Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI

Objective: As part of routine care at Veterans Affairs facilities, veterans with a service-related traumatic brain injury (TBI) are administered a self-report post-concussive symptom measure, the Neurobehavioral Symptom Inventory (NSI). Interpreting the NSI can be problematic given that over-reporting on self-report measures is often found in both civilian and military patient populations. This study investigates embedded scales on the NSI that identify possible and probable symptom exaggeration. Method: 183 veterans with a history of mild TBI were administered the Minnesota Multiphasic Personality Inventory, 2nd edition, Restructured Form (MMPI-2-RF) and the NSI. The participants were divided into symptom validity testing pass and fail groups based on their performance on the MMPI-2-RF symptom validity scales. Cut scores on the NSI Total and Validity-10 scores were then established and applied to two additional veteran populations. Results: Sensitivity and specificity values were derived for all NSI Total and Validity-10 values. Optimal cut scores were determined based on specificity levels of ≥95%. The NSI Total cut score was ≥57 for possible and ≥67 for probable symptom exaggeration and the Validity-10 cut score was ≥22 for possible and ≥27 for probable symptom exaggeration, with sensitivity ranging from 27 to 43%. Applying these cut scores to a broader clinical and research sample resulted in lower rates of suspected exaggeration. Conclusions: Both the NSI Total and Validity-10 cut scores consistently identified potential symptom exaggeration across three mild TBI samples. Clinicians and researchers who use the NSI are encouraged to utilize either embedded validity measure in their practice.     

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.     

Fake bad scale: the case of the missing construct,a response to Larrabee,Bianchini, Boone,and Rohling (2017)

The ‘Commentary’ of Drs. Larrabee, Bianchini, Boone, and Rohling (2017) attributes to us a view of the Fake Bad/Symptom Validity Scale (FBS/FBS-r) that is wholly erroneous, a view we do not hold and have never taken. In doing so, the authors have confused the thrust of our article with the assertions made in an earlier article which preceded publication of the FBS. This earlier article held that many physical and cognitive symptoms/complaints observed in personal injury plaintiffs are most parsimoniously understood as manifestations of the stresses that may routinely accompany plaintiffs’ involvement in such litigation. In this response, I therefore, wish to clarify this misunderstanding and to elaborate upon several of the issues raised in our article.     

Postconcussion symptom reporting is not associated with diffusion tensor imaging findings in the subacute to chronic phase of recovery in military service members following mild traumatic brain injury

Introduction: The purpose of this study was to examine the relation between white matter integrity of the brain and postconcussion symptom reporting following mild traumatic brain injury (MTBI).

Method: Participants were 109 U.S. military service members (91.7% male) who had sustained a MTBI (n = 88) or orthopedic injury without TBI (trauma controls, TC, n = 21), enrolled from the Walter Reed National Military Medical Center, Bethesda, Maryland. Participants completed a battery of neurobehavioral symptom measures and underwent diffusion tensor imaging (DTI; General Electric 3T) of the whole brain, on average 44.9 months post injury (SD = 42.3). Measures of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated for 18 regions of interest (ROIs). Participants in the MTBI group were divided into two subgroups based on International Classification of Diseases–10th Revision (ICD–10) Category C criteria for postconcussion syndrome (PCS): PCS-present (n = 41) and PCS-absent (n = 47).

Results: The PCS-present group had significantly worse scores on all 13 neurobehavioral measures than the PCS-absent group (p < .001, d = 0.87–2.50) and TC group (p < .003, d = 0.84–2.06). For all ROIs, there were no significant main effects across the three groups for FA, MD, AD, and RD (all ps >.03). Pairwise comparisons revealed no significant differences for all ROIs when using FA and RD, and only two significant pairwise differences were found between PCS-present and PCS-absent groups when using MD and AD [i.e., anterior thalamic radiation and cingulate gyrus (supracallosal) bundle].

Conclusions: Consistent with past research, but not all studies, postconcussion symptom reporting was not associated with white matter integrity in the subacute to chronic phase of recovery following MTBI.     

Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: Results from the PRISMO 10-year follow-up

BackgroundSymptoms of post-traumatic stress disorder (PTSD) can manifest several years after trauma exposure, and may impact everyday life even longer. Military deployment can put soldiers at increased risk for developing PTSD symptoms. Longitudinal evaluations of PTSD symptoms in deployed military personnel are essential for mapping the long-term psychological burden of recent operations on our service members, and may improve current practice in veterans’ mental health care.MethodsThe current study examined PTSD symptoms and associated risk factors in a cohort of Dutch Afghanistan veterans 10 years after homecoming. Participants (N = 963) were assessed seven times from predeployment up to 10 years after deployment. Growth mixture modeling was used to identify distinct trajectories of PTSD symptom development.ResultsThe probable PTSD prevalence at 10 years after deployment was 8%. Previously identified risk factors like younger age, lower rank, more deployment stressors, and less social support were still relevant 10 years after deployment. Four trajectories of PTSD symptom development were identified: resilient (85%), improved (6%), severely elevated-recovering (2%), and delayed onset (7%). Only the delayed onset group reported increasing symptom levels between 5 and 10 years postdeployment, even though 77% reported seeking help.ConclusionsThis study provides insights into the long-term burden of deployment on the psychological health of military service members. It identifies a group of veterans with further increasing PTSD symptoms that does not seem to improve from currently available mental health support, and underlines the urgent need for developing and implementing alternative treatment opportunities for this group.     

Residential treatment following outpatient treatment for children with mild to borderline intellectual disabilities: A study of child and family characteristics

In this study, the question was explored whether children with a mild intellectual disability (MID) who were placed in residential treatment following outpatient treatment differ significantly on child and family characteristics from children with MID and not placed in residential treatment following outpatient treatment. The records of the children were examined with respect to various child and family characteristics. Retrospective case analyses were thus undertaken. The results showed those children placed in residential treatment to have experienced significantly more often a traumatic event than the other children. Those children placed in residential treatment had received significantly fewer months of outpatient treatment than those not placed in residential treatment. Finally, there were significantly more children placed in residential treatment having educationally incapable parents or parents with alcohol/drug problems and/or psychiatric problems than in the other group. The findings are discussed in light of a disturbed balance between the support needs and means of the family which can lead to placement of a child in a residential treatment. The possibilities of a multisystemic model for outpatient treatment are discussed.     

Utility of Schwann/2E and Sox10 in distinguishing CD57-negative olfactory groove schwannoma from olfactory ensheathing cell tumor: A case report and review of the literature

We herein report a patient who was diagnosed as having olfactory groove schwannoma (OGS) which was negative for CD57 (Leu7) but positive for Schwann/2E and Sox10. A 13-year-old female with a chief complaint of headache was referred to our department due to a tumor lesion in the anterior skull base identified by magnetic resonance imaging (MRI). At the first visit, she did not exhibit altered consciousness, motor palsy, anosmia, seizures, or café au lait spots. On contrast-enhanced computed tomography (CT), a heterogeneously enhanced tumor, 50 × 45 × 50 mm in size, was observed at the anterior skull base. The left cribriform plate was thinner on bone window CT. The tumor exhibited strong, heterogeneous gadolinium enhancement on MRI as well. Slight tumor staining was observed by angiography of the left internal carotid artery but not the left external carotid artery. The patient was preoperatively diagnosed as having meningioma and underwent gross tumor resection via the basal interhemispheric approach. The tumor was strongly positive for S-100 protein and negative for epithelial membrane antigen and CD57 by immunostaining. The tumor was positive for both Schwann/2E and Sox10, which aided in the differential diagnosis between OGSs and olfactory ensheathing cell (OEC) tumors, and the definitive diagnosis was OGS. The assessment of immunoreactivities for Schwann/2E and Sox10 might be necessary to differentiate CD57-negative Schwannomas from OEC tumors.     

