MMPI-2 interpretation of patients with cerebrovascular disease: a correction factor.

The validity of the conventional Minnesota Multiphasic Personality Inventory (MMPI) interpretation as applied to neurologic patients has been increasingly questioned on the grounds of the test's psychiatric normative base and inclusion of items that may be sensitive to bona fide neurologic symptoms. This study used 110 patients with cerebrovascular disease (CVD) to (i) determine whether the 370-item pool of the MMPI-2 (abbreviated form) contains a unitary neurologic symptom factor, and (ii) devise a systematic approach to correct for patient endorsement of such items. Commonly endorsed items that differentiated the CVD sample from a group of normal adults were factor analyzed. Bona fide neurologic complaints (21 items) emerged as the major discriminative source of variance in the 370 MMPI-2 item pool that tends to inflate estimates of psychopathology (Scales 1, 2, 3, and 8), alter profile codes types, and potentially affect decision-making related to the diagnosis and treatment of CVD patients. Recommendations regarding a greater reliance upon content scales and the use of a corrective scoring key are discussed.

A procedure for assessing storage and retrieval on the Wechsler Memory Scale-Revised.

A methodology to assist in distinguishing deficient memory storage from compromised retrieval operations is presented for use with the Logical Memory (LM) and Visual Reproduction (VR) subtests of the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987). A 21-item five-option multiple choice recognition test for LM and a cuing technique for VR are presented, followed by descriptive data based on a sample of 94 psychiatric inpatients (mixed diagnoses) and a sample of 99 brain-injured (BI) patients. The BI sample performed worse than the psychiatric sample on all of the LM and VR measures, with VR-CUED showing the highest degree of discrimination. In both groups, many subjects initially acquired much more information than they reported during the standard free recall format. The supplemental scoring format and reference data reported herein provide clinically useful information regarding a person's ability to store and access new information.

MMPI-2 interpretation and closed-head trauma: cross-validation of a correction factor.

A substantial body of research suggests that the MMPI-2 contains a number of items that are sensitive to closed-head trauma (CHT) and other neurologic conditions. A correction procedure was recommended by Gass (1991) using an index consisting of 14 neurologically sensitive items that were extracted from a predominantly male veteran sample of CHT patients. The generalizability of these correction items was assessed in the present study by investigating the MMPI-2 scoring characteristics of an outpatient referral sample of 54 CHT patients (28 male, 26 female) who had sustained recent and mild head trauma. Their frequency of endorsement of MMPI-2 was contrasted with that of the MMPI-2 normative sample (N = 2,600). Chi-square analyses identified the 15 MMPI-2 items that best differentiated this CHT sample from normal subjects. The results indicate that: (a) unlike those in an inpatient psychiatric sample (n = 524), the MMPI-2 items that best distinguished the CHT Ss from normals consisted of neurologic symptom content; (b) of these 15 items, 10 were included in the 14-item correction (Gass, 1991); and (c) 13 of the 14 correction items effectively discriminated the cross-validation sample of CHT Ss from normals. These findings offer empirical support for the application of the MMPI-2 correction with patients who have mild and recent head trauma.

MMPI correlates of poststroke neurobehavioral deficits.

MMPI profiles of 130 male veterans with cerebrovascular accidents were examined in relation to type and degree of neuropsychological deficit, hemispheric location of lesion, and time poststroke. Three neurobehavioral factors (Verbal, Visuospatial, Sensorimotor) were extracted from the Halstead-Reitan Battery and Wechsler Memory Scale. Canonical analyses revealed verbal impairment to be associated with greater openness in reporting emotional difficulties (Scale F) and limited social facility (Scale Hy). Sensorimotor deficits were associated with anxiety and distress (Pt) in patients with left hemisphere (LHD) but not right hemisphere damage (RHD). Although RHD and LHD patients had similar composite MMPI profiles, neuropsychological deficits in RHD were unrelated to MMPI scores. Time poststroke was independent of MMPI findings in both LHD and RHD samples.

Familial Creutzfeldt-Jakob disease: a neuropsychological case study.

