MMPI-2 Restructured Form Over-Reporting Scales in First-Episode Psychosis

MMPI-2-RF over-reporting scales for physical, cognitive, or psychological symptoms were examined in 130 consecutive referrals to a first-episode psychosis (FEP) clinic. Although acutely ill upon presentation, consistent and responsive profiles were obtained in 79% of the sample. There was no indication of under-reporting on defensive scales, and anticipated elevations were observed on clinical scales sensitive to thought disorder, ideas of persecution, and aberrant experiences. The Infrequent Somatic (Fs), Symptom Validity Scale (FBS-r), and Response Bias (RBS) scales did not indicate somatic or cognitive over-reporting, but the Infrequent Psychopathology Scale (Fp-r) showed a moderate elevation that may suggest a propensity for over-reporting or an effect of clinical symptoms on the over-reporting scale. Clinician ratings of positive symptoms of psychosis were related to the Fp-r. Although the over-reporting classifications with the RBS were relatively low, RBS scores were directly related to positive and general symptoms of psychosis. The MMPI-2-RF appears to have clinical value in an acutely ill FEP sample. The sample was not prone to over-reporting pathology, but associations between both the Fp-r and the RBS with clinical symptoms will warrant further investigation.     

The detection of content-based invalid responding: a meta-analysis of the MMPI-2-Restructured Form’s (MMPI-2-RF) over-reporting validity scales

Objective: This study synthesized research evaluation of the effectiveness of the over-reporting validity scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) for detecting intentionally feigned over-endorsements of symptoms using a moderated meta-analysis. Method: After identifying experimental and quasi-experimental studies for inclusion (k = 25) in which the validity scales of the MMPI-2-RF were compared between groups of respondents, moderated meta-analyses were conducted for each of its five over-reporting scales. These meta-analyses explored the general effectiveness of each scale across studies, as well as the impact that several moderators had on scale performance, including comparison group, study type (i.e. real versus simulation), age, education, sex, and diagnosis. Results: The over-reporting scales of the MMPI-2-RF act as effective general measures for the detection of malingering and over endorsement of symptoms with individual scales ranging in effectiveness from an effect size of 1.08 (Symptom Validity; FBS-r) to 1.43 (Infrequent Pathology; Fp-r), each with different patterns of moderating influence. Conclusions: The MMPI-2-RF validity scales effectively discriminate between groups of respondents presenting in either an honest manner or with patterned exaggeration and over-endorsement of symptoms. The magnitude of difference observed between honest and malingering groups was substantially narrower than might be expected using traditional cut-scores for the validity scales, making interpretation within the evaluation context particularly important. While all over-reporting scales are effective, the FBS-r and RBS scales are those least influenced by common and context specific moderating influences, such as respondent or comparison grouping.     

Scores on the MMPI-2-RF scales as a function of increasing levels of failure on cognitive symptom validity tests in a military sample

This research examined associations between the full range of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales and increasing levels of cognitive symptom validity test (SVT) failure in a sample of 501 military members who completed a neuropsychological evaluation primarily for mild traumatic brain injury resulting from a closed head injury and blast exposure or heat injury. SVT failure was associated with significant linear increases in all of the over-reporting MMPI-2-RF validity scales and most of the substantive scales. For the validity scales, all over-reporting scales had large effect sizes (ESs) when comparing a group that failed no SVTs with a group that failed three SVTs. A comparison between these two groups for the substantive scales revealed the largest ESs for scales related to somatic/cognitive complaints and emotional dysfunction. RBS (Response Bias Scale) had the largest ES of all scales (d = 1.69), followed by FBS-r (Symptom Validity Scale; d = 1.34), AXY (Anxiety, d = 1.21), and COG (Cognitive Complaints, d = 1.19). The scales related to behavioral dysfunction had the smallest ESs of all of the substantive scales, and there were no significant associations between the vast majority of these scales and SVT failure. With respect to clinically significant elevations, those who did not fail SVTs had clinically significant elevations only on COG and NUC (Neurological Complaints), and MLS (Malaise) approached clinical significance. For those who failed SVTs, RBS was the only over-reporting scale that was elevated across all failure groups. Those who failed any SVT had clinically significant elevations on COG, MLS, NUC, and AXY. Those who failed three SVTs had additional elevations on scales related to emotional dysfunction.     

