Malingering response styles on the memory assessment scales and symptom validity tests.

This study identified malingering strategies of test performance and investigated their presence in the responses to computer-mediated versions of Rey's Dot-Counting and 15-Items tests, a forced-choice symptom validity procedure and the Memory Assessment Scales (MAS). Sixty volunteer subjects were randomly assigned to control (n = 30) or malingering (n = 30) groups. The control subjects were instructed to perform their best and the malingerers were instructed to fake a poor performance on the tests. As expected, malingering subjects scored significantly worse than control subjects on virtually all tests. Malingerers had slower response times on most tests. They also performed worse on recognition tasks in contrast to performance on recall tasks. Their response style was characterized by intentional wrong and random responding on recognition tasks. Malingerers did not show the expected worse-than-chance responding on the forced-choice symptom validity procedure. Current tests of symptom validity may not have sufficient sensitivity to detect milder forms of malingering.     

Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests.

This study examined the effect of depression on neurocognitive performance in patients who passed symptom validity testing. The Beck Depression Inventory (BDI) was used to assess depression in 420 patients with heterogeneous referral diagnoses (more than half of these cases were head injury or neurological disease). All patients had demonstrated satisfactory effort by passing two symptom validity tests. No differences were found on objective cognitive and psychomotor measures in groups sorted based on their self-reported depression. In contrast, on the self-report measures [i.e., Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Symptom Checklist-90-Revised (SCL-90-R), and Memory Complaints Inventory (MCI)], differences were found indicating that patients with depression report more emotional, somatic, and cognitive problems. Contrary to expectation, these data suggest that depression has no impact on objective neurocognitive functioning.     

Performance of children on symptom validity tests: TOMM, MSVT, and FIT

Symptom validity testing is a major topic in the field of neuropsychological research, but until now, few studies focus on effort testing in children. Three symptom validity tests (SVTs), the Medical Symptom Validity Test, the Test of Memory Malingering, and the Fifteen Item Test plus several standard neuropsychological tests were administered to 73 German-language school children from 6 to 11 years.Participants were either instructed to give full effort or to follow a malingering scenario. It could be demonstrated that, except for one child, all participants with a basic reading level of grade 2 were able to pass all administered SVTs according to established cutoffs for poor effort (i.e., earned a score higher than the cutoff). For the experimental malingerers, however, it was fairly difficult to act according to the scenario throughout the session. While they scored worse in the neuropsychological tests, all but one of them failed at least one SVT. The results support the use of SVTs in childhood age. More elaborate experimental designs and studies with bona-fide patients and suspected malingerers are needed in order to evaluate both the appropriateness of available effort tests and the capabilities of children to fake poor performance.     

A comparison of four tests of malingering and the effects of coaching.

This study examined the ability of four measures of suboptimal performance to correctly classify four groups of subjects (normal controls, uncoached malingering, coached malingering, and head injured). Only the Portland Digit Recognition Test-Computerized (PDRT-C) identified simulating malingerers with greater than chance accuracy while minimizing false positives. Coached subjects were better able than their uncoached counterparts to avoid detection on all measures. In an additional analysis, a discriminant function using the response latency and total correct scores from the PDRT-C identified 70% of the coached malingerers on cross validation. The three other tests (Nonverbal Forced Choice Test, 21-Item Test, and Dot Counting Test) failed to obtain a satisfactory classification rate for the malingering groups as a whole and coached malingerers in particular.     

Verbal Paired Associates tests limits on validity and reliability.

The Verbal Paired Associates (VPA) subtest from the Wechsler Memory Scale-III (WMS-III) is one of the most widely used instruments for assessing explicit episodic memory performance. The normative data for the VPA subtest in the WMS-III manual show clear evidence of performance ceiling effects that limit the usefulness of this instrument. For this reason, we developed a new 15-item VPA test and we report normative data obtained from a partially stratified sample of 351 healthy adults between 18 and 91 years of age. Only a small fraction of participants obtained perfect scores on our new Paired Associates test. The results show the expected large age-related decline in memory acquisition, indexed by performance on the first study test trial, together with a much smaller age effect on learning across trials. The results also show that performance on the Paired Associates test is related to education, verbal IQ, and to a lesser extent, participants' sex. We provide various equations for precise predictions of Paired Associates test performance.     

