Medical clinic patients with emotional disorders

Demographic, psychologic, social, and medical characteristics of 327 patients in a general medical clinic who were judged in need of psychiatric treatment were compared with those of 371 patients who were judged not in need of such treatment. Significant differences were found in such factors as age, sex, family relationships, history of treatment for “nerves,” and scores on the Hopkins Symptom Checklist.     

Symptom Validity Testing of remote memory in a criminal forensic setting.

Symptom Validity Testing (SVT) has been used effectively with sensory perception and short-term memory. The procedure was recently adapted to assess remote memory for specific events. Memory for remote events is particularly important to the criminal justice system, and courts are beginning to draw on neuropsychology to assist in the assessment of claimed remote memory loss. This report discusses the importance of this objective technique to neuropsychologists involved with criminal courts and presents its use in three cases from the criminal forensic arena. Normative results for the three case study tests are presented and suggest the procedure is a robust version of SVT. Implications of these results are discussed.     

Validity of the Wonderlic Personnel Test as a brief measure of intelligence in individuals referred for evaluation of head injury.

Some have argued that the Wonderlic Personnel Test (WPT) may represent a brief and efficient measure of intellectual functioning (e.g., Dodrill, 1980). The present study investigated the validity of the WPT as such a measure, in individuals with head injury. The findings suggested that, although the WPT showed relatively high agreement with the Wechsler Adult Intelligence Scale-Revised (WAIS-R) in the whole group, it did not have good agreement with WAIS-R scores on an individual case basis. Since clinical practice typically seeks to evaluate individual performance, it is suggested that the WPT is not a suitable tool for psychological assessment of individuals with known or suspected head injury.     

The latent structure of cognitive symptom exaggeration on the Victoria Symptom Validity Test.

Previous studies have focused on the ability of cognitive symptom validity tests to identify simulated malingering or distinguish between clinical samples of individuals at low or high risk of cognitive symptom exaggeration. However, no published studies have examined the latent structure of negative response bias on cognitive tests: measures of cognitive symptom exaggeration may evaluate a continuum of poor effort/invalid responding or a dichotomy of adequate versus inadequate effort. The present study examined whether Victoria Symptom Validity Test (VSVT) indices evaluate a latent dimension or category of response distortion. The VSVT and personality data were obtained from 300 individuals who participated in neuropsychological evaluations as part of standard clinical care. Results indicated that VSVT accuracy scores measure a latent category of inadequate/adequate effort. Individuals classified as taxon members showed significantly poorer performance IQ and memory relative to individuals not classified as exhibiting distortion. The base rate of the identified cognitive symptom exaggeration taxon was estimated to be approximately .13-.14 in the present sample. Likelihood ratios are presented to assist clinical detection of individuals exhibiting the category of cognitive symptom exaggeration.     

Validity of the Medical College Admission Test for predicting medical school performance.

PURPOSE: Since the introduction of the revised Medical College Admission Test (MCAT(R)) in 1991, the Association of American Medical Colleges has been investigating the extent to which MCAT scores supplement the power of undergraduate grade point averages (uGPAs) to predict success in medical school. This report is a comprehensive summary of the relationships between MCAT scores and (1) medical school grades, (2) United States Medical Licensing Examination (USMLE) Step scores, and (3) academic distinction or difficulty. METHOD: This study followed two cohorts from entrance to medical school through residency. Students from 14 medical schools' 1992 and 1993 entering classes provided data for predicting medical school grades and academic difficulty/distinction, while their peers from all of the U.S. medical schools were used to predict performance on USMLE Steps 1, 2, and 3. Regression analyses assessed the predictive power of combinations of uGPAs, MCAT scores, and undergraduate-institution selectivity. RESULTS: Grades were best predicted by a combination of MCAT scores and uGPAs, with MCAT scores providing a substantial increment over uGPAs. MCAT scores were better predictors of USMLE Step scores than were uGPAs, and the combination did little better than MCAT scores alone. The probability of experiencing academic difficulty or distinction tended to vary with MCAT scores. MCAT scores were strong predictors of scores for all three Step examinations, particularly Step 1. CONCLUSIONS: MCAT scores almost double the proportion of variance in medical school grades explained by uGPAs, and essentially replace the need for uGPAs in their impressive prediction of Step scores. The MCAT performs well as an indicator of academic preparation for medical school, independent of the school-specific handicaps of uGPAs.     

