Gender Differences in Cognitive and Emotional Adjustment to Traumatic Brain Injury

This study examined gender differences in cognitive and emotional status after traumatic brain injury (TBI) among 262 men and 140 women with TBI referred for neuropsychological evaluations. In this cross-sectional study, cognition was measured in terms of both absolute level of functioning (i.e., raw/standard scores) and estimated decline from premorbid levels expressed as z-deficit scores in the following domains: intelligence [Wechsler Adult Intelligence Scale—Revised (WAIS-R)], memory and attention [Wechsler Memory Scale—Revised (WMS-R)], processing speed (Trails A), and cognitive flexibility (Trails B). Emotional functioning was measured in terms of depression (Beck Depression Inventory) and general emotional distress (Brief Symptom Inventory). Kruskal–Wallis nonparametric one-way ANOVAs indicated that women and men differed significantly on 2 of 8 raw/standard cognitive scores [men demonstrated lower WMS-R General Memory (p < .05) and Trails B scores (p < .0001) and 4 of 8 relative decline scores [women demonstrated more estimated change in VIQ (Verbal IQ) [p < .0001], FSIQ (Full Scale IQ) [p < .01], and Attention (p < .01)]; men demonstrated greater estimated z-decline scores on Trails B (p < .01)]. Women reported significantly higher levels of depression (p < .01), but men endorsed significantly greater general psychological distress (p < .05). Research and assessment recommendations are suggested.     

Assessing executive abilities following acute stroke with the trail making test and digit span

The Trail Making Test and Digit Span are neuropsychological tests widely used to assess executive abilities following stroke. The Trails B and Digits Backward conditions of these tests are thought to be more sensitive to executive impairment related to frontal lobe dysfunction than the Trails A and Digits Forward conditions. Trails B and Digits Backward are also thought to be more sensitive to brain damage in general. Data from the Stroke and Lesion Registry maintained by the Washington University Cognitive Rehabilitation Research Group were analyzed to compare the effects of frontal versus nonfrontal strokes and to assess the effects of stroke severity. Results showed that the performance of patients with frontal and nonfrontal strokes was comparable in each condition of both the Trail Making Test and Digit Span, providing no support for the widely held belief that Trails B and Digits Backward are more sensitive to frontal lobe damage. Further, Trails A was as strongly correlated with stroke severity as Trails B, whereas Digits Backward was more strongly correlated with stroke severity than Digits Forward. Overall, the Trail Making Test and Digit Span are sensitive to brain damage but do not differentiate between patients with frontal versus nonfrontal stroke.     

Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Convergent and discriminant validity of Russell's revised Wechsler memory scale

The convergent and discriminant validity of Russell's Revised Wechsler Memory Scale (RWMS) was investigated in a sample of 228 males referred to a VA Medical Center Psychology Service for evaluation. Results of correlational and regression analyses involving background characteristics (race, age, ward assignment) and scores on other measures (WAIS, MMPI, Graham-Kendall Memory for Designs, Tapping, Trails, Aphasia Screening Test) suggested both strengths and weaknesses in the RWMS. Strenghts included minimal relationships between RWMS scores and personality disturbance, race, or age, and substantially lower correlations with IQ than reported for the original WMS. Weaknesses involved the measurement properties of the retention scores, and uncertain discriminant validity in relation to the various other ability measures.     

MMPI code types and the fantasy prone personality

We administered the MMPI and the Inventory of Childhood Memories and Imagining (ICMI) to 1,200 college students. Application of diagnostic efficiency statistics for the ability of differing ICMI cutoff scores to identify college students producing a schizophrenia spectrum MMPI code type revealed that scores greater than or equal to 29 on the ICMI had good positive predictive power. Scores less than 29 on the ICMI had very good negative predictive power. ICMI scores were also used to form a group of fantasizers (n = 30) and a control group (n = 30). Fantasizers were much more likely to produce MMPI codes associated with a vulnerability to schizophrenia (70%) than were controls (3.33%). Although most controls(70%) produced non-elevated MMPI scores, 66.67% of the fantasizers produced three or more elevated clinical scales on the MMPI. The modal MMPI profile for the fantasizers was an 8-9 code, indicating that fantasizers appear at heightened risk for eccentric thinking and a Cluster A or B personality organization.     

