James P. Choca

Interpretative guide to the Millon Clinical Multiaxial Inventory

This work is designed to help mental health graduate students and professionals understand and interpret the MCMI-III. It discusses the design, development and operating characteristics of the inventory, along with the basics of personality theory.

Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/ Study of Latinos

PURPOSE To describe prevalence and relationships to cardiovascular morbidity of depression, anxiety, and medication use among Hispanic/Latinos of different ethnic backgrounds. METHODS Cross-sectional analysis of 15,864 men and women aged 18 to 74 years in the population-based Hispanic Community Health Study/Study of Latinos. Depressive and anxiety symptoms were assessed with shortened Center for Epidemiological Studies Depression Scale and Spielberger Trait Anxiety Scale. RESULTS Prevalence of high depressive symptoms ranged from low of 22.3% (95% confidence interval [CI], 20.4-24.3) to high of 38.0% (95% CI, 35.2-41.0) among those of Mexican or Puerto Rican background, respectively. Adjusted odds ratios for depression rose monotonically with number of cardiovascular disease (CVD) risk factor from 1.46 (95% CI, 1.18-1.75) for those with one risk factors to 4.36 (95% CI, 2.47-7.70) for those with five risk factors. Antidepressant medication was used by 5% with striking differences between those with and without history of CVD (15.4% and 4.6%, respectively) and between insured (8.2%) and uninsured (1.8%). CONCLUSIONS Among US Hispanics/Latinos, high depression and anxiety symptoms varied nearly twofold by Hispanic background and sex, history of CVD, and increasing number of CVD risk factors. Antidepressant medication use was lower than in the general population, suggesting under treatment especially among those who had no health insurance.

Neurocognitive Function Among Middle-aged and Older Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos

We sought to examine and describe neurocognitive function among middle-aged and older Hispanic/Latino Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants. We analyzed baseline cross-sectional data from the middle-aged and older (ages 45-74 years old) participants (n = 9,063) to calculate neurocognitive function scores and their correlates. Older age and higher depressive symptoms scores were associated with lower average neurocognitive performance, whereas greater educational attainment and household income were associated with higher neurocognitive performance. Hispanic/Latino heritage groups significantly varied in neurocognitive performances. Some neurocognitive differences between Hispanics/Latinos were maintained after controlling for language preference, education, household income, and depressive symptoms. We found notable differences in neurocognitive scores between Hispanic/Latino heritage groups that were not fully explained by the cultural and socioeconomic correlates examined in this study. Further investigations into plausible biological and environmental factors contributing to the Hispanic/Latino heritage group differences in neurocognitive found in the HCHS/SOL are warranted.

Administering the category test by computer: Equivalence of results

Abstract A computerized version of the Halstead Category Test (CT) was compared to the standard projector version of the test using adult neurologically impaired patients. Every subject was tested with both versions and the order of administration was alternated. Results indicated that the difference in mean number of errors made between the two versions of the test was not significant. The scores obtained with the two versions were seen as similar to what would be expected from a test-retest administration of the same instrument. Implications for the validity of the computer version are discussed.

The Halstead Category Test: A Fifty Year Perspective

The Category Test, a major part of the Halstead-Reitan Neuropsychological Battery, was first described in a 1943 article by Halstead and Settlage. This paper reviews the development of the test, the psychometric properties of the instrument, available administration and scoring methods, discusses various interpretative strategies, and the empirical support for the tests clinical validity. Recent developments are then reviewed, as well as what the authors see as the future potential for this instrument.

Obstructive sleep apnea and neurocognitive function in a Hispanic/Latino population

Objective: We evaluated the association between obstructive sleep apnea (OSA) and neurocognitive function among community-dwelling Hispanic/Latino individuals in the United States. Methods: Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos middle-aged and older adults, aged 45 to 74 years, with neurocognitive test scores at baseline measurements from 2008 to 2011. Neurocognitive scores were measured using the Word Fluency (WF) Test, the Brief–Spanish English Verbal Learning Test (SEVLT), and the Digit Symbol Substitution (DSS) Test. OSA was defined by the apnea-hypopnea index (AHI). Multivariable linear regression models were fit to evaluate relations between OSA and neurocognitive scores. Results: The analysis consisted of 8,059 participants, mean age of 56 years, 55% women, and 41% with less than high school education. The mean AHI was 9.0 (range 0–142; normal AHI <5/h). There was an association between the AHI and all 4 neurocognitive test scores: Brief-SEVLT–sum (β = −0.022) and –recall (β = −0.010), WF (β = −0.023), and DSS (β = −0.050) at p < 0.01 that was fully attenuated by age. In the fully adjusted regression model, female sex was a moderating factor between the AHI and WF (β = −0.027, p < 0.10), SVELT-sum (β = −0.37), SVELT-recall (β = −0.010), and DSS (β = −0.061) at p < 0.01. Conclusion: OSA was associated with worse neurocognitive function in a representative sample of Hispanic/Latino women in the United States.