An exploration of the construct validity of the Heaton memory tests.

The Heaton techniques for assessing memory differ from most other memory measures by employing the combination of learning trials, repeated exposure to test stimuli, and 4-hour recall measures. The present study was designed to explore the relationship between the Heaton Story and Figure memory procedures, the California Verbal Learning Test (CVLT), and measures of attention, word fluency, and spatial perception. Data from 126 individuals were analyzed. Three separate factor analyses were performed that examined measures of attention, learning, and recall. Each revealed a three-factor solution accounting for 71, 70, and 72% of the variance, respectively. Regression analyses supported the visual components of Figure Memory and the verbal components of Story Memory obtained in the factor analyses. Overall, the findings supported the independence of the Heaton Memory procedures and the role of spatial factors in performance of Figure Memory. Additionally, both Figure and Story Memory shared variance with the CVLT, supporting the validity of both procedures as memory measures.     

The validity of the letter memory test as a measure of memory malingering: robustness to coaching.

The letter memory test (LMT) is a computerized forced-choice test of malingering detection including two face valid difficulty manipulations: increase in target stimulus length and increase of response foils. Prior research suggests the LMT shows promise as a malingering detection measure. In the present study, the utility of the LMT in the identification of malingering was further explored, using a counterbalanced design in a simulated malingering sample. Prior work was extended by assessing the robustness of the LMT to coaching and assessing the effectiveness of an additional scoring method, utilizing the face valid difficulty manipulations. Results were consistent with prior research on the LMT, with the standard cutoff score yielding high indices of accuracy. The LMT showed no order effects and was superior to the 15-item test in accuracy indices. Both the standard LMT score and the proposed score based on difficulty manipulations were relatively robust to coaching. Overall, findings indicate the LMT is a viable contender among measures of memory malingering.     

Verification and validation of diagnostic laboratory tests in clinical virology.

This review summarizes major issues of verification and validation procedures and describes minimum requirements for verification and validation of diagnostic assays in clinical virology including instructions for CE/IVD-labeled as well as for self-developed ("home-brewed") tests or test systems. It covers techniques useful for detection of virus specific antibodies, for detection of viral antigens, for detection of viral nucleic acids, and for isolation of viruses on cell cultures in the routine virology laboratory.     

Detection of simulated ADHD and reading disorder using symptom validity measures

Previous studies have typically focused on the ability of cognitive symptom validity tests to identify cognitive symptom exaggeration in the context of head injury or memory loss. Few published studies have examined the detection of simulated attention-deficit/hyperactivity disorder (ADHD) or reading disorder (RD). The present study examined the accuracy of symptom validity measures in the detection of simulated ADHD and RD. Results indicated that several commonly used symptom validity measures show good validity for detecting simulated ADHD and RD. Total Validity Indicator Profile (VIP) scores and hard item accuracy score from the Victoria Symptom Validity Test (VSVT) were the most accurate at distinguishing simulation of ADHD and RD from adequate effort. Percentages of control participants and participants in simulation conditions scoring below a specified cut score are provided to give clinicians an estimate of the simulator (true) positive and control (false) positive rates.     

Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea.

The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms--snoring, sleep disturbances and diurnal hypersomnia--if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) greater than 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from -23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 +/- 18.4; p less than 0.01). The positive predictive value of DPSG was 63% (10/16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.     

精神分裂症复发风险量表的效度和信度检验

目的:开发适用于临床日常工作的精神分裂症复发风险评估工具。方法:通过德尔菲法确定精神分裂症复发风险量表(SRRS),评估北京市朝阳区在册共197例稳定期和复发期患者,使用精神分裂症复发征兆问卷(SRSQ)和药物依从性问卷(MAQ)作为效标,两周后随机选取其中57例进行重测。结果:通过德尔菲法选择标准,得出12条目,再采用条目分析形成9条目的量表。通过探索性因子分析形成治疗维持和治疗效果两个因子,可解释总方差的51.4%。量表总分与SRSQ总分呈正相关(r=0.52,P<0.01)。总量表的内部一致性Cronbachα系数为0.80,重测信度(ICC)为0.95。结论:精神分裂症复发风险量表具有较好的效度和信度,可以用来评估精神分裂症的复发风险。     

The ecological validity of clinical tests of memory and attention in multiple sclerosis.

