Kriscinda A. Whitney

Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms☆

Executive function deficits are seen in both schizophrenia and obsessive-compulsive disorder (OCD), but research suggests that dorsolateral prefrontal (DLPF) dysfunction is associated with schizophrenia and orbitofrontal (OBF) dysfunction is associated with OCD. As part of a comprehensive neuropsychological assessment, the Bechara Gambling Task (BGT) was used to assess OBF function and the Wisconsin Card Sorting Test (WCST) was used to assess DLPF function among three groups: 26 individuals with schizophrenia/schizoaffective disorder with obsessive-compulsive symptoms (SCZ+), 28 individuals with schizophrenia/schizoaffective disorder without obsessive-compulsive symptoms (SCZ-), and, 11 individuals with OCD. It was predicted that the SCZ+ group and the OCD group would show impairments in OBF function, as compared to the SCZ- group, and that the SCZ+ and SCZ- groups would show impairments in DLPF function, as compared to the OCD group. It was also predicted that the SCZ+ group would perform more poorly than the SCZ- and OCD groups in a number of other cognitive domains. Contrary to expectation, no divergence between groups was seen on tests of executive function. Instead, there was a statistical trend for the SCZ+ and SCZ- groups, when combined, to perform worse than individuals with OCD on the measure of OBF. Although not significant at the designated alpha level, the profile results showed that the SCZ+ group performed slightly below the OCD and SCZ- groups across nearly all neuropsychological domains.

Obsessive–compulsive symptoms in schizophrenia: prevalence, correlates and treatment

Literature from the turn of the 20th Century to the present suggests that obsessive–compulsive symptoms occur among persons with schizophrenia at rates that far exceed what is found among persons not suffering from psychoses. Less clear, however, is the significance of those symptoms. Are obsessive–compulsive symptoms, for instance, related to other aspects of schizophrenia or do they represent another isolated dimension of distress? To address this issue, a review of studies is presented that explores the relationships between obsessive–compulsive symptoms; positive, negative and depressive symptoms; psychosocial dysfunction; and neurocognitive deficits. Results are interpreted as indicating that obsessive–compulsive symptoms are linked with graver impairments in psychosocial function. Regarding the relationship between obsessive–compulsive symptoms and neurocognition, results from across a broad range of studies are equivocal. A review of studies of pharmacological treatments for obsessive–compulsive symptoms has also failed to produce consistent results. While some agents have been found to lead to improvement in obsessive–compulsive symptoms, other studies suggest that these medications may exacerbate those same symptoms. In general, it appears that, at best, there are currently few effective treatments. Directions for future research are reviewed. Recommendations include the development of tailored psychological and psychopharmacological interventions, and the implementation of longitudinal studies sensitive to the possibility that there are qualitatively distinct groups of patients with schizophrenia and obsessive–compulsive symptoms.

Utility of the Response Bias Scale (RBS) and other MMPI-2 validity scales in predicting TOMM performance

The present study represents a replication and extension of the original Response Bias Scale (RBS) validation study. In addition to examining the relationship between the Test of Memory Malingering (TOMM), RBS, and several other well-researched Minnesota Multiphasic Personality Inventory 2 (MMPI-2) validity scales (i.e., F, Fb, Fp, and the Fake Bad Scale), the present study also included the recently developed Infrequency Post-Traumatic Stress Disorder Scale and the Henry-Heilbronner Index (HHI) of the MMPI-2. Findings from this retrospective data analysis (N=46) demonstrated the superiority of the RBS, and to a certain extent the HHI, over other MMPI-2 validity scales in predicting TOMM failure within the outpatient Veterans Affairs population. Results of the current study confirm the clinical utility of the RBS and suggest that, particularly if the MMPI-2 is an existing part of the neuropsychological assessment, examination of RBS scores is an efficient means of detecting negative response bias.

Validity of the Wechsler Test of Adult Reading (WTAR): Effort Considered in a Clinical Sample of U.S. Military Veterans

The current study represents an examination of the construct validity of the Wechsler Test of Adult Reading (WTAR) among a sample of U.S. military veterans referred for outpatient neuropsychological evaluation that included a measure of negative response bias, namely, the Test of Memory Malingering (TOMM). This retrospective data analysis examined the relationship between the WTAR and measures of current verbal general intellectual function and current cognitive skills. Findings showed that, among patients passing the TOMM (N = 98), WTAR scores were most highly correlated with current verbal IQ but also showed significant correlations with verbal memory and lesser, but still significant, correlations with measures of visual-spatial memory. Discriminant validity for the WTAR was also shown among the group passing the TOMM in the sense that the WTAR, which is designed to measure verbal premorbid general intellectual skill, was not as highly correlated with measures of learning and memory as was a measure of current verbal general intellectual skill. Whereas scores on most study measures did significantly differ between the groups that passed versus failed the TOMM (N = 26), scores on the WTAR did not, suggesting that the WTAR may remain robust even in the face of suboptimal effort.

