The detection of fake-bad and fake-good responding on the Millon Clinical Multiaxial Inventory III.

The purpose of this study was to examine the effectiveness of the 3 Modifying Indices of the Millon Clinical Multiaxial Inventory III (MCMI—III) in the detection of fake-bad and fake-good responding. The sample consisted of 160 psychiatric outpatients. Paired t tests were performed to examine the effects of instructional set (faking vs standard instructions). As hypothesized, instructional set produced significant differences on Scale X, Scale Y, and Scale Z in both fake-bad and fake-good analyses. Single-scale cutoff scores were as effective as multiple-scale cutoffs. The overall rates of successful classification indicated moderate effectiveness and utility of the MCMI—III Modifying Indices in the detection of dissimulated responding. When base rates were varied to more closely approximate a general clinical population, overall classification accuracy increased, but identification of faking (positive predictive power) gradually eroded with declining base-rate estimates. At lower base rates of faking, MCMI—III standard cutoff points yielded a high number of false positives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying comorbid depression in elderly medical patients: Use of the Extracted Hamilton Depression Rating Scale.

The high prevalence and low rate of detection of comorbid depression in primary care is now well documented. Older adults with multiple medical problems represent a population at higher risk for underrecognition. The Extracted Hamilton Depression Rating Scale (XHDRS) was evaluated as a screening instrument for depression diagnosed according to Research Diagnostic Criteria in a sample of 150 geriatric medical and surgical inpatients. Scale reliability and validity were evaluated, and its sensitivity, specificity, and predictive power were calculated at multiple cutoff points. Results indicated good internal consistency, interrater reliability, concurrent validity, convergent validity, and discriminant validity. Additionally, use of the XHDRS offered greatly improved case identification when compared with use of conventional screening procedures. The XHDRS also showed improved specificity and positive predictive power when compared with several widely used self-report symptom scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic efficiency of DSM–IV indicators for binge eating episodes.

Objective: Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of the 5 Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994) “indicators for impaired control” specified to help determine loss of control while overeating (i.e., binge eating). We examined the diagnostic efficiency of these indicators proposed as part of the research criteria for BED (eating until uncomfortably full; eating when not hungry; eating more rapidly than usual; eating in secret; and feeling disgust, shame, or depression after the episode). Method: A total of 916 community volunteers completed a battery of measures including questions about each of the indicators. Participants were categorized into 3 groups: BED (N = 164), bulimia nervosa (BN; N = 83), and non-binge-eating controls (N = 669). Four conditional probabilities (sensitivity, specificity, positive predictive power [PPP], and negative predictive power [NPP]) as well as total predictive value (TPV) and kappa coefficients were calculated for each indicator criterion in separate analyses comparing BED, BN, and combined BED + BN groups relative to controls. Results: PPPs and NPPs suggest all of the indicators have predictive value, with eating alone because embarrassed (PPP = .80) and feeling disgusted (NPP = .93) performing as the best inclusion and exclusion criteria, respectively. The best overall indicators for correctly identifying binge eating (based on TPV and kappa) were eating when not hungry and eating alone because embarrassed. Conclusions: All 5 proposed indicators for impaired control for determining binge eating have utility, and the diagnostic efficiency statistics provide guidance for clinicians and the DSM–5 regarding their usefulness for inclusion or exclusion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in the sensitivity of two self-report depression scales in older depressed inpatients.

Both the Geriatric Depression Scale (J. A. Yesavage et al; see record 1984-02939-001) and the Beck Depression Inventory were less effective in identifying depressed men than women in a sample of 191 geriatric psychiatric inpatients with major unipolar depression. From one quarter to one half of the men were missed cases, depending on the cutoff score used. Separate cutoff scores for older men and women on depression screening instruments may be appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of bedside screening procedures for cognitive deficits in chronic psychiatric inpatients

The Mini-Mental State Examination (MMSE) and the Trail Making Test, part B (TMT-B) were compared for screening cognitive deficits in a sample of 104 psychiatric inpatients at a long-term hospital. The TMT-B classified 84% of the patients as impaired. The classic MMSE cutoff score (< or = 23) using serial sevens and spelling classified 42% and 24% of the patients respectively, as impaired. The new MMSE cutoff classified 71% as impaired. Education, gender, and medication may influence impairment when using the MMSE classic cutoff scores. In TMT-B only, impairment was influenced by chronicity. The TMT-B was able to distinguish patients impaired in the MMSE. The TMT-B, therefore, may be more useful than the MMSE to screen for cognitive deficits in chronic psychiatric inpatients.     

The utility and comparative incremental validity of the MMPI-2 and Trauma symptom Inventory validity scales in the detection of feigned PTSD.

