An update of the Millon Clinical Multiaxial Inventory (MCMI)

Reviews, commentary, and recent research on the MCMI are examined. There has been controversy over the impact on research of delayed availability of hand scoring materials, the discrepancies between Millon's diagnostic conceptualizations and DSM-III, and MCMI construction idiosyncrasies. MCMI use for clinical diagnosis continues to be suspect, but clinicians now have an augmented awareness of DSM limitations as a result of this version of the Millon instrument.     

Detection of deception on the Millon Clinical Multiaxial Inventory (MCMI)

Subjects from a correctional inmate (94 incarcerated males with no history of psychiatric treatment) and a forensic inpatient (144 males and 7 females) setting were divided into distorted and nondistorted groups based on "fake bad" instructions and concurrent MMPI profiles. All subjects also were administered the MCMI. Significant differences were found between groups for MCMI profile validity, weight factor scores, and total profile correction scores. MCMI profiles were consistent with expected symptomatology, test design, and previous research. Results suggest that MCMI weight factor scores may be valuable indicators of symptom distortion in otherwise valid profiles in forensic settings. Results also indicated that the diagnostic accuracy of MCMI reports may vary greatly in relation to clinical population, symptom prevalence, and diagnostic category.     

The detection of faking on the Millon Clinical Multiaxial Inventory (MCMI)

This study investigated the effects of a variety of faking strategies on the Weight Factor correction scores (designed to detect malingering) of the Millon Clinical Multiaxial Inventory, a relatively new personality questionnaire. Subjects (both psychiatric patients [N = 95] and general medical/surgical controls [N = 90]) were asked to take the MCMI according to one of the following instructional sets: traditional faking-good; traditional faking-bad; role faking-positive; role faking-negative; role faking-neutral; and honest. The results indicated that neutral social role faking resulted in no significant differences in weight factor correction from subjects in the honest condition and that directionally role faked profiles did not differ in correction from those in the traditional "best" and "worst" conditions. Finally, only the Weight Factor corrections in the protocols from the fake bad conditions (whether in traditional "worst" or negative social role conditions) differed significantly from those in the honest conditions for both subject groups. Implications for the practicing clinician are discussed.     

The Millon Clinical Multiaxial Inventory (MCMI) as a treatment outcome measure for psychiatric inpatients

The Millon Clinical Multiaxial Inventory (MCMI) is a 175-item inventory designed to assess both clinical symptomatology and underlying, more enduring personality traits and syndromes. The purpose of this study was to determine whether the MCMI personality scales evidenced greater stability over time than did the MCMI symptom scales. The MCMI was administered to 151 consecutively admitted inpatients at an acute care, private psychiatric hospital. Patients were administered the MCMI shortly after admission and shortly before discharge. Results indicated that the personality scales evidenced greater stability than the symptomatology scales, although statistically significant changes between admission and discharge scores also occurred for the personality scales. Implications are discussed.     

Use of the Millon Clinical Multiaxial Inventory (MCMI) as a screening instrument at a community mental health center

Comparison of the Millon Clinical Multiaxial Inventory (MCMI) and clinician-generated DSM-III diagnoses for a sample of psychiatric outpatients (N = 72) indicated only chance agreement. The MCMI was of limited use as a screening device because of overdiagnosis and failure to identify individuals who prematurely terminated treatment. Other potential problems with the instrument included substantial intercorrelation among scales and possible pathologizing of stereotypic feminine traits. The characteristic structure of the MCMI appeared stable across patient samples; there was evidence for identification of a mean profile for psychiatric patients who voluntarily seek treatment for subjective distress.     

The relationship between the Millon Clinical Multiaxial Inventory and the MMPI in a private outpatient mental health clinic population

The concurrent validity of the MCMI as compared to the MMPI was assessed by administering both tests to 106 newly admitted outpatients and calculating the intercorrelations between these two tests. Of the 20 MCMI scales, 12 were found to correlate with the MMPI in a manner that suggested that they do measure some degree of personality dysfunction, emotional disturbance, or specific psychological symptomatology. Eight of the MCMI scales failed to show correlations that would indicate that they effectively measure any of the pathological personality characteristics or clinically significant symptom patterns known to be measured by the MMPI.     

