必选数字记忆测验对伪装记忆损伤的鉴别作用

目的：探讨Hiscock必选数字记忆测验对伪装记忆缺损的作用，并确定该测验判定伪装记忆缺损的划界分。方法；以66名不同损伤程度的非赔偿性脑外伤患者及24名赔偿性脑外伤伴有伪装智力低下者为研究对象，并与58名正常人作对照，对各组的必选数字记忆测验结果进行方差分析，计算累计百分率，并对伪装划界分作判定分析。结果：伪装组回答正确数与对照组及3个非伪装组之间差异均有非常显著性；容易条目的回答正确数小于等于11，或者困难条目的回答正确数小于等于7，可判定为仿装。判定的总正确率为98．6％，假阳性率为1．4％。结论：必选数字记忆测验是鉴别伪装记忆缺损的有效的评定工具。     

精神发育迟滞患者二项必选数字记忆测验的结果分析

二项必选数字记忆测验 (ＢＦＤＭＴ ,以下简称“二项测验”)在正常人、自愿模拟伪装者、赔偿性脑外伤患者中进行了一些初步研究 ,发现该测验对识别伪装记忆或智力低下有较高的判定正确率[1,2 ] 。在对实际病损而无赔偿的脑外伤患者的研究中还发现 ,轻、中、重度的非赔偿性脑外伤患者的二项测验成绩无明显差异[1] 。但是 ,由于脑外伤的程度与智力损伤的程度并无严格的对应关系 ,严重的脑外伤并不一定引起智力损伤 ;而轻型脑外伤也不一定无智力伤残[3] 。因此 ,对不同程度脑外伤患者的二项测验研究还不足以反映智力缺损及其缺损程度对该测验成…     

老年认知功能缺损者二项必选数字记忆测验结果分析

目的：探讨认知功能缺损程度对二项必选数字记忆测验(简称二项测验)成绩的影响。方法：用简易智力状态量表和韦氏成人智力量表简式调查出38例认知功能缺损者(研究组)和19例无认知功能缺损者(对照组)，同时实施二项数字测验。结果：(1)研究组与对照组二项测验容易条目、困难条目、总分的得分差异均无显著性。(2)智商70-89者困难条目分及总分显著高于智商50-69及34-49者；各组间容易条目分的差异均无显著性。(3)二项测验的假阳性率随着认知功能缺损的加重而有增加趋势。结论：二项测验成绩在一定程度上受认知功能缺损的影响，尤其是严重认知功能减退者，应注意假阳性率的问题。     

脑外伤后伤残鉴定患者二项必选数字记忆测验应用结果分析

目的 :研究二项必选数字记忆测验 (二项测验 )鉴别伪装智力低下的实证效度。方法 :用二项测验对一年内脑外伤伤残鉴定的患者进行测查 ,并与经验性评定结果、瑞文标准推理测验成绩以及最终评残等级进行比较。全部病例均在深圳市医务劳动鉴定委员会鉴定终结后予以回访。结果 :(1)二项测验总分判定伪装率为 78.1% ,与经验性评定的伪装率 (43.8% )相比 ,提高伪装识别率 34.3%。 (2 )经验性评定的“有伪装”、“无伪装”和“不确定”的三组人数比率差异无显著性 ,其中 ,16例“不确定”者 ,均被二项测验判定为“有伪装” ,占 2 5 % (16 / 6 4 )。 (3)回访 6 4例智力评残者中 ,仅 1例 (1.6 % )被鉴定委员提出异议。结论 :二项必选数字记忆测验是鉴别伪装智力低下的有效评定工具 ,尤其对经验性评定难以定论的伪装有良好的识别作用     

伪装与非伪装脑外伤患者瑞文标准推理测验结果分析

目的 :探讨瑞文标准推理测验对受试者成绩真实性的评估价值。方法 :比较分析伪装与非伪装两组脑外伤患者瑞文测验的五个分测验分、总分及测验斜率的复相关系数的差异及其特征。结果 :①两组患者A、B、C、D四个分测验及总分的均数差异均有显著性 ;分测验E差异无显著性。②以P <0 .0 5为水准 ,伪装组中测验斜率值(R2 ) <0 .6 4 8者显著多于非伪装者 ;而非伪装组中测验斜率值≥ 0 .6 4 8者显著多于伪装者。结论 :瑞文标准推理测验各分测验成绩的梯度变化及斜率值的显著水准对受试成绩真实性评估有一定的参考价值     