The spectrum of neuropsychological features of familial Creutzfeldt-Jakob disease (CJD) have seldom been reported, possibly because of (a) the rarity of this hereditary form of prion disease; (b) frequent delays in diagnosis, and; (c) the typically rapid demise of the patient, which affords little opportunity for comprehensive testing or serial analysis. Here we describe the neurobehavioral characteristics of a 48-year-old right-handed male (JD) who presented with complaints of poor depth perception, unsteady gait, and unusual sensory experiences in his face and neck. JD was followed serially over the final 4 months of his 5-month illness. Immediately following hospital admission, he underwent a neuropsychological evaluation that revealed moderate to severe impairment of delayed (30-minute) verbal memory, tactual performance in his right hand, and word-finding ability. In contrast, other abilities that are commonly classified within the verbal, visuospatial, and memory domains showed minimal or no compromise. Parallel studies of electroencephalographic activity revealed diffuse slowing and, later, 1-Hz rhythmical discharges over the left hemisphere, and mild prominence of the lateral ventricles and cerebral sulci on magnetic resonance imaging. Autopsy revealed spongiform changes and reactive astrocytosis, and genetic testing demonstrated a codon 200 mutation in the prion protein gene. These findings indicate that CJD can result in clinical manifestations compatible with multifocal asymmetric cerebral involvement before more diffuse neurodegeneration ensues, providing a strong impetus for the study of additional cases. This long-term understanding can help to determine whether the multiple loci of clinical involvement are specified by genetic or epigenetic factors, or both.

MMPI-2 scale F(p) and symptom feigning: scale refinement.

The F(p) scale of the MMPI-2 is widely used to help identify exaggeration of psychological problems in psychiatric, forensic, and neuropsychological settings. The scale was constructed by selecting all MMPI-2 items (N = 27) that were endorsed by less than 20% of a sample of VA psychiatric inpatients and 20% of the normative sample used in restandardizing the MMPI-2. Although F(p) is used to measure symptom exaggeration and malingering, 4 of its 27 items load on the Lie (L) scale, which is known to be a measure of defensiveness and symptom underreporting. These four items, which express a denial of occasional anger, irritability, and procrastination, could conceivably measure an uncommon expression of defensiveness. This study used 150 neuropsychological referrals to test the hypotheses that (a) the four L scale items measure defensiveness, not exaggeration, and (b) the elimination of these items improves the utility of F(p) in assessing symptom exaggeration. The results indicate that the four L scale items are associated with defensiveness, not with symptom exaggeration. One third of the patients had an average T-score artifact of 9.5 points on F(p) as a result of endorsing these L scale items, with a range of 0T to 21T. Using the K scale as a criterion for level of problem disclosure, a shortened version of F(p) (omitting the four L scale items) was superior to F(p) as a measure of symptom exaggeration (r = -.46 vs. -.36, r2 = 21% vs. 13% of the variance). The implications for clinical practice are discussed.

MMPI-2 short form: psychometric characteristics in a neuropsychological setting.

A 180-item short form of the MMPI-2 (MMPI-2-180) was recently developed by Dahlstrom and Archer and has been proposed for clinical use under special circumstances. This study investigated the psychometric characteristics of the MMPI-2-180 in order to delineate its strengths, limitations, and appropriate scope of clinical application. Using a neuropsychological referral sample (N = 205), we examined accuracy of the short-form as it pertains to the following (a) the prediction of basic scale scores and profile code types, (b) the identification of high-point scales, and (c) the classification of scores as pathological (T > or = 65) or normal range. The results indicate that the MMPI-2-180 provides an unreliable basis for predicting clinical code types, identifying the high-point scale, or predicting the scores on most of the basic scales. In contrast, scores on the MMPI-2-180 are accurate predictors of whether the full-scale scores fall within the pathological range (T > or = 65). These findings suggest that (a) standard interpretive procedures involving profile configuration should not be used, in most cases, with the 180-item short-form results, (b) properly interpreted, this shortened version provides potentially useful information regarding the probable presence of various problem areas, and (c) this information is very limited when contrasted with that obtained using the complete or abbreviated (i.e., 370 item) version of the MMPI-2.

Interpretation of VIQ-PIQ and intersubtest differences on the Spanish version of the WAIS.

