Adapting assessment processes to consider cultural mistrust in forensic practices: An example with the MMPI instruments.

OBJECTIVE: Our first goal in this study was to identify cultural mistrust critical items (CMCIs) on two versions of the Minnesota Multiphasic Personality Inventory (MMPI)-the MMPI-Second Edition-Restructured Form (MMPI-2-RF) and MMPI-Third Edition (MMPI-3)-that might be endorsed by people of color because of cultural mistrust rather than clinical paranoia. Our second goal was to determine whether CMCIs and items on the MMPI-2-RF/MMPI-3 Ideas of Persecution scale (Restructured Clinical Scale 6 [RC6]) were endorsed at different rates across cultural groups in a nonclinical college sample and a forensic inpatient sample. HYPOTHESES: Our primary hypothesis was that expert raters would reliably identify a subset of MMPI-2-RF and MMPI-3 items as reflective of cultural mistrust. Black college students would endorse the highest level of CMCIs, followed by Latina/o students, and then White students. We hypothesized that the same pattern of findings would occur in forensic inpatients but that the differences would be attenuated because of the high base rate of psychiatric symptomatology and the nature of the forensic assessment setting. METHOD: Three Black female and three Black male psychologists rated the degree to which each item on the MMPI-2-RF and MMPI-3 reflected cultural mistrust. Black (n = 90), Latina/o (n = 83), and White (n = 100) college students were compared on CMCIs and on MMPI-2-RF/MMPI-3 RC6 item endorsement. The same comparisons were made among Black (n = 221), Latina/o (n = 142), and White (n = 483) forensic inpatients who completed the MMPI-2-RF. RESULTS: Black college students endorsed the highest levels of cultural mistrust, followed by Latina/o students, and then White students, resulting in small-to-medium effect sizes (Hedges's gs = 0.14-0.52). Although we observed some item-level differences in forensic patients, the overall pattern of item endorsement did not significantly differ in this group. CONCLUSIONS: There are multiple reasons for the reporting of clinical paranoia and cultural mistrust in forensic assessment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measurement of Eating Pathology Using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3).

Eating disorders are prevalent among college student populations. Although previous iterations of the instrument did not include specific measurement of eating pathology, the Minnesota multiphasic personality inventory-3 (MMPI-3) now includes a specific scale (i.e., Eating Concerns [EAT]) to assess problematic eating behaviors. The current study examined the MMPI-3 assessment of eating pathology among 249 undergraduate women. A pattern emerged where symptoms of internalizing psychopathology on the MMPI-3 were generally associated with symptoms of eating disorder. However, the newly included EAT scale demonstrated the strongest associations with most areas of eating dysfunction. Further, hierarchical regression analyses suggested that the EAT scale added substantial incremental predictive utility (up to 23%) over other MMPI-3 scales combined in assessing eating pathology. Classification accuracy statistics yielded high sensitivity and specificity coefficients when predicting eating disorder risk at an EAT scale score cutoff of 75 T or higher. These findings support the use of the MMPI-3 in assessing eating pathology in college women, although its performance with men and with women not of college age remains to be studied.

The MacCAT-CA and the ECST-R in Competency to Stand Trial Evaluations: A Critical Review and Practical Implications.

There is debate regarding the utility of standardized instruments in the assessment of competence to stand trial (CST). Though the field generally has a positive view of the second-generation nomothetic instruments available, the frequency of use falls far behind this favorable impression. The current paper reviewed two standardized instruments used in CST evaluations, the Evaluation of Competency to Stand Trial - Revised (ECST-R) and the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). We first review the psychometric properties of both instruments, including a review of limitations. Next, we discuss the legal standing of both instruments, including a review of past admissibility challenges and a discussion of potential issues in cross-examination. Finally, we end with practical guidance for clinicians; namely, that these instruments are generally valid indicators of competence to stand trial and are likely to be particularly useful in cases where competence is ambiguous and the clinician would benefit from additional standardized data to make a clear clinical decision.

Survival After Being Wedged in a Crevasse for 16 Hours in Alaska.

