An introduction to organic brain syndromes

Organic brain syndromes are of forensic interest for several reasons. First, patients with organic brain syndromes may require judicial determination of competence in any of a number of areas, e.g., testamentary capacity, need for financial guardianship, or competence to make medical decisions. Second, any patient whose mental state is of legal interest will need evaluation for contributing organic factors; uncovering these factors may have considerable medical and legal consequence. Third, the discovery of organic factors may be decisive in the outcome of a judicial proceeding, where “hard” biological data are often accorded more weight, and are thus more persuasive, than “soft” psychological data. This article provides an introductory overview of the organic brain syndromes. For each syndrome, the clinical features are described and are illustrated with a case vignette, the more common etiologies are presented, and selected aspects to the evaluation are highlighted. In addition, since the detectian of malingered mental illness is a key component in many forensic contexts, characteristics are described which help to distinguish actual from malingered mental illness.     

The use of structured multi-domain job analysis for the construction of assessment center methods and procedures

This article addresses the defensibility of the assessment center based on a content oriented validation strategy. One reason for the confusion in this area is the fact that there are no agreed upon methods for constructing the assessment procedures. Therefore, the purpose of this article is to describe how structured multi-domain job analysis information can be used to develop an assessment center which is well grounded with regard to content validity.     

Irrational beliefs in the articulated thoughts of college students with social anxiety

Cognitive conceptualizations of social anxiety emphasize the role of negative self-statements, unrealistic expectations, and irrational beliefs in the development and maintenance of anxiety in social-evaluative situations. Research into these cognitive factors has entailed administration of questionnaires and instructions to subjects to write down their thoughts during a preceding or impending real-life encounter. These methodologies are criticized on several grounds, such as their assessment of abstract, generalized views by the subject of his/her typical way of thinking over a broad range of circumstances; constraints on responses because of experimenter-provided alternatives; and delays between the eliciting events and self-talk such that recall is subject to distortion and forgetting. Reported here is the use of a recently developed paradigm for uncovering thoughts in complex social situations. In the articulated thoughts during simulated situations method, subjects role-play participation in an audiotaped interpersonal encounter and, at predetermined points, verbalize thoughts elicited by a short segment of the fictitious event. The think-aloud data are taped for later content analysis. The purpose of this study was to explore the relationship between irrational beliefs and social anxiety. Results confirm those of two previous related experiments in that subjects articulated thoughts of greater irrationality when confronted with a stressful social-evaluative situation than with a neutral one. In addition, individuals with a tendency to become anxious in social situations articulated more irrational thoughts than did control subjects, confirming the basic assumption of cognitive-behavioral approaches that certain paterns of unrealistic thinking are associated with psychological distress.     

Multifactor measurement of bodily feelings: Conceptual development,scale construction,and empirical validation

A series of studies is described demonstrating a coherent exploratory and confirmatory factor-analytic approach to the scaling of self-reported bodily feelings. This approach attempts to optimize the orthogonality, parsimony, and meaningfulness of a multifactor inventory. Psychometric properties of the resulting 35-item Bodily Feeling Scale (BFS) are presented and its comparability with other inventories is discussed. A validity study using item-content-based scales of the Minnesota Multiphasic Personality Inventory showed both concurrent and discriminative validity of the BFS. Implications for clinical and research utility are discussed.Portions of this research were conducted while the first author was supported by a University Graduate Fellowship awarded by the Graduate School of Arts and Sciences at Vanderbilt University.Professor Nunnally passed away in August 1982. His major contributions to the several stages of this research program are recognized through coauthorship.     

Adjustment to hemodialysis treatment through behavioral controls

The present study was conducted to examine the hypothesis that compliant chronically ill patients, typically described as adjusted, reinforce more positive social environments using behavioral controls than noncompliant patients, typically described as maladjusted. Specifically, it is hypothesized that diet-compliant chronic hemodialysis patients emit significnatly more active involvement-in-treatment behaviors and more social behaviors than diet-noncompliant chronic hemodialysis patients. Subjects, who ranged in age from 30 to 77 years, were outpatients at a kidney center. Behavioral observations were conducted to assess the occurrence or frequency of (1) four involvement-in-treatment behaviors that are routinely taught to all patients and (2) two social behaviors, which were patient verbalizations and smiles. The results showed that compliant patients emitted significantly more involvement-in-treatment behaviors and smiles than noncompliant patients. Results support the proposed control framework that compliant, in contrast to non-compliant, chronically ill patients have recourse through positive behavioral controls when adjusting to the stresses of illness. It was proposed that through these controls, compliant patients reinforce positive environments rather than simply respond to life circumstances as given.     

Millon Clinical Multiaxial Inventory (MCMI) computer-generated diagnoses: How do they compare to clinician judgment?

During the past several decades, computers have achieved increasing prominence in psychological assessment procedures. This is particularly true for computer-based test interpretation and diagnosis. This study reports on a study designed to compare the accuracy of computer-based diagnoses with clinician-generated diagnoses. The Millon Clinical Multiaxial Inventory (MCMI) was administered to 151 consecutively admitted inpatients at a large private psychiatric hospital. The computer-generated diagnoses were compared with those generated by admitting psychiatrists. The results indicated that the MCMI diagnostic impressions underestimated the severity of depressive disorders when compared with clinician diagnoses on Axis I. Specifically, clinicians diagnosed major depression much more frequently than did the MCMI. In addition, clinicians diagnosed anxiety disorders much less frequently than did the MCMI.     

Old-age deficits in the sense of smell as gauged by thresholds, magnitude matching, and odor identification

Twenty elderly subjects (70-90 years old) and 20 young control subjects (18-24 years old) underwent three kinds of olfactory testing: absolute thresholds to three odorants (d-limonene, iso-amyl butyrate, benzaldehyde), magnitude matching of these odorants to salt tastes, and odor identification of 30 common substances. For all three odorants elderly subjects' mean threshold significantly exceeded that of the young by about ninefold for d-limonene, about threefold for benzaldehyde, and about twofold for iso-amyl butyrate. These threshold differences predict approximate concentration differences necessary to arouse the same estimated odor strength above the threshold for the elderly and the young. Young subjects also scored better than the elderly in odor identification, even when subjects were given four alternatives from which to select the correct label. Unimpaired olfactory functioning is uncommon in the elderly; correlational tests show that as a group the young have better olfactory ability and show more interindividual uniformity.