J.I.M. Egger

Comparability of scores on the MMPI-2-RF scales generated with the MMPI-2 and MMPI-2-RF booklets.

In most validity studies on the recently released 338-item MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Restructured Form (MMPI–2–RF; Ben-Porath & Tellegen, 2008; Tellegen & Ben-Porath, 2008), scale scores were derived from the 567-item MMPI–2 booklet. In this study, we evaluated the comparability of the MMPI–2–RF scale scores derived from the original 567-item MMPI–2 booklet with MMPI–2–RF scale scores derived from the 338-item MMPI–2–RF booklet in a Dutch student sample (N = 107). We used a counterbalanced (ABBA) design. We compared results with those previously reported by Tellegen and Ben-Porath (2008). Our findings support the comparability of the scores of the 338-item version and the 567-item version of the 50 MMPI–2–RF scales. We discuss clinical implications and directions for further research.

Psychometric Evaluation of the MMPI–2 Restructured Clinical Scales in Two Dutch Samples

In this article, we evaluate internal validity, internal consistency, and test–retest reliability of the MMPI–2 Restructured Clinical (RC) scales in the Dutch MMPI–2 normative sample (N = 1,244) and a Dutch outpatient psychiatric sample (N = 1,066). We pay special attention to a critique regarding construct drift of RC3 and the redundancy of the RC scales with existing MMPI–2 scales. The results indicate that the RC scales in both samples show comparable or better internal consistencies than the Clinical scales. Also, in both samples, the RC scales demonstrate lower scale-level intercorrelations than the Clinical scales. As to the structural characteristics, principal component analysis of the RC scales provided a clearer pattern than an analysis of the Clinical scales. Furthermore, mean raw scores on the RC scales for men in the Dutch normative sample corresponded highly with those in the U.S. normative sample except for RC2 and RC4. Less correspondence was found for women. Overall, we conclude that the RC scales show satisfactory reliability and promising internal validity in our Dutch samples. We suggest that U.S. validation studies on the RC scales may be generalized to the Dutch-language version of the MMPI–2 RC scales.

Applicability of the Rivermead Behavioural Memory Test - Third Edition (RBMT-3) in Korsakoff's syndrome and chronic alcoholics

Purpose To examine the applicability of the newly developed Rivermead Behavioural Memory Test – Third Edition (RBMT-3) as an ecologically-valid memory test in patients with alcohol-related cognitive disorders. Patients and methods An authorized Dutch translation of the RBMT-3 was developed, equivalent to the UK version, and administered to a total of 151 participants – 49 patients with amnesia due to alcoholic Korsakoff’s syndrome, 49 patients with cognitive impairment and a history of chronic alcoholism, not fulfilling the Korsakoff criteria, and 53 healthy controls. Between-group comparisons were made at subtest level, and the test’s diagnostic accuracy was determined. Results Korsakoff patients performed worse than controls on all RBMT-3 subtests (all P-values < 0.0005). The alcoholism group performed worse than controls on most (all P-values < 0.02), but not all RBMT-3 subtests. Largest effects were found between the Korsakoff patients and the controls after delayed testing. The RBMT-3 had good sensitivity and adequate specificity. Conclusion The RBMT-3 is a valid test battery to demonstrate everyday memory deficits in Korsakoff patients and non-Korsakoff patients with alcohol abuse disorder. Korsakoff patients showed an impaired performance on subtests relying on orientation, contextual memory and delayed testing. Our findings provide valuable information for treatment planning and adjustment in patients with alcohol-related cognitive impairments.

EXECUTIVE FUNCTIONING AND THE TWO-FACTOR MODEL OF PSYCHOPATHY: NO DIFFERENTIAL RELATION?

There are indications that the interpersonal affective factor and the social deviation factor, both of which are underlying dimensions of psychopathy, have a positive and a negative relationship, respectively, with executive functioning. However, this is seldom taken into consideration in the research on the relationship between executive functioning and psychopathy, which may be an explanation for the many inconsistent results in this area as reported in the literature (e.g., Rogers, 2006). In the present study, executive functioning was studied using the Wisconsin Card Sorting Test (WCST) in 53 inpatients of a Dutch forensic psychiatric clinic who were classified by means of the Psychopathy Checklist-Revised (PCL-R). Special attention was given to the relationship between the two separate factors and executive functioning. Age, educational level, and substance abuse were controlled for in the analysis. No difference was found between psychopathic (N = 17) and nonpsychopathic (N = 36) patients in the WCST scoring categories, nor was there a significant difference in the four diagnostic subgroups defined by the two factors. However, the trends observed do justify further study in this direction.

Integrating Psychopathology and Personality Disorders Conceptualized by the MMPI–2–RF and the MCMI–III: A Structural Validity Study

The Minnesota Multiphasic Personality Inventory–2–Restructured Form (Ben-Porath & Tellegen, 2008) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory–III (Millon, Millon, Davis, & Grossman, 2009) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.