Although the Spanish version of the Wechsler Adult Intelligence Scale (WAIS; Escala de Inteligencia Wechsler para Adultos [EIWA]) is the most frequently used intellectual assessment for Spanish speaking clients in the United States, there is little information available on score differences necessary to establish reliable and abnormal differences between Performance IQ (PIQ) and Verbal IQ (VIQ), and between the various subtests of the EIWA. The present study, based on EIWA standardization data (N = 616 Puerto Ricans), reports reliability data and base rates to assist in evaluating the clinical significance of PIQ-VIQ differences. The results demonstrated substantial similarity between the EIWA and the English versions of the Wechsler tests. The interpretation of these differences is discussed, and tables are presented of statistically and clinically significant differences.

Emotional impact on trail making test performance.

This study assessed the effect of emotional factors on Trail Making Test Part B performance for a sample of 105 neuropsychological referrals for whom there was no neurodiagnostic evidence of brain damage. Trails B scores declined in relation to elevated MMPI scores on Scales 6, 7, and 8, though only nine patients performed within the impaired range. The results suggest that (a) Trails B performance is resilient to a variety of emotional influences, (b) psychotic symptoms and severe anxiety impede Trails B performance, though rarely to the extent caused by brain damage, and (c) the MMPI provides objective criteria that help rule out emotional effects on Trails B performance.

Emotional variables and neuropsychological test performance.

Although previous studies have demonstrated the general success of neuropsychological tests in discriminating brain-impaired patients from normals and patients with psychiatric disorders, limited attention has addressed the more specific effects of emotional disturbance on test performance. This study investigated MMPI correlates of Halstead-Reitan test (HRB) performance in a sample of 105 neuropsychological referrals (predominantly psychiatric) who had negative neurologic findings. The results indicated significant effects for age and education on many of the tests, with smaller but statistically significant relationships between the quality of HRB test performance and MMPI scores.

MMPI-2 interpretation and stroke: cross-validation of a correction factor.

Accumulating data indicate that the MMPI-2 contains items that may be sensitive to neurologic conditions independent of a patient's psychological status. Gass (1992) identified 21 stroke-related MMPI/MMPI-2 items which were recommended for use as a score-correction index. This study examined these items using a cross-validation sample of 50 VA stroke patients. Item endorsement rates were contrasted with those of the MMPI-2 normative sample. The following results were obtained: The MMPI-2 items that distinguished stroke patients from normals have neurologic symptom content, all 21 correction items were upheld as effective discriminators, and the 21 items were commonly endorsed by the CVA patients (mean = 52%, range: 22% to 75%). These findings support the composition of the MMPI-2 correction for stroke and the rationale on which its application is based.

Therapeutic influence as a function of therapist attire and the seating arrangement in an initial interview.

Investigated the impact of therapist attire and seating arrangement on observers' perceptions of a therapist's attractiveness, expertise, and trustworthiness in an initial interview analogue. Each of 233 undergraduates listened to an audiotaped interview segment while viewing a synchronized slide presentation of a male therapist in one of four conditions cross-matched on attire formality (coat and tie vs. sports shirt) and seating arrangement (behind desk vs. no desk). Significant effects emerged for therapist attire, seating arrangement, and S gender. The casual attire/no desk setting elicited the highest attraction ratings, and the effects of the seating arrangement were mediated by the S gender. Females responded to the behind-desk arrangement with lower ratings of the therapist across all measures. Initial impressions, which were influenced by the therapist's attire and seating arrangement, were correlated highly with Ss' willingness to see this therapist for consultation.

MMPI correlates of performance intellectual deficits in patients with right hemisphere lesions.

This study investigated the emotional adjustment of 50 patients with focal brain damage in the right hemisphere (RHD). The impact of functional loss (as assessed by the WAIS Performance IQ) was assessed by a multivariate comparison of the composite MMPI profiles of these patients as classified into three groups: Below Average, Average, and Above Average Performance IQ. Regardless of the extent of decline in Performance-related abilities, right hemisphere impairment was associated with symptoms of mild depression, loss of initiative, anxiety, denial, and somatic preoccupations. MMPI scores were not correlated significantly with their WAIS Performance IQs. Implications for neuropsychological assessment are discussed.

MMPI correlates of verbal-intellectual deficits in patients with left hemisphere lesions.