2项必选数字记忆测验在精神发育迟滞鉴定中的对比研究

目的探讨2项必选数字记忆测验得分在精神发育迟滞患者司法鉴定与非鉴定组的异同。方法精神发育迟滞（MR）患者司法精神医学鉴定者43例,非鉴定者44例,分别进行2项必选数字记忆测验（BFDMT）和韦氏成人智力量表测查（WAIS-RC）,对鉴定组和非鉴定组之间的结果进行比较和分析。结果MR鉴定组总分、容易条目得分明显低于非鉴定组（分别为P〈0.05、P〈0.001）,在困难条目得分上两组之间无显著性差异（P〉0.05）;鉴定组的智商、言语智商值都明显低于非鉴定组,有显著性差异（P〈0.05）;操作智商两组之间无显著性差异（P〉0.05）。MR鉴定组BFDMT测验总分、容易条目分、困难条目分与WAIS-RC测验的智商总分、言语智商、操作智商分之间均呈显著正相关。结论BFDMT得分的高低有助于司法鉴定MR患者的诊断。     

认知伪装甄别测验的编制和信效度分析

目的：编制一套甄别认知伪装的心理测验，并检验它的信效度。方法：按照Rogers提出的伪装甄别策略，编制了两个迫选式再认分测验一数字迫选测验和图符迫选测验，每个分测验含30个条目。264名正常人、33名脑损害病人和125名可疑伪装的鉴定者完成认知伪装甄别测验．其中303名被试接受华文认知能力量表测试、297名被试接受多维记忆评估量表测试。结果：数字迫选测验和阿符迫选测验的重测相关系数分别为0．603和0．571。数字迫选测验的信度系数在0．749—0．888之间，图符迫选测验的信度系数在0．753—0．872之间，全量表的信度系数为0．843—0．936。认知伪装甄别测验成绩与华文认知能力量表和多维记忆评估量表各分测验分数有显著性相关，相关值在0．308—0．608之间。正常人不同年龄组的测验成绩有明显的差异，正常组、脑损害病人组和鉴定组的测验成绩和成绩曲线有明显的不同。结论：认知伪装甄别测验具有较好的信度和效度．可以作为认知伪装的甄别工具。     

二项必选数字记忆测验在精神分裂症应用中的对比研究

目的了解在精神分裂症应用中,精神症状对二项必选数字记忆测验(BFDMT)结果的影响。方法选择住院的精神分裂症患者65例,正常对照组65名,进行二项必选数字记忆测验,精神分裂症患者进行阳性和阴性症状量表(PANSS)评定,PANSS评分≥60分,对两组测查结果进行比较。结果精神分裂症患者BFDMT测查总分、容易得分、困难得分均低于对照组(P0.05,P0.001);二项数字记忆测验得分的高低与PANSS评分之间无显著相关(P0.05)。结论精神症状对BFDMT测查结果存在影响。     

成人词汇测验的初步编制

目的：编制成人词汇测验，用于成人言语性学业成就和智能的简易评估。方法：用编制的测验测试450名16-65周岁、按年龄和文化程度分层抽取的成人，进行条目分析、信度和效度检验。结果：大多数条目的难度分布于0.25-0.75、点二例相关和鉴别指数大于0.30、条目偏差绝对值在0.10之内，信度指数多在0.90以上，测验量表分与受教育年限相关0.683，与中国修订韦氏成人智力量表（WAIS-RC）言语智商、操作智商和全量表智商相关系数分别为0.605、0.495、0.591.结论：成人词汇测验条目基本符合要求，分数可靠，有一定的效度。     

