Thomas Swirsky-Sacchetti

Neuropsychological and structural brain lesions in multiple sclerosis A regional analysis

Quantified lesion scores derived from MRI correlate significantly with neuropsychological testing in patients with multiple sclerosis (MS). Variables used to reflect disease severity include total lesion area (TLA), ventricular-brain ratio, and size of the corpus callosum. We used these general measures of cerebral lesion involvement as well as specific ratings of lesion involvement by frontal, temporal, and parieto-occipital regions to quantify the topographic distribution of lesions and consequent effects upon cognitive function. Lesions were heavily distributed in the parieto-occipital regions bilaterally. Neuropsychological tests were highly related to all generalized measures of cerebral involvement, with TLA being the best predictor of neuropsychological deficit. Mean TLA for the cognitively impaired group was 28.30 cm2 versus 7.41 cm2 for the cognitively intact group (p < 0.0001). Multiple regression analyses revealed that left frontal lobe involvement best predicted impaired abstract problem solving, memory, and word fluency. Left parieto-occipital lesion involvement best predicted deficits in verbal learning and complex visual-integrative skills. Analysis of regional cerebral lesion load may assist in understanding the particular pattern and course of cognitive deficits in MS.

Neuropsychological function in borderline personality disorder.

To evaluate the possibility of an underlying dimension of organicity in borderline personality disorder (BPD), a carefully diagnosed group of borderline patients was assessed across a wide range of neuropsychological functions and then was compared to an age- and education-matched non-patient control group. The BPD group had significantly lower Verbal, Performance, and Full Scale IQ scores on the WAIS-R. The BPD group also was impaired significantly on motor skills, figural memory, complex visuomotor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients.

The sensitivity of the Mini‐Mental State Exam in the white matter dementia of multiple sclerosis

Fifty-six patients diagnosed with definite multiple sclerosis (MS) according to Poser criteria were administered the Mini-Mental State Examination (MMSE) and a comprehensive battery of neuropsychological tests. Extent of cerebral lesion involvement was determined by quantitative magnetic resonance imaging (MRI) ratings. The MMSE correlated with overall levels of physical disability, but did not correlate with total lesion area on MRI. Sensitivity of the MMSE to the subcortical dementia of MS was low (28%) when performance on the neuropsychological testing battery was used as the criterion. Impairment on tests of memory, speed of information processing, abstract reasoning, naming/verbal fluency, as well as visuoperceptual organization, were correlated highly with total lesion area on MRI. The low sensitivity of the MMSE to cognitive impairment in MS is discussed in terms of its item composition and the characteristic pattern of deficits found in MS.

Distinguishing between Neuropsychological Malingering and Exaggerated Psychiatric Symptoms in a Neuropsychological Setting

It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory–III (MCMI–III), were examined. TOMM and RDS scores were uncorrelated with MCMI–III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting.

The Effects of a Comprehensive Self-Hypnosis Training Program on the Use of Factor Viii in Severe Hemophilia

Abstract Hemophilia, the bleeders disease, is characterized by internal bleeding episodes which have been associated anecdotally with psychological stress. The focus of the present investigation was to study the potential utility of a comprehensive self-hypnosis training program to decrease stress and to assess the amount of clotting factor used for bleeding by those individuals trained in self-hypnosis compared to a control group. 30 severe hemophiliacs on home therapy were randomly assigned to a treatment or to a waiting list control group. The treatment group received a comprehensive 6-week training program including support, education, deep relaxation, and self-hypnosis. Over the 18-week follow-up, the treatment group significantly reduced the amount of factor concentrate used to control bleeding in comparison to controls. The treatment group also significantly reduced general distress level as measured by a symptom checklist. The training was extremely cost effective, and the results support the eff...

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.

Sex Differences and Handedness in Hemispheric Lateralization of Tactile-Spatial Functions

Sex differences in spatial processing and handedness were studied with a tactile-spatial task in 27 male and 29 female right-handed undergraduate students in psychology. Subjects were asked to identify amorphous shapes to investigate possible male right-hemisphere specialization for spatial functions and bilateral representation among the women. The Annett handedness questionnaire estimated extent of right-handedness. Subjects were classified by major, and women by phase of menstrual cycle. Analysis shows significantly more right-handedness in women and ambidexterity in men. Over-all, men do not perform significantly better than women, although men outperform women with their left hands when handedness is covaried. Within sex, no difference is seen between left and right hand scores for men, but women perform significantly better with right than left hands. Further analyses suggest men appear right-hemisphere dominant for this task whereas women show left-hemisphere dominance. Analyses of hormonal data support recent research, in that for women on the pill there is a trend to perform worse than all other groups. Engineering students perform significantly better than all other majors.

