Differentiating poor validity from probable impairment on the medical symptom validity test: a cross-validation study

Aims: In neuropsychological evaluations, it is often difficult to ascertain whether poor performance on measures of validity is due to poor effort or malingering, or whether there is genuine cognitive impairment. Dunham and Denney created an algorithm to assess this question using the Medical Symptom Validity Test (MSVT). We assessed the ability of their algorithm to detect poor validity versus probable impairment, and concordance of failure on the MSVT with other freestanding tests of performance validity.

Methods: Two previously published datasets (n?=?153 and n?=?641, respectively) from outpatient neuropsychological evaluations were used to test Dunham and Denney’s algorithm, and to assess concordance of failure rates with the Test of Memory Malingering and the forced choice measure of the California Verbal Learning Test, two commonly used performance validity tests.

Results: In both datasets, none of the four cutoff scores for failure on the MSVT (70%, 75%, 80%, or 85%) identified a poor validity group with proportionally aligned failure rates on other freestanding measures of performance validity. Additionally, the protocols with probable impairment did not differ from those with poor validity on cognitive measures.

Conclusions: Despite what appeared to be a promising approach to evaluating failure on the easy MSVT subtests when clinical data are unavailable (as recommended in the advanced interpretation program, or advanced interpretation [AI], of the MSVT), the current findings indicate the AI remains the gold standard for doing so. Future research should build on this effort to address shortcomings in measures of effort in neuropsychological evaluations.     

Disproportionate outdating of group A blood

The authors studied the factors responsible for the disproportionate outdating of group A blood compared with group O blood over a 6-month interval. Distribution, transfusion, and outdate data for 99,251 units of blood were collected from representative hospitals within the region served by the Atlanta Regional Red Cross Blood Center. Factors evaluated included: neonatal transfusion of type O blood to type A recipients; use of type O blood in emergencies or due to group-specific shortages; demographic donor and recipient differences; and blood importing practices. Of 43,757 group O units (44.1% of total) available for distribution, 2050 (4.7%) were outdated, compared with 3908 (10.7%) of 36,501 group A units (36.8% of total). One thousand two hundred and seventy-nine units of type O blood were transfused to recipients who were not type O, including 842 group A neonatal patients. A larger inner-city hospital, where 46.8 percent of recipients were group O and 29.2 percent were group A, accounted for 180 more group O and 509 fewer group A transfusions than would be expected if donor-recipient ABO distributions were the same. Three hundred and seventy-four more group A units were imported than were needed. ABO-mismatched transfusions due to shortage or emergency were insignificant. It was concluded that increased use of group O blood for neonatal transfusions, donor-recipient differences in blood group frequencies, and blood importing practices are the major factors that increase the rate of group A outdating.     

Hematologic problems in psychosomatic medicine.

Vitamin B12 deficiency is associated with problems in cognition, mood, psychosis, and less commonly, anxiety. Folate deficiency primarily is associated with problems in mood. Patients who have sickle cell disease, a disease of chronic pain, experience difficulties with depression, anxiety, stigma, and are at risk for substance abuse and dependence. Patients with hemophilia have benefited from advances in treatment; however, their morbidity and mortality were compounded in those who received blood products contaminated with HIV, or hepatitis B and C. Psychiatrists who practice psychosomatic medicine should expect to encounter patients with the above problems, as they are frequently seen in medical settings. Finally, most of the commonly used psychotropic medications have uncommon but potentially important hematologic side effects or may interact with the anticoagulants used in medically ill patients.     

WAIS-R verbal-performance IQ discrepancies in persons with lateralized lesions: utility of a seven subtest short form.

WAIS-R Verbal-Performance IQ difference scores for Ward's (1990) seven subtest short form and the complete WAIS-R were examined in patients with lateralized and diffuse lesions. For both versions, the expected Performance > Verbal pattern was observed in the right hemisphere lesion group, while no summary score differences were seen in the left hemisphere group. Verbal-Performance IQ discrepancies for the short form fell within +/- 5 points of the WAIS-R discrepancy scores in about 75%of the cases, regardless of lesion location. Statistically reliable IQ differences between the complete and abbreviated WAIS-R attained 66%, 91%, and 89% agreement for the left, right, and diffuse groups, respectively. The results support the clinical utility of the seven subtest short form.     

Granulocyte precursors are the principal cells in bone marrow that stimulate allospecific cytolytic T-lymphocyte responses.

Mouse bone marrow cells were fractionated and enriched for functional activity as stimulators of allospecific cytolytic T-lymphocyte (CTL) responses in vitro. The relevant stimulator cells were enriched sequentially in the low-density fraction of bone marrow, its 2-hr adherent and 18-hr non-adherent fractions and in the FcR-negative fraction of 18-hr non-adherent cells. The functionally enriched cell population contained over 90% granulocyte precursors by ultrastructural analysis. The results indicate that granulocyte precursors are the principal cells in bone marrow that stimulate alloreactive T-cell responses.     

Learning in escape/avoidance tasks in female rats does not vary with reproductive condition

To determine whether the development of novel stimulus-response associations by the mother during the periparturient period is attributable to a general facilitation of learning produced by the hormonal milieu during that period, learning ability under various reproductive conditions was assessed in two tasks unrelated to the periparturitional situation. The two tasks, selected because they equalized the various groups for motivation and performance variables, were acquisition of a water-maze escape (including two reversals), and acquisition and retention of an unsignalled shuttlebox shock avoidance. The groups tested in the water maze were a midpregnant group, an immediately prepartum group, and an immediately postpartum group. In the shuttlebox, the same conditions (different rats) were compared, together with a nonpregnant estrus condition, and a nonpregnant diestrus condition. The results of both experiments indicate that although learning occurred, the characteristics of acquisition and retention were not influenced by reproductive condition.     

Ras oncogene-transformed and nontransformed cell populations are each heterogeneous but respond differently to the chemotherapeutic drug cytosine arabinoside (Ara-C)

 In order to determine whether the growth of ras oncogene-transformed cells and nontransformed cells was inhibited differently by the chemotherapuetic drug cytosine arabinoside (Ara-C) their growth was analyzed by a novel colony-based assay that is sensitive and appropriate for heterogeneous cell populations. Colonies of nontransformed NIH3T3 cells, or ras onco- gene-transformed NIH(ras) cells, were grown in the absence of drug and then divided into subclones. Subclones were allowed to continue to grow in the absence or presence of drug. Growth inhibition was determined by comparing the growth of drug-treated subclones with the growth of related untreated subclones. Colonies of nontransformed cells grown in the absence of the drug displayed a large variation in growth, and when grown in the presence of the drug displayed a large variation in growth inhibition. Colonies of transformed cells also displayed a large variation in the absence and presence of the drug. For each cell line, related subclones were more similar to each other than to unrelated subclones, implying inheritance of growth rates and drug response. For NIH3T3 cells, the growth of subclones in the presence of drug was highly correlated with the growth of related subclones in the absence of drug. However, for NIH3T3(ras) cells the growth of subclones in the presence of drug was not correlated with the growth of related subclones in the absence of drug. Therefore, ras oncogene-transformed and nontransformed cell populations differ in their response to Ara-C. Received: 3 November 1995/Accepted: 30 July 1996