Scores on the MMPI-2-RF Scales as a Function of Increasing Levels of Failure on Cognitive Symptom Validity Tests in a Military Sample

This research examined associations between the full range of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales and increasing levels of cognitive symptom validity test (SVT) failure in a sample of 501 military members who completed a neuropsychological evaluation primarily for mild traumatic brain injury resulting from a closed head injury and blast exposure or heat injury. SVT failure was associated with significant linear increases in all of the over-reporting MMPI-2-RF validity scales and most of the substantive scales. For the validity scales, all over-reporting scales had large effect sizes (ESs) when comparing a group that failed no SVTs with a group that failed three SVTs. A comparison between these two groups for the substantive scales revealed the largest ESs for scales related to somatic/cognitive complaints and emotional dysfunction. RBS (Response Bias Scale) had the largest ES of all scales (d?=?1.69), followed by FBS-r (Symptom Validity Scale; d?=?1.34), AXY (Anxiety, d?=?1.21), and COG (Cognitive Complaints, d?=?1.19). The scales related to behavioral dysfunction had the smallest ESs of all of the substantive scales, and there were no significant associations between the vast majority of these scales and SVT failure. With respect to clinically significant elevations, those who did not fail SVTs had clinically significant elevations only on COG and NUC (Neurological Complaints), and MLS (Malaise) approached clinical significance. For those who failed SVTs, RBS was the only over-reporting scale that was elevated across all failure groups. Those who failed any SVT had clinically significant elevations on COG, MLS, NUC, and AXY. Those who failed three SVTs had additional elevations on scales related to emotional dysfunction.     

Association Between the MMPI-2 Restructured Form (MMPI-2-RF) and Malingered Neurocognitive Dysfunction Among Non-Head Injury Disability Claimants

The current study examined the over-reporting Validity Scales of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) in relation to the Slick, Sherman, and Iverson (1999) criteria for the diagnosis of Malingered Neurocognitive Dysfunction in a sample of 916 consecutive non-head injury disability claimants. The classification of Malingered Neurocognitive Dysfunction was based on scores from several cognitive symptom validity tests and response bias indicators built into traditional neuropsychological tests. Higher scores on MMPI-2-RF Validity Scales, particularly the Response Bias Scale (Gervais, Ben-Porath, Wygant, & Green, 2007), were associated with probable and definite Malingered Neurocognitive Dysfunction. The MMPI-2-RF's Validity Scales classification accuracy of Malingered Neurocognitive Dysfunction improved when multiple scales were interpreted. Additionally, higher scores on MMPI-2-RF substantive scales measuring distress, internalizing dysfunction, thought dysfunction, and social avoidance were associated with probable and definite Malingered Neurocognitive Dysfunction. Implications for clinical practice and future directions are noted.     

Utility of the MMPI-2-RF in detecting non-credible somatic complaints

We examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales (infrequent responses (F-r), infrequent psychopathology responses (Fp-r), infrequent somatic responses (Fs), symptom validity (FBS-r), and response bias (RBS)) in differentiating individuals who were asked to feign physical health problems from a group of somatoform disorder patients and genuine medical patients with no history of mental health problems. A large group of undergraduate students were instructed to feign physical health problems as if they were participating in a disability evaluation for a work-related injury. Comparison groups were drawn from archival databases and consisted of non-litigating medical patients or individuals carefully diagnosed with somatoform disorder. The Fs and Fp-r scales were associated with the best differentiation between the three groups; the Fs scale was the most sensitive to somatic malingering, whereas the Fp-r scale was the most specific. Both scales were associated with high likelihood ratios in differentiating the somatic malingering group from the somatoform and medical illness groups. Although the FBS-r scale was overall the most sensitive in differentiating non-credible somatic complaints from genuine medical illness, it could not differentiate well between the somatic malingering and somatoform patient conditions. The MMPI-2-RF appears to have considerable promise in detecting individuals who feign physical health problems. Not surprisingly, differentiating somatic malingering from somatoform disorder with the MMPI-2-RF was less accurate than differentiating somatic malingering from bona-fide medical patients.     

Differential sensitivity of the Response Bias Scale (RBS) and MMPI-2 validity scales to memory complaints

The MMPI-2 Response Bias Scale (RBS) is designed to detect response bias in forensic neuropsychological and disability assessment settings. Validation studies have demonstrated that the scale is sensitive to cognitive response bias as determined by failure on the Word Memory Test (WMT) and other symptom validity tests. Exaggerated memory complaints are a common feature of cognitive response bias. The present study was undertaken to determine the extent to which the RBS is sensitive to memory complaints and how it compares in this regard to other MMPI-2 validity scales and indices. This archival study used MMPI-2 and Memory Complaints Inventory (MCI) data from 1550 consecutive non-head-injury disability-related referrals to the first author's private practice. ANOVA results indicated significant increases in memory complaints across increasing RBS score ranges with large effect sizes. Regression analyses indicated that the RBS was a better predictor of the mean memory complaints score than the F, F(B), and F(P) validity scales and the FBS. There was no correlation between the RBS and the CVLT, an objective measure of verbal memory. These findings suggest that elevated scores on the RBS are associated with over-reporting of memory problems, which provides further external validation of the RBS as a sensitive measure of cognitive response bias. Interpretive guidelines for the RBS are provided.     