中国幼儿智力量表测验形式在7—15岁儿童中的适用性研究

目的：了解中国幼儿智力量表在7－15岁儿童中的适用性。方法：以中国幼儿智力量表为基础，包括8个基本量表的分测验和一个附加分测验，对除模型旋转外的8个分测验在增加测题难度后，试用于7至15岁儿童。测试样本包括7、9、11、13、15岁5个年龄组，采用个别法进行测试，每组测试40人，男女比例相等。结果：①各分测验中约50％的条目难度指数在0．30－0．70之间，各分测验平均难度指数在0．46－0．69范围，50－80％测验项目鉴别指数在0．20以上，这表明幼儿智力量表各分测验项目具有向儿童阶段的可延伸性；②各分测验平均分半信度在0．76－0．95之间，大多数0．80以上，平均为0．86，与国际上同类智力量表结果如WISC－R（韦氏儿童智力量表修订版）、S－B4（斯坦佛一比奈智力量表第四版）等的结果相接近，达到了心理测量学的要求，提示各分测验项目具有良好的内部一致性；③各分测验组分均值随年龄的增长而呈稳定的递增趋势，符合人们对智力发展的理论认识；④结果还发现在模型旋转分测验条目偏小，缺少难的项目，这有待于今后做进一步的改进。结论：中国幼儿智力量表的测验形式在7至15岁儿童阶段具有良好的适用性，基本达到了预定的构想。     

Discriminating between simulated malingering and closed head injury on the Wechsler memory scale-revised

We tested the hypothesis that malingering is distinguished by poorer performance on recognition relative to recall tasks by evaluating the ability of discriminant functions to distinguish between 89 subjects simulating malingering and 44 subjects with a history of closed head injury (CHI) on the Wechsler Memory Scale - Revised (WMS-R). Functions with good accuracy in discriminating between simulated malingerers and controls in prior studies did not have adequate specificity when applied to the CHI group. A newly derived discriminant function achieved overall classification accuracy of 79% for the malingering versus CHI groups on cross-validation, with 79% sensitivity (true positives for malingering) and 80% specificity (true negatives for closed head injured). A complex performance pattern on seven WMS-R subtests distinguished malingering subjects from those with CHI, but did not support the recognition versus recall hypothesis. The malingering pattern involved: (a) power performance on two relatively (but inconspicuously) easy tasks dependent on immediate recall (Visual Reproduction I and Visual Memory Span); (b) better performance on two relatively (but inconspicuously) easy tasks dependent on immediate recall (Visual Paired Associates I and Digit Span); (c) poorer performance on two relatively difficult delayed tasks (Logical Memory II and Visual Paired Associates II); and (d) better performance on another difficult task involving delayed recall (Visual Reproduction II).     

The effects of coaching on the sensitivity and specificity of malingering measures.

This study sought to identify patterns of performance indicative of malingering on the Auditory Verbal Learning Test (AVLT). Participants were randomly assigned to perform normally, simulate head injury, or simulate head injury with warning that there might be attempts to detect malingering. Participants completed an expanded AVLT and a forced-choice task, in addition to several other memory tests. The warned simulators performed worse than normals on the forced-choice task, but better than those simulating head injury without a warning, suggesting that the warned subjects recognized forced choice as a malingering test. A combination of AVLT indices was able to predict group status for both nai;ve and warned malingerers (73.6% for nai;ve malingerers, 84.8% for warned, no false positives). The forced-choice measure detected only 31.6% of the nai;ve malingerers when specificity was maximized, and detected only 6.5% of the warned malingerers, a significant drop in detection rate. Findings suggest that pattern of performance indices are useful in detecting malingering, even when subjects are aware of attempts to detect malingering.     

The use of the rey memory test to assess malingering in criminal defendants

An attempt was made to evaluate the utility of the Rey Memory Test (Rey, 1964) to assess malingering in criminal defendants referred for inpatient forensic evaluation. The performance of 14 diagnosed malingerers was compared to a control group of 14 forensic inpatients who had been acquitted by reason of insanity. Malingerers performed significantly less well on the test than did controls. A previously suggested cut-off score of 9 items remembered (Lezak, 1983) resulted in correct classification of 86% of the subjects as either malingering or not malingering. However, a cut-off of 3 rows remembered correctly was found to be inappropriate because 57% of the controls would have been labeled incorrectly as malingerers.     

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.     

Cross-validation of indicators of malingering: a comparison of nine neuropsychological tests, four tests of malingering, and behavioral observations.

