Novelty seeking and introversion do not predict the long-term risk of Parkinson disease.

OBJECTIVE: It has been suggested that people who develop Parkinson disease (PD) may have a characteristic premorbid personality. We tested this hypothesis using a large historical cohort study with long follow-up. METHODS: We conducted a historical cohort study in the region including the 120-mile radius centered in Rochester, MN. We recruited 7,216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 through 1965 and we considered 5 MMPI scales to measure sensation seeking, hypomania, positive emotionality, social introversion, and constraint. A total of 6,822 subjects (94.5% of the baseline sample) were followed over 4 decades either actively (via interview and examination) or passively (via medical records). RESULTS: During follow-up, 227 subjects developed parkinsonism (156 developed PD). The 3 MMPI scales that we selected to measure the extroverted personality construct (sensation seeking, hypomania, and positive emotionality) did not show the expected pattern of higher scores associated with reduced risk of PD. Similarly, the 2 MMPI scales that we selected to measure the introverted personality construct (social introversion and constraint) did not show the expected pattern of higher scores associated with increased risk of PD. However, higher scores for constraint were associated with an increased risk of all types of parkinsonism pooled together (hazard ratio 1.39; 95% CI 1.06-1.84; p = 0.02). CONCLUSIONS: We suggest that personality traits related to introversion and extroversion do not predict the risk of PD.

Pessimistic explanatory style: a psychological risk factor for poor pain and functional outcomes two years after knee replacement.

Seligman's theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favourable health outcomes. We identified 702 patients who had undergone 894 primary total knee replacements between 1993 and 2005, who responded to follow-up surveys at two (n = 783 knee replacements) and/or five years (n = 443 knee replacements) and had also completed the Minnesota Multiphasic Personality Inventory long before the joint replacement (median = 16.6 and 14.5 years for two- and five-year cohorts, respectively). Scores from the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale were used to categorise patients as pessimistic (t-score > 60) or non-pessimistic (t-score < or = 60). Multivariate logistic regression models assessing the effect of pessimistic explanatory style on pain or improvement in knee function were adjusted for gender, age, distance from the place of treatment and depression score. Pessimists reported (a) significantly more moderate or severe pain at two years with odds ratio 2.21 (95% confidence interval (CI) 1.12 to 4.35; p = 0.02), but not at five years when the odds ratio was 1.21 (95% CI 0.51 to 2.83; p = 0.67); and (b) less improvement in knee function at two years when the odds ratio was 0.53 (95% CI 0.30 to 0.96; p = 0.04), but not at five years when the odds ratio was 1.26 (95% CI 0.57 to 2.77; p = 0.57). No significant associations with moderate or severe limitation of activity were seen at two or five years. We conclude that a pessimistic explanatory style is associated with worse pain and functional outcomes two years after total knee replacement.

Incidence of reading disability in a population-based birth cohort, 1976-1982, Rochester, Minn.

OBJECTIVE: To report the incidence of reading disability among school-aged children. SUBJECTS AND METHODS: In this population-based, retrospective birth cohort study, subjects included all 5718 children born between 1976 and 1982 who remained in Rochester, Minn, after the age of 5 years. Based on records from all public and nonpublic schools, medical facilities, and private tutorial services and on results of all individually administered IQ and achievement tests, extensive medical, educational, and socioeconomic information were abstracted. Reading disability was established with use of research criteria based on 4 formulas (2 regression-based discrepancy, 1 non-regression-based discrepancy, and 1 low achievement). RESULTS: Cumulative incidence rates of reading disability varied from 5.3% to 11.8% depending on the formula used. Boys were 2 to 3 times more likely to be affected than girls, regardless of the identification methods applied. CONCLUSIONS: In this population-based birth cohort, reading disability was common among school-aged children and significantly more frequent among boys than girls, regardless of definition.

Boy/girl differences in risk for reading disability: potential clues?

The authors conducted a case-control study to determine whether risk factors for reading disability (RD) differentially affect boys and girls. The study population included all children born between 1976 and 1982 in Olmsted County, Minnesota (n = 5,701). A total of 303 RD cases were identified by using intelligence quotient and achievement test scores collected from school and medical records. After excluding those who met exclusion criteria (n = 869), controls consisted of all children not identified with RD (n = 4,529). The authors examined the association between RD and potential risk factors in boys and girls and confirmed their results in multivariable logistic regression models. Multivariable models indicated that girls of low birth weight were more than twice as likely to be identified as RD (odds ratio (OR) = 2.94, 95% confidence interval (CI): 1.09, 6.25). Girls whose mothers had 12 or fewer years of education were twice as likely to be identified as RD (OR = 2.14, 95% CI: 1.24, 3.72). However, girls whose fathers were aged 35 years or older at the time of birth were less likely to be identified as RD (OR = 0.24, 95% CI: 0.06, 0.92). Only 12 or fewer years of paternal education was associated with increased RD in boys (OR = 2.28, 95% CI: 1.59, 3.27). Boys and girls appear to be differentially susceptible to RD risk factors, suggesting that the biologic processes leading to RD may differ between boys and girls.