Differential sensitivity of the Response Bias Scale (RBS) and MMPI-2 validity scales to memory complaints

The MMPI-2 Response Bias Scale (RBS) is designed to detect response bias in forensic neuropsychological and disability assessment settings. Validation studies have demonstrated that the scale is sensitive to cognitive response bias as determined by failure on the Word Memory Test (WMT) and other symptom validity tests. Exaggerated memory complaints are a common feature of cognitive response bias. The present study was undertaken to determine the extent to which the RBS is sensitive to memory complaints and how it compares in this regard to other MMPI-2 validity scales and indices. This archival study used MMPI-2 and Memory Complaints Inventory (MCI) data from 1550 consecutive non-head-injury disability-related referrals to the first author's private practice. ANOVA results indicated significant increases in memory complaints across increasing RBS score ranges with large effect sizes. Regression analyses indicated that the RBS was a better predictor of the mean memory complaints score than the F, F_B, and F_P validity scales and the FBS. There was no correlation between the RBS and the CVLT, an objective measure of verbal memory. These findings suggest that elevated scores on the RBS are associated with over-reporting of memory problems, which provides further external validation of the RBS as a sensitive measure of cognitive response bias. Interpretive guidelines for the RBS are provided.     

Examination of the new MMPI-2 Response Bias Scale (Gervais): relationship with MMPI-2 validity scales

Validity scales were recently developed to improve assessment of symptom validity beyond original MMPI-2 validity scales. In an initial study, the Response Bias Scale (RBS; Gervais, 2005) was developed based upon non-head-injury claimant performances on a cognitive effort measure, the Word Memory Test (WMT). The present study examined relationships of the RBS with numerous MMPI-2 validity scales in a sample of 211 participants with secondary gain (SG) or no secondary gain (NSG). Of the validity scales observed, RBS yielded the largest effect size difference between groups (d = .65), followed closely by FBS (d = .60) and the L-scale (d = .51). Overall, RBS correlated most significantly (r = .74, p < .001) with FBS, but also showed significant correlations with most other validity scales for both groups. RBS further demonstrated significant correlations (p < .001) with all clinical scales except for Mf. Findings suggest that RBS and FBS may represent a similar construct of symptom validity, and may outperform other MMPI-2 validity scales in discriminating SG and NSG groups. Findings provide preliminary support for use of RBS within the forensic context.     

Dementia does not Preclude Very Reliable Responding on the MMPI-2 RF: A Case Report

The Minnesota Multiphasic Personality Inventory (MMPI) family of personality tests has long been used by psychologists, in part because it provides extensive information on the validity of patient responses. Although much of the research on MMPI validity indicators has focused on over-reporting or under-reporting symptoms, the consistency (i.e., reliability, a requirement for validity) of responding is also critical to examine. Clinicians tend to avoid using the MMPI-2 or the MMPI-2-RF (Restructured Form) in patients with dementia based on the belief that severe cognitive impairment would make reliable responding impossible given the large number of items (567 and 338, respectively). In contrast with this belief we present the case of a 65-year-old woman with severe memory impairments and executive dysfunction due to a non-specific dementia syndrome who was able to provide remarkably consistent responding on the MMPI-2-RF. Implications and future directions are discussed.     

Comparison of MMPI-2 validity scale scores of personal injury litigants and disability claimants

Five validity scales derived from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Infrequency Scale (F), Infrequency-Psychopathology Scale (F[p]), Symptom Validity Scale (FBS), Henry-Heilbronner Index (HHI), and Response Bias Scale (RBS) were evaluated in 118 litigation patients (LPs) and 163 clinical patients (CPs). Varied statistical methods, including hierarchical logistic regression analyses, Receiver Operating Characteristic (ROC) curve, Area Under the Curve (AUC) values, and sensitivity/specificity analyses, showed that RBS performed better than the other four scales in identifying LPs. The regression analyses found RBS to be the most significant predictor of LP and CP group membership (p?相似文献   

Elevation discrepancies between MMPI-2 clinical and MMPI-2-RF restructured clinical (RC) scales in people with seizure disorders