Obsessive–compulsive and negative symptoms in schizophrenia: Associations with coping preference and hope

Although agreement exists regarding the high occurrence of obsessive-compulsive (OC) symptoms in schizophrenia, it is less clear how OC symptoms are related to the traditional symptoms of schizophrenia and co-occurring deficits. One possibility is that there may be two distinct groups of persons with schizophrenia who experience OC symptoms: one group with poor and another with relatively good function. In the present study, the relationships between OC symptoms, coping, and hope were examined among 67 persons with schizophrenia spectrum disorders. First, participants with significant levels of OC symptoms were compared with participants without OC symptoms. Then, participants with significant levels of both OC symptoms and negative symptoms were compared with participants with negative symptoms, but no OC symptoms, and to participants with neither OC symptoms nor negative symptoms. Analysis of variance revealed participants with significant levels of OC symptoms were significantly more likely to experience greater levels of hopelessness and endorse a preference for avoidant focused coping strategies relative to participants without significant OC symptoms. Participants with both negative symptoms and OC symptoms also had less hope and greater preferences for ignoring stressors than participants with negative symptoms but no OC symptoms and participants with neither OC symptoms nor negative symptoms. Implications for theory, practice and research are discussed.

Predicting Test of Memory Malingering and Medical Symptom Validity Test Failure within a Veterans Affairs Medical Center: Use of the Response Bias Scale and the Henry–Heilbronner Index

The ability of the Response Bias Scale (RBS) and the Henry-Heilbronner Index (HHI), along with several other MMPI-2 validity scales, to predict performance on two separate stand-alone symptom validity tests, the Test of Memory Malingering (TOMM) and the Medical Symptom Validity Test (MSVT), was examined. Findings from this retrospective data analysis of outpatients seen within a Veterans Affairs medical center (N = 194) showed that group differences between those passing and failing the TOMM were largest for the RBS (d = 0.79), HHI (d = 0.75), and Infrequency (F; d = 0.72). The largest group differences for those passing versus failing the MSVT were greatest on the HHI (d = 0.83), RBS (d = 0.80), and F (d = 0.78). Regression analyses showed that the RBS accounted for the most variance in TOMM scores (20%), whereas the HHI accounted for the most variance in MSVT scores (26%). Nonetheless, due to unacceptably low positive and negative predictive values, caution is warranted in using either one of these indices in isolation to predict performance invalidity.

Is the montreal cognitive assessment superior to the mini-mental state examination in detecting subtle cognitive impairment among middle-aged outpatient U.S. Military veterans?

The Montreal Cognitive Assessment (MoCA) is a relatively newly designed test that was developed as a tool to screen patients with mild cognitive problems that are not typically detected by the Mini-Mental State Exam (MMSE). While early research suggests that the MoCA is more sensitive to subtle cognitive impairment than the MMSE, there is concern about potential decreased specificity when using the MoCA. The aim of the present study was to examine the comparative utility of using the MoCA and the MMSE to detect subtle cognitive impairment among a group of 82 middle-aged U.S. military veterans referred for outpatient neuropsychological testing. Using receiver operating characteristic analyses, the MoCA was shown to be a better predictor of subtle cognitive impairment on neuropsychological testing than the MMSE. When using an adjusted cutoff, the MoCA was shown to be more sensitive (i.e., 0.72 vs. 0.52) and nearly as specific as the MMSE (0.75 vs. 0.77).

Digit Span Age Scaled Score in Middle-Aged Military Veterans: Is It More Closely Associated with TOMM Failure than Reliable Digit Span?

The relative usefulness of two digit span (DS) variables in detecting negative response bias, as defined by below cut-off performance on the Test of Memory Malingering (TOMM), was examined among primarily middle-aged military veteran outpatients who were judged clinically to be at increased risk for displaying negative response bias on cognitive testing. Digit span variables included DS Age Scaled Score (DS Age SS) and Reliable DS. Findings from this retrospective data analysis (N = 46) suggest that DS Age SS is preferable for use over Reliable DS in predicting TOMM failure. Results of the current study suggest that, particularly if the Wechsler scales are an existing part of the neuropsychological assessment, examination of DS Age SS is an efficient means of detecting negative response bias.

IQ and Scores on the Mini-Mental State Examination (MMSE): Controlling for Effort and Education Among Geriatric Inpatients

ABSTRACT The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of “impaired” performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.

The Non-Credible Score of the Rey Auditory Verbal Learning Test: Is It Better at Predicting Non-Credible Neuropsychological Test Performance Than the RAVLT Recognition Score?

The ability of both the non-credible score of the Rey Auditory Verbal Learning Test (RAVLT NC) and the recognition score of the RAVLT (RAVLT Recog) to predict credible versus non-credible neuropsychological test performance was examined. Credible versus non-credible group membership was determined according to diagnostic criteria with consideration of performance on two stand-alone performance validity tests. Findings from this retrospective data analysis of outpatients seen for neuropsychological testing within a Veterans Affairs Medical Center (N = 175) showed that RAVLT Recog demonstrated better classification accuracy than RAVLT NC in predicting credible versus non-credible neuropsychological test performance. Specifically, an RAVLT Recog cutoff of ≤9 resulted in reasonable sensitivity (48%) and acceptable specificity (91%) in predicting non-credible neuropsychological test performance. Implications for clinical practice are discussed. Note: The views contained here within are those of the authors and not representative of the institutions with which they are associated.