Millon Clinical Multiaxial Inventory (MCMI-III): the inability of the validity conditions to detect random responders

The effectiveness of the MCMI-III Validity scale, Scale X, and the Clinical Personality Pattern scales to detect random responding is put to the test. The binomial expansion and Monte Carlo techniques were used. If the examiner is willing to interpret tests of questionable validity, then 50% of the random responders will not be detected. Scale X and the Clinical Personality Pattern scales were useless in detecting random responders.     

A cluster analysis of Million Clinical Multiaxial Inventory (MCMI) profiles: more about a taxonomy of alcoholic subtypes

MCMI and MMPI data were obtained from 125 male veteran alcoholic inpatients. MCMI profiles were classified into five relatively homogeneous subgroups by a hierarchical clustering technique. One-way ANOVAs were calculated for each of the MMPI scales; patients were classified according to MCMI group membership. Results showed that conceptually meaningful clusters exist among MCMI profiles, that statistically significant relationships exist between MCMI profiles and MMPI scale scores, and that these relationships are consistent with trends reported in the literature. The study provides additional support for the idea that a potentially useful taxonomy exists for alcoholics and suggests that the MCMI could be a useful tool in subsequent research on understanding and treating different patterns of alcoholism.     

Excision biopsy findings of patients with breast needle core biopsies reported as suspicious of malignancy (B4) or lesion of uncertain malignant potential (B3)

AIMS: The UK National Health Service Breast Screening Programme has proposed five categories for reporting breast needle core biopsies. The majority of cores are reported as benign (B1), normal (B2) or malignant (B5). The predictive value of the two borderline categories suspicious of malignancy (B4) and lesion of uncertain malignant potential (B3) was studied. METHODS AND RESULTS: Over a 2-year period a total of 3822 breast needle core biopsies were performed, with 2997 from symptomatic patients and 825 from women undergoing mammographic screening, including 43 B4 reports (40 patients) and 120 B3 reports (116 lesions in 115 patients). The frequencies of B4 (2.5% versus 0.7%) and B3 cores (7.3% versus 2.0%) were both higher in screening than in symptomatic patients. B4 was most commonly used for small fragments of atypical cells separate from the main core or focal atypical intraductal proliferations. The criteria for calling a core B3 were: atypical intraductal epithelial proliferations (including foci that in excision specimens would be classified as atypical ductal hyperplasia), lobular neoplasia, radial scar, papillary lesion, fibroepithelial lesion with cellular stroma and spindle cell proliferations. Excision biopsies were performed in 39 patients with B4 core and 96 with B3 core. Invasive carcinoma or ductal carcinoma in situ was seen in 33 of the patients with B4 (85%) and in 29 of those with B3 cores (25%). Some categories of B3 core were associated with a higher rate of malignancy (40% for atypical intraductal epithelial proliferations and 46% for lobular neoplasia). CONCLUSIONS: The positive predictive value for carcinoma is high following a B4 core (86%). The lesion should be excised, but definitive cancer treatment is not appropriate. In some cases a definite diagnosis of malignancy can be made on repeat core. The B3 group is more heterogeneous and has a lower rate of malignancy on further biopsy (25%). The majority of B3 lesions require excision. All these patients should be discussed at multidisciplinary meetings.     

Development and initial evaluation of the Clinical Information Systems Success Model (CISSM)

PurposeMost clinical information systems (CIS) today are technically sound, but the number of successful implementations of these systems is low. The purpose of this study was to develop and test a theoretically based integrated CIS Success Model (CISSM) from the nurse perspective.MethodsModel predictors of CIS success were taken from existing research on information systems acceptance, user satisfaction, use intention, user behavior and perceptions, as well as clinical research. Data collected online from 234 registered nurses in four hospitals were used to test the model. Each nurse had used the Cerner Power Chart Admission Health Profile for at least 3 months.ResultsPsychometric testing and factor analysis of the 23-item CISSM instrument established its construct validity and reliability. Initial analysis showed nurses’ satisfaction with and dependency on CIS use predicted their perceived CIS use Net Benefit. Further analysis identified Social Influence and Facilitating Conditions as other predictors of CIS user Net Benefit. The level of hospital CIS integration may account for the role of CIS Use Dependency in the success of CIS.ConclusionsBased on our experience, CISSM provides a formative as well as summative tool for evaluating CIS success from the nurse's perspective.     