PurposePeople with seizure disorders experience elevated rates of psychopathology, often undiagnosed and untreated. Accurate diagnosis of psychopathology remains an important goal of quality health care for people with seizure disorders. One of the most widely used dimensional measures of psychopathology is the Minnesota Multiphasic Personality Inventory—Second Edition (MMPI-2). Research in heterogeneous mental health samples suggests that the 2008 revision of this measure, the Minnesota Multiphasic Personality Inventory—Second Edition—Restructured Form (MMPI-2-RF), offers better construct fidelity and more cost-effective administration. This study seeks to extend research on MMPI-2-RF scale elevations to a sample of people with seizure disorders.MethodsIn a consecutive, heterogeneous sample of people with seizure disorders, MMPI-2 and MMPI-2-RF scores were compared in terms of categorical classification agreement (clinically elevated versus not clinically elevated). Scores were also compared in terms of variance attributable to diagnosis-specific items, general demoralization, subtle items, social desirability, and demographic factors.Key findingsScores on MMPI-2 and MMPI-2-RF provided a statistically significant level of agreement between corresponding clinical diagnostic scales ranging from 68% to 84%. Most classification disagreement was attributable to MMPI-2 clinical scale elevations when MMPI-2-RF scales were not elevated. Regression analysis supported the interpretation that general demoralization, subtle items, social desirability, and demographic factors led to MMPI-2 clinical scale elevations.SignificanceThe results provide evidence that in the context of strong psychopathology classification agreement, the MMPI-2-RF restructured clinical scales provide better construct fidelity compared with the more trait heterogeneous MMPI-2 clinical scales. These results should encourage clinicians to use the MMPI-2 Restructured Form (MMPI-2-RF) for improved psychopathology assessment compared with the MMPI-2 in patients with seizure disorders.     

Comparison of MMPI-2 Validity Scale Scores of Personal Injury Litigants and Disability Claimants

Five validity scales derived from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Infrequency Scale (F), Infrequency-Psychopathology Scale (F[p]), Symptom Validity Scale (FBS), Henry-Heilbronner Index (HHI), and Response Bias Scale (RBS) were evaluated in 118 litigation patients (LPs) and 163 clinical patients (CPs). Varied statistical methods, including hierarchical logistic regression analyses, Receiver Operating Characteristic (ROC) curve, Area Under the Curve (AUC) values, and sensitivity/specificity analyses, showed that RBS performed better than the other four scales in identifying LPs. The regression analyses found RBS to be the most significant predictor of LP and CP group membership (p?<?.001). The effectiveness of RBS in identifying LPs, all of whom reported neuropsychological symptoms, was attributed to its development based on cognitive effort test scores.     

Impaired Performance on the Reading the Mind in the Eyes Test in First-Episode Psychosis and Clinical High Risk for Psychosis

ObjectiveAlthough previous studies have reported impaired performance in the reading the mind in the eyes test (RMET), which measures complex emotion recognition abilities, in patients with schizophrenia, reports regarding individuals at clinical high risk (CHR) for psychosis have been inconsistent, mainly due to the interacting confounding effects of general cognitive abilities and age. We compared RMET performances across first-episode psychosis (FEP) patients, CHR individuals, and healthy controls (HCs) while controlling for the effects of both general cognitive abilities and age. MethodsA total of 25 FEP, 41 CHR, and 44 HC subjects matched for age participated in this study. RMET performance scores were compared across the groups using analysis of variance with sex and intelligence quotient as covariates. Exploratory Pearson’s correlation analyses were performed to reveal the potential relationships of RMET scores with clinical symptom severity in the FEP and CHR groups. ResultsRMET performance scores were significantly lower among FEP and CHR participants than among HCs. FEP patients and CHR subjects showed comparable RMET performance scores. RMET scores were negatively correlated with Positive and Negative Syndrome Scale (PANSS) positive symptom subscale scores in the FEP patients. No significant correlation was identified between RMET scores and other clinical scale scores. ConclusionImpaired RMET performance is present from the risk stage of psychosis, which might be related to positive symptom severity in early psychosis. Longitudinal studies are necessary to confirm the stability of complex emotion recognition impairments and their relationship with social functioning in early psychosis patients.     

