Robin J. Heinrichs

Validation of MMPI-2-RF validity scales in criterion group neuropsychological samples.

This study utilized multiple criterion group neuropsychological samples to evaluate the “over-reporting” and “under-reporting” MMPI-2-RF validity scales. The five criterion groups included in this study were (1) litigating traumatic brain injury patients who failed Slick et al. criteria for probable malingering, (2) litigating traumatic brain injury patients who passed Slick et al. criteria, (3) mixed neuropsychological outpatients who passed SVTs and were diagnosed with primary neurological conditions, (4) mixed neuropsychological outpatients who passed SVTs and were diagnosed with primary psychiatric conditions, and (5) epileptic seizure disorder inpatients who were diagnosed via video-EEG. Using the data from these groups, cumulative percentages for all possible T-scores and sensitivity and specificity rates for optimal cutoff scores were determined. When specificity rates were set at 90% across all non-malingering neurological condition groups, sensitivity rates ranged from 48% (FBS-r) to 10% (K-r).

Assessment of quality of life among the elderly with epilepsy.

As the elderly represent the most rapidly growing population in the United States, it is critical that physicians are capable of managing their chronic illnesses, including epilepsy. Optimal treatment of epilepsy integrates an understanding of health-related quality of life (HRQOL), yet limited information is available to guide HRQOL issues among the elderly. This study found that seniors with epilepsy do not have poorer HRQOL compared with general epilepsy populations. However, when compared with general populations without epilepsy, seniors with epilepsy report a significantly lower HRQOL across all domains. Multiple factors may uniquely affect HRQOL among elderly populations with epilepsy: aging, comorbid conditions, and epilepsy variables. However, to our knowledge, no one instrument addresses all of these aspects. The development of HRQOL instruments specifically for an elderly population with epilepsy may be useful and needed.

Efficacy of Test of Memory Malingering Trial 1, Trial 2, the Retention Trial, and the Albany Consistency Index in a Criterion Group Forensic Neuropsychological Sample

The Test of Memory Malingering is one of the most popular and heavily researched validity tests available for use in neuropsychological evaluations. Recent research has suggested, however, that the original indices and cutoffs may require modifications to increase sensitivity rates. Some of these modifications lack cross-validation and no study has examined all indices in a single sample. This study compares Trial 1, Trial 2, the Retention Trial, and the newly created Albany Consistency Index in a criterion group forensic neuropsychological sample. Findings lend support for the newly created indices and cutoff scores. Implications and cautionary statements are provided and discussed.

Differences in MMPI-2 FBS and RBS Scores in Brain Injury, Probable Malingering, and Conversion Disorder Groups: A Preliminary Study

This study examined differences in raw scores on the Symptom Validity Scale and Response Bias Scale (RBS) from the Minnesota Multiphasic Personality Inventory-2 in three criterion groups: (i) valid traumatic brain injured, (ii) invalid traumatic brain injured, and (iii) psychogenic non-epileptic seizure disorders. Results indicate that a >30 raw score cutoff for the Symptom Validity Scale accurately identified 50% of the invalid traumatic brain injured group, while misclassifying none of the valid traumatic brain injured group and 6% of the psychogenic non-epileptic seizure disorder group. Using a >15 RBS raw cutoff score accurately classified 50% of the invalid traumatic brain injured group and misclassified fewer than 10% of the valid traumatic brain injured and psychogenic non-epileptic seizure disorder groups. These cutoff scores used conjunctively did not misclassify any members of the psychogenic non-epileptic seizure disorder or valid traumatic brain injured groups, while accurately classifying 44% of the invalid traumatic brain injured individuals. Findings from this preliminary study suggest that the conjunctive use of the Symptom Validity Scale and the RBS from the Minnesota Multiphasic Personality Inventory-2 may be useful in differentiating probable malingering from individuals with brain injuries and conversion disorders.

Does True Neurocognitive Dysfunction Contribute to Minnesota Multiphasic Personality Inventory-2nd Edition-Restructured Form Cognitive Validity Scale Scores?

Previous research has demonstrated RBS and FBS-r to identify non-credible reporters of cognitive symptoms, but the extent that these scales might be influenced by true neurocognitive dysfunction has not been previously studied. The present study examined the relationship between these cognitive validity scales and neurocognitive performance across seven domains of cognitive functioning, both before and after controlling for PVT status in 120 individuals referred for neuropsychological evaluations. Variance in RBS, but not FBS-r, was significantly accounted for by neurocognitive test performance across most cognitive domains. After controlling for PVT status, however, relationships between neurocognitive test performance and validity scales were no longer significant for RBS, and remained non-significant for FBS-r. Additionally, PVT failure accounted for a significant proportion of the variance in both RBS and FBS-r. Results support both the convergent and discriminant validity of RBS and FBS-r. As neither scale was impacted by true neurocognitive dysfunction, these findings provide further support for the use of RBS and FBS-r in neuropsychological evaluations.