This study investigated the emotional adjustment of patients (N = 31) with left hemisphere damage (LHD) as a function of the degree of impairment in verbal intelligence as measured by the Wechsler Adult Intelligence Scale. A multivariate comparison was made of the composite MMPI profiles of three groups of LHD patients classified according to Verbal IQ. The three groups produced fairly similar composite profiles, which indicated the presence of mild dysphoria, dissatisfaction, withdrawal, decreased initiative, and mild somatic preoccupations. Significant correlations emerged between the degree of verbal-intellectual disability and MMPI F, PT, SC, and SI. However, when the variance in MMPI scores due to premorbid status (education) was partialled out, these correlations dropped to nonsignificant levels. These findings failed to support previous studies that linked verbal deficits with emotional disturbance, and they underscore the importance of premorbid intelligence in the psychological adjustment to organic impairment.

MMPI profiles of closed head trauma patients: impact of neurologic complaints.

The MMPI is used commonly with neurologic patients despite concerns about its validity with this population. The basis for this concern--possible artifactual effects due to neurologic-related MMPI items (NRIs)--was assessed in this study of 58 closed head trauma (CHT) patients. The MMPI profiles of these patients were analyzed before and after statistical correction was made for 42 NRIs that were identified by three neurologists. Significant effects occurred on Scales 1 (HS), 2 (D), 3 (HY), 7 (PT), and 8 (SC) in regard to their T scores, frequency of pathological elevation (T greater than 69), and representation in configural codes. The results suggest that MMPI content scales and subscales may help to distinguish the relative contribution of neurologic and emotional complaints on MMPI profiles.

Cognitive complaints in closed-head injury: relationship to memory test performance and emotional disturbance.

Self-appraisal of cognitive difficulties by a sample of 63 male patients with closed-head injury (CHI) was examined in relation to their performance on the Wechsler Memory Scale - Revised (WMS-R; Wechsler, 1987), WAIS-R Digit Span (Wechsler, 1981), and to their scores on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) measures of anxiety and depression. In an initial step, the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), consisting of 39 self-report items, was factor analyzed using a sample of 255 consecutive neuropsychological referrals with documented brain impairment. Seven orthogonal dimensions emerged: Attention and Concentration, Orientation and Memory, Praxis, Domestic Activities, Facial Recognition, Task Efficiency, and Errand and Name Recall. Within a sample subset consisting of 63 patients with CHI, subjective complaints on the CDS were predictive of WMS-R Logical Memory performance (r = -.51, p < .0005). In contrast, CDS scores were generally poor predictors of Digit Span and Visual Reproduction scores (rs < .31). Cognitive complaints were also associated with emotional distress on the MMPI-2. The CDS appears to be a useful measure of self-appraised cognitive difficulties in patients with CHI, and may assist in the assessment of their self-reflective insight.

Emotional correlates of fluency test and maze performance.

This study tested the hypothesis that depression, anxiety, and bizarre thought content, as measured by MMPI-2 scales, would show a negative relationship with performance on widely used measures of executive functioning. Subjects were 70 male psychiatric patients who were ostensibly free of any neurologic disease or history of substance abuse. Correlational analyses were performed between age and education-corrected scores on the Controlled Oral Word Association Test (FAS), Design Fluency, and WISC-R Mazes, and scores on MMPI-2 scales D, PT, Anxiety, Fears, Obsessional Thinking, Depression, and Bizarre Mentation. The findings suggest that fluency and maze performance is (1) largely independent of measures of depression (D, DEP) and bizarre mentation (BIZ); (2) mildly associated with a measure of generalized anxiety (ANX); and (3) strongly related to an MMPI-2 measure of fearfulness (FRS).

Factor analysis of the WISC-R (Spanish version) at 11 age levels between 6 1/2 and 16 1/2 years.

The Spanish version of the Wechsler Intelligence Scale for Children-Revised (WISC-R, Wechsler, 1974)-the Escala de Inteligencia para Niños-Revision (EIWN-R, Wechsler, 1982)-has a potentially important role in the assessment of Hispanic children. However, little is known regarding its psychometric characteristics. This study used the normative data from the EIWN-R standardization sample (N = 532 Cuban Americans) to examine its factorial composition and general comparability with the WISC-R. Within each of the 11 age groups (ages 6 1/2 to 16 1/2), the correlation matrix of raw scores was subjected to a principal components analysis and varimax rotation. The results supported a 2-factor solution across age groups roughly corresponding with Wechsler's verbal and performance dimensions. The existence of a meaningful third factor, which has empirical support in the WISC-R literature, failed to emerge for the EIWN-R.