Cognitive functioning and positive and negative symptoms in schizophrenia

The present study examined schizophrenics' performance on a variety of cognitive measures in order to explore the relationship between schizophrenic symptoms and cognitive performance. The Wechsler Adult Intelligence Scale and a battery of neuropsychological tests, developed at the Montreal Neurological Institute, were administered to 38 acutely ill, hospitalized schizophrenics. Patients were diagnosed using DSM III criteria. Negative symptoms were assessed with the SANS and positive symptoms with the SAPS. Both the cognitive tests and the symptom rating scales were re-administered to this sample at a 6 month follow-up period. Analyses revealed that, at both time periods cognitive deficits were more likely to be associated with high negative symptom ratings than with positive symptoms. Only certain tests showed significant improvement at the follow-up period. Furthermore, improved cognitive functioning was related to an improvement in positive, but not negative, symptoms.     

Let's Not Get Hysterical: Comparing the MMPI-2 Validity,Clinical, and RC Scales in TBI Litigants Tested for Effort

The MMPI-2 restructured clinical (RC) scales replace the traditional clinical scales in the MMPI-2 restructured form (MMPI-2-RF). Few studies to date have examined the MMPI-2 RC scales in traumatic brain injury (TBI) litigants. We compared MMPI-2 validity, clinical, and RC scales profiles of 83 mild, complicated mild, and moderate/severe TBI litigants who were tested for effort. Past research shows that patients referred for neuropsychological evaluations with mild TBIs paradoxically have higher MMPI-2 clinical scale elevations than patients with moderate/severe TBIs. Failure on cognitive symptom validity tests (SVTs) has also been associated with elevated validity and clinical scales profiles. The “conversion V” (elevated Hs and Hy, followed by D) is the most frequent elevated profile configuration in mild TBI and/or SVT failure. We sought to determine if these patterns of symptom reporting would replicate on the RC scales profile. Archival data from independent neuropsychological examinations were used to correlate TBI severity, cognitive test effort as indicated by SVTs, and MMPI-2 profiles. Results suggest that the validity, clinical, and RC scales profiles all correlate well with indices of cognitive test effort (namely that failure on SVTs is correlated with elevated symptom reporting). In addition, the validity scales profile, but not the clinical or RC scales profiles, was significantly inversely related to TBI severity. Discriminant function analyses suggest that the MMPI-2 RC scales can aid in the diagnosis of over-reported TBI symptomatology. However, RC3—the RC equivalent of the Hy scale—no longer appears to serve as a marker of somatization and/or malingering.     

Empirical Correlates and Interpretation of the MMPI-2-RF Cognitive Complaints (COG) Scale

The MMPI-2-RF Cognitive Complaints (COG) scale (Ben-Porath & Tellegen, 2008) was developed to assess self-reported memory and other cognitive difficulties. The present study explores cognitive and self-report correlates of the COG scale and provides recommendations for its interpretation. We examined archival demographic, cognitive test, and self-report symptom data from 1741 consecutive, non-head injury disability claimants seen in a private-practice setting. Insufficient cognitive effort and cognitive symptom exaggeration were controlled by excluding cases that scored in the biased responding range on cognitive symptom validity tests and the Response Bias Scale (RBS). Results of the study found that performance on COG was strongly related to subjective cognitive and emotional complaints, but not to objective cognitive deficits. We present three case studies to illustrate interpretive strategies for the COG scale.     

Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia

Empathy is a multidimensional construct that relies on affective and cognitive component processes. A few studies have reported impairments of both cognitive and affective empathy components in patients with schizophrenia. It is, however, not known whether these difficulties are already present at psychosis onset. The affective and cognitive components of empathy were thus assessed in 31 patients with first-episode psychosis (FEP) and 31 matched healthy controls using the Interpersonal Reactivity Index (IRI). Our results were then compared to previous studies of empathy in patients with more chronic schizophrenia via a meta-analysis. In addition, we also assessed the relationship between empathy ratings, Mentalizing performance and clinical symptoms. Contrary to what has been reported in people with more chronic schizophrenia, the IRI ratings did not significantly differ between FEP and controls in our study, though a trend was observed for the Personal distress scale. For the Perspective taking scale, our meta-analysis revealed a significantly lower effect size in this study with FEP patients relative to previous schizophrenia studies. In the FEP group, the IRI ratings were not related to positive, negative or general psychopathology symptoms, but a significant relationship emerged between the Liebowitz Social Anxiety Scale and Perspective taking (negative correlation). In addition, a significant positive correlation was observed between the Empathic concern subscale and our theory of mind task. This study supports the idea that the cognitive component of empathy is less affected in patients with first-episode psychosis relative to patients with more chronic schizophrenia, and the impairments reported in previous reports with more chronic populations should be interpreted in light of a possible deterioration of this cognitive skill. The findings also provide some insight into the relationship between empathy and clinical symptoms such as social anxiety.