Patterns of verbal learning and memory in traumatic brain injury.

CVLT and WMS-R Digit Span variables were used to calculate indexes of seven specific short- and long-term memory processes: working memory span and central executive functions, and long-term memory encoding, consolidation, retention, retrieval, control abilities. Scores on these indexes were then cluster-analyzed to determine whether subtypes of memory performance exist that correspond to deficits in these theoretical memory constructs. Parallel analyses were conducted with two large samples (N = 150 and N = 151) of individuals who had sustained a traumatic brain injury (TBI). Findings showed that TBI results in subgroups of memory disorders with specific deficits in consolidation, retention, and retrieval processes. Control problems (keeping track of list versus non-list items) only appeared in conjunction with retrieval deficits. Working memory span and central executive functioning (i.e., the ability to manipulate information in working memory) do not appear to be deficits characteristic of TBI as no such clusters emerged in the analyses. By using specific indexes of memory processes, and in contrast to previous studies, patterns of memory dysfunction were found that correspond to deficits in theoretically meaningful memory constructs.

Material-specific memory in traumatic brain injury: differential effects during acquisition, recall, and retention.

Material-specific memory refers to the ability to learn and recall new episodic information on the basis of the nature of the stimulus material (e.g., verbal vs. nonverbal-visuospatial). Structural equation modeling was used to analyze data from a sample of patients with traumatic brain injury to compare 3 models of memory functioning: material-specific, material-specific plus general, and general (non-material-specific). The models were examined separately for acquisition, delayed free recall, and retention aspects of memory. Results suggest that, at least in a population with traumatic brain injury, the acquisition of new information takes place in a material-specific memory fashion, delayed free recall involves both material-specific and general (non-material-specific) memory components, but retention relies primarily on general (non-material-specific) memory processes.

Verbal learning and memory deficits in traumatic brain injury: encoding, consolidation, and retrieval.

The present study examined the nature of verbal memory deficits in individuals with traumatic brain injury (TBI) compared to healthy controls. The study was designed to control for methodological shortcomings of previous related research. Three groups of participants were used: (a) a head injured sample with moderate to severe traumatic brain injuries (N=55), (b) a control sample matched on age and initial performance on CVLT Trial 5 and Sum of Trials 1 to 5 (N=55), and (c) a control sample matched on age, education, and race, but not on initial CVLT learning performance (N=55). Current findings indicate that: (a) rate of learning was comparable across groups, consistent with no encoding differences, (b) TBI patients have a significantly more rapid rate of forgetting of new information than either acquisition-matched or demographic-matched controls, consistent with consolidation problems in TBI, (c) TBI patients have less proactive interference than demographic-matched control participants, consistent with a consolidation problem in the TBI group, (d) TBI patients and acquisition-matched controls have comparably low rates of proactive interference, consistent with impaired acquisition in both of these groups, and (e) TBI patients and controls do not differ in the benefit experienced from semantic or recognition retrieval cues, consistent with no differences in retrieval processes. These data support an impaired consolidation hypothesis, rather than encoding or retrieval deficits, as the primary deficit underlying memory impairment in TBI.

Malingering assessment: evaluation of validity of performance.

Consideration of symptom exaggeration or overt malingering is of particular importance in assessment of alleged mild head trauma and other mild or questionable personal injury situations. Validity is the extent to which tests assess what they were designed to measure. The determination of invalidity is part of the overall neuropsychological interpretation process. In neuropsychology a line of validity assessment research has developed, leading to three general approaches to validity and/or malingering assessment: (a) symptom validity measures, (b) invalid patterns of performance on clinical neuropsychological measures, and (c) concomitant extra-test behavioral information or observations. In each case some aspect of behavior is compared to an external standard or to other intra-subject behavior. Inconsistencies and discrepant comparisons are cause for validity concerns. These approaches are described and recommendations are provided based on the extant literature. However, validity assessment is difficult and at times ambiguous in part because real and feigned deficits are not mutually exclusive. In some clinical situations the most that can be said about an invalid performance is that it is not indicative of the true neurobehavioral capabilities of the person being evaluated, and is not consistent with the presumed etiologic event.

Acute impact of severe traumatic brain injury on family structure and coping responses.

