Manfred F. Greiffenstein

MMPI-2 validity scales versus domain specific measures in detection of factitious traumatic brain injury

Abstract A known group methodology was used to compare the predictive accuracies of MMPI-2 validity scales and malingered amnesia measures in the detection of real versus feigned traumatic brain-injury. The domain specific compliance measures were consistently more accurate in the separation of factitious brain-injury patients (n = 68) from severe brain-injury patients (N = 56). Among MMPI-2 measures, only scale Sc improved on base-rate predictions of probable malingering. Anti-social traits, as measured by Pd, had no relationship to malingered amnesia. Factor analysis suggested independent psychiatric and neurological malingering factors. The implications for DSM-IV malingering criteria and models of feigned illness are discussed.

Test of Memory Malingering and Word Memory Test: A new comparison of failure concordance rates

Two commonly used symptom validity tests are the Test of Memory Malingering (TOMM) and Word Memory Test (WMT). After examining TOMM-WMT failure concordance rates, Green [Green, P. (2007). Making comparisons between forced-choice effort tests. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment (pp. 50-77). New York: Guilford] urged widespread adoption of the WMT, arguing the TOMM is insensitive to feigned impairment. But Green (2007) used a skewed concordance method that favored WMT (one TOMM subtest vs. three WMT subtests). In the present study we compare pass/fail agreement rates with different combinations of TOMM and WMT subtests in 473 persons seeking compensation for predominately mild neurological trauma. We replicated Green (2007) using his asymmetrical method, but otherwise we found the WMT and TOMM produce comparable failure rates in samples at-risk for exaggeration with balanced comparison (three TOMM subtests vs. three WMT). Further work is necessary to compare WMT and TOMM specificities, as failure concordance designs establish reliability but are insufficient for proving validity.

Clinical Myths of Forensic Neuropsychology

Clinical myths and lore are unfounded beliefs that still influence practice decisions. I examine the validity of six beliefs commonly encountered in forensic neuropsychology practice: the admissibility of test batteries; avoidance of practice effects; forewarning insures good effort; average deficits in bright persons; 15% chronic impairment in mild brain injury; and examiner bias causing malingering. I show these beliefs are invalid because of material misunderstandings of case law and literature, falsification by empirical findings, and lack of authoritative sources. The benefits, costs, and persistence of clinical myths are discussed.

Neuropsychological improvement following endarterectomy as a function of outcome measure and reconstructed vessel

30 patient receiving right or left carotid reconstruction and 15 medically matched controls were compared pre- and post-surgically on measures of motor speed, sustained vigilance, verbal memory and verbal and nonverbal intellectual function. The group receiving right sided vessel reconstruction demonstrated the largest post-operative improvement in intellectual function in any of the groups. The findings suggest that increased blood perfusion following right sided endarterectomy facilitates the right hemispheres exclusive control of bilateral attention/arousal responses. In addition, findings suggest that detection of post-endarterectomy improvement may be dependent on the specific task dimension sampled, e.g., speed vs. cognitive ability and verbal-graphic vs. nonverbal symbol manipulation.

Validity Testing in Dually Diagnosed Post-Traumatic Stress Disorder and Mild Closed Head Injury

Prospects for the coexistence of post-traumatic stress syndrome (PTSS) and mild traumatic brain injury (mTBI) rely exclusively on subjective evidence, increasing the risk of response bias in a compensatable social context. Using a priori specificities derived from genuine brain disorder groups, we examined validity failure rates in three domains (symptom, cognitive, motor) in 799 persons reporting persistent subjective disability long after mild neurological injury. Validity tests included the Test of Memory Malingering, MMPI-2 Fake Bad Scale, and Infrequency (F) scales, reliable digit span, and Halstead-Reitan finger tapping. Analyses showed invalidity signs in large excess of actuarial expectations, with rising invalidity risk conditional on post-traumatic complexity; the highest failure rates were produced by the 95 persons reporting both neurogenic amnesia and re-experiencing symptoms. We propose an “over-endorsement continuum” hypothesis: The more complex the post-traumatic presentation after mild neurological injury, the stronger the association with response bias. Late-appearing dual diagnosis is a litigation phenomenon so intertwined with secondary gain as to be a byproduct of it.