Linking personality disorders and clinical syndromes on the MCMI-III.

We examined the relationship between personality disorders (PDs) and clinical syndromes (CSs) as measured by the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1997) in a large, heterogeneous sample of psychiatric patients (N = 2,366) who completed the instrument as part of routine assessment following presentation for treatment. Using separate sets of base rate (BR) and nonoverlapping scale scores, we factor analyzed the PD and CS scales together and then separately. We correlated results from the latter analyses to determine how trait dimensions were associated with syndrome dimensions. We also studied co-occurrence at the scale level by examining CS score profiles of patients who were grouped according to their highest PD scale elevation ≥ BR75. Results for the two score sets were very similar and were consistent with previous research on the MCMI-III and its predecessors that identified 3 underlying dimensions loading both PD and CS scales. Three fourths (76.2%) of the sample had a highest PD scale ≥ BR75, and among these, 90% had at least 1 CS scale ≥ BR75, whereas 62.4% had 3 or more CS scales above this elevation. Findings underscore the substantial overlap between PDs and CSs along 3 dimensions that resemble Horneys (1945) tripartite interpersonal distinction of moving toward, away, and against, as well as Eysencks (1994) higher order factors of neuroticism, extraversion, and psychoticism.

Construct Validity of the Bender-Gestalt II: Comparison with Wechsler Intelligence Scale for Children–III

This study investigated the relationships of visuomotor constructs as measured by the Bender-Gestalt II with the subtests of the WISC–III. A factor analysis included the standardized Copy and Recall scores of the Bender-Gestalt II and subtest scores of the WISC–III. The Copy score was predicted to load on measures of visual and spatial thinking and the Recall score on a short-term memory factor. The results of a principal components analysis suggest a four-factor solution with the Bender-Gestalt II Copy score loading on a visual and spatial thinking factor primarily with WISC-III Perceptual Organization subtests. The Recall score loaded on a visual and spatial thinking factor as well as a short-term memory factor with the WISC-III Digit Span subtest. The results suggest the Bender-Gestalt II Copy subtest shared commonality with the visual and spatial tasks given the similarity in the visuomotor demands of each test and was less influenced by processing speed or cultural knowledge than other tests on the visual and spatial thinking factor. Also, results suggest Bender-Gestalt II Recall measures elements of both visual and spatial thinking as well as aspects of short-term memory and memory retrieval. Clinical guidelines for co-administration and underlying processing demands are discussed.

Racial bias and the MCMI.

We studied the scores obtained on the Millon Clinical Multiaxial Inventory (MCMI) by Black and White male psychiatric inpatients to determine the presence or absence of racial bias. In predicting psychopathology for the two races, comparisons of MCMI performance indicated significant differences for all diagnoses except the personality disorders. The subjects were then matched into two groups of 209 patients each, according to DSM-III psychiatric diagnoses. The data were analyzed at the item, scale, and structural levels. At the item level, application of the Mantel-Haenszel Procedure revealed that 45 of the 175 items of the inventory were answered significantly different by the two racial groups. Because this number was higher than what could be expected by chance, the finding suggested possible deficiencies in terms of the culture-fairness of the items used in the test. At the scale level, an analysis of variance (ANOVA) demonstrated that the scores obtained by the Black and White groups were significantly different in 9 of the 20 scales (Histrionic, Narcissistic, Antisocial, Paraphrenia, Hypomania, Dysthymia, Alcohol Abuse, Drug Abuse, and Psychotic Delusion). With the exception of the Dysthymic scale, all of the differences were in the direction of the Blacks obtaining a higher score than the Whites. At the structural level, however, a principal components factor analysis performed on each group resulted in factor structures that looked identical.

Assessing personality and psychopathology after traumatic brain injury with the Millon Clinical Multiaxial Inventory–III

Purpose: Despite the widespread use of objective personality inventories as part of neuropsychological assessments of traumatic brain injury (TBI) patients, little research exists to support the use of these instruments with TBI populations. The purpose of the present study is two-fold: first, to examine the prevalence and extent of personality and psychopathological disturbance in TBI patients compared with a general psychiatric sample and, secondly, to determine whether personality profiles of TBI patients fall within a pathological range relative to normative psychiatric and non-psychiatric populations. Methods: Age-, gender- and ethnically-matched TBI and psychiatric patients (n = 462) completed the Millon Clinical Multiaxial Inventory–III (MCMI-III). Results: TBI patients had more frequent elevations on histrionic, compulsive and somatoform scales compared with the matched psychiatric sample. Most scales for TBI patients fell outside of the range of the tests normative psychiatric population. Conclusions: Implications for interpretation of MCMI-III profiles of TBI patients are discussed.