MMPI configural interpretation as applied to posttraumatic stress disorder in Vietnam veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

MMPI Configural Interpretation as Applied to Posttraumatic Stress Disorder in Vietnam Veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

Concurrent Validation of Hutt's Bender Gestalt Screening Method for Schizophrenia,Depression, and Brain Damage

The effectiveness of Hutt's Bender Gestalt scoring system in screening for schizophrenia, depression, and brain damage was investigated in a sample of mixed, psychiatric inpatients. Fifteen patients represented each diagnostic category. After an examination of each patient's Bender Gestalt protocol according to Hutt's criteria, it was found that the true positive and true negative success rates of the screening procedures for depression and brain damage were significantly higher than corresponding base rates. The Lacks Bender Gestalt screening method for brain damage was no more successful than the Hurt method in identifying true positives and true negatives. With the brain-damaged patients excluded, Hutt's screening procedures for both depression and schizophrenia resulted in significantly high rates of successful identification of true positives and true negatives. Moreover, these rates did not significantly differ from those determined by patients' Minnesota Multiphasic Personality Inventory (MMPI) T scores on corresponding scales.     

Emotional and personality changes following cingulotomy

The effects of bilateral anterior cingulate cortex (ACC) lesions on emotional and personality functioning were studied. Patients undergoing cingulotomy for chronic intractable pain were assessed on the Minnesota Multiphasic Personality Inventory (MMPI), the Profile of Mood States (POMS), cognitive tests, and pain ratings, pre- and postsurgically. Patients with intractable pain, not treated with cingulotomy, served as controls. Cingulotomy patients experienced reductions in POMS-Tension, POMS-Anger, and MMPI Scale 7 (Psychasthenia) compared with baseline and the controls. POMS-Tension was significantly correlated with attention-intention performance. The results indicate that the ACC modulates emotional experience, related to self-perceived tension, and that there is relationship between the emotional and the attentional effects of cingulotomy.     

Verbal learning and visuomotor attention in Alzheimer's disease and geriatric depression

We compared the verbal learning and visuomotor attention of 34 Alzheimer's patients and 18 depressive patients. Verbal learning was assessed using The Hopkins Verbal Learning Test--Revised (HVLT--R); visuomotor attention was assessed using the Trail Making Test (TMT). The Alzheimer's patients had significantly lower scores on immediate and delayed recall of a word list. There was a nonsignificant trend in this group toward a fewer number of true positives and a greater number of false positives. Alzheimer's patients were significantly slower on Trails A, with a nonsignificant trend toward slower performance on Trails B. No difference was observed in accuracy of attentional processing. The results are discussed in terms of other factors, such as stage of cognitive decline, which might have influenced the findings.     

Utility of the MMPI in a geriatric population

Despite the popularity of the Minnesota Multiphasic Personality Inventory (MMPI), there exists a relative dearth of normative and validity research regarding its use with persons over the age of 60. Our investigation was designed to examine the MMPI performance of both a normal and a clinical sample of older men and women. Specifically, a nonpatient community sample of 204 subjects and an outpatient psychiatric sample of 30 subjects, between the ages of 60 and 90, were administered the MMPI as well as structured psychiatric interview, the Psychiatric Status Schedule (PSS). Results revealed that, on most of the MMPI scales, the mean scores were well above the norms (i.e., 5-10 t-score points). Through comparisons between the clinical and community subjects as well as between MMPI and PSS performance, the MMPI demonstrated substantial discriminative and concurrent criterion validity within this geriatric sample. The results of the study suggest that, with a few important exceptions, the MMPI, as generally utilized, is valid for use in the geriatric population.     

Utility of the MMPI in a Geriatric Population

Despite the popularity of the Minnesota Multiphasic Personality inventory (MMPI), there exists a relative dearth of normative and validity research regarding its use with persons over the age of 60. Our investigation was designed to examine the MMPI performance of both a normal and a clinical sample of older men and women. Specifically, a nonpatient community sample of 204 subjects and an outpatient psychiatric sample of 30 subjects, between the ages of 60 and 90, were administered the MMPI as well as a structured psychiatric interview, the Psychiatric Status Schedule (PSS). Results revealed that, on most of the MMPI scales, the mean scores were well above the norms (i.e., 5-10 t-score points), Through comparisons between the clinical and community subjects as well as between MMPI and PSS performance, the MMPI demonstrated substantial discriminative and concurrent criterion validity within this geriatric sample. The results of the study suggest that, with a few important exceptions, the MMPI, as generally utilized, is valid for use in the geriatric population.     

Oral-dependence and gender: factors in help-seeking response set and self-reported psychopathology in psychiatric inpatients

Psychoanalytic theory suggests that orality and being female are positively related to adopting a help-seeking stance in the world. This may result in inflated scores on self-report psychological tests. These hypotheses were investigated using Rorschach-based, oral-dependence scores (Masling, 1986), the Minnesota Multiphasic Personality Inventory (MMPI) help-seeking F minus K index (Gough, 1950; Meehl, 1951), and the MMPI clinical and supplementary scales. High orals are found to be more likely than low orals to adopt a help-seeking response set which in turn results in inflated scores on a number of MMPI clinical scales. Contrary to stereotypes, women are no more likely than men to be help seeking or oral dependent. Several other significant findings, including that orality is positively related to MMPI Scale 2 (Depression) scores for women, not men, are also discussed.     