Fluid intelligence and executive functioning more alike than different

Objective Fluid intelligence (Gf) has been related to executive functioning (EF) in previous studies, and it is also known to be correlated with crystallized intelligence (Gc). The present study includes representative measures of Gf, Gc, and EF frequently used in clinical practice to examine this Gf–EF relation. It is hypothesised that the Gf–EF relation is higher than the Gc–EF relation, and that working memory in particular (as a measure of EF) shows a high contribution to this relation. Method Confirmatory factor analysis was performed on a mixed neuropsychiatric and non-clinical sample consisting of 188 participants, using the Kaufman Adolescent and Adult Intelligence Test, and three executive tasks of the Cambridge Neuropsychological Test Automated Battery, covering working memory, planning skills, and set shifting. Results The model fitted the data well [χ2(24)=35.25, p=0.07, RMSEA=0.050]. A very high correlation between Gf and EF was found (0.91), with working memory being the most profound indicator. A moderate to high correlation between Gc and EF was present. Current results are consistent with findings of a strong relation between Gf and working memory. Conclusion Gf and EF are highly correlated. Gf dysfunction in neuropsychiatric patients warrants further EF examination and vice versa. It is discussed that results confirm the need to distinguish between specific versus general fluid/executive functioning, the latter being more involved when task complexity and novelty increase. This distinction can provide a more refined differential diagnosis and improve neuropsychiatric treatment indication.

Klinefelter’s Syndrome and Prader-Willi Syndrome: A Rare Combination

In this paper a review is presented of the rare combination of Klinefelter’s syndrome and Prader-Willi syndrome (PWS) and a second case of this combination with a uniparental disomy (UPD) etiology of PWS is described. Patients outlined in all other 8 reports and the present case have a PWS phenotype. Virtually no information is available on the behavioral and psychopathological phenotype in this combination. The latter may be explained by the observation that psychiatric syndromes are especially prevalent in PWS patients with a UPD. It is concluded that instability in mood and behavior in this and other syndromes should be preferentially treated with mood stabilizing agents.

A 12q24.31 interstitial deletion in an adult male with MODY3: Neuropsychiatric and neuropsychological characteristics

A 39‐year‐old male patient with a disharmonic intelligence profile and juvenile diabetes mellitus is described. At 14 months of age, minor facial dysmorphisms were noticed. He had delayed motor development, obesity at early age, and a diagnosis of insulin‐dependent diabetes at the age of 10 years. He successfully completed secondary education and has been engaged in unskilled work activities, living independently. Upon examination, no psychiatric symptoms were present and his neuropsychological profile showed normal, although disharmonic, intellectual capacities and suboptimal social cognition. Genome wide array analysis identified an interstitial 12q24.31 deletion of 1.67 Mb encompassing hepatocyte nuclear factor‐1‐alpha gene (HNF1A), supporting a diagnosis of maturity‐onset diabetes of the young. Results are discussed in relation to the few identified or published overlapping deletions. This is the first patient with normal intelligence in whom the presence of subtle facial dysmorphisms were decisive for introducing genetic analysis that, in turn, disclosed a rare form of diabetes necessitating modifications in treatment regimen. Clinicians, including those involved in psychiatry, should be aware of the diagnostic and prognostic value of atypical physical features in patients with a long history of complicated glucose regulation.

Decline of executive function in a clinical population: age, psychopathology, and test performance on the Cambridge Neuropsychological Test Automated Battery (CANTAB).

This study presents a cross-sectional examination of the age-related executive changes in a sample of adults with a history of psychiatric illness using the Cambridge Neuropsychological Test Automated Battery. A total of 406 patients, aged 18 to 72 years old, completed executive function tests of working memory, strategic planning, and set shifting. Using current Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition criteria, patients were diagnosed with: (a) affective disorders (N = 153), (b) substance-related disorders (N = 112), (c) personality disorders (N = 82), or (d) pervasive developmental disorders (N = 59). Test performances were compared to those of 52 healthy adults. Similar rates of age-related executive decline were found for patients and healthy participants. However, as adults with a history of psychiatric illness started out with significantly lower baseline levels of executive functioning, they may require less time before reaching a critical threshold where functional deficits emerge. Limitations as well as implications for future research were discussed.

P-701 - Executive dysfunctions as part of the behavioural phenotype of aarskog-scott syndrome

Introduction Aarskog syndrome (AAS) also called Aarskog-Scott syndrome faciodigitogenital syndrome or faciogenital dysplasia is a genetically heterogeneous developmental disorder, first described in 1970 by the Norwegian pediatrician Dagfin Aarskog and further delineated by Scott in 1971. It is a predominantly X-linked disorder, phenotypically characterized by short stature, craniofacial dysmorphisms, brachydactyly and urogenital abnormalities. The level of intelligence shows a great variability and no specific behavioural phenotype has been described so far. In about 20 percent of Aarskog families, a mutation in the FGD1 gene located in Xp11.21 can be identified. Objectives The delineation of the potential behavioural phenotype of AAS. Aims Neuropsychological and neuropsychiatric investigation of four males from one kindred. Methods Four affected affected males from the fourth generation of a previously published large Dutch family (Van de Vooren et al., 1983) are assessed in detail by means of an extensive neuropsychological battery and semi-structured psychiatric examination. In addition, mutation analysis was performed. Results A novel FGD1 missense mutation (R402W) at position 1204 (1204C>T) was demonstrated. In the patients, the level of intelligence varied between normal and severely disabled. Their behavioural profile showed, among others, elements of attention deficit hyperactivity disorder, primarily reflected by impaired executive attentional processes that may be sensitive to systematic training. Conclusions In AAS, dysfunctional executive cognitive processes can be considered as part of the behavioural phenotype of the syndrome. Cognitive training and structuring of daily life may therefore reduce the intensity of disinhibited behaviours that are reported in AAS patients