We present a case of an un-roped mountaineer who fell into a crevasse during descent from the summit of Denali (Mount McKinley). He was wedged about 20 m deep in the crevasse for a total of 16 h; this included 4.5 h waiting for a rescue team to arrive, and an 11.5 h extrication process. His condition deteriorated and he eventually lost consciousness. Even though the rescue team collectively felt there was little or no chance of survival, they continued until the victim was extricated from the crevasse. He was almost immediately placed in a hypothermia wrap with active warming, loaded on a rescue helicopter, and transported for 1 h 40 min to a hospital in Fairbanks, Alaska. During the flight, he was placed on supplemental oxygen. He was cold to the touch; respiration was detectable, but a pulse was not, and he was responsive to verbal stimuli. Initial bladder temperature in hospital was 26.1°C. He was released from hospital after 14 d and made a full recovery. This case highlights an important mix of preventative and resuscitative lessons regarding crevasse rescue in an isolated location. The lessons include the dangers of travelling un-roped on a crevassed glacier, the challenges of extrication from a confined space, the fact that respirations are often more easily detected than pulses, an extended transport time to medical facilities, and the necessity of trying unorthodox extrication methods. This case emphasized the need to continue extrication and treatment efforts for a cold patient even when survival with hypothermia seems impossible.

Assessing ICD-11 personality trait domain qualifiers with the MMPI-2-RF.

OBJECTIVE: The current study examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in assessing ICD-11 personality psychopathology trait domain qualifiers. METHOD: Using a community sample (N = 217) weighted for externalizing dysfunction, this study evaluated the convergence between ICD-11 trait domains as measured by the personality inventory for DSM-5 (PID-5) with hypothesized MMPI-2-RF scales. Particular emphasis was placed on evaluating the convergence between the ICD-11 trait domain qualifiers and the MMPI-2-RF personality psychopathology-5 (PSY-5) scales, as the latter are meant to represent broadband domains of personality pathology. RESULTS: Correlation and regression analyses demonstrated expected associations between ICD-11 domains and conceptually expected MMPI-2-RF scales, with some minor exceptions. Notably, the Anankastia domain showed associations with scales assessing negative affect, but did not show expected negative associations with scales related to disinhibition. CONCLUSIONS: The findings generally supported the use of the MMPI-2-RF in assessing individual expressions of personality dysfunction from the ICD-11 trait domain qualifier perspective.

Women in oncology pharmacy leadership: A white paper.

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.

Observing Severe Drought Influences on Ozone Air Pollution in California.

Drought conditions affect ozone air quality, potentially altering multiple terms in the O3 mass balance equation. Here, we present a multiyear observational analysis using data collected before, during, and after the record-breaking California drought (2011-2015) at the O3-polluted locations of Fresno and Bakersfield near the Sierra Nevada foothills. We separately assess drought influences on O3 chemical production ( PO3) from O3 concentration. We show that isoprene concentrations, which are a source of O3-forming organic reactivity, were relatively insensitive to early drought conditions but decreased by more than 50% during the most severe drought years (2014-2015), with recovery a function of location. We find drought-isoprene effects are temperature-dependent, even after accounting for changes in leaf area, consistent with laboratory studies but not previously observed at landscape scales with atmospheric observations. Drought-driven decreases in organic reactivity are contemporaneous with a change in dominant oxidation mechanism, with PO3 becoming more NO x-suppressed, leading to a decrease in PO3 of ∼20%. We infer reductions in atmospheric O3 loss of ∼15% during the most severe drought period, consistent with past observations of decreases in O3 uptake by plants. We consider drought-related trends in O3 variability on synoptic time scales by analyzing statistics of multiday high-O3 events. We discuss implications for regulating O3 air pollution in California and other locations under more prevalent drought conditions.

Implications for the Measurement of Psychopathy in the DSM-5 Using the Computerized Adaptive Test of Personality Disorder.

This study investigated the ability of the Computerized Adaptive Test of Personality Disorder (CAT-PD) model to capture psychopathy in a sample consisting of U.S. (n = 565) and Australian (n = 99) undergraduates and a U.S. community sample (n = 210). More specifically, this study examined (a) the association between CAT-PD facets, particularly those consistent with DSM-5 Section III antisocial personality disorder (ASPD), and measures of psychopathy, (b) the extent to which CAT-PD ASPD traits improve on DSM-5 Section II ASPD in measuring psychopathy, and (c) the utility of measuring functional impairment in additional to dimensional traits in assessing psychopathy. Analyses revealed CAT-PD ASPD traits, including traits' associations with Section III psychopathy specifier, were strongly associated with measures of psychopathy. Furthermore, CAT-PD ASPD was found to be an improvement over DSM-5 Section II ASPD in measuring psychopathy, and the dimensional nature of the CAT-PD was found to render the addition of measures of impairment unnecessary. These findings generally support the utility of the CAT-PD in the measurement of psychopathy, particularly as it relates to the dimensional assessment of psychopathy in the DSM-5 alternative model for personality disorder.