Adult T-cell leukemia with CD3 (-), CD4 (-) and CD8 (-)]

A case of an adult T-cell leukemia (ATL) with double negative (CD4-, CD8-) phenotype is reported. A-57-year-old man was consulted by his home doctor with us because of leucocytosis, splenomegaly and systemic lymphadenopathy. On admission, white blood cell count was 87,500/microliters with 77% of convoluted atypical cells. Serum anti-HTLV-1 antibody was positive and monoclonal insertion of HTLV-1 provirus into the atypical cell-gene was proved with southern blotting hybridization technique. A diagnosis of an ATL was made. Immunophenotypic analysis of leukemic cells showed CD3 (-), CD4 (-), CD8 (-) and genes encoding both TCR alpha and beta chains were rearranged. Though the patient responded to some degree to the combination chemotherapies including VEPA, he died of infectious complications about 4 months after admission.     

Speculation on the lineage relationships among CD4(-)8(+) gut-derived T cells and their role(s).

The thymus-independent T lymphopoietic capacity of the murine intestinal mucosa has been established. Cryptopatches have now been identified as the location of the elusive precursors for gut-derived T cells. These cryptopatch cells have been shown to give rise to intestinal T cells expressing either TCRgammadelta or TCRalphabeta. Here we discuss the role of MHC in the development and selection of gut-derived T cells. Through the analysis of iIEL selection in animals expressing a transgenic TCRalphabeta, in the presence or absence of p56(lck), we discuss lineage relationships among CD4(-)8(+) iIEL subsets, and their possible function(s).     

Relationships between 2H4 (CD45RA) and UCHL1 (CD45RO) expression by normal blood CD4+CD8-, CD4-CD8+, CD4-CD8dim+, CD3+CD4-CD8- and CD3-CD4-CD8- lymphocytes.

We characterized and established relationships between the expression of membrane 2H4 (CD45RA) and UCHL1 (CD45RO) by enriched lymphocyte fractions prepared by selective immunomagnetic depletion of monoclonal antibody-defined populations. Cell fractions analysed in this study could be divided into two broad groups according to the presence (CD3+CD4+CD8-, CD3+CD4-CD8+, CD3+CD4-CD8dim+ and CD3+CD4-CD8-) or absence (CD3-CD4-CD8dim+ and CD3-CD4-CD8-) of the CD3 antigen. Preliminary studies confirmed a reciprocal relationship for CD45RA and CD45RO expression by major lymphoid components and further showed that the level or intensity of membrane 2H4 staining (2H4+, 2H4int and 2H4-) could be directly related to UCHL1 expression. As a reflection of their differential functions, the various CD3+ populations examined showed much greater heterogeneity in 2H4 and UCHL1 expression. CD3+CD4+CD8- cells generally showed significant proportions of 2H4+, 2H4int and 2H4- components, whereas the CD3+CD4-CD8+ population was characterized by a predominance of 2H4+ cells. The results of this current investigation further suggested a higher proportion of dual-positive (2H4+UCHL1+) cells and a much greater degree of inter-individual variation than previously suspected. In contrast to CD3+ lymphocytes, natural killer (NK) associated CD3-CD4-CD8dim+ and CD3-CD4-CD8- populations were mostly 2H4+ with only minor 2H4int components and very low expression of UCHL1. An additional observation of note was that the proportions of 2H4+ and 2H4- cells comprising the CD4+CD8- fraction in any given individual was highly correlated (P = 0.002) with the distributions of 2H4+ and 2H4- components within the CD4-CD8+ fraction. This suggests the possible existence of a common control mechanism for the acquisition of immunological memory by distinct lymphocyte populations and further indicates that individual variations in the distribution of 2H4/UCHL1 lymphocyte subpopulations may be a direct consequence of 'immunological experience' rather than age alone.     