Few studies to date have cross-validated indicators of malingering that have been suggested on various neuropsychological tests. This study presents data cross-validating several indicators of malingering on neuropsychological tests, as well as on tests of malingering and via behavioral observations. It incorporates methodological recommendations by Rogers [Researching dissimulation. In: R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 309-327). New York: Guilford Press.] resulting in an ecologically valid design utilizing college students with a history of mild head injury as analog malingerers. Results indicated that the Letter Memory Test (LMT) and the Digit Memory Test (DMT) attained the highest hit rates for the detection of malingering, while the sensitivity of many other measures declined on cross-validation.     

Quantitative measures of memory malingering on the Wechsler Memory Scale--Third edition in mild head injury litigants.

Wechsler Memory Scale-Third edition (WMS-III) performance in 25 mild traumatic brain injury (TBI) litigants who met the criteria for probable malingered neurocognitive dysfunction (MND) was compared with 50 nonmalingering subjects. The base rate for probable MND in the population studied was 27%. Overall, malingerers showed globally depressed memory function. They returned significantly poorer scores than nonmalingerers on all WMS-III indexes and subtests, and on selected WMS-III index difference scores and intelligence-memory difference scores. Using the minimum score returned in the nonmalingerers as the cut-off for malingering, the delayed auditory recognition memory tasks were highly effective in detecting malingering. Raw scores below 43 on the auditory recognition-delayed (AR-D) subtest or below 18 on word list II-recognition, identified around 80% of the malingerers. In a group of 50 severe TBI litigants, only a very small proportion (i.e., <10%) returned scores below the cut-offs for malingering for the mild TBI subjects.     

Estimation of the incidence of head injury in Korea: an approximation based on national traffic accident statistics.

Head injury is a leading cause of death and disability in Korea. It usually results from an avoidable accident. Epidemiologic data on the head injury is important for the effective reduction of this controllable disaster. The aim of this study is to estimate the incidence of head injury in Korea. Data on the incidence of the traffic accidents were collected from Traffic Accident Statistics 1998 by the National Police Agency. Proportion of head injuries due to traffic accidents was obtained from various literatures. The incidence of head injury was approximated simply by a formula H=T/0.625 [the total number of patients after traffic accidents (T) would be 62.5% of the total number of patients with head injury (H)]. In 1998, the estimated number of head injury was 109,462. The annual incidence was 236/100,000 person, 334/100,000 for males and 136/100,000 for females. The causes were road traffic accident in 62.5%, and falls in 15.6%. The operation was performed in 20.2% with a mortality of 4.0% in average. Case fatality rate was 8.2%. Annual death rate was 19/100,000 population. A public campaign is required on the basis of trustworthy epidemiologic data to reduce the incidence of head injury for the public health.     

特殊类型髋臼骨折的一期全髋关节置换

背景：髋臼骨折最有效的治疗方法是采用切开复位内固定。然而某些特殊类型的髋臼骨折切开复位内固定治疗预后均不理想,容易发生创伤性关节炎和股骨头缺血性坏死等并发症。 目的：观察特殊类型髋臼骨折患者行切开复位内固定一期全髋关节置换的效果。 方法：髋臼骨折12例,车祸伤7例,压砸伤3例,坠落伤2例。骨折类型：后壁骨折2例,后柱伴后壁骨折2例,T型骨折1例,横行伴后壁骨折5例,臼顶粉碎性骨折2例。伴有股骨头中心性脱位1例,后脱位5例,股骨头骨折3例。患者受伤前患有髋关节骨性关节炎3例,股骨头缺血性坏死2例。采用髋臼骨折切开复位内固定一期全髋关节置换,其中生物型假体9例,骨水泥型假体3例。入院距置换时间3-15 d,平均6 d。置换后第1年每2个月随访患者1次,应用Harris评分评估髋关节功能恢复情况。 结果与结论：12例患者置换后无伤口及深部感染,无关节脱位,无下肢深静脉栓塞,无死亡病例。其中11例获得长期随访,时间6-82个月。复位的髋臼骨折在6-16个月愈合,无假体松动及下沉等。末次随访时根据Harris评分法评估髋关节功能恢复情况：优8例,良2例,可1例,优良率为91%。髋臼骨折切开复位内固定一期全髋关节置换可避免长期卧床,尽早下床活动及有效的肢体功能训练,减少并发症,进而重建一个无痛的、功能良好的髋关节。