A practical guide for the safe implementation of early phase drug development and immunotherapy program in gynecologic oncology practice.

The success of targeted and immune therapies in other malignancies has led to an exponential increase in the number of active and pending clinical trials using these therapeutic approaches in patients with gynecologic cancers. These novel investigational agents are associated with unique and potentially life-threatening toxicities and many require special multidisciplinary logistical considerations. The objective of this review is to describe a practical approach for the safe implementation of targeted and immune therapies in academic gynecologic oncology practices based on our experience at M.D. Anderson Cancer Center.

Avelumab: A Review of Its Application in Metastatic Merkel Cell Carcinoma.

OBJECTIVE: To summarize the clinical development of avelumab and its clinical relevance in metastatic Merkel cell carcinoma (MCC). DATA SOURCES: An English-language literature search using PubMed was performed using the terms avelumab, anti-PD-1, anti-PD-L1, and MCC from January of 1950 to March 2018. Data were also obtained from package inserts, meeting abstracts, and clinical registries. STUDY SELECTION/DATA EXTRACTION: All relevant published articles of avelumab were reviewed. Clinical trial registries and meeting abstracts were used for information about ongoing trials. DATA SYNTHESIS: Avelumab is a fully human monoclonal antibody that inhibits programmed death ligand-1, which reverses T-cell exhaustion and induces antitumor responses. Avelumab is safe and effective in previously treated metastatic MCC based on a phase II trial of previously treated patients with objective response rates in 28 of 88 patients, including 10 complete responses and 19 partial responses. Median overall survival (OS) was 12.9 months, and 1-year progression-free survival and OS were 30% and 52%, respectively. Grade 3 treatment-related side effects included lymphopenia (2 patients), serum creatine phosphokinase increase (1 patient), aminotransferase elevation (1 patient), and serum cholesterol increase (1 patient). Relevance to Patient Care and Clinical Practice: This review outlines the pharmacology and clinical trial data for avelumab in metastatic MCC and guides clinicians on avelumab's place in therapy. CONCLUSIONS: Avelumab is the first Food and Drug Administration-approved medication for metastatic MCC and provides an advantage of durable responses and possibly improved tolerability compared with traditional platinum-based chemotherapy. Clinical trials are under way to expand its utility into the adjuvant and frontline settings.

Construct Validity of the DSM-5 Section III Personality Trait Profile for Borderline Personality Disorder.

This study evaluated the nomological network of the borderline personality disorder (BPD) trait profile in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]) Section III. BPD symptoms include a variety of maladaptive thoughts and behaviors, and it is important to determine if the Section III trait operationalization for BPD captures these behavioral symptoms, as well as shows similar associations as the traditional Section II version with external criteria. For this purpose, we used a sample of 285 undergraduate students and conducted correlation and regression analyses to delineate the associations between Section III BPD traits and conceptually relevant external criteria. A Section III Total score was meaningfully associated with all criteria. Moreover, externalizing psychopathology tended to be most highly associated with disinhibitory Section III BPD traits, whereas internalizing psychopathology tended to have its strongest unique associations with traits reflective of negative affectivity. These results provide support for the construct validity of the trait profile for BPD in DSM-5 Section III.

Dabrafenib therapy for advanced melanoma.

