Katrina R. Rayls

Cognitive-behavioral prevention of postconcussion syndrome☆

The symptoms of postconcussion syndrome (PCS) are persistent, and no empirically tested treatment is available. The treatment group (n = 29) in this study received a printed manual and met with a therapist prior to hospital discharge to review the nature and incidence of expected symptoms, the cognitive-behavioral model of symptom maintenance and treatment, techniques for reducing symptoms, and instructions for gradual resumption of premorbid activities. The control group (n = 29) received routine hospital treatment and discharge instructions. Both groups had sustained mild head injuries characterized by Glascow Coma Scale scores of 13-15 on admission without any measurable period of posttraumatic amnesia. Group assignment was random. Groups did not differ significantly on age, Glascow scores, litigation status, gender, or initial number of PCS symptoms. Patients were contacted 6 months following injury by an interviewer who was unaware of group assignment to obtain outcome data. Treated patients reported significantly shorter average symptom duration (33 vs. 51 days) and significantly fewer of the 12 symptoms at followup (1.6 vs. 3.1). Subjects were also asked how often each symptom had occurred in the previous week, and how severe the symptom typically was. The treatment group experienced significantly fewer symptomatic days (.5 vs. 1.3) and lower mean severity levels. Results suggest that brief, early psychological intervention can reduce the incidence of PCS.

Identification of Malingered Head Injury on the Wechsler Adult Intelligence Scale - 3rd Edition.

Head injured patients show an IQ subtest pattern that can be discriminated from the profile produced by individuals who attempt to malinger intellectual decline due to head trauma. The current paper demonstrates that previously replicated methods for making this discrimination on the WAIS – R generalize to the WAIS – 3. The discriminant function equation accurately classified 83% of nonlitigating head-trauma patients with documented injuries and 72% of persons simulating intellectual impairment due to head trauma. A total of 45% of litigating mild head-trauma patients with purported intellectual decline but no documented loss of consciousness, hospitalization, or CT abnormality were classified as malingering by the discriminant function. A Vocabulary-Digit Span difference score provided 71% overall diagnostic accuracy, and may be informative when screening profiles by visual inspection or when complete WAIS – 3 results are unavailable.

Prospective study of the MMPI-2 correction factor after mild head injury.

Gass (1991) proposed a correction factor composed of 14 MMPI-2 items that were characteristically endorsed by patients with closed-head injury. Their frequency of occurrence suggested that the items reflected the neurological rather than emotional consequences of head injury. The current study was designed to evaluate the interpretive significance of correction factor items after mild head trauma. Patients were examined immediately upon hospitalization and followed prospectively for at least 3 months. Correction factor items were endorsed more frequently during acute hospitalization than in the MMPI-2 standardization sample. At follow-up, none of the items were endorsed more often by patients with chronic mild head injury than by uninjured controls. These results suggest that the correction factor is sensitive to the acute neurological consequences of mild head trauma, but that these symptoms can typically be expected to resolve. Chronic endorsement of the items in this population is therefore most likely related to psychological factors.

Impact of Cognitive Function on MMPI-2 Validity in Neurologically Impaired Patients:

The Wechsler Memory Scale—Revised (WMS-R), Wechsler Adult Intelligence Scale-Revised (WAIS-R), and Minnesota Multiphasic Personality Invcntory-2 (MMPI-2) were completed by 88 outpatients at a neuropsychology clinic who had diagnoses of central nervous system dysfunction. Extent of IQ, memory, or attention impairment were associated with elevations on MMPI-2 validity scales. Magnitude of estimated IQ loss separated valid from invalid profile groups more clearly than did obtained Full Scale IQ. Nonresponsivity to item content is probable when the patient scores below 70 on the WMS-R Memory or Attention/Concentration indexes, or earns a WAIS-R IQ that falls 20 points or more below expected premorbid level. These effects appear to be relatively independent of the patients measured reading or intellectual levels. The MMPI-2 appears to provide valid information about the emotional status of patients with moderate and mild neurocognitive impairment.