David G. Lamb

Effects of Two Types of Information on Malingering of Closed Head Injury on the MMPI-2: An Analog Investigation.

The impact of detailed information on closed-head injury (CHI) and/or the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scales on malingering of psychological symptoms of CHI on the MMPI-2 was investigated. In an analog investigation using college student Ss, experimental malingerers produced reliably different MMPI-2 protocols relative to controls answering honestly. Experimental malingerers were divided into 4 groups on the basis of the complete crossing of 2 factors: CHI information (present/absent) and MMPI-2 validity scale information (VAL; present/absent). No two-way interactions were noted, but main effects for both factors were found on several MMPI-2 clinical and validity scales

Overreporting of Closed-Head Injury Symptoms on the MMPI-2.

Minnesota Multiphasic Personality Inventory (MMPI-2) validity scales were compared in 4 groups : nonclinical participants answering under standard instructions (n = 20), nonclinical participants instructed to fake closed-head injury (CHI) symptoms (n = 18), non-compensation-seeking CHI patients (n = 31), and compensation-seeking CHI patients (n = 30). The highest scores on MMPI-2 overreporting scales were obtained by nonclinical participants faking CHI, and significantly higher scores on these scales were obtained by compensation-seeking relative to non-compensation-seeking CHI patients. These results suggest that MMPI-2 overreporting scales are sensitive to fabrication of CHI complaints, and possibly to exaggeration of CHI complaints, although further research is necessary to evaluate the latter hypothesis fully.

Outcomes from milieu-based neurorehabilitation at up to 11 years post-discharge

Outcome in patients with brain injury after milieu-based day treatment neurorehabilitation was examined at up to 11 years post-discharge. Follow-up data in this cross-sectional study were sought from all admissions since May 1986 to May 1998 at 3 months, 1, 3, 5, 7, 9, and 11 year intervals. The 164 participants who responded had heterogeneous brain injury aetiologies and represented 73.9% of all patients who were successfully discharged from the programme. Rates of productivity (defined as gainful employment, school, and/or volunteer work) and employment (defined as work for pay) were examined in this follow-up sample. The results demonstrate that 83.5% of patients were productive up to 11 years post-discharge, with 67.1% engaged in work or school, and no decline in productivity was seen over time from discharge. Better vocational/school outcomes were associated with younger age, male gender, and higher staff working alliance ratings of patients and their families.

Isocapnic hypoxemia and neuropsychological functioning

We evaluated the cognitive effects of hypoxemia independent of hypocapnia in 20 right-handed male subjects using a battery of brief neuropsychological tests. Results of a profile analysis indicated that performance during hypoxia was reliably different for Digit Symbol and Finger Tapping tests. Trend analysis demonstrated a significant linear pattern for Finger Tapping results, such that lower levels of oxygen were associated with slower rates of tapping. No significant trends were observed for Digit Symbol results. The observation of hypoxic effects on Digit Symbol and Finger Tapping tests is consistent with previous findings of neuropsychological changes secondary to hypoxia. The negative results observed for the remaining tests are inconsistent with past literature. It is likely that methodological differences contributed to these discrepancies, including previous reliance on inspired air to index hypoxemia rather than monitoring arterial oxygen saturation directly and failure to control for differences in CO2 levels during induced hypoxia. These variables should be controlled in future research.

Ethical considerations in research on coached malingering.

This article discusses ethical considerations for research on coached malingering on psychological tests. A fundamental tension exists between the desire of clinicians to know the extent to which commonly used tests such as the MMPI-2 are vulnerable to coached faking and the danger that such information will be used to improve the success of coached malingerers. Although it is important to make clinicians aware of a tests susceptibility to faking, care should be taken not to reveal details of successful coaching strategies. Several options for evaluating the balance between the ethical requirement to protect the integrity of psychological tests and the need for clinicians to know the vulnerability of the test to coached malingering are reviewed

Methodologic issues in neuropsychological research with HIV-spectrum disease

Conflicting data have emerged from the initial studies of the neuropsychogical sequelae of human immunodeficiency virus (HIV) infection. This paper reviews key methodologic issues that must be addressed when embarking upon new research on the neuropsychology of HIV spectrum disease. Finally, suggestions are given for methodologic pitfalls to be avoided when conducting or interpreting research in this domain.

Practical Clinical Memory Compensations

Before offering my thoughts on Barbara A. Wilson’s new text, I must admit I am primarily a scientist-PRACTITIONER, and as such I look for science that can be forged into a practical application. For this reason, I was intrigued to read Dr. Wilson’s bookMemory rehabilitation: Integrating theory and practice and can report that for the most part it lives up to its name: it does indeed describe theoretical concepts through relevant research, but more importantly, it also suggests how to translate these theories into ways to treat memory-impaired patients. It is filled with specific techniques on how to help patients compensate for memory deficits, and even provides an entire chapter on how to create a memory rehabilitation program, covering both inpatient and outpatient settings. An empirical foundation is laid out, but the primary value of the work is in the detailed descriptions of how to fashion clinical tools and implement them with actual patients. In fact, even when presenting relevant research, concepts are tied to everyday examples, assisting the clinician in better understanding the theoretical ideas in action. For example, after describing the PQRST method, the reader is warned that research suggests this method is more successful with clients who have less severe memory deficits and are learning shorter amounts of material. The book is filled with comments based on Dr. Wilson’s clinical experiences, with treatment vignettes that are rich in practical detail. Specific recommendations are provided, such as how to talk to relatives about their expectations regarding their loved-one’s recovery from brain injury. Almost always, the clinical information resonates with my own experience in the field of neurorehabilitation. The first three chapters of the book provide overviews of memory concepts and memory impairments associated with brain injury (Chapter 1), mechanisms of recovery of memory functions (Chapter 2), and the assessment of memory abilities (Chapter 3). The next six chapters lay out the substance of the book relative to clinical practice. Chapter 4 describes numerous types of external memory aids,