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.     

Unanswered questions in assessment center research

This study compared the predictive validity of two types of overall assessment center ratings (clinical and mechanical) and two types of performance ratings (supervisor and subordinate). Data were gathered on approximately 50 law enforcement agency managers over a four-year time span. Results indicated that clinical predictions were not significantly better than mechanical ones and that prior performance ratings were better predictors of future performance ratings than were assessment centers. Further, dimension ratings within the assessment center were found to be unrelated to ratings of the same dimensions on the job four years later, supporting the notion of subtle criterion contamination (Klimoski & Strickland, 1977) and raising questions about the central assumptions underlying the assessment center approach.     

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.     

“Marital trap analysis”—incompetence,complementarity, and success traps: Identifying potential future dysfunctions based on a couple's current collusive agreements

This paper describes three types of traps or collusive marital agreements-incompetence traps, complementarity traps, and success traps-in which the mates renounce or forgo competent functioning in vital areas of marital roles and experience. It is suggested that responsible clinical work with the couple should include a careful evaluation of such traps and the potential breakdown or dysfunction inherent in each one, and a decision as to whether or not to attempt therapeutic penetration into such collusive agreements even before the couple complain directly about their arrangement.     

A structural model for postpartum responses to the somatic and cognitive items on the Beck Depression Inventory

A distinction can be drawn between those items on the Beck Depression Inventory (BDI) that reflect mainly cognitive and emotional symptoms and those that reflect somatic symptoms. Responses to the BDI were obtained from women at 3, 6, 9, and 24 weeks postpartum. The covariances of cognitive and somatic symptom scores across the four time points were closely fit by a structural equations model referred to as the simplex. The modeling indicates that earlier cognitive scores directly predict later somatic scores but that early somatic scores do not directly predict later cognitive scores. Other data confirm the results.Much of this research was supported while the first author was an NIMH Fellow at the University of Iowa (MH15168).     

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.