The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, FB, Fp, FBS) to detect feigned posttraumatic stress disorder (PTSD). Remitted trauma victims (n = 60) completed the TSI and MMPI-2 under standard (honest) instructions and then were randomly assigned to 1 of 2 experimental conditions (noncoached/validity scale coached) in which they were administered these instruments again with instruction to fake PTSD. These test protocols were compared with TSI and MMPI-2 results from workplace injury claimants with PTSD (n = 84). The ATR and FBS were able to distinguish only the noncoached participants instructed to fake from the PTSD claimants; in contrast, the F, FB, and Fp scales were able to distinguish both the noncoached and the validity-scale-coached participants from the PTSD claimants. F, FB, and Fp always outperformed the ATR and FBS; neither the ATR nor the FBS was able to add incremental predictive variance to that of F, FB, or Fp. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent validity of three WAIS—R short forms in psychiatric inpatients.

Several investigators have proposed short forms of the Wechsler Adult Intelligence Scale—Revised (WAIS—R) to provide more cost-effective estimates of intellectual ability. The present study compared the concurrent validity of A. B. Silverstein's (1982) 2-subtest, Doppelt's (1956) 4-subtest, and L. C. Ward's (1990) 7-subtest short forms in predicting the WAIS—R Full Scale IQs of 304 psychiatric inpatients. Although Full Scale IQs were highly correlated with 2- and 4-subtest estimates, a significantly higher correlation was obtained with the 7-subtest short form. Errors in predicted IQ were smallest for the 7-subtest form. The results support previous research that found better predictive accuracy for the 7-subtest short form than for the 2- and 4-subtest methods, despite little additional cost in administration time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Escherichia coli prlC gene encodes a trypsin-like proteinase regulating the cell cycle

BACKGROUND AND PURPOSE: Mood disorders are common after stroke and may impede physical, functional, and cognitive recovery, making early identification and treatment of potential importance. We aimed to compare the accuracy of the General Health Questionnaire (GHQ-30) and the Hospital Anxiety and Depression (HAD) Scale in detecting psychiatric morbidity after stroke and to determine the most suitable cutoff points for different purposes. METHODS: One hundred five hospital-referred stroke patients completed both the GHQ-30 and HAD Scale 6 months after onset before a blinded psychiatric assessment in which the Schedule for Affective Disorders and Schizophrenia with some supplementary questions was used to determine a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis. Measures were compared in terms of sensitivity, specificity, and receiver operating characteristic curves. RESULTS: No significant differences were found between the GHQ-30 and the HAD Scale in identifying those patients with any DSM-IV diagnosis (P=0.95), grouped depression (P=0.56), or anxiety (P=0.25) disorders. The previously recommended cutoff points for identifying "cases" for the GHQ (4/5) and for the HAD Scale (8/9 and 11/12) were found to be suboptimal in this population. CONCLUSIONS: The GHQ-30 and HAD scale exhibited similar levels of sensitivity and specificity. Data are presented, taking into account the "cost" of false-positives and negatives, to allow a choice of cutoff points suitable for differing situations.     

Examining scale discriminability in the BDI and CES-D as a function of depressive severity.

Scale discriminability is the ability of a measure to discriminate among individuals ordered along some continuum, such as depressive severity. We used a nonparametric item-response model to examine scale discriminability in the Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) in both college and depressed outpatient samples. In the college sample, the CES-D was more discriminating than the BDI, but a standard CES-D cutoff score of 16 overestimated the likely prevalence of depression (45%). The CES-D may be more effective than the BDI in detecting differences in depressive severity in college students but may be less specific. In the depressed outpatient sample, the CES-D was again more discriminating than the BDI. The superior scale discriminability of the CES-D offers one explanation for its poorer specificity in college samples. Endorsing many items that discriminate at low levels of depressive severity can result in scores that exceed a cutoff criterion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness.

A 9-point clinical rating scale was used to assess the severity of hopelessness in 141 patients hospitalized with suicidal ideation. The patients were followed from 5 to 10 years, and 10 (7.1%) eventually committed suicide. The mean hopelessness rating for the patients committing suicide was significantly higher than that for the patients not committing suicide. A cutoff score of 6 or above successfully predicted 9 (90.0%) of those committing suicide. The results supported previous findings in which self-reported hopelessness on the Beck Hopelessness Scale was reported to predict suicide in both psychiatric outpatients and inpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

Although self-harming behavior is a common and costly problem for psychiatric inpatients released from the hospital, standardized tools that assess patients' risk for self-harm are rarely used in clinical settings. In this study of dually diagnosed psychiatric inpatients (N = 147), we assessed the utility of patients' self-perceptions of risk in predicting self-harm in the community. Patients' self-perceptions of risk predicted self-harm 8 weeks after discharge from the hospital (Lag 1; area under the curve [AUC] = 0.75). Self-perceptions of risk at the 8-week interview also predicted self-harm 2 months later (Lag 2; AUC = 0.72). Self-perceived risk added predictive utility above and beyond scores on a measure of depression and seemed to capture changes in risk state over time. The results suggest that inpatients can accurately perceive their own risk and therefore may be important collaborators in the risk management process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Lateralization of Epileptic Foci by Neuropsychological Testing in Mesial Temporal Lobe Epilepsy.

