsychological tests as these indexes might be related to the activation of particular cell assemblies, which in turn are differentially impacted by aging.

Preliminary validation of the computerized N-Tri - A Tri-Choice naming and response bias test.

The study describes the validation of a computerized adaptation of the novel Tri-Choice Naming and Response Bias Measure (N-Tri) developed to detect untruthful responding while being less susceptible to coaching than existing measures. We hypothesized that the N-Tri would have comparable sensitivity and specificity to traditional tests but would have improved accuracy for detecting coached simulators. Four-hundred volunteers were randomly assigned to one of three groups: uncoached simulators' group (n = 118), coached simulators' group (n = 136), or control group (n = 146). Both simulator groups were asked to feign concussion symptoms, but the coached group received a test-taking strategy and a description of concussion symptoms. The participants were administered the computerized version of the new measure in conjunction with computerized adaptations of two well-validated response bias tests commonly used to detect cognitive malingering, the Reliable Digit Span (RDS) and Portland Digit Recognition Test (PDRT). Our data show the new measure correlated highly with other established measures. However, the classification accuracy did not significantly increase when compared to the traditional tests. Our findings support that the N-Tri performs at a comparable level to existing forced choice measures of response bias. Nevertheless, the N-Tri could potentially improve the detection of response bias as existing tests become more recognizable by the public.

Impulsivity, aggression and suicide risk among male schizophrenia patients.

INTRODUCTION: Impulsivity has been shown to be a major variable in the etiology of suicide and aggression, but has not been researched as much in the schizophrenic population, which is characterized by serious suicide and aggression risks. METHODS: 68 male schizophrenia patients responded to a battery of measures including the Positive and Negative Syndrome Scale (PANSS), the impulsivity control scale (IS), the Suicide Risk Scale (SRS) and the Overt Aggression Scale. RESULTS: We divided our subjects into those who received scores above and below the median on the IS. The high-impulsivity group had higher present and past rates of suicidal ideation and showed a trend for more lifetime suicidal attempts than the low-impulsivity group. The impulsivity score correlated positively with the SRS score and with some of the scores of the PANSS (the positive symptoms score, the general psychopathology score and the total score). A multiple regression analysis revealed that an older age, higher levels of aggression, high impulsivity and an elevated score on the general psychopathology subscale of the PANSS contributed positively and significantly to the explained variance of the SRS. CONCLUSIONS: Our study supports the contention that high impulsivity in schizophrenia patients is significant in the etiology of suicide in schizophrenia. However, the relationship between impulsivity and aggression in schizophrenia patients, and also the amelioration of impulsivity by pharmacological interventions, require further study.

Geriatric Complex Figure Test: A test for the assessment of planning, visual spatial ability, and memory in older adults.

The present study describes the development of a simplified complex figure for older adults. This new figure is based on theoretical organizational strategy models developed for the Rey Complex Figure Test and combines several new technologies for the enhancement of the data capture. The study shows that the accuracy and memory scores for the new measure correlate significantly with Trail Making Test, Five Point Test, and RBANS Complex Figure scores. The new figure's strategy scores correlate with predominantly nonverbal and to a lesser extent with verbal executive functions, supporting the construct validity of these scores and illustrating that computer-based data recording methodologies can reliably discern the multiple cognitive operations that impact performance on this and similar graphomotor measures.

Circulatory neurosteroid levels in smoking and non-smoking chronic schizophrenia patients.