Ecological validity--the degree to which clinical tests of cognitive functioning predict functional impairment--has recently become an area of interest in neuropsychology. The current study used a sample of 31 cognitively and functionally impaired multiple sclerosis (MS) patients to determine if tests commonly used to assess memory and attentional functioning in MS are ecologically valid. Two methods of improving the ecological validity of cognitive testing were employed. Stepwise multiple regression analyses suggested that tests of memory and attention more analogous to everyday tasks are better predictors of functional impairment in MS than both standard clinical tests of memory and attention, and memory questionnaires completed by the patient or a significant other. Nonetheless, both standard clinical tests and more ecologically valid tests significantly predicted functional impairment. Importantly, they were not significantly correlated with one another, suggesting that the inclusion of both types of tests in evaluating MS patients is warranted.     

Concurrent validity of the clinical symptom syndrome scales of the millon clinical multiaxial inventory

This study examined relationships between the clinical symptom syndrome scales of the Millon Clinical Multiaxial Inventory (MCMI) and the various clinically meaningful mood or symptom states measured by the six Profile of Mood States (POMS) scales (N = 243). The MCMI symptom scale—POMS symptom/mood scale relationships found in this study were compared with MCMI symptom scale—MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual (Millon, 1983). Results of the present investigation, when combined with results of the previous analyses reported in the MCMI manual, reveal a number of consistent associations of moderate strength between MCMI symptom scales and selected mood or symptom scales from the MMPI and Symptom Checklist-90 as well as from the POMS. Although most relationships between the MCMI symptom scales and the symptom/mood scales of the POMS, MMPI and SCL-90 were consistent with expectation, the Anxiety, Dsythymia and Psychotic Depression scales of the MCMI show limited ability to discriminate appropriately between anxiety and depression in several of the concurrent validity analyses considered herein.     

The influence of stress upon symptom structure

Evaluated the influence of stress on the factor structure of symptoms in a nonclinical population. A random sample of 299 persons in the process of divorcing were subdivided into those high and low on stressful life events. Separate factor analyses of symptoms for each group provided evidence that stress does affect symptom structure. Ruminative Depression was the only stable factor. Two anxiety factors from the low stress group merged into one factor among the high stressed, while agitated depression appeared only in the low stress condition. A factor suggestive of stress response syndrome was evident among the high stressed.     

Construct validity of neuropsychological tests of conceptual and attentional abilities

In a mixed sample of community-living adults, this study examined the construct validity of five neuropsychological tests: Category Test (CAT), Wisconsin Card Sorting Test (WCST), Paced Auditory Serial Addition Task (PASAT), Visual Search and Attention Test (VSAT) and Trail Making Test: Part B (TMT-B). Principal components analyses showed that PASAT, VSAT, and TMT-B defined an attention factor and that CAT and WCST defined a conceptual factor. The results were discussed in terms of common interpretations of these procedures as well as in terms of Mirsky's (1989) components of attention.     

An Italian validation of the Comparative Psychotherapy Process Scale: Reliability and validity

The Comparative Psychotherapy Process Scale (CPPS) is an instrument designed to measure therapist interventions in a psychotherapy session. The scale includes 20 items divided into two subscales: the PI (psychodynamic‐interpersonal) scale, which describes psychodynamic‐interpersonal techniques; and the CB (cognitive‐behavioural) scale, which includes cognitive‐behavioural interventions. The aim of the study was to examine the psychometric properties of the CPPS, comparing the PI and CB subscales with the psychodynamic, cognitive and STTP prototypes, as described by the Psychotherapy Process Q‐set(PQS). The sample comprised 94 sessions (N = 94) of psychodynamic and cognitive‐behavioural orientation. Two groups of independent raters with excellent interrater reliability (ICC = .78) evaluated the sessions. The results suggest that the CPPS is a valid and reliable instrument that provides a clinically sensitive and psychometrically robust evaluation of a therapist's techniques. The clinical and research implications of the results are discussed.