Victoria Symptom Validity Test performance in acute severe traumatic brain injury: implications for test interpretation.

Effort testing has become commonplace in clinical practice. Recent research has shown that performance on effort tests is highly correlated with performance on neuropsychological measures. Clinical application of effort testing is highly dependent on research derived interpretive guidelines. The Victoria Symptom Validity Test (VSVT) is one of many measures currently used in clinical practice. The VSVT has recommended interpretive guidelines published in the test manual, but the samples used in developing interpretive guidelines are small and heterogeneous and concern has been expressed regarding high false negative rates. In this study, a homogeneous sample of acute, severely brain injured persons were used to assess the sensitivity of the VSVT. Results confirmed that acute, severely brain injured persons (N=71) perform very well on the VSVT. The severe brain injury population is 99% likely to have between 44.1 and 46.8 correct VSVT Combined Score responses. While the VSVT was insensitive to memory dysfunction, the presence of severe visual perceptual (Benton Visual Form Discrimination Score<21) and verbal fluency (Controlled Oral Word Association Score<15) deficits predicted poor performance on the VSVT. These results provide further evidence that performance expectations currently incorporated in the VSVT manual interpretative criteria are too conservative. Empirically based alternative criteria for interpreting VSVT Combined Scores in the TBI population are presented.     

Analysis of 88 adult patients referred for genetics evaluation

We present a series of 88 adult patients referred for diagnostic genetic services in two settings. Patients referred for prenatal diagnosis, adult-onset neurodegenerative disease or cancer susceptibility counseling were specifically excluded from analysis. Information was obtained regarding age, gender, referral sources, previous genetics evaluation, referring diagnosis, final diagnosis, diagnostic test, and recommendations. The patients were able to be grouped into seven general categories: multiple congenital anomalies with or without mental retardation (26 patients), collagen-connective tissue disorders (18 patients), mental retardation (12 patients), chromosomal abnormalities (12 patients), bone growth disorders (6 patients), endocrine/metabolic (8 patients), and miscellaneous (6 patients). Patients and referring providers were not surveyed regarding utility of the evaluation. However, genetics notes were reviewed on all patients and potential benefits of the evaluation were identified. All patients had at least one potential benefit, with the majority having several. This study represents one of the largest published groups of non-institutionalized adult patients that have undergone comprehensive genetic evaluation. The role of the clinical geneticist as a member of the health care team in this population will be discussed.     

Coverage of the Test of Memory Malingering,Victoria Symptom Validity Test,and Word Memory Test on the Internet: Is test security threatened?

In forensic neuropsychological settings, maintaining test security has become critically important, especially in regard to symptom validity tests (SVTs). Coaching, which can entail providing patients or litigants with information about the cognitive sequelae of head injury, or teaching them test-taking strategies to avoid detection of symptom dissimulation has been examined experimentally in many research studies. Emerging evidence supports that coaching strategies affect psychological and neuropsychological test performance to differing degrees depending on the coaching paradigm and the tests administered. The present study sought to examine Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it. Steps that could be taken to improve this situation and limitations to this exploration are discussed.     

Characterization of clinically significant isolates of Staphylococcus epidermidis from patients with endocarditis.

Biotyping, slime production, bacteriophage typing, serotyping, antibiograms, and plasmid profiles were used to characterize 19 Staphylococcus epidermidis strains isolated from 12 patients with prosthetic valve endocarditis and from 7 patients with native valve endocarditis. With the API Staph battery, 12 different biocodes with, at the most, three differences were obtained. Slime production was found for 10 strains (53%). Agglutinogens investigated by agglutination with two specific sera were found for 12 strains (63.1%). Three strains were phage typable (15.2%). Against a panel of nine antimicrobial agents, 15 different profiles were found. Multiply antibiotic-resistant strains were isolated from patients with prosthetic valve endocarditis when disease onset occurred less than 18 months after heart surgery and from patients with native valve endocarditis who received antibiotics immediately prior to their illness. All of the strains were available for plasmid analysis, and all the DNA profiles were distinct. On gels run in Tris-borate buffer, 73.7% of the strains had large plasmids of more than 30 megadaltons. A small plasmid of 2.8 megadaltons was found in multiply resistant strains and in strains resistant only to tetracyclines. None of the isolates appeared to be the same strain, and the bacteriological differences between the strains were confirmed mainly by the antibiotic susceptibility profile and the plasmid pattern analysis. These bacteriological results were in agreement with the clinical data.     