INTRODUCTION: Schizophrenia patients display an extremely high rate of smoking. Neurosteroids appear to play a possible role in the pathophysiology and management of schizophrenia and have been proposed to be involved in the pathophysiology of nicotine addiction. Although many studies have evaluated blood levels of neurosteroids in schizophrenia patients, only a few studies have taken into consideration the effect of smoking on levels of neurosteroids in the illness. METHODS: Forty-five DSM-IV-TR chronic schizophrenia patients were sampled for plasma levels of three steroids: cortisol, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulphate (DHEA-S). Patients were rated with the Positive and Negative Syndrome Scale (PANSS) and provided data on their smoking behavior. RESULTS: The mean level of plasma cortisol in our sample (N=45) was 197.9 nmol/L (S.D.=81.5), and the levels of DHEA and DHEA-S were 23 nmol/L (S.D.=5.5) and 4276.6 nmol/L (S.D.=2665.58), respectively. Despite a trend for lower levels of cortisol, DHEA and DHEA-S among the smokers, only DHEA, but not DHEA-S and cortisol, was significantly lower among the smokers (33% decrease, p=0.012). Smoking predicted the positive and negative scores of the PANSS, whereas cortisol was correlated with the PANSS-negative subscale. CONCLUSIONS: Smoking in chronic schizophrenia patients appears to be associated with lower DHEA levels. The role of this decrease in the pathophysiology of nicotine addiction and schizophrenia merits further investigation.

Prevalence of self-reported specific phobia symptoms in an Israeli sample of young conscripts.

Specific phobia is a very prevalent disorder with high comorbidity rates. The aim of this study was to assess prevalence of specific phobia symptoms in a sample of Israeli young adults. Eight hundred fifty young Israeli soldiers participated in the study. Measures included a questionnaire on specific phobias and a socio-demographic questionnaire. Data on eight specific fears representing DSM-IV-TR specific phobias were analyzed to evaluate prevalence of phobic symptoms and find potential socio-demographic correlates. Prevalence of fears and specific phobic symptoms was 49.1 and 8.7%, respectively. Most frequent phobic symptoms were from animals, being alone, heights, injury and closed places. The following variables were accompanied by more phobic symptoms: male gender, role of mechanic, not having completed the matriculation exams, lack of friends and romantic relationships, therapy prior to enlistment or during the military service and having received psychotropic drugs in the past. Based on a stepwise regression analysis, the following variables contributed significantly to the prediction of phobic symptoms: lack of friends and romantic relationships, school absenteeism and role of mechanic. Our findings corroborate results from other studies in the Western world regarding the high prevalence of specific phobia symptomatology, as well as its distribution and socio-demographic correlates.

Base-rate data and norms for the Rey Auditory Verbal Learning Embedded Performance Validity Indicator.

The present study examines the Rey Auditory Verbal Learning Test (RAVLT) Embedded Performance Validity Indicator (EPVI) for detecting performance validity. This retrospective study analyzes the performance of four groups of 879 participants comprised of 464 clinically referred patients with suspected dementia, 91 forensic patients identified as not exhibiting adequate effort on other measures of response bias, 25 patients with well documented TBI, and a random sample of 198 adults collected in the Gulf State of Oman. The EPVI was also put to the test using normative data collected from the literature. Using sensitivity and specificity analyses, the results indicate moderate to high sensitivity yet low specificity. In conclusion, the study shows that the EPVI is a reasonably good indicator for inadequate effort on the RAVLT but those who fail this measure might not necessarily be exhibiting adequate effort. The limitations and benefits of utilizing the EPVI in clinical practice are discussed.

Anterograde and retrograde amnesia in a person with bilateral fornix lesions following removal of a colloid cyst.

AD, a 45-year-old man, presented with a severe and global anterograde amnesia following surgery for removal of a colloid cyst. Structural neuroimaging confirmed bilateral lesions to the fornix and a small lesion in the basal forebrain. Testing for remote episodic memory of autobiographical events, and for remote semantic memory of personal and public events, and of famous people, revealed that AD had a severe retrograde amnesia for autobiographical episodes that covered his entire lifetime, and a time-limited retrograde amnesia for semantic memory. Because the fornix and basal forebrain lesions disrupted major afferent and efferent pathways of the hippocampus, it was concluded that the integrity of the hippocampus and its projections are needed to retain and/or recover autobiographical memories no matter how old they are. By contrast, hippocampal contribution to semantic memory is time-limited. These findings were interpreted as consistent with Multiple Trace Theory, which holds that the hippocampal system is essential for recovering contextually rich memories no matter how old they are, but is not needed for recovering semantic memories.