Optimists vs pessimists: survival rate among medical patients over a 30-year period.

OBJECTIVE: To examine explanatory style (how people explain life events) as a risk factor for early death, using scores from the Optimism-Pessimism scale of the Minnesota Multiphasic Personality Inventory (MMPI). SUBJECTS AND METHODS: A total of 839 patients completed the MMPI between 1962 and 1965 as self-referred general medical patients. Thirty years later, the vital status of each of these patients was ascertained. RESULTS: Of the 839 patients, 124 were classified as optimistic, 518 as mixed, and 197 as pessimistic. Follow-up was available for 723 patients. Among these, a 10-point T-score increase on the Optimism-Pessimism scale (e.g., more pessimistic) was associated with a 19% increase in the risk of mortality. CONCLUSION: A pessimistic explanatory style, as measured by the Optimism-Pessimism scale of the MMPI, is significantly associated with mortality.

Potential influence of migration bias in birth cohort studies.

OBJECTIVE: To assess the potential bias, due to migration from the community, in a birth cohort study of learning disability in Olmsted County, Minnesota. MATERIAL AND METHODS: The 1976 through 1982 birth cohort consisted of 8,548 children born to mothers who were residents of Rochester, Minnesota, at the time of delivery. The current status of all children was determined for the 1995 to 1996 school year with the resources of Independent School District #535, the Rochester Epidemiology Project, and the Rochester Reading Center. Information from birth certificates was compared between migrants and nonmigrants with use of standard statistical tests. RESULTS: The cumulative probability of migration by age 5 years was 32.2% (95% confidence interval, 31.2 to 33.2%). When migrants were compared with nonmigrants, the distributions of Apgar scores, father's age, gestational age at birth, and number of children in the family were virtually identical. In contrast, migrants were more likely to be nonwhite (6% versus 2%), be born to a single parent (11% versus 7%), and have a congenital defect noted at birth (1.5% versus 0.7%). When considered simultaneously in a logistic regression model, the parents of migrants were more highly educated, migrant mothers were younger and had fewer prenatal visits, and migrant children were more likely to be black. CONCLUSION: This report demonstrates the extreme effort that must be made to assemble a birth cohort in our mobile society. Furthermore, the results suggest that only slight differences exist between migrants and nonmigrants; these are unlikely to compromise the future results of the ongoing learning disability study.

Status of patients with chronic pain 13 years after treatment in a pain management center.

This study describes the current vital, health, and employment status of 249 patients with chronic pain who were treated in a pain management center at the Mayo Clinic, on average, 13 years ago. These patients do not have an increased risk of mortality; their death rate is similar to that of the US white population. However, 68% of the patients reported worse-than-average or an abnormal level of bodily pain, with increased morbidity in their physical health, physical functioning, and social functioning. Emotional and mental health were claimed to be adequate. About half of the patients reported being gainfully employed.

Pessimism in the profile: estimating explanatory style from the MMPI.

Regression equations are presented for converting the non-K-corrected raw scores on the Minnesota Multiphasic Personality Inventory (MMPI) basic scales to an estimated optimism-pessimism score. This score describes an individual's explanatory style on a continuum from optimistic to pessimistic. These equations will enable clinicians and researchers to estimate an optimism-pessimism score if the MMPI item responses are not accessible or if computer scoring facilities for individual items are unavailable.

Waddell's nonorganic signs and Minnesota Multiphasic Personality Inventory profiles in patients with chronic low back pain.

STUDY DESIGN: An analysis of clinical data gathered at an orthopedic outpatient clinic is presented. OBJECTIVE: To examine the relationship between Waddell scores and the Minnesota Multiphasic Personality Inventory response patterns. SUMMARY OF BACKGROUND DATA: Waddell's study of nonorganic signs of low back pain showed consistent correlations with Minnesota Multiphasic Personality Inventory scales 1 to 3. METHODS: A Waddell score was obtained from 507 consecutive patients with chronic low back pain to whom an Minnesota Multiphasic Personality Inventory also was administered. The sample was divided into those patients with a high Waddell score (high waddell score = 3 to 5) and those with a low Waddell score (low waddell score = 0 to 2); men and women were scored separately. RESULTS: Among male patients, statistically significant differences were found between the high Waddell score and low Waddell score groups on Minnesota Multiphasic Personality Inventory scales, 1, 3, and 8, but among females, differences were statistically significant only on scale 8. CONCLUSIONS: Correlations between the Waddell score and the first three scales of the Minnesota Multiphasic Personality Inventory were not fully replicated. The difference between the high Waddell and low Waddell groups on scale 8, however, was significant for men and women.