An Examination of the Frequency of Invalid Forgetting on the Test of Memory Malingering

The Test of Memory Malingering (TOMM) is the most used performance validity test in neuropsychology, but does not measure response consistency, which is central in the measurement of credible presentation. Gunner, Miele, Lynch, and McCaffrey (2012) developed the Albany Consistency Index (ACI) to address this need. The ACI consistency measurement, however, may penalize examinees, resulting in suboptimal accuracy. The Invalid Forgetting Frequency Index (IFFI), created for the present study, utilizes an algorithm to identify and differentiate learning and inconsistent response patterns across TOMM trials. The purpose of this study was to assess the diagnostic accuracy of the ACI and IFFI against a reference test (Malingered Neurocognitive Dysfunction criteria), and to compare both to the standard TOMM indexes. This retrospective case-control study used 59 forensic cases from an outpatient clinic in Southern Kansas. Results indicated that sensitivity, negative predictive value, and overall accuracy of the IFFI were superior to both the TOMM indexes and ACI. Logistic regression odds ratios were similar for TOMM Trial 2, Retention, and IFFI (1.25, 1.24, 1.25, respectively), with the ACI somewhat lower (1.18). The IFFI had the highest rate of group membership predictions (79.7%). Implications and limitations of the present study are discussed.

The Coin-in-the-Hand Test and dementia: more evidence for a screening test for neurocognitive symptom exaggeration.

Background:The Coin-in-the-Hand Test was developed to help clinicians distinguish patients who are neurocognitively impaired from patients who are exaggerating or feigning memory complaints. Previous findings have shown that participants asked to feign memory problems and patients suspected of malingering performed worse on the test than patients with genuine neurocognitive dysfunction. Objective:We reviewed the literature on the Coin-in-the-Hand Test and evaluated test performance by 45 hospitalized patients who had dementia with moderately to severely impaired cognition. Methods:We analyzed Coin-in-the-Hand Test scores, neuropsychological findings, and other data to determine whether demographic or neurocognitive variables affected Coin-in-the-Hand Test scores. We also calculated base rates of these scores and provided cutoff ranges for clinical use. Results:Coin-in-the-Hand Test scores were independent of neurocognitive functioning, age, education level, and type of dementia. Base rates of scores suggest that a low cutoff can help differentiate between patients with true neurocognitive impairments and those exaggerating or feigning memory complaints. Conclusions:Both the literature and our findings show the Coin-in-the-Hand Test to have potential as a quick and easy screening tool to detect neurocognitive symptom exaggeration. This test could effectively supplement commonly used neurocognitive screens such as the Mini-Mental State Examination, the Saint Louis University Mental Status Examination, and the Montreal Cognitive Assessment.

Rates of Abnormally Low TOPF Word Reading Scores in Individuals Failing Versus Passing Performance Validity Testing.

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer’s dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.

Wernicke-Korsakoff Syndrome as a Consequence of Delusional Food Refusal: A Case Study.

Wernicke-Korsakoff syndrome is caused by thiamine (vitamin B1) deficiency, typically resulting from malnutrition secondary to chronic alcohol abuse. Less often, other conditions can lead to malnutrition and Wernicke-Korsakoff syndrome. We describe a 35-year-old man who developed Wernicke-Korsakoff syndrome with a typical neurologic and neuropsychological presentation after somatic delusions led him to refuse to eat. Cases like his serve to heighten awareness of the interplay between psychiatric and neurologic conditions, their sometimes atypical pathogenesis, and the value to primary care providers of consulting with psychiatrists, neurologists, and neuropsychologists when managing patients with possible Wernicke-Korsakoff syndrome.

Research methods in performance validity testing studies: criterion grouping approach impacts study outcomes

Abstract Objective: Performance validity test (PVT) research studies commonly utilize a known-groups design, but the criterion grouping approaches within the design vary greatly from one study to another. At the present time, it is unclear as to what degree different criterion grouping approaches might impact PVT classification accuracy statistics. Method: To analyze this, the authors used three different criterion grouping approaches to examine how classification accuracy statistics of a PVT (Word Choice Test; WCT) would differ. The three criterion grouping approaches included: (1) failure of 2+ PVTs versus failure of 0 PVTs, (2) failure of 2+ PVTs versus failure of 0–1 PVT, and (3) failure of a stand-alone PVT versus passing of a stand-alone PVT (Test of Memory Malingering). Results: When setting specificity at ≥.90, WCT cutoff scores ranged from 41 to 44 and associated sensitivity values ranged from .64 to .88, depending on the criterion grouping approach that was utilized. Conclusions: When using a stand-alone PVT to define criterion group status, classification accuracy rates of the WCT were higher than expected, likely due to strong correlations between the reference PVT and the WCT. This held true even when considering evidence that this grouping approach results in higher rates of criterion group misclassification. Conversely, when using criterion grouping approaches that utilized failure of 2+ PVTs, accuracy rates were more consistent with expectations. These findings demonstrate that criterion grouping approaches can impact PVT classification accuracy rates and resultant cutoff scores. Strengths, weaknesses, and practical implications of each of the criterion grouping approaches are discussed.