Increased suicidal risk among smoking schizophrenia patients.

INTRODUCTION: Schizophrenia patients display a high suicidal risk, although this risk is difficult to predict. One of the variables associated with increased suicide risk is smoking. In the present study, we assessed the suicidal risk in schizophrenia patients, smokers and nonsmokers. We also evaluated the impact of various variables such as psychotic symptoms, impulsivity, and extra-pyramidal side effects on suicidal risk. METHODS: Sixty-one schizophrenia patients responded to a battery of measures, including the suicidal risk scale (SRS), the positive and negative syndrome scale (PANSS), the impulsivity control scale, and the Simpson Angus Scale for extrapyramidal side effects. The effect of smoking on the various measures, especially suicidal risk, was examined. RESULTS: Schizophrenia patients who smoke obtained higher PANSS scores (both total score and positive and negative subscales), but did not differ on the Simpson Angus scale of extrapyramidal side effects. They also exhibited higher suicide risk as reflected by higher scores on the SRS, and a trend for higher impulsivity as measured by the impulsivity control scale. Women that smoked had higher SRS scores as compared with female nonsmokers, and also higher than in males, smokers and nonsmokers. Smoking and a history of suicide attempt predicted in our regression analysis a higher SRS score. When conducting separate analyses for the male and female patients, the significant contributors were the PANSS total score among the males and the number of pack-years among the female patients. CONCLUSIONS: Despite hints toward the role of smoking in suicidal behavior in Schizophrenia, especially among female patients, more studies are needed to elucidate the association between smoking and suicidality in schizophrenia patients.

The BPQ: a scale for the assessment of borderline personality based on DSM-IV criteria.

The aim of the study was to develop a self-report measure that assesses borderline personality traits as defined by DSM-IV criteria, including separate subscales for each criterion. A sample of normal subjects from community colleges in the midwestern region of the United States was used to develop the scale. The psychometric properties of the scale were examined using an additional United States sample and student samples from England and Australia. The scale was compared with existing measures of borderline and schizotypal personality. Evidence for the internal consistency and convergent and divergent validity of the new scale is presented. The results of several analyses of variance comparing males and females in the three national groups are reported. A Principal Components Analysis of the subscales suggested either a single factor or two correlated factors. Oblique rotation yielded a structure that distinguished identity/interpersonal and impulsivity borderline personality traits. It is concluded that the new scale provides a useful tool for clinicians and researchers interested in screening for borderline personality traits in both general and clinical populations. Suggestions for further research are indicated.

The Rey Auditory Verbal Learning Test forced-choice recognition task: Base-rate data and norms.

The present study describes a novel Forced-Choice Response (FCR) index for detecting poor effort on the Rey Auditory Verbal Learning Test (RAVLT). This retrospective study analyzes the performance of 4 groups on the new index: clinically referred patients with suspected dementia, forensic patients identified as not exhibiting adequate effort on other measures of response bias, students who simulated poor effort, and a large normative sample collected in the Gulf State of Oman. Using sensitivity and specificity analyses, the study shows that much like the California Verbal Learning Test-Second Edition FCR index, the RAVLT FCR index misses a proportion of individuals with inadequate effort (low sensitivity), but those who fail this measure are highly likely to be exhibiting poor effort (high specificity). The limitations and benefits of utilizing the RAVLT FCR index in clinical practice are discussed.

Cognitive functions in severe congestive heart failure before and after an exercise training program.