Utility of the Rey-15 recognition trial to detect invalid performance in a forensic neuropsychological sample.

The current study sought to address the utility of the Rey Fifteen Item Test (Rey-15), with the use of a combined score [recall correct + (recognition correct – false positives)], to distinguish between valid and invalid performance among a sample of litigating persons referred for neuropsychological evaluation. Scores on the Rey-15 were analyzed across four comparison groups: (1) litigating persons with evidence of invalid performance (n = 29), (2) litigating persons with valid performance (n = 63), (3) learning-disabled patients (n = 36), and (4) a mixed clinical neuropsychological sample not involved in litigation (n = 54). A Rey-15 combined cutoff score of < 21 yielded the highest sensitivity (70%) and specificity (92.8%) rates. If the Rey-15 is to be used in clinical practice to detect invalid performance, the recognition trial with combined score < 21 should be used. Findings support the use of the combined Rey-15 score in place of the previously used recall Rey-15 score to improve sensitivity and specificity rates for detection of invalid performance in litigating neuropsychological referrals.

Red flags in the clinical interview may forecast invalid neuropsychological testing

Abstract Objective: Evaluating assessment validity is expected in neuropsychological evaluation, particularly in cases with identified secondary gain, where malingering or somatization may be present. Assessed with standalone measures and embedded indices, all within the testing portion of the examination, research on validity of self-report in the clinical interview is limited. Based on experience with litigation-involved examinees recovering from mild traumatic brain injury (mTBI), it was hypothesized that inconsistently reported date of injury (DOI) and/or loss of consciousness (LOC) might predict invalid performance on neurocognitive testing. Method: This archival study examined cases of litigation-involved mTBI patients seen at an outpatient neuropsychological practice in Philadelphia, PA. Coded data included demographic variables, performance validity measures, and consistency between self-report and medicolegal records. Results: A significant relationship was found between the consistency of examinees’ self-report with records and their scores on performance validity testing, X2 (1, N = 84) = 24.18, p < .01, Φ = .49. Post hoc testing revealed significant between-group differences in three of four comparisons, with medium to large effect sizes. A final post hoc analysis found significance between the number of performance validity tests (PVTs) failed and the extent to which an examinee incorrectly reported DOI r(83) = .49, p < .01. Using inconsistently reported LOC and/or DOI to predict an examinee’s performance as invalid had a 75% sensitivity and a 75% specificity. Conclusion: Examinees whose reported DOI or LOC differs from records may be more likely to fail one or more PVTs, suggesting possible symptom exaggeration and/or under performance on cognitive testing.s

The Neuropsychological Assessment of Justice-Involved Men: Descriptive Analysis, Preliminary Data, and a Case for Group-Specific Norms

Objective Neuropsychological expertise has played an increasing role in legal decision-making in criminal contexts. Valid neuropsychological evidence in criminal forensic contexts requires normative data that are representative of justice-involved individuals. Unfortunately, existing normative data appear unlikely to represent justice-involved individuals due to significant demographic and clinical factors specific to this population. As a result, the interpretation of neuropsychological performance with justice-involved individuals using existing normative data may increase the risk of inaccurate description, invalid clinical conceptualization, misdiagnosis of impairment, and misattribution of deficits in functional-legal capacities. The current study aimed to examine the use of neuropsychological assessment with justice-involved men. Method A sample of incarcerated men (N = 95) was assessed using a battery of demographic, clinical, and neuropsychological measures. Results Descriptive analyses showed the demographic and clinical diversity of justice-involved men. Inferential statistical analyses, effect size calculations, and clinical analyses demonstrated that a sample of justice-involved men performed significantly differently and was more impaired than commonly referenced normative samples across multiple measures of intellectual functioning, attention, verbal fluency, and executive functioning. Preliminary data are provided to aid the use of the selected neuropsychological measures with justice-involved men. Conclusions Justice-involved men appear to represent a distinct neuropsychological population. Group-specific normative data will be useful to help ensure that opinions about these individuals are relevant, valid, and admissible within legal decision-making in criminal contexts. The current data can guide future efforts to develop substantive normative data on neuropsychological measures likely to be used in the assessment of justice-involved men.