This study investigated the lateralizing value of neuropsychological testing in presurgical evaluation of mesial temporal lobe epilepsy (MTLE). This study differed from previous ones in that the cutoff values were determined to yield high positive predictive values (PPVs), multiple neuropsychological predictors were considered in combination, and patients with atypical language dominance or low intelligence were not excluded from the sample. The participants were 92 patients with MTLE (left, n = 47; right, n = 45) who showed good postoperative seizure control. With a stringent cutoff criterion, the multiple neuropsychological predictors considered in combination yielded a sensitivity of 15% and a PPV of 93%, and with a less stringent cutoff criterion, a sensitivity of 37% and a PPV of 83%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the Adult Suicidal Ideation Questionnaire and the Reasons for Living Inventory in an adult psychiatric inpatient sample.

This study investigated the factor structure of the Adult Suicidal Ideation Questionnaire (ASIQ) and the Linehan Reasons for Living Inventory (LRFI) in a sample of 205 adult psychiatric inpatients. Confirmatory factor analyses provided moderate support for the construct validity of each instrument. Coefficient alphas for the ASIQ (.98) and LRFL (.93) were high. In addition, a range of different clinical cutoff points was derived for each instrument. Both instruments were also better than chance in differentiating between the suicide attempter and psychiatric control groups. High ASIQ and low LRFL scores were significantly associated with scores on selected Minnesota Multiphasic Personality Inventory-2 Content scales. The analyses also indicated that only the ASIQ added to the symptoms of hopelessness and negative affect in differentiating between the suicide attempter and psychiatric control groups. Results suggest that both instruments may be useful screening tests for suicidal behavior in psychiatric long-term care inpatient samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of Personality Assessment Inventory and Rorschach Indices of Schizophrenia in a Public Psychiatric Hospital.

The present study investigated the performance of indices of schizophrenia from the Personality Assessment Inventory (PAI-SCZ; L. C. Morey, 1991) and Rorschach (Rorschach SCZI; J. E. Exner, 1993) in a heterogeneous sample of 24 inpatients at a public psychiatric hospital in the southeastern United States. Results indicated modest agreement between the PAI-SCZ and Rorschach SCZI. More important, the PAI-SCZ but not Rorschach SCZI reliably differentiated inpatients with schizophrenic-spectrum diagnoses from inpatients with other psychiatric diagnoses. In settings in which psychotic disorders falling outside the schizophrenic spectrum are common, the PAI-SCZ may be better suited than the Rorschach SCZI to aid in the differential diagnosis of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond correlational analysis of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS): A classification validity study.

This study investigated the classification validity of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) using a sample of kindergarteners (N = 177). Results indicated the cutoff scores for determining at-risk status on the DIBELS produced substantial false negative rates. Cutoff scores identifying students as at some risk produced substantial false positive rates. At both levels of risk status, the DIBELS showed low positive predictive power, but high negative predictive power, indicating it was far better at identifying students with adequate reading skills than those with inadequate reading skills. Recommendations for appropriate use of the DIBELS for reading screening and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simple, but effective: Odd- and even-item short forms for the WAIS—R.

Two easy-to-administer Wechsler Adult Intelligence Scale—Revised (WAIS—R) short forms for test–retest situations were developed. One sample of 90 22–67 yr old male psychiatric inpatients and a cross-validation sample of 30 22–79 yr old psychiatric inpatients completed the full WAIS—R. Test results were scored in the standard fashion and for 2 short forms developed by an odd–even split on 9 of the 11 subtests. Verbal, Performance, and Full Scale IQs derived from both short form scales closely approximated standard-form WAIS—R IQs. Short-form subtest-scaled scores, however, were more discrepant from the standard-form subtest-scaled scores. The short forms' practical advantages are discussed. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on early development of the murine fetal oral vestibule

The Spontaneous Selective Attention Task (SSAT) is a visual word-identification task that measures the type of selective attention that occurs spontaneously when there are multiple stimuli, all potentially relevant, and insufficient time to process each of them fully. The present study was designed to examine the sensitivity of the SSAT by comparing the performance of 40 schizophrenic inpatients and 30 schizophrenic outpatients to that of 70 normal controls. The pattern of results reported previously for schizophrenic inpatients versus normals was replicated, and these findings were extended to include schizophrenic outpatients in partial symptom remission. Schizophrenic inpatients and outpatients were just as accurate in identifying words as normals, but spontaneous selective attention under conditions of predictability was abnormal in both patient groups. Furthermore, the ability of the SSAT to discriminate between schizophrenic patients and controls was confirmed. A ratio measure of spontaneous selective attention had a sensitivity of 77% and a base rate of 9% in a normal population (when a cutoff value was set to minimize false positives and false negatives). Thus, the SSAT is a sensitive measure of an attentional phenotype that may be useful in genetic studies of schizophrenia.