BACKGROUND: Congestive heart failure is associated with cognitive impairment, particularly of attentional skills. We assessed, in a hypothesis-generating study, the effect of an exercise training program on cognitive functions among patients with severe congestive heart failure. METHODS: Patients with severe congestive heart failure (n=20; New York Heart Association functional class III; left ventricular ejection fraction < or =35%) were evaluated before and following a standardized and supervised exercise training program (x2/week for 18 weeks; exercise group), while 5 additional patients did not undergo an exercise training program (control group). A battery of cognitive tests was used to assess cognitive functions. Physical performance was assessed by the 6-min walk test and the modified Bruce exercise test, cardiac index and systemic vascular resistance using thoracic electrical bioimpedance, and cerebral vasomotor reactivity to hypercapnia by means of the breath-holding index using transcranial Doppler. RESULTS: Time of completion of the trail making A (105+/-116 to 75+/-52; p=0.02) and B (169+/-100 to 119+/-65; p=0.002) tests, and of the Stroop part A (40+/-13 to 37+/-13; p=0.04) was shorter in patients completing the exercise training program, but not in control patients, while the other neuropsychological measures remained unchanged in both groups. Cerebral vasomotor reactivity to hypercapnia remained diminished (breath-holding index 0.64+/-0.27 vs. 0.68+/-0.37) despite significant improvements in exercise capacity (6-min walk test 308+/-87 to 423+/-91 m, p<0.001; modified Bruce exercise test 5.6+/-3.8 to 9.8+/-3.4 min, p<0.001). CONCLUSIONS: Patients with severe congestive heart failure undergoing an exercise training program improve in some measures of cognitive functions that are limited to general attention and psychomotor speed. Based on these preliminary findings, further evaluations are designed within the framework of a larger controlled clinical trial.

Analysis of mean learning of normal participants on the Rey Auditory-Verbal Learning Test.

Analysis of the mean performance of 58 groups of normal adults and children on the free-recall trials of the Rey Auditory-Verbal Learning Test shows that the mean auditory-verbal learning of each group is described by the function R1 + Sln(t), where R1 is a measure of the mean immediate memory span, S is the slope of the mean logarithmic learning curve, and ln(t) is the natural logarithm of the trial number t. The analysis also shows that R1 varies with age and other demographic factors, whereas S is almost a constant, and it yields equations for estimating the effect of these factors on R1. Potential use of these findings for assessment of auditory-verbal memory and learning in comparative clinical studies is discussed.

Psychiatric inpatients' reactions to the SARS epidemic: an Israeli survey.

BACKGROUND: The threat of the potential spreading of the SARS epidemic caused significant stress to many individuals from non-affected countries. In this study, we investigated whether the SARS threat affected the subjective mood and behavior of Israeli patients with schizophrenia and compared their reactions with those noted in their clinical staff. METHODS: Subjects were evaluated with a specially designed questionnaire and a modified form of the Spielberger Scale for State Anxiety. RESULTS: As compared to staff, patients had higher scores on the Modified Spielberger State Anxiety Scale. However, many responses (e.g., dysphoria) to the SARS threat did not differ from staff. Patients felt more protected by the authorities and some perceived the epidemic in a psychotic manner. CONCLUSIONS: It seems that patients attempt to reduce the effect of external stressors by living in an "autistic bubble" (in which outside threats cannot enter) or by denying the significance of these stressors and over-emphasizing the power of medical authorities to protect them. On the other hand, some patients also psychotically interpreted these stressors.

The effects of second-language acquisition on verbal fluency among elderly israelis.

The present study investigated the effect of age of second-language acquisition (Hebrew) on verbal fluency in a random sample of 196 elderly Israelis from four distinct ethnic groups. Using conventional statistics, it was shown that phonemic fluency, particularly switching, is associated with education and the age of Hebrew acquisition, while semantic fluency, particularly clustering, is associated with age. Ethnic differences were not significant after controlling for the age of Hebrew acquisition and education. Additional analyses show that the tendency of subjects to use borrowed, non-Hebrew words on the phonemic fluency task was associated with lower total scores on this task and later age of Hebrew acquisition. In contrast, the tendency to use non-Hebrew words on the semantic fluency task was associated with age and higher total scores. These findings are discussed with regard to recent functional imaging studies of bilingual subjects. Such findings indicate that native and second languages form distinct areas of activation in the dominant anterior language area, an area often associated with phonemic processing and switching, whereas an overlap of activation of various languages has been demonstrated within the posterior language areas, those that are often associated with semantic processing.