Diagnostic outcomes of 27 children referred by pediatricians to a genetics clinic in the Netherlands with suspicion of fetal alcohol spectrum disorders

The characteristics of fetal acohol spectrum disorders (FASD) constitute a specific facial phenotype, growth failure and neurodevelopmental defects. Reported FASD prevalences vary widely from 0.08 per 1,000 up to 68.0–89.2 per 1,000. We aimed to evaluate to which extent children referred with a suspicion of FASD, indeed have FASD. We included all 27 children referred to our genetic department with a suspicion of FASD between 2005 and 2010. Nineteen children (70.3%) were of non‐Dutch ancestry, and 24 (88.9%) had been adopted. We used both the 4‐Digit Code and the Revised Institute of Medicine criteria. More than half of the children did not meet either criteria for the diagnosis of FASD. Of note, after evaluation 8/27 children appeared not to have confirmed prenatal alcohol exposure. Two children referred for suspicion of FASD (neither of which were exposed to alcohol or met the criteria for FASD) had a pathogenic microstructural chromosomal rearrangement (del16p11.2 of 542 KB and dup1q44 of 915 KB). In 22/24 children (91.7%) there were other factors that may have affected their intellectual abilities, such as familial intellectual disability and social deprivation. We recommend a critical approach towards the diagnosis FASD, and to investigate all patients suspected to have FASD for other causative factors including genetic abnormalities. © 2013 Wiley Periodicals, Inc.     

Validity of the MMPI 168 on private clinic subpopulations

The diagnostic efficiency of the MMPI 168 and the standard MMPI was compared on three private psychiatric subpopulations: a hospitalized adult inpatient sample, a hospitalized adolescent inpatient sample, and an outpatient sample composed of vocational rehabilitation referrals. The MMPI 168 was found to be a viable alternative to the standard Form R on all three groups by separating invalid from valid profiles, normal from abnormal profiles, and by differentiating among neurotic, psychotic, characterological, and indeterminate profiles.     

Characterization of two unusual clinically significant Francisella strains.

We have isolated two phenotypically distinct nonfastidious Francisella strains (Fx1 and Fx2) from the blood of compromised patients with pneumonia and compared them with eight other Francisella strains, including Francisella tularensis biovar tularensis, F. tularensis biovar novicida, and F. philomiragia. Our isolates grew well on sheep blood agar, chocolate agar, modified Thayer-Martin agar, and Trypticase soy agar. Fx1 and Fx2 were determined to be within the Francisella genus by cellular fatty acid analysis and by the utilization of glucose, production of H2S and catalase, and lack of motility, oxidase, nitrate reductase, and gelatinase. They were additionally shown to belong to the species F. tularensis by sequencing of two variable regions comprising approximately 500 nucleotides of the 16S rRNA gene. Also, RNA probe hybridization confirmed their belonging to the species F. tularensis. However, the new strains, which are not identical, are distinguished from other F. tularensis strains by growth characteristics, repetitive extragenic palindromic PCR fragment pattern, and some biochemical tests. Key biochemical differences included the findings that Fx1 was positive for beta-galactosidase and arabinose hydrolysis and that both strains were citrulline ureidase positive and glycerol negative. Commercial F. tularensis antiserum agglutinated stock F. tularensis strains but not Fx1, Fx2, F. tularensis biovar novicida, or F. philomiragia; serum from either patient failed to agglutinate or only weakly agglutinated commercial antigen but showed agglutination when tested against each patient's respective isolate. Fx1 and Fx2 produced beta-lactamase. Because of their good growth, negative serology, and biochemical profile, the organisms could be misidentified in the clinical laboratory if standard strategies or commercial identification systems are used.     

Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic.