Atypical psychosis in relation to the schizophrenia spectrum: Report of a family and review of the literature

The genetic concepts of genotypes, phenotypes, and phenocopies, when put into use in psychiatry, could offer a new perspective that needs to be validated or invalidated by future research. The sharing of a common genotype or genotypes by distinct phenotypes underlies the basic concept of schizophrenia spectrum. In this article, the following hypothesis will be considered: Certain “atypical” psychotic conditions, sometimes difficult to distinguish clinically and by family histories from mania, may share a common genotype or genotypes with “typical” schizophrenia. In other words can the schizophrenia spectrum include phenocopies of manic states?The pedigree method has been used extensively in the study of schizophrenic disorders but no mode of transmission, Mendelian or other type, has been demonstrated.^1,2 Despite this negative result, the pedigree method can offer insight into the relationship of the different types of psychosis when they occur in the same family.This report is about a family in which the proband had a “manic-depressive-like” disorder. Her initial diagnosis was that of a schizo-affective disorder, but 16 months after her first admission she displayed and experienced manic signs and symptoms. She was placed on Lithium carbonate and a four month follow-up on this drug has shown her to be asymptomatic. The proband's sister has a schizophrenic disorder. The case histories of each affected member are summarized.     

重型颅脑伤病人脑氧和脑温的监护经验(附116例报告)

目的研究亚低温治疗重型颅脑损伤病人脑组织氧分压(PbtO2)和脑温的变化规律及其临床意义。方法将重型颅脑损伤病人116例分为亚低温组和常温对照组各58例,对病人监测PbtO2、脑温,平均86h。结果24hPbtO2均值(13.7 ±4.94)mmHg,较正常值(16～40mmHg)低;亚低温组比对照组PbtO2恢复到均值的时间缩短(10±4.15)h(P <0.05);亚低温组存活率(60.4%)高于对照组(46.6%);复温后PbtO2随脑温升高而增加。手术组脑温与肛温的差距低于正常者占66.7%,非手术组脑温与肛温的差距高于正常者占52.9%,两组有显著性差异。结论亚低温治疗能提高严重脑伤病人的生存率。PbtO2、脑温直接监测技术安全可靠,对于判定病情和指导治疗有重要意义。     

Platelet adhesion to type I collagen and alpha 1 (I)3 trimers: involvement of the C-terminal alpha 1 (I) CB6A peptide

The adhesion of human platelets to calf-skin acid-soluble and pepsin extracted type I and type III collagens has been determined. In fibrillar form, all three preparations were equiactive. Modification of their charge pattern (methylation, deamidation) diminished or abolished platelet adhesiveness. Alpha 1(I) and alpha 2 chains, isolated from type I collagen by preparative PAGE followed by CMC chromatography, did not induce the adhesion of platelets. After reassociation as fibrillar trimers, (alpha 1(I))3 fibrils were active while (alpha 2)3 were not, suggesting that in the ordered structure required for platelet adhesion to type I collagen, the alpha 1 chains are essential. Platelets adhered significantly to alpha 1(I) CB6 peptide obtained by the cyanogen bromide cleavage of alpha 1(I) chains : the adhesive properties of type I collagen therefore seems to be associated with the C terminal end of the alpha 1 chains.     

Psychological considerations in the management of patients with thalassaemia major: (1) Reactions to chronic illness in childhood and adolescence: A report of a case