Czech version of Rey Auditory Verbal Learning test: normative data.

The present study provides normative data stratified by age for the Rey Auditory Verbal Learning test Czech version (RAVLT) derived from a sample of 306 cognitively normal subjects (20-85 years). Participants met strict inclusion criteria (absence of any active or past neurological or psychiatric disorder) and performed within normal limits on other neuropsychological measures. Our analyses revealed significant relationships between most RAVLT indices and age and education. Normative data are provided not only for basic RAVLT scores, but for the first time also for a variety of derived (gained/lost access, primacy/recency effect) and error scores. The study confirmed a logarithmic character of the learning slope and is consistent with other studies. It enables the clinician to evaluate more precisely subject's RAVLT memory performance on a vast number of indices and can be viewed as a concrete example of Quantified Process Approach to neuropsychological assessment.

The Cleveland Sorting Test: a preliminary study of an alternate form of the Wisconsin Card-Sorting Test.

During the past two decades, studies have repeatedly shown that the Wisconsin Card-Sorting Test (WCST) is not as sensitive to prefrontal-lobe functioning as was originally suspected. Specifically, both clinical and brain-imaging studies have shown that several distinct neural circuits contribute to one's ability to successfully complete different aspects of the test. Another limitation of the WCST is its length, which makes it difficult and frustrating for certain clinical populations. To address the above limitations, researchers have proposed the development of new indexes and the integration of an adaptive testing approach that will allow for the premature termination of the test. Unfortunately, given the proprietary nature of the WCST, none of the above recommendations have been adopted. The present preliminary study examined an alternate form of the 64-Item WCST (WCST-64), the Cleveland Sorting Test (CST-64). The normative data of the two measures as well as the total number of errors, perseverative responses, perseverative errors, and categories completed were compared using a repeated-measures design. Overall, the study supports psychometric approximation of the CST-64 and the WCST-64. Suggestions for future studies and modifications of the CST-64, including the use of recently proposed indexes and adaptive administration approaches, are provided.

Czech version of the Trail Making Test: normative data and clinical utility.

The Trail Making Test (TMT) comprises two psychomotor tasks that measure a wide range of visual-perceptual and executive functions. The purpose of this study was to provide Czech normative data and to examine the relationship between derived TMT indices and demographic variables. The TMT was administered to 421 healthy adults. Two clinical groups (n = 126) were evaluated to investigate the clinical utility of the TMT-derived scores: amnestic mild cognitive impairment (n = 90) and Alzheimer's disease (n = 36). Statistical analyses showed that age and education, but not gender, were significantly associated with TMT completion times and derived scores. Of all the indices, only the TMT ratio score was insensitive to age. We present normative values for the Czech version of the TMT, providing a reference for measuring individual performance in native Czech speakers. Moreover, we found that accuracy on the TMT was improved with the attenuation of age.

The Rey Auditory Verbal Learning Test: normative data for the Arabic-speaking population and analysis of the differential influence of demographic variables

The Rey Auditory Verbal Learning Test (RAVLT) is the one of the most widely used neuropsychological tests of verbal memory. It has been translated into numerous languages including Spanish, German, Arabic, Hebrew, Czech, Portuguese, and English. The present study examined the hypothesis that the learning of word lists forms an algorithmic pattern across all cultures. To this end, a sample of 200 Arabic-speaking Omani adults between the ages of 18 and 50 years was collected. The resulting norms were then compared withexisting American and Brazilian samples. The study confirmed that the first trial on the RAVLT correlates with demographic variables, whereas the learning slope on subsequent trials is almost identical across all cultures. Based on the above finding, the slope of the verbal learning test is hypothesized to measure a psychophysiological process linked with the hippocampal formation and allows for the laying down of new memories. In contrast, the first trial of the test is amenable to more cultural, demographic, and environmental factors.