OBJECTIVE: To summarize the clinical development of dabrafenib and to highlight the clinically relevant distinct characteristics of dabrafenib in contrast to vemurafenib. DATA SOURCE: An English-language literature search of MEDLINE/PubMed (1966-June 2013), using the keywords GSK2118436, dabrafenib, vemurafenib, selective BRAF inhibitor, and advanced melanoma, was conducted. Data were also obtained from package inserts, meeting abstracts, and clinical registries. STUDY SELECTION AND DATA EXTRACTION: All relevant published articles on dabrafenib and vemurafenib were reviewed. Clinical trial registries and meeting abstracts were used for information about ongoing studies. DATA SYNTHESIS: BRAF(V600E) mutation confers constitutive BRAK kinase activation in melanoma cells, promoting tumor growth. This discovery led to the development of BRAF kinase inhibitors like vemurafenib and dabrafenib. Dabrafenib has been approved to treat patients with BRAF(V600E)-positive unresectable or metastatic melanoma based on its clinical benefit demonstrated in a randomized phase III study. It has also been shown to be safe and effective in patients with BRAF mutant advanced melanoma involving the brain. Dabrafenib is well tolerated, with the most common adverse effects being hyperkeratosis, headache, pyrexia, and arthralgia. Currently, there is no evidence to suggest that one BRAF inhibitor is superior to the other. With similar efficacy, therapy selection will likely be influenced by differential tolerability and cost. CONCLUSIONS: Dabrafenib joins vemurafenib to confirm the superior clinical outcome of the BRAF inhibitors when compared with dacarbazine in patients with BRAF(V600E)-positive advanced melanoma. Active research is ongoing to expand its utility into the adjuvant setting and to circumvent rapid emergence of drug resistance.

Convergence between DSM-5 Section II and Section III diagnostic criteria for borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a common mental health condition in psychiatric settings. The current study examined the overlap between the operationalization of BPD listed in Section II (Diagnostic Criteria and Codes) and the alternative, dimensional personality trait-based operationalization listed in Section III (Emerging Measures and Models) of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, the unique contributions of specific personality traits for indexing the traditional BPD operationalization were also evaluated, including conceptually relevant traits not originally proposed for Section III BPD. METHOD: Participants were 145 consecutive patients from a psychiatric unit in a hospital in the USA. These individuals completed a series of questionnaires that index both traditional (DSM-IV/DSM-5 Section II) and alternative (DSM-5 Section III personality traits) diagnostic criteria for BPD. RESULTS: Structural equation modeling results revealed that latent constructs representing the Section II and Section III operationalizations of BPD, respectively, overlapped substantially (r = 0.86, p < 0.001). Hierarchical latent regression models indicated that at least five of the seven traits proposed to define Section III BPD uniquely accounted for variance (69%) in a latent Section II BPD variable. Finally, at least one other conceptually relevant trait (Perceptual Dysregulation) augmented the prediction of latent BPD scores. CONCLUSIONS: The proposed personality traits for Section III BPD are clearly aligned with traditional conceptualizations of this important personality disorder construct. At least five of the seven dimensional traits proposed to define Section III contributed uniquely to the characterization of Section II BPD, and these traits can be augmented by Perceptual Dysregulation. If replicated in other settings, these findings might warrant some modification to the operationalization of DSM-5 Section III BPD.

New and emerging therapies for advanced or metastatic soft tissue sarcoma.

Soft tissue sarcomas include a rare variety of tumors, which require a multidisciplinary approach to treatment. Patients with advanced or metastatic disease are typically treated with anthracycline-based therapy, but these chemotherapy regimens are associated with poor response rates and average survival duration of one year. Much attention has been turned toward overexpressed gene pathways, and utilizing targeted therapies to inhibit tumor growth. Many new and approved targeted therapies and chemotherapy agents are currently in clinical and preclinical studies for soft tissue sarcoma. As the results of these studies are reported, we hope to see improved response rates and less toxicity, both in the frontline setting and for patients with advanced disease. This article will review the available data for some of the more promising therapies for advanced or metastatic soft tissue sarcomas.

Exploring the hierarchical structure of the MMPI-2-RF Personality Psychopathology Five in psychiatric patient and university student samples.

In this study our goal was to examine the hierarchical structure of personality pathology as conceptualized by Harkness and McNulty's (1994) Personality Psychopathology Five (PSY-5) model, as recently operationalized by the MMPI-2-RF (Ben-Porath & Tellegen, 2011) PSY-5r scales. We used Goldberg's (2006) "bass-ackwards" method to obtain factor structure using PSY-5r item data, successively extracting from 1 to 5 factors in a sample of psychiatric patients (n = 1,000) and a sample of university undergraduate students (n = 1,331). Participants from these samples had completed either the MMPI-2 or the MMPI-2-RF. The results were mostly consistent across the 2 samples, with some differences at the 3-factor level. In the patient sample a factor structure representing 3 broad psychopathology domains (internalizing, externalizing, and psychoticism) emerged; in the student sample the 3-factor level represented what is more commonly observed in "normal-range" personality models (negative emotionality, introversion, and disconstraint). At the 5-factor level the basic structure was similar across the 2 samples and represented well the PSY-5r domains.