Family stress following traumatic brain injury (TBI) is well documented. Previous studies have shown that family adaptation and the use of coping strategies moderate the stresses of TBI in the long term. However, relatively little is known about the impact on the family and family response during the acute stage of recovery. The present study used Olson's Circumplex Model to examine acute changes in family structure and examined changes in coping responses pre- and post-TBI. Wives of 20 male TBI survivors completed the Couples Version of the Family Adaptability and Cohesion Evaluation Scales-II (FACES-II) and the Coping Responses Inventory (CRI). These questionnaires were completed retrospectively for a stressful event that occurred six months prior to the TBI, then for the current period following the TBI. Results found that 60% of all families experienced a significant change in structure following TBI. As predicted by the Circumplex Model, balanced families changed most, with 70% changing to the extreme type post-TBI. Focus of coping (problem versus emotion) and coping techniques (cognitive versus behavioral) also changed significantly from pre- to post-TBI and differed, depending on post-TBI family structure. Family interventions based on these differences in family structure and coping are presented.

Correspondence between five-factor and RIASEC models of personality.

In this study, we examined relationships between the full five-factor (FF; Costa & McCrae, 1985, 1992; Digman, 1990) and Holland's (1985a) RIASEC models of personality in a sample of 1,034 adults. The NEO Personality Inventory-Revised (Costa & McCrae, 1992) and the Self-Directed Search (Holland, 1985c) provided measures of the FF and RIASEC dimensions, respectively. Canonical correlation analyses provided evidence primarily for a pattern of linkages between the FF Extraversion, Openness, and Agreeableness measures and the RIASEC Enterprising, Artistic, and Social scales. Findings from this and previous studies indicated that the FF model appears to ignore the Realistic dimension and provides coverage of the Investigative and Conventional dimensions in women only. In turn, the RIASEC model appears to provide modest coverage of the FF Neuroticism and Conscientiousness domains for women and not at all for men.

Discriminability of the Wisconsin Card Sorting Test using the standardization sample.

The four neurological patient groups and the normals from the Wisconsin Card Sorting Test (WCST) standardization sample were used to examine the discriminability of the WCST's indices. Results reveal consistent differentiation of normals from the patient groups on all WCST variables, with classification rates averaging 71% accuracy. However, patient groups with frontal, diffuse, and nonfrontal lesions were not consistently discriminable from each other. The results suggest that the WCST is most usefully conceptualized as a measure of executive abilities that involves the frontal lobes, but should not be considered solely as a marker of isolated frontal lobe pathology.

Construct validity of various verbal and visual memory tests.

Factor analysis was conducted on attention, information processing, verbal and visual memory scores of 112 patients. Factor structure did not vary as a function of age. The Expanded Paired Associates Test, Verbal Selective Reminding Test, Continuous Recognition Memory Test, and Continuous Visual Memory Test defined a general memory factor. The PASAT, WMS Mental Control, and WAIS-R Digit Span defined an attention/information processing factor. Immediate Visual Reproduction (VR) loaded primarily on visual/nonverbal intelligence, whereas delayed VR loaded primarily with the memory factor. The Trail Making Test, Part B was more closely associated with visual/nonverbal intelligence than with attention/information processing. Serial Digit Learning was more closely associated with attention/information processing than with general memory.

Personality variables and self-medication in substance abuse.

Khantzian (1985) has proposed a model of substance abuse that asserts that some drug-dependent individuals select a drug of choice to provide relief from specific painful affective states. This study was undertaken to examine the self-medication hypothesis in four groups of substance abusers defined by their use of specific drugs. The Personality Assessment Inventory (Morey, 1991), an inventory characterized by scales of homogeneous clinical content, was used to examine group differences in symptomatology and personality traits. Results suggest that there are traits or symptoms that separate various groups of drug-dependent patients, but not in concordance with the self-medication hypothesis.

Construct validity of the Continuous Visual Memory Test.

The construct validity of the Continuous Visual Memory Test (CVMT), a new measure of visual recognition memory was evaluated based on the performance of 92 healthy, normal adults. A series of factor analyses were conducted utilizing marker variables for verbal memory, visual memory, attention and concentration, and verbal and visual/nonverbal intellectual functions. CVMT acquisition scores were associated with verbal and visual/nonverbal intellectual factors as well as with attentional ability. The CVMT delayed recognition score was shown to be a factorially "pure" measure of visual memory.