Oral-Dependence and Gender: Factors in Help-Seeking Response Set and Self-Reported Psychopathology in Psychiatric Inpatients

Psychoanalytic theory suggests that orality and being female are positively related to adopting a help-seeking stance in the world. This may result in inflated scores on self-report psychological tests. These hypotheses were investigated using Rorschach-based, oral-dependence scores (Masling, 1986), the Minnesota Multiphasic Personality Inventory (MMPI) help-seeking F minus K index (Gough, 1950; Meehl, 1951), and the MMPI clinical and supplementary scales. High orals are found to be more likely than low orals to adopt a help-seeking response set which in turn results in inflated scores on a number of MMPI clinical scales. Contrary to stereotypes, women are no more likely than men to be help seeking or oral dependent. Several other significant findings, including that orality is positively related to MMPI Scale 2 (Depression) scores for women, not men, are also discussed.     

Estimation of MCMI DSM-III axis II constructs from MMPI scales and subscales

Wiggins, Harris and Lingoes, and Serkownek Minnesota Multiphasic Personality Inventory (MMPI) scores were used to predict Millon Clinical Multiaxial Inventory (MCMI) scores in a 100-patient sample. Equations from the first sample were cross-validated on a sample of 212 inmate subjects. We conclude that scores on 19 of the 20 MCMI scales can be successfully predicted by the Wiggins, Harris and Lingoes, and Serkownek subscales of the MMPI. In further cross-validation, the equations were used to predict the Morey, Waugh, and Blashfield MMPI composites for the prison sample, again with strongly positive results. The results appear quite promising for the estimation of personality disorder constructs from MMPI scales and subscales.     

Estimation of MCMI DSM-III Axis II Constructs From MMPI Scales and Subscales

Wiggins, Harris and Lingoes, and Serkownek Minnesota Multiphasic Personality Inventory (MMPI) scores were used to predict Millon Clinical Multiaxial Inventory (MGMI) scores in a 100-patient sample. Equations from the first sample were cross-validated on a sample of 212 inmate subjects. We conclude that scores on 19 of the 20 MCMI scales can be successfully predicted by the Wiggins, Harris and Lingoes, and Serkownek subscales of the MMPI. In further cross-validation, the equations were used to predict the Morey, Waugh, and Blashfield MMPI composites for the prison sample, again with strongly positive results. The results appear quite promising for the estimation of personality disorder constructs from MMPI scales and subscales.     

Psychometric deviance measured by MMPI in adoptees at high risk for schizophrenia and their adoptive controls

Psychometric deviance in personality traits as assessed by the Minnesota Multiphasic Personality Inventory (MMPI; Dahlstrom, Welsh, & Dahlstrom, 1982) was compared between adopted-away, high-risk (HR) offspring of schizophrenic biologic mothers and low-risk (LR) controls. A subsample of the Finnish Adoptive Family Study (Tienari et al., 2000) included 60 HR adoptees and 76 LR control adoptees who were tested by the MMPI before the onset of any psychiatric disorder at the mean age of 24 years. The HR group was found to be distinguishable based on deviant scores on the scales HOS and HYP, indicating emotional unresponsiveness, restricted affectivity, and decreased energy. These may also be considered possible premorbid and prodromal signs of future schizophrenia among the HR adoptees.     

Prediction of Boston Naming Test performance from vocabulary scores: preliminary guidelines for interpretation.

Patients with limited education or underdeveloped vocabulary skills may perform below the normal range on the Boston Naming Test when compared to the original published norms, even in the absence of brain damage. To reduce the frequency of false positive dysnomic classifications of patients with limited vocabulary skills, we developed a score adjustment to account for the significant shared variance between scores on this test and the WAIS-R Vocabulary subtest. Vocabulary significantly predicted performance on the Boston Naming Test (r = .65, p < .0001) in a sample of 62 outpatients who had no objective evidence of brain damage. Linear regression was used to derive expected performance on the Boston Naming Test from Vocabulary scaled scores. Relative to the original published norms, scores based on the Vocabulary subtest cut-offs produced fewer false positives and more accurately classified group membership for patients with and without objectively verified brain damage. These performance predictions are offered as tentative guidelines to assist clinicians in evaluating the presence of naming deficits by controlling for the variance associated with knowledge of vocabulary.