Waves earlier than P3 are more informative in putative subcortical Dementias: A study with mapping and neuropsychological techniques

SummaryThirty subjects (normal controls, patients with putative subcortical dementia and non-demented patient controls) were studied using advanced neurophysiological (16 scalp-electrode positions, computer-assisted brain electrical activity mapping, auditory oddball paradigm) and neuropsychological techniques. Our study suggests that waves earlier than P3 (N1, P2 and N2) are all correlated with global measures of cognitive functions. They are, however, differentially correlated with specific measures of cognitive functions, N1 and P2 with mental speed and N2 with short-term memory. The abnormalities of these waves (earlier than P3) may be an electrophysiologic marker of dementia in patients with putative subcortical states.

Symptom Validity Testing in Medically Unexplained Pain: A Chronic Regional Pain Syndrome Type 1 Case Series

This study examines validity findings in a particular behavioral pain disorder. We examined two types of validity scores in 73 participants with a primary diagnosis of the controversial Complex Regional Pain Syndrome Type I (CRPS-1). All participants were incentivized by a disability-seeking context. Failure rates on performance validity tests ranged from 23% (Test of Memory Malingering) to 50% (Reliable Digit Span). Positive findings on symptom validity tests (MMPI-2 or MMPI-2-RF) ranged from 15% to 50% of subsamples. At least 75% of the sample failed one performance validity indicator and over half showed at least one positive symptom validity score. This initial study suggests that CRPS-1 could serve as a good patient model for studying the role of simulation in pain-related disability.

Carbamazepine offers no psychotropic advantage over phenytoin in adult epileptic subjects

We compared 19 men on carbamazepine (CBZ) monotherapy with 19 men on phenytoin (PHT) monotherapy, all of whom had standard therapeutic levels. The two groups were matched for age, sex, education, premorbid predicted IQ, seizure frequency, duration, number, type and aetiology, weekly ethanol consumption and psychiatric history. The two groups did not differ statistically on self- and reliable-informant rated personality inventories, word recognition, face recognition, confrontation naming, finger oscillation or trailmaking series completion times. These data fail to support a behavioural and cognitive advantage of CBZ over PHT in adult epileptics.

Deceptive Examinees Who Committed Suicide: Report of Two Cases

Deceptive behavior by neuropsychological examinees does not preclude the presence of significant psychopathology. To illustrate this fact we present two cases. Case 1 had a diagnosis of factitious disorder and clear evidence on neurological and neuropsychological exams of exaggeration. Case 2 had a somatoform disorder and provided a deceptive social history. Long after the neuropsychological evaluations, both persons committed suicide. These cases provide anecdotal evidence that deceptive behavior does not preclude the presence of serious psychopathology, and that deceptive behavior and self-destructive behavior sometimes coincide.

Inconsistent Responding on the MMPI-2-RF and Uncooperative Attitude: Evidence From Cognitive Performance Validity Measures.

It is generally well understood that possible reasons for inconsistent responding on the Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI-2-RF), as measured by the Variable Response Inconsistency (VRIN-r) and True Response Inconsistency (TRIN-r) scales, include reading or language limitations, cognitive impairment, and intentional random responding; however, the interpretive recommendations for the test suggest that higher scores on these scales can also result from an uncooperative test-taking approach. This study utilized a sample of 3,457 predominately non–head injury disability claimants to examine the association between inconsistent responding on the MMPI-2-RF and performance on cognitive tests as well performance validity tests (PVTs), an independent indicator of uncooperative test-taking attitude. Analysis of variance found that both VRIN-r and TRIN-r were associated with statistically lower cognitive test scores. These analyses also supported that TRIN-r was associated with poor performance on collaterally administered PVTs in a subsample of individuals with average reading levels. Illustrating the practical effects of these results, in follow-up relative risk ratio analyses, individuals with elevations on TRIN-r were at up to five times greater risk of PVT failure than those without elevations. Overall, the results of this study provide some support for the interpretation that inconsistent responding on the MMPI-2-RF is associated not only with cognitive/reading problems or limitations but also an uncooperative test-taking approach, particularly for elevated TRIN-r scores.