BACKGROUND: Depressive symptoms are associated with noncompliance and even sudden death in asthma patients. Some studies suggest that low-income, minority, inner-city asthma patients may be at high risk for asthma-related morbidity and mortality in which depression may be a risk factor. Minimal data are available on the prevalence of depression and other mood disorders in asthma patients. OBJECTIVE: In this pilot study, we examined the prevalence of depression and the association between depression and measures of asthma severity in patients at an inner-city asthma clinic. METHODS: Mood disorders were diagnosed using a diagnostic interview given to patients (N = 44) at asthma clinic visits. Inhaled steroid dose, FEV1 percentage, and asthma severity were also obtained. RESULTS: Eighteen patients (41%) had a lifetime mood disorder but only seven of these patients received pharmacotherapy. Patients with a past mood disorder had significantly higher FEV1 percentage predicted values (P = 0.03) than those without a mood disorder. Trends toward less severe asthma (P = 0.13) and lower inhaled steroid dose (P = 0.13) in patients with a mood disorder history were also found. CONCLUSIONS: The data suggest that mood disorders are common, but often unrecognized and untreated in asthma patients. The data also suggest that mood disorders are not necessarily associated with more severe asthma, at least in the population studied.     

精神症状评定量表中文版的信度、效度分析

目的:建立精神症状评定量表(PSYRAT)中文版,并分析其信度和效度。方法:选取221例符合精神障碍诊断和统计手册第四版(DSM-IV)精神分裂症、精神分裂症样障碍、分裂情感性精神障碍、妄想性精神障碍、短暂精神病性障碍诊断标准的患者进行PSYRAT、阳性与阴性症状量表(PANSS)评定。结果:总量表的标准化Cronbach’sα系数为0.943,重测信度为0.853,评估者间一致性为0.998。各条目对因子的负荷系数为0.840-0.929。PSYRAT幻听、妄想分量表及总分与PANSS量表的幻觉、妄想及阳性症状量表分的相关系数分别为0.909、0.833及0.737。结论:精神症状评定量表(PSYRAT)中文版具有良好的信度和效度,可作为评定幻听及妄想严重程度的有效测量工具。     

相倚性自我价值量表中文版在医学生中的信效度检验

目的评估相倚性自我价值(Contingencies of Self-Worth,CSW)量表中文版的信度和效度。方法在某医科大学随机抽取70名临床专业本科生进行预实验,之后采取分层抽样,选取该医科大学临床专业本科生372名进行CSW中文版的测试,2周后随机抽取70名被试进行重测。结果 CSW中文版各分量表Cronbachα系数在0.74~0.88之间,全量表α系数为0.90,重测相关系数为0.71~0.83(P<0.01)。CSW中文版的KMO值为0.82,Bartlet t检验χ2=3547.89(df=435.00,P<0.01),表明条目间有共同因子存在,可以进行因素分析。验证性因素的拟合指标NFI,CFI,GFI,RMSEA分别为0.90,0.92,0.90,0.06。结论宗教信仰分量表的内部一致性很差,不适用于我国大学生的评测,CSW中文版其他6个分量表具有良好的信度和效度,可以满足国内今后相关研究和应用的需要。     

Performance and Symptom Validity Testing in Pediatric Assessment: A Review of the Literature

ABSTRACT

There has been an increased recognition that validity testing is an integral component of evaluations conducted with youth. The incorporation of validity testing provides an objective basis for placing confidence in the test data as an accurate assessment of the child’s or adolescent’s current ability level and/or an accurate indication of the child’s or adolescent’s current symptoms or behavioral functioning. The use of objective performance validity and symptom validity is consistent with the current emphasis of data-driven decision-making. This paper provides a review of the literature on performance and symptom validity tests for children and adolescents. The strengths and limitations of the available validity tests are discussed, and recommendations for use in pediatric assessments are provided.     

Validity of two WPPSI short forms in outpatient clinic settings

Investigated the validity of two- and four-subtest short forms for the WPPSI in an outpatient clinic population of 116 children aged 4 and 5 years. The short forms differed in ability to approximate the Full Scale IQ. Both short forms correlated highly with the Full Scale IQ and accounted for a high percentage of variance. Both short forms misclassified a substantial percentage of Ss in relation to intelligence category. It was concluded that only the four-subtest short form was useful as a screening device in an outpatient mental health setting.