Affective differences among empirically derived subgroups of headache patients.

We (Kinder, Curtiss, & Kalichman, 1991) reported four distinct subgroups of male and female headache patients based on the results of a cluster analysis of the Minnesota Multiphasic Personality Inventory (MMPI). We extended these results by providing further descriptive information of the subgroups. The MMPIs of 229 (52 males and 177 females), composing the second cohort in our (Kinder et al., 1991) study of headache patients, were reclassified into subgroups. Differences between subgroups on independent measures of anxiety, anger, anger expression, and depression were investigated. Significant differences were found among the empirically derived subgroups. Results are discussed in the context of previous research on headache and back pain patients.

Alexithymia among empirically derived subgroups of chronic back pain patients.

A seeded cluster analysis procedure was applied to the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 102 male and 63 female back-pain patients. For both men and women, the resulting subgroups were found to correspond closely to similar subgroups obtained in several previous investigations. New data on the psychometric properties of the MMPI Alexithymia scale (Kleiger & Kinsman, 1980) are presented. Significant differences in alexithymia among empirically derived MMPI subgroups were found in the male sample only.

Specific components in the etiology, assessment, and treatment of male sexual dysfunctions: controlled outcome studies.

Controlled outcome studies investigating specific components in the etiology, assessment, and treatment of male sexual disorders are reviewed. Premature ejaculators appear just as accurate in assessing their levels of sexual arousal as are men not suffering from this condition. Absolute levels of sexual activity or desire do not seem to be as important for these individuals as has been suggested. Attempts to distinguish organic versus functional erectile failure using the MMPI or historical data have generally proved unsuccessful. Treatment effectiveness in premature ejaculation may be due to elevating the sensory threshold or may be an artifact of simply prescribing more frequent sexual activities. Removing performance demands through cognitive restructuring and sexual communication training shows promise in the treatment of erectile failure.

Anxiety and anger as predictors of MMPI elevations in chronic pain patients.

Studies utilizing the Minnesota Multiphasic Personality Inventory (MMPI) with chronic pain patients have almost without exception found marked elevations on the Hypochondriasis (Hs), Depression (D), and Hysteria (Hy) scales. The present data reveal that Trait Anxiety was a significant predictor of elevations on all three of these scales for both males and females. Trait Anger emerged as a classical suppressor variable for males only. The implications of these findings are discussed.

Factor structure and construct validity of the Denman Neuropsychology Memory Scale.

Correlational data on the recently published Denman Neuropsychology Memory Scale (DNMS; Denman, 1984) were subjected to a series of factor analyses. Although a major feature of the DNMS is computation of Verbal, Non-Verbal and Full Scale Memory Quotients, the factor analyses did no support this practice. Since the factor results demonstrated initial support for the construct validity of some of the DNMS subtests, it is recommended that interpretation be based on subtest performance. The present results and suggested future investigations of DNMS construct validity are discussed in relation to current issues in clinical memory assessment.

The adolescent antisocial behavior check list.

Described the development and validation of a behavioral checklist that focuses on adolescent inpatient (N = 55) antisocial behavior. Reliability data and three sub-studies that tend to establish the validity of this instrument as a measure of antisocial behavior were presented. The implications for the study of adolescent antisocial behavior as a dependent variable were discussed.

Rorschach differences in normal and delinquent white male adolescents: A discriminant function analysis.

Rorschach productions from 38 normal and 30 delinquent White male adolescents were scored by three Ph.D. clinical psychologists according to the method given by Beck. The groups were equated for IQ, social class, and age at the time of testing. Rorschach scales representative of various personality dimensions, i.e.,R, M, F, F+, FC, CF, C, FC: CF + C, Sum C, Affective Ratio, Shading, H, andA, were subjected to a linear discriminant analysis. The results showed highly significant and accurate differentiation between the groups (p<0.0005, correct classification rate =86.8%); however, theAffective Ratio was the only scale that heavily contributed to the discrimination. The difference between the groups on this scale was attributed to the delinquents' passive cognitive style. The results also lend support to the notion that delinquents differ from normals along the dimension of impulsivity, a finding relevant to psychodynamic theories of delinquency as reflective of serious ego deficits. Fuller consideration of Rorschach symbolic content and qualitative features of response is recommended.