Debbie Green

Factors Associated with Recommitment of NGRI Acquittees to a Forensic Hospital

The current archival study assesses risk factors associated with recommitment of 142 individuals adjudicated Not Guilty by Reason of Insanity (NGRI) from civil settings to a forensic hospital in New York State. Within 10 years of transfer from a forensic hospital, 40 (28.2%) were recommitted. Using survival analyses to account for the wide range in opportunity for recommitment, period of transfer (i.e., pre versus post the 1995 case of George L, which clarified factors related to assessments of dangerousness) and the Historical scale and specific items of the HCR-20 emerged as important risk factors for recommitment. Specifically, hazard of recommitment was 2.9 times higher for those with high Historical scores as compared to those with low scores. However, few individual risk factors were associated with recommitment. Prior supervision failure, negative attitude, problems with substance use, and absent or less serious major mental illness and relationship problems were informative in predicting recommitment over 10 and 3 year follow-up periods.

Evaluation of the MMPI-2-RF for Detecting Over-reported Symptoms in a Civil Forensic and Disability Setting

Objective: This study investigated the classification accuracy of the Minnesota Multiphasic Personality Inventory-2-Restructured Form validity scales in a sample of disability claimants and civil forensic litigants. Method: A criterion-groups design was used, classifying examinees as “Failed Slick Criteria” through low performance on at least two performance validity indices (stand-alone or embedded) and “Passed Slick Criteria.” The stand-alone measures included the Test of Memory Malingering and the Dot Counting Test. The embedded indices were extracted from the Wechsler Adult Intelligence Scales Digit Span and Vocabulary subtests, the California Verbal Learning Test-II, and the Wisconsin Card Sorting Test. Results: Among groups classified by primary complaints at the time of evaluation, those alleging neurological conditions were more frequently classified as Failed Slick Criteria than those alleging psychiatric or medical conditions. Among those with neurological or psychiatric complaints, the F-r, FBS-r, and RBS scales differentiated between those who Passed Slick Criteria from those who Failed Slick Criteria. The Fs scale was also significantly higher in the Failed Slick Criteria compared to Passed Slick Criteria examinees within the psychiatric complaints group. Conclusions: Results indicated that interpretation of scale scores should take into account the examinees’ presenting illness. While this study has limitations, it highlights the possibility of different cutoffs depending on the presenting complaints and the need for further studies to cross-validate the results.

New and improved? A comparison of the original and revised versions of the structured interview of reported symptoms.

The current study evaluated the accuracy of the Structured Interview of Reported Symptoms, Second Edition (SIRS-2) in a criterion-group study using a sample of forensic psychiatric patients and a community simulation sample, comparing it to the original SIRS and to results published in the SIRS-2 manual. The SIRS-2 yielded an impressive specificity rate (94.3%) that exceeded that obtained using the original SIRS scoring method (92.0%) and approached that observed in the SIRS-2 normative data (97.5%). However, changes in scoring resulted in markedly lower sensitivity rates of the SIRS-2 (36.8% among forensic patients and 66.7% among simulators) compared with the SIRS (47.4% and 75.0%, respectively). The removal of the Total Score from the SIRS-2 further hindered identification of feigning. Analyses also evaluated the additive value of the new RS-Total and MT Index scales in the SIRS-2. Implications of these results for forensic psychologists are discussed.