Divergent behaviour of oxidative stress markers 8-hydroxydeoxyguanosine (8-OHdG) and 4-hydroxy-2-nonenal (HNE) in breast carcinogenesis

Karihtala P, Kauppila S, Puistola U & Jukkola‐Vuorinen A
(2011) Histopathology 58, 854–862
Divergent behaviour of oxidative stress markers 8‐hydroxydeoxyguanosine (8‐OHdG) and 4‐hydroxy‐2‐nonenal (HNE) in breast carcinogenesis Aims: To clarify the role of oxidative stress during breast carcinogenesis by studying the expression of 8‐hydroxydeoxyguanosine (8‐OHdG) (a marker of oxidative DNA damage) and 4‐hydroxy‐2‐nonenal (HNE) (a marker of lipid peroxidation) during the different phases of breast carcinogenesis. Methods and results: The study material consisted of a total of 219 patients: 31 with usual ductal hyperplasia (UDH), 25 with atypical ductal hyperplasia (ADH), 30 with ductal carcinoma in situ (DCIS) and 133 with invasive carcinoma. The expression of 8‐OHdG and HNE were evaluated immunohistochemically. Both 8‐OHdG (77.4%) and HNE (45.8%) expression was already seen in UDH lesions. Interestingly, the trend of these two immunostainings during breast carcinogenesis was diverse. 8‐OHdG expression diminished significantly in invasive breast carcinomas compared to non‐invasive lesions (P < 0.005 when set against non‐invasive cohorts). Also within the same lesions, 8‐OHdG expression was the most intensive in benign cells. Conversely, HNE immunostaining was strongest in invasive breast carcinomas (UDH versus invasive cohort, P = 0.015). Conclusions: 4‐hydroxy‐2‐nonenal as a marker of lipid peroxidation increases during breast carcinogenesis, reflecting the role of oxidative stress in the pathogenesis of breast cancer. However, 8‐OHdG shows diminished levels in carcinomas, possibly resulting from the induction of DNA repair in these invasive lesions.     

Congenital generalized lipodystrophy: The evaluation of clinical follow-up findings in a series of five patients with type 1 and two patients with type 4

Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by lipoatrophy affecting the face, limbs and trunk, acromegaloid features, hepatomegaly, hypertriglyceridemia, and insulin resistance. The aim of this study is to evaluate the long-term follow-up findings including gastrointestinal and cardiac manifestations of the patients with CGL1 and CGL4, caused by mutations in the AGPAT2 and CAVIN1 genes, respectively. Two patients aged 2 and 9 years with the same biallelic CAVIN1 mutation and five patients aged between 6 months and 11 years 4 months with AGPAT2 mutations have been followed up for 3–9 years. The patients were between 7 and 20 years of age at their last examination. One of the two patients with CGL4 had congenital pyloric stenosis. The other patient with CGL4 have developed recurrent duodenal perforations which have not been reported in CGL patients previously. The pathological examination of duodenal specimens revealed increased subserosal fibrous tissue and absent submucosal adipose tissue. None of the five CGL1 patients had gastrointestinal problems. Two patients with CGL4 developed hypertrophic cardiomyopathy (HCMP) and severe cardiac arrhythmia, only one patient with CGL1 had HCMP. Hyperinsulinemia was detected in one patient with CGL4 and three patients with CGL1, these three CGL1 patients also had acanthosis nigricans. Hepatic steatosis was detected in one patient with CGL4 and two patients with CGL1 by ultrasonography. In conclusion, these findings suggest that CGL4 patients should also be carefully followed up for gastrointestinal and cardiac manifestations.     