The observations reported are of the emotional, cognitive and affective reactions of youngsters with thalassaemia major, and are based upon direct, long-term clinical experience with more than a hundred children and adolescent patients who have been treated for this fatal illness, in the Department of Paediatrics and Child Care, Hadassah University Hospital, Jerusalem, Israel. These psychological reactions, which may be unique to this illness, appear to be significantly influenced by predisposing specific and idiosyncratic cognitive and cultural approaches and conceptualisations, and by the combined effects of early diagnosis and subsequent availability of modern medical therapeutics and technology. Maintenance of a relatively high haemoglobin level (above 9 dl) allows affected children to attend normal school settings and to lead relatively unrestricted lives during the early childhood and adolescent years. However, denial, unrealistic expectations, linked and combined with wide ranging cognitive distortions of illness, profound clinical depression and a pathological passivity and easy regression, social withdrawal and isolation, unsolicited dependency and profound psychological decompensation often appear to be common dynamic elements, at least during the adolescent years, foreshadowing imminent death. Emotional reactivity of the affected adolescent may be quite bewildering, and a case presentation together with an analysis of human figure drawings produced by youngsters with this illness has been included in an attempt to document these special neuro-psychological and active disruptive management issues. When affected children grow up and emotionally mature, thalassaemic adolescents, in our experience, tend to exhibit an uncharacteristic unprotesting and uncritically acquiescent and pathologically-based passivity and, further, exhibit unwarranted and, hence, often unrealistically-maintained high levels of optimism, unconsciously linked to much denial in what is clearly and tragically an inescapable confrontation with the prospects of a fatal illness with a prognosticated early death. Survival beyond age twenty-five is rare. Organising a more comprehensively orchestrated concerned psychological approach to both developmental and maturational needs with the establishment of a trusting, mutually-respectful therapeutic alliance with the medical team may in part help to overcome some of the inevitable difficulties which may otherwise menacingly interfere with optimal medical management. Hundreds of medical and technician staff contacts with frequent hospitalisations and the prospect of surgical intervention contribute to the equation of anxiety. Parental reactions to the inescapable prospects of an early death at adolescence or later often parallel those of the affected children. Anxiety, guilt, body-image disturbances of a profound and malignant psychological order combine with chronic inclinations and an easy readiness towards depression which are transparently evident in both children and their respective parents at times of acute crises, surgery or later medical decompensation. Therapeutic guidelines and principles of behavioural management are laid down which will assist the active clinician in better recognising and understanding some often difficult problems which are too easily avoided lest special attention be drawn to them.     

Vulnerability to stressor-induced disturbances in self-stimulation from the dorsal and ventral A10 area: Differential effects of intraventricular D-Ala-Met-enkephalinamide, D-Ala, N-Me-Phe, Gly-Ol-enkephalin, and D-Pen, D-Pen- enkephalin administration

D-Ala²-Met⁵-enkephalinamide (DALA) (1.0 μg/μl) was administered intraventricularly to mice responding for electrical stimulation from the dorsal or ventral aspects of the VTA immediately prior to footshock (Experiment 1). Predictably, footshock reduced self-stimulation from the dorsal but not the ventral VTA immediately, 24, and 168 h following the stressor. Intraventricular DALA administration effected a partial attenuation of stressor-induced self-stimulation reductions from the dorsal VTA immediately and 24 h poststressor. Deficits appeared among DALA-Shocked mice responding for brain stimulation from the ventral VTA during comparable test intervals. The long-term depressant influence of footshock on self-stimulation from the dorsal VTA was abolished among DALA-treated mice and DALA-associated reductions in self-stimulation from the ventral A10 region among stressed mice were not evident 1 week later. Administration of D-Ala², N-Me-Phe⁴, Gly-Ol⁵-enkephalin (DAGO) (0.01 μg/μl) or D-Pen², D-Pen⁵-enkephalin (DPDPE) (1.0 μg/μl) intraventricularly prior to footshock effected an immediate and a delayed antagonism, respectively, of the stressor on self-stimulation from the dorsal VTA, which persisted for 1 week. Prophylactic administration of 0.001 μg/μl DAGO or 0.01 μg/μl DPDPE prior to the stressor failed to influence self-stimulation from the ventral VTA (Experiment 2). Administration of 0.01 μg/μl DAGO or 1.0 μg/μl DPDPE among mice responding for brain stimulation from the dorsal VTA following footshock produced a weak therapeutic effect immediately poststressor, but effected protracted amelioration of footshock-induced reductions of self-stimulation from the dorsal VTA (Experiment 3). Taken together, μ, δ, and μ-δ activation influenced self-stimulation differentially from the dorsal and ventral VTA according to the temporal order of opioid peptide challenge relative to stressor imposition. These data are discussed with respect to stressors, motivational alterations, and the putative modulating influence of endogenous enkephalin activity in subareas of the VTA.