Exploring Potential Ethnic Bias Among MMPI-3 Scales in Assessing Personality Psychopathology.

This study examined statistical bias in the measurement of personality psychopathology in the Latinx population using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3). Data were extracted from two studies that yielded a composite data set of 103 White individuals and 250 Latinx individuals. All participants were administered the MMPI-2-Restructured Form-Extended Battery (MMPI-2-RF-EX) or MMPI-3 and the Personality Inventory for the DSM-5 Short Form (PID-5-SF). First, we conducted correlation analyses between theoretically overlapping scales of the PID-5-SF and the MMPI-3 among White and Latinx individuals. The majority of theoretically associated scales were found to be at least moderately associated in the total sample. In addition, Steiger's z-tests indicated that correlations were similar in magnitude across the White and Latinx ethnic groups. Hierarchical regression subsequently determined the presence of slope and/or intercept bias. Only one analysis (the MMPI-3 Anger Proneness prediction of PID-5-SF Negative Affectivity) indicated statistically significant intercept bias. No evidence of slope bias was found. In other words, these analyses indicated that the vast majority of the relationships between MMPI-3 scales and associated personality psychopathology constructs (as measured by the PID-5-SF) remained consistent across both ethnic groups. Overall, the results supported the appropriate cross-cultural use of the MMPI-3 to assess personality psychopathology.

Examining the necessity for and utility of the Psychopathic Personality Inventory-Revised (PPI-R) validity scales.

The present study aimed to investigate the need for and utility of the Psychopathic Personality Inventory-Revised (PPI-R) Deviant Responding (DR) and Virtuous Responding (VR) validity scales in identifying overreporting and underreporting, respectively. Since the PPI-R was published, there has not been an independent peer-reviewed examination of these scales. Participants were 384 undergraduate individuals asked to respond to the PPI-R under standard, underreporting, or overreporting instructions. A comparison group consisting of 200 forensic psychiatric patients was also used for the overreporting analyses. Effects of response bias on mean elevations on the PPI-R substantive scales were examined along with the effects on the PPI-R total, factor, and content scales' correlations with other relevant extratest measures of psychopathy. Mean elevations differed significantly, and correlations with extratest measures of psychopathy were significantly lower. Substantial decrement in psychometric validity of PPI-R scores was observed in the simulation conditions. In addition, the utility of the PPI-R validity scales in differentiating between groups was also determined. Both the VR and DR scales showed utility in differentiating between their respective dissimulation condition and the comparison groups, with acceptable rates of sensitivity and specificity.

Psychological pain: A moderating factor between personality psychopathology and self-harm.

Objective: Self-harm and personality psychopathology have been linked, with the most robust correlations existing between negative affectivity and self-harm. Psychological pain, an emotionally-based aversive feeling, has been linked to self-harm. Considering the connection between personality psychopathology and self-harm, psychological pain may enhance self-harm risk. Participants: Analyses were conducted on 525 undergraduate students in the Spring and Fall semesters of 2019. Methods/Results: Correlation analyses indicated that self-harm was moderately correlated with Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Additionally, self-harm was correlated with psychological pain. When examining if psychological pain moderates the relation between personality psychopathology and self-harm, results were mixed. In the cases of Disinhibition and Psychoticism, psychological pain enhanced self-harm. There was no moderating effect on the relations with Negative Affectivity, Detachment, or Antagonism. Conclusions: These findings support the role of psychological pain in self-harm outcomes for those experiencing personality psychopathology; however, this varies depending on the maladaptive traits.

Clinical assessment in the time of COVID-19: Introduction to the special issue.

The COVID-19 pandemic placed much of the practice of psychological assessment in unchartered territory-including assessment via telehealth, assessment with masks or other safety measures, and accounting for the impact of a major global event in measuring performance or psychopathology. The goal of this special issue was to highlight research that addresses the numerous ways in which the pandemic impacted psychological assessment, covering three broad areas. Several articles addressed pandemic restrictions (i.e., telehealth assessment due to lockdown or social distancing, masks) and their impact on the assessment process or test validity. Another set of articles examined the impact of the pandemic on psychopathology and assessment performance more broadly, highlighting the impact on assessment and normative expectations, including in the areas of neuropsychological performance, academic achievement, and levels of psychopathology. Finally, several articles examined the validity of measures developed specifically to assess COVID-19 pandemic-related experiences. Each study is briefly reviewed, and implications for clinical practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).