Detecting incomplete effort on the MMPI-2: an examination of the Fake-Bad Scale in mild head injury.

The current study is an investigation of the MMPI-2 Fake Bad Scale ( FBS ) in the detection of incomplete effort in mild head injury (MHI). Using ROC curve analysis, we found that a cutoff score of 21 had a sensitivity of 90% and specificity of 90%, providing an overall correct classificatory rate of 90%. In addition, traditional indices of faking bad on the MMPI-2, the F and F-K indices, fared relatively poorly by comparison and added no predictive power over the FBS. Finally, multivariate analyses revealed that although the FBS shares a number of items with Hs and Hy scales, the FBS carried the majority of variance in predicting incomplete effort in our MHI sample. Overall, these findings indicate that the FBS has high sensitivity and specificity in identifying incomplete effort in mild head injury.

The Memory Assessment Scales in the detection of incomplete effort in mild head injury.

Despite differences in the constructs measured, the Memory Assessment Scales (MAS) remain an alternative to the Wechsler Memory Scales (WMS) as a broad-band instrument for assessing multiple aspects of attention and memory. Although a number of studies have examined indices of the WMS as indicators of malingering, few studies have similarly investigated the MAS. In this study, we examined the degree to which the MAS was effective in detecting incomplete effort in a clinical sample of patients referred for neuropsychological evaluation after mild head injury. Included in the sample were 21 financially compensable (FC) participants with alleged mild head injury and 21 participants who were not involved in litigation and suffered more serious head injuries. Examination of the four MAS domain indices indicated that Short-Term Memory was most useful at identifying incomplete effort. We also examined subscales of the MAS. Consistent with previous findings, brief tests such as Verbal and Visual Span had high rates of diagnostic sensitivity and specificity. Although tests based on a forced-choice recognition paradigm (e.g., Immediate and Delayed Visual Recognition) predicted group membership above chance levels, they failed to significantly add to prediction above Verbal and Visual Span subtests.

Insomnia screening in postacute traumatic brain injury: utility and validity of the Pittsburgh Sleep Quality Index.

OBJECTIVE: To assess insomnia in a rehabilitation population, the authors examined the utility and validity of the Pittsburgh Sleep Quality Index (PSQI). The assessment of insomnia is relevant to the treatment of traumatic brain injury at the postacute level and routine screening for insomnia may be enhanced by the availability of a standardized, conveniently used, self-report sleep questionnaire. DESIGN: The authors prospectively studied 91 consecutive patients with traumatic brain injury who were admitted to an outpatient neurorehabilitation program. Besides administering the PSQI, Beck Depression Inventory, Epworth Sleepiness Scale, and Multidimensional Pain Inventory, sleep diary and interview data were obtained and used to divide subjects into insomnia and noninsomnia groups according to the criteria established by the Diagnostic and Statistical Manual of Mental Disorders, ed 4. RESULTS: Sensitivity and specificity rates to the clinical diagnosis of insomnia were 93% and 100%, respectively, for a PSQI Global Score of >8, and 83% and 100% for a diagnosis of insomnia based exclusively on PSQI-derived sleep variable data. Sleep diary data provided concurrent validity for PSQI estimates of sleep-onset latency, sleep duration, and sleep efficiency. The Beck Depression Inventory, Epworth Sleepiness Scale, and Multidimensional Pain Inventory established concurrent validity for individual PSQI items pertaining to mood, hypersomnia, and pain disturbance. CONCLUSION: The PSQI was demonstrated to be a valid and useful screening tool for assessing insomnia among postacute patients with traumatic brain injury.

Stability of normal personality traits after traumatic brain injury.

OBJECTIVE: To test the hypothesis that changes in personality traits are evident after traumatic brain injury (TBI) using current models of normal adult personality variation. DESIGN: Comparison of inception cohort and control group at two measurement occasions. SETTING: A large urban academic medical center. PARTICIPANTS: Retrospective personality assessments were obtained from significant others of 21 TBI patients within 30 days of injury and at 6-month follow-up and from a control group of significant others of 25 persons without neurological history twice over a 6-month interval. MAIN OUTCOME MEASURES: Five scales-Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness-from the revised NEO Personality Inventory (NEO PI-R), Form R, and an observer rating scale for retrospective estimates of change (REC). RESULTS: Significant score changes were found for only one of the five trait domains in the patient sample; controls showed minimal changes overall. Patients' Extraversion scores declined to average levels at 6-month follow-up, diminishing premorbid differences between patients and controls on this dimension. Subjective change estimates made by raters after follow-up reflected perceptions of increased neuroticism in patients that were inconsistent with the serial NEO PI-R data the raters provided. CONCLUSIONS: The absence of systematic changes in personality trait scores among the patients cautions against presuming that such changes account for the behavior of TBI patients.

Four-month test-retest reliability of the MMPI-2 with normal male clergy.

This investigation examined the test-retest coefficients and absolute score changes with the Basic, Supplementary, and Content scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 111 active male clergy who were not receiving mental health services at the time of their participation and who completed the MMPI-2 on two occasions separated by 4 months. A repeated measures multivariate analysis of variance for the three groups of scales revealed nonsignificant changes in mean T scores. In general, the test-retest coefficients obtained were similar to those reported in the MMPI-2 manual by Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer (1989) and by Spiro, Butcher, Levenson, Aldwin, and Bosse (1993). Increases or decreases of 3 to 6 T-score points were observed for the majority of the scales, and instances in which T-score changes exceeded 10 points were observed on every scale. In sum, the test-retest reliability of the majority of MMPI-2 scales, as represented in this nonclinical sample, appears acceptable and compares favorably with the original MMPI.

Evaluation of malingering in the neuropsychological examination of mild head injury.

The evaluation of malingering in the neuropsychological examination of mild head injury is a multiple method diagnostic process that takes into consideration injury severity, typical neuropsychological test performance patterns, differential diagnosis of other medical and psychiatric disorders, and the use of neuropsychological indicators of suboptimal effort. Current methods and trends in the evaluation of malingering are reviewed, including the use of specialized tests of effort and motivation and the application of conventional neuropsychological tests. Symptom validity techniques and tests with a multiple-choice format along with statistically-derived univariate and multivariate formulas appear to considerable merit in the detection of suboptimal effort or malingering.

The Recognition Memory Test in the assessment of memory impairment after financially compensable mild head injury: a replication.

The current investigation replicated the findings from a 1992 study by Millis. 20 subjects with claimed mild head injury who were seeking financial compensation obtained significantly lower scores on both subtests of the Recognition Memory Test than did 66 rehabilitation inpatients with documented moderate and severe traumatic brain injuries. The direct discriminant function derived by Millis was cross-validated on the current sample and yielded an improved over-all correct classification rate of 83%, with 85% and 82% of the mild and severe traumatic brain-injured subjects classified correctly, respectively. Over-all correct classification rate in the original study was 76%.