Use of Measures of Cognitive Effort and Feigned Psychiatric Symptoms with Pretrial Forensic Psychiatric Patients

This study examined the classification accuracy of measures of cognitive effort, as well as the impact of estimated IQ and psychiatric symptoms on these measures in a sample of hospitalized pretrial criminal defendants. A criterion-groups design was used to classify patients into those suspected of feigning (n = 25) and those believed to be genuinely mentally ill (n = 93). The Test of Memory Malingering (TOMM), Dot Counting Test (DCT), and Rey Fifteen-Item Memory Test (RMT) were roughly comparable to the SIRS-2 in classifying patient groups but the Validity Indicator Profile (VIP) Verbal subscale was not. Several measures of cognitive effort increased detection of suspected feigning over the SIRS-2 alone. However, among genuinely mentally ill psychiatric patients, level of estimated intelligence was significantly associated with scores on each of the measures of cognitive effort (r s = .38 to .65), with false positive rates in excess of 30% for patients with estimated intelligence in the Extremely Low range. Performance on measures of cognitive effort was only modestly associated with types, but not total severity of psychiatric symptoms. Implications for the assessment of feigning in clinical settings are discussed.

Exploring the Accuracy and Utility of the Rey Fifteen Item Test (RMT) with Recognition Trial in a Forensic Psychiatric Population

The Rey Fifteen Item Test (RMT; Rey, 1941) is one of the most commonly used measures to assess the validity of cognitive and memory deficits. A recent recognition trial has been developed to enhance sensitivity of the RMT (Boone, Salazar, Lu, Warner-Chacon, & Razani, 2002). The RMT was administered to 116 forensic patients hospitalized for restoration of competency to stand trial who were classified by treating psychiatrists as “genuine” or “feigning,” and 36 community simulators. Consistent with previous research, the recognition trial increased the sensitivity of the RMT from 44% to 64% among suspected feigners, while decreasing specificity from 82.4% to 74.7% among genuine patients. The optimal cut score for maximizing specificity was 11 in this sample, while the optimal cut score for enhancing the utility of the RMT as a screening measure was found to be 24. Implications of using the RMT with recognition trial as a screening tool in forensic psychiatric assessment are discussed.

Identifying Aggression in Forensic Inpatients Using the MMPI-2-RF: An Examination of MMPI-2-RF Scale Scores and Estimated Psychopathy Indices

Prior research has examined the relationship between personality characteristics and problematic behaviors, suggesting the utility of self-report personality measures in assessing risk of aggression. This study examined the relationship between select Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) scales and estimated psychopathy indices derived from MMPI-2-RF scales, and institutional aggression among hospitalized pre-trial defendants. Scores on Thought Dysfunction (THD), Aberrant Experiences, Juvenile Conduct Problems, and Psychoticism-Revised (PSYC-r) were associated with mild-severe aggression. Similarly, THD and PSYC-r were associated with moderate-severe aggression. Regarding psychopathy, impulsive-antisociality, but not fearless-dominance, was associated with both aggressive outcomes. Overall, the relevant MMPI-2-RF scales demonstrated higher classification accuracy than the estimated psychopathy indices.

Inconsistent Responding in a Criminal Forensic Setting: An Evaluation of the VRIN-r and TRIN-r Scales of the MMPI–2–RF

ABSTRACT Criminal forensic evaluations are complicated by the risk that examinees will respond in an unreliable manner. Unreliable responding could occur due to lack of personal investment in the evaluation, severe mental illness, and low cognitive abilities. In this study, 31% of Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI–2–RF; Ben-Porath & Tellegen, 2008/2011) profiles were invalid due to random or fixed-responding (T score ≥ 80 on the VRIN–r or TRIN–r scales) in a sample of pretrial criminal defendants evaluated in the context of treatment for competency restoration. Hierarchical regression models showed that symptom exaggeration variables, as measured by inconsistently reported psychiatric symptoms, contributed over and above education and intellectual functioning in their prediction of both random responding and fixed responding. Psychopathology variables, as measured by mood disturbance, better predicted fixed responding after controlling for estimates of cognitive abilities, but did not improve the prediction for random responding. These findings suggest that random responding and fixed responding are not only affected by education and intellectual functioning, but also by intentional exaggeration and aspects of psychopathology. Measures of intellectual functioning and effort and response style should be considered for administration in conjunction with self-report personality measures to rule out rival hypotheses of invalid profiles.

