C. Don Morgan

Discriminant validity of the SCL-90 dimensions of anxiety and depression.

Although the SCL-90 and other self-report measures of anxiety and depression have long been criticized for inadequate factor structure and unacceptably high correlations with each other, recent evidence indicates the use of homogeneous samples results in greatly improved discriminant validity. This study utilized homogeneous samples of anxious (N = 54) or depressed (N = 120) outpatients and a factor analysis was conducted on their responses to the depression and anxiety items on the SCL-90. Clearly separate factors for anxiety and depression emerged. Results are discussed with respect to implication for measures of depression and anxiety.

The sexual experience of women diagnosed with anorexia nervosa or bulimia nervosa

OBJECTIVE Women with bulimia nervosa generally have reported greater sexual activity and experience relative to women with anorexia nervosa. However, past research has been based on small samples and has not controlled for potential confounding variables or symptom severity. We further investigated sexual experience among women diagnosed with an eating disorder. METHODS Women evaluated in an outpatient eating disorders program, and subsequently diagnosed with either anorexia nervosa (n = 131) or bulimia nervosa (n = 319), completed the Diagnostic Survey for Eating Disorders-Revised (DSED-R) at intake. Sexual experience variables (masturbation, coitus, sexual satisfaction), as well as control variables (age, weight, and menarche) and measures of symptom severity, were derived from the DSED-R. Logistic regression analyses were used to predict sexual experience. RESULTS After controlling for relevant covariates, bulimics were more likely than anorexics to have engaged in sexual intercourse. Masturbation experience, as well as self-ratings of current sexual satisfaction, were inversely related to degree of restriction of caloric intake, particularly among women with anorexia nervosa. When compared to anorexics, bulimics reported greater sexual interest and earlier age of first coitus. DISCUSSION Coitus (sexual activity involving a partner) was related to eating disorder diagnosis independent of symptoms, whereas masturbation (self-focused sexual activity) was related to caloric restriction for the sample as a whole and anorexia nervosa patients in particular. These relationships between sexual experience and eating disorder symptoms and diagnosis may illuminate the personality features of women with anorexia nervosa versus bulimia nervosa as well as the functional role of caloric restriction.

NEUROPSYCHOLOGICAL TESTING AND ASSESSMENT SCALES FOR DEMENTIA OF THE ALZHEIMER'S TYPE

Neuropsychological assessment plays an important role in the process of diagnosing DAT. Whereas the brief screens are sensitive to the cognitive deficits associated with DAT, full battery measures should be used to rule out early dementia or to differentiate among the various dementing illnesses. Following diagnosis, there are numerous assessment measures that facilitate management and placement decisions. These measures include instruments that help stage the illness to determine severity, instruments that evaluate the patients capacity to perform activities of daily living, and measures that evaluate for the behavior symptoms common in later-stage dementia.

The ability of the Millon Clinical Multiaxial Inventory--Third Edition to detect malingering

This study investigated the ability of the Millon Clinical Multiaxial Inventory--Third Edition (MCMI-III) to discriminate students malingering psychopathology (n = 106) from bona fide psychiatric inpatients (n = 202). Students were randomly assigned to a fake-bad or an honest-responding condition. Analyses investigated the ability of the modifier indices to discriminate fake-bad group participants from the psychiatric inpatients. Scale X raw cutoff score > 178 yielded a positive predictive power (PPP) of 0.0, a negative predictive power (NPP) of 63.1, and a hit rate of 63.1%. Optimal cutoff scores were developed. Scale X Base Rate (BR) > 84 provided a PPP of 55.6, an NPP of 72.1, and a hit rate of 65.2%. Scale Y BR < 26 yielded a PPP of 52.5 and a hit rate of 64.8%. Receiver operating characteristic analyses found that Scale X best classified malingerers. Overall, the MCMI-III modifier indices were of minimal clinical utility in distinguishing college student malingerers from bona fide psychiatric inpatients.

A comparison of the MCMI-III personality disorder and modifier indices with the MMPI-2 clinical and validity scales.

In this study, we examined the relationship of the MCMI-III (Millon, Davis, & Millon, 1997; Millon, Millon, & Davis, 1994) modifier indices and personality disorder scales to the validity and basic clinical scales of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MCMI-III modifier indices highly correlated with all of the MMPI-2 validity scales except for the F(p) scale. Similarly, the MCMI-III personality disorder scales strongly covaried with the MMPI-2 validity and clinical scales except for the F(p) and 5 (Mf) scales. A factor analysis with Promax rotation revealed substantial relationships between the MMPI-2 and MCMI-III. However, the MMPI-2 F(p) scale did not tend to correlate with MMPI-2 or MCMI-III scales, indicating that F(p) scale variance was largely independent of other scales. The results suggest that clinicians should consider the interrelationship between personality characteristics and dissimulation.

Overreport on the MCMI-III: concurrent validation with the MMPI-2 using a psychiatric inpatient sample.

The MCMI-III (Millon, Davis, & Millon, 1997) is a widely used measure of personality often used in inpatient psychiatric settings. Although patients in such settings often overreport or exaggerate their symptoms, relatively little is known about how such a response set presents on the validity indexes of the MCMI-III. In this study, we used a sample of 191 psychiatric inpatients and compared MCMI-III modifier indices (Disclosure, Desirability, and Debasement) with the validity measures (L, F, Fb, F(p), K, and F - K) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In addition, the MCMI-III Disclosure Index (Scale X, which imposes a set cutoff score for invalidity due to overreport) was compared to several cutoff scores on the validity scales of the MMPI-2. Although the MCMI-III indexes generally performed as expected, the MCMI-III had a very high tolerance for overreport. When contrasted with MMPI-2 F scale, the MCMI-III Disclosure Index (which gauges overreport) remained valid until scores on MMPI-2 F scale approached a T score of 120. In addition, the Disclosure Index was at the upper end or slightly exceeded the highest recommended cutoff scores on all other MMPI-2 validity scales except F - K. Clinicians using the MCMI-III alone are cautioned to consider the high tolerance the MCMI-III has for overreport.

Death due to alcoholic complications in a young woman with a severe eating disorder: A case report

OBJECTIVE Recently, a good deal of attention has been focused on alcoholism and eating disorders as comorbid conditions. Early identification of biologic, psychologic, and sociocultural factors that contribute to comorbid alcoholism and eating disorders may improve the outcome for such patients. METHOD The following case report is of a 26-year-old woman who developed a severe eating disorder in her early teens that was followed by alcoholism. RESULTS The combination of eating disorder and alcoholism in this patient led to approximately 70 hospitalizations for medical complications of her alcoholism. This paper chronicles her last few living months including her death due to alcoholic complications.

Development of discriminant functions to detect dissimulation for the Millon Clinical Multiaxial Inventory (3rd edition)

Abstract This study investigated the ability of the MCMI-III to discriminate student dissimulators from psychiatric inpatients by re-analyzing data previously obtained by the authors. The sample consisted of 181 psychiatric inpatients and 218 college undergraduates. Students were randomized to either a fake-bad (FB) or standard instruction (SI) condition. Discriminant analyses were used to determine whether combining Scales X, Y, and Z with the clinical scales could improve the ability of the MCMI-III to identify dissimulators beyond using single scale cutoff scores. Two functions were developed. Function A yielded a positive predictive power (PPP) of 72%, a negative predictive power (NPP) of 75%, and an overall hit rate (HR) of 76%. Function B provided a PPP of 71%, a NPP of 80%, and a HR of 77%. The algorithms improved the ability of the MCMI-III correctly to identify dissimulators over any single scale cutoff score. The benefits and limitations of the discriminant functions are discussed.