Expansion of a T lymphocyte subpopulation (CD3+,4-,8-) after immunodepression associated with disseminated histoplasmosis

A major subpopulation of T lymphocytes bearing a high density of CD3 (T3/Leu 4) with no detectable CD4 (T4/Leu 3a) or CD8 (T8/Leu 2a) was found in a patient with cardiomyopathy. Previously the patient had developed disseminated histoplasmosis which had been associated with a profound anergic state. The proportion of CD3+ lymphocytes that bore the phenotype CD3+,4-,8- has been increasing in the absence of reactivation of the histoplasmosis. The CD3+,4-,8- lymphocytes bound anti-CD2 but did not bind WT31, a monoclonal antibody specific for the alpha beta heterodimer of the T cell antigen receptor.     

Characterization of CD4+ T helper cells in patients with Kawasaki disease (KD): preferential production of tumour necrosis factor-alpha (TNF-alpha) by V beta 2- or V beta 8- CD4+ T helper cells.

KD is an acute febrile illness in children characterized by coronary arteritis accompanied by aneurysm and thrombotic occlusion. The etiology of KD is unknown. It has been recently reported that KD is associated with the selective expansion of V beta 2+ and V beta 8.1+ T cells in peripheral blood lymphocytes (PBL), by studying the T cell receptor (TCR) repertoire of in vitro activated T cells. KD may therefore be caused by a superantigen [1-3]. To understand better the immunopathology of KD, we investigated TCR V beta 2 and V beta 8.1 expression on both the T cells of freshly isolated PBL and T cell clones (TCC) from patients with KD. Cytokine production by TCC was also studied. Blood samples were obtained from patients with acute (n = 20) and convalescent (n = 20) KD, age-matched children with non-infectious diseases (n = 18), and healthy adults (n = 20). Among these four groups, there were no significant differences in the percentages of either V beta 2+ or V beta 8.1+ T cells of freshly isolated PBL. The same was true for the CD4+ or CD8+ T cell subsets. One hundred and five TCC (98 CD3+ CD4+ CD8- and seven CD3+ CD4- CD8+) established from the affected skin, lymph node or PBL of six patients with KD were also negative for either V beta 2 or V beta 8.1 TCR. Sixty-eight of 105 TCC (65%) produced detectable levels (> 5 pg/ml) of TNF-alpha (6-1016 pg/ml), in the absence of any stimuli. In contrast, only 11 (10%) of 105 TCC or 7 (7%) of 97 TCC produced detectable levels of IL-2 or IL-6, respectively, in the absence of any stimuli. Stimulation with phytohaemagglutinin (PHA) and phorbol myristate acetate (PMA) induced most TCC to produce higher amounts of TNF-alpha, IL-2 and IL-6. These results suggest that CD4+ T helper cells expressing TCR-beta other than V beta 2 or V beta 8 receptor, primarily through TNF-alpha production, are involved in the immunopathology of KD.     

Clinical evaluation of prophylactic intranasal 1-phenyl-3-(4-phenyl-2-thiazolyl) guanidine (CL 88,277) medication against rhinovirus 44 challenge

The prophylactic intranasal medication with a new antiviral compound, 1-phenyl-3-(-4 phenyl-2-thiazolyl) guanidine (CL 88, 277) was evaluated in humans against rhinovirus 44 challenge. One ml containing 250 mg of CL 88,277 was administered to 10 seronegative volunteers three times a day plus one dose prior to the rhinovirus challenge (32 TCID₅₀) and for six consecutive post-challenge days. Ten other subjects received 56% polyethylene glycol (PEG-400), the solvent of CL 88,277, at the same time. Five subjects in each of the CL 88,277-treated and placebo-treated groups developed illness. There were no differences between the two groups in the occurrence of the severe illness and of the moderate and severe illnesses. Each sign and symptom occurred almost equally in the two groups and there was no difference in their scores between the two groups. The challenge virus was isolated from both groups but the total number of the virus isolates was less and the time span of virus excretion was shorter for the drug-treated group. The post-challenge serum antibody titers were markedly lower in the drug-treated group.Prophylactic intranasal CL 88,277 medication did not affect the course of illness induced by rhinovirus 44 challenge. It appears, however, that the virus replication in the nose was reduced and as a result the serum antibody response was diminished. PEG-400 caused a transient irritation of the nasal mucosa in all recipients.This study was supported by a grant from Lederle Laboratories, Pearl River, New York