Personality, Psychiatric, and Cognitive Predictors of Length of Time for Competency to Stand Trial Restoration

ABSTRACT Certain defendant characteristics, including psychiatric diagnosis, externalizing problems, and cognitive deficits, are associated with longer periods of restoration of competency to stand trial and general lack of treatment success. Prior research has called for a more detailed examination of symptom-level differences between defendants rapidly restored to competency and those who require lengthier treatment for competency restoration. The present study evaluated whether specific aspects of psychopathological constructs assessed by the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), and specific cognitive abilities assessed by the Wechsler Abbreviated Scale of Intelligence (WASI/WASI-II), were associated with length of competency restoration among 344 male pretrial defendants hospitalized at a maximum security forensic psychiatric hospital. Higher Juvenile Conduct Problems (JCP) scores were associated with restoration within 90 days, and Antisocial Behavior (RC4) predicted restoration status at 90 days; no MMPI-2-RF or WASI/WASI-II scales predicted restoration status at 180 days when controlling for age. Overall, results suggested that externalizing behaviors are among factors that may play a role in predicting restoration status at select time points.

Evaluation of the Response Bias Scale and Improbable Failure Scale in assessing feigned cognitive impairment.

The present study evaluated the Response Bias scale (RBS), a symptom validity test embedded within the Minnesota Multiphasic Personality Inventory (MMPI)-2 Restructured Form (MMPI-2-RF) that assesses for feigned neurocognitive complaints, in a sample of pretrial incompetent to stand trial (IST) criminal defendants. Additionally, we examined the Improbable Failure (IF) scale, a performance validity test embedded within the Structured Interview of Reported Symptoms, Second Edition (SIRS-2), which similarly assesses for feigned cognitive impairment (FCI). Results indicated that both the RBS (area under the curve [AUC] = .76) and IF scale (AUC = .72) achieved moderate classification accuracy using the Test of Memory Malingering (TOMM) as the criterion. Further, the RBS and IF scale appeared to be most useful for screening out those defendants who presented as genuine (specificity = 99% and 88%, respectively), and less effective at classifying those defendants suspected of feigning according to the TOMM (sensitivity = 29% and 46%, respectively). In order to identify a significant proportion of IST defendants who may be feigning impairment, considerably lower cutoff scores than those recommended in each measure’s manual were evaluated. An RBS T score of 63 (sensitivity = 86%; specificity = 37%), and IF scale raw score of 2 (sensitivity = 80%; specificity = 43%), was required to achieve ≥80% sensitivity; these alternate cutoff scores may therefore be useful when screening inpatient forensic psychiatric IST defendants. Further, the 2 scales effectively predicted TOMM classification in combination, although only the RBS significantly contributed to the model. Implications for the assessment of FCI in forensic psychiatric settings are discussed.

A Comparison of the HCR-20V3 Among Male and Female Insanity Acquittees: A Retrospective File Study

Abstract The current retrospective risk assessment study evaluated the use of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20V3) in a sample of 100 male and 24 female insanity acquittees, comparing the presence of risk factors and its validity in assessing violence in a state forensic hospital across males and females. Over an average of 15.5 months, 44.4% of the total sample engaged in any act of violence within the institution, highlighting the need for effective risk assessment and management tools. An equivalent proportion of males and females engaged in violence (42.0% of males and 54.2% of females). Results indicated higher interrater reliability on scoring risk factors among males as compared to females, calling for future research into the role of item indicators across genders and possible differences in interpretations of scoring guidelines. Results indicated that females exhibited similar numerical ratings of presence risk factors as males, although they were rated higher on Past Problems in Relationships and Traumatic Experiences. The relationships between scale scores and violence were higher among males than females. However, gender was not a significant moderator in logistic regression analyses predicting likelihood of violence. Additional research is necessary to evaluate how ratings of risk factors are translated into summary risk estimates, opinions about dangerousness, and treatment interventions, with a particular focus on how such decision-making is influenced by the gender of examinees.