Premorbid personality characteristics in Alzheimer's disease: an exploratory case-control study.

Linking data from a case-control study of Alzheimer's disease with data from a Minnesota Multiphasic Personality Inventory (MMPI) outpatient study, we identified 13 Alzheimer's disease cases and 16 controls for case-control comparison. The mean time between personality testing and onset of Alzheimer's disease (or corresponding age for controls) was 13 years in cases and 14 years in controls. Alzheimer's disease cases, but not the controls, had scores significantly greater than the normative reference on MMPI scales measuring Social Introversion (p = 0.05), and Pessimism (p = 0.01). When compared to controls, Alzheimer's disease cases had significantly greater scores on the Social Introversion scale (p = 0.03). Despite the small sample size and some design limitations of this exploratory study, our findings may suggest that subjects who score higher on these personality scales have a greater risk of Alzheimer's disease.

Nicotine patch therapy in adolescent smokers.

OBJECTIVE: To evaluate the safety, tolerance, and efficacy of 24-hour nicotine patch therapy in adolescent smokers who were trying to stop smoking. DESIGN: Nonrandomized, open-label, 6-month clinical trial. SETTING: Five public high schools in the Rochester, MN, area. SUBJECTS: Twenty-two adolescent smokers, aged 13 through 17 years, with current smoking rate of 20 or more cigarettes per day (cpd). INTERVENTION: Daily nicotine patch therapy for 8 weeks (22 mg/d for 6 weeks followed by 11 mg/d for 2 weeks). Weekly individual behavioral counseling and group support continued for 8 weeks with follow up visits at 3 and 6 months and a mailed survey at 1 year. MAIN OUTCOME MEASURES: Self-reported smoking abstinence verified by expired air carbon monoxide of 8 ppm or less, nicotine withdrawal symptoms, adverse experiences, and blood cotinine levels. RESULTS: Subjects had a mean +/- SD smoking rate of 23.3 +/- 5.0 (range, 20 to 35) cpd at study entry and 2.6 +/- 1.6 years of smoking; the mean age was 15.9 +/- 1.2 (range 13 through 17) years, and 68% were girls. Of the 22 participants, 19 (86%) completed patch therapy, 3 (14%) had biochemically validated smoking cessation at week 8, and 1 continued to be smoke free at 3 and 6 months after patch initiation. There was a significant decrease from baseline in the mean nicotine withdrawal scores for days 4 and 7 of week 1 and the mean for weeks 2 through 8. Skin reactions were the most common adverse event. As the worst skin reactions, 55% had erythema only, 5% had erythema and edema, and 9% had erythema and vesicles, whereas 32% had no skin reactions. Other reported adverse events were headaches (41%), nausea and vomiting (41%), tiredness (41%), dizziness (27%), and arm pain (23%). None of these were considered serious, life threatening, or led to the discontinuation of patch therapy. In adults with comparable smoking rates, we found that the adolescents had lower blood cotinine levels. Those smoking 20 to 25 cpd had cotinine levels of 146 +/- 84 (adolescents) vs 260 +/- 98 (adults) ng/ml, and those smoking 26 to 35 cpd had levels of 169 +/- 73 vs 276 +/- 110 ng/ml, respectively. CONCLUSION: Nicotine patch therapy seems safe in adolescent smokers. Placebo-controlled trials are needed to establish the efficacy of nicotine patch therapy in adolescents.

Learned helplessness, attributional style, and depression in epilepsy. Bozeman Epilepsy Surgery Consortium.

PURPOSE: We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy. METHODS: Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self-report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies-Depression scale (CES-D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale. RESULTS: Attributional style was significantly associated with increased self-reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance]. CONCLUSIONS: The results indicate that the concept of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.

Assessing explanatory style in teenagers: adolescent norms for the MMPI Optimism-Pessimism Scale.

This article reports adolescent norms for the Optimism-Pessimism (PSM) scale of the Minnesota Multiphasic Personality Inventory (MMPI). The PSM scale measures explanatory style on a continuum from optimistic to pessimistic by using 298 MMPI items. It is based on Seligman's theory of explanatory style and was constructed by applying the Content Analysis of Verbatim Explanations (CAVE) technique to the MMPI item pool. The normative equations are based on a random sample of 624 normal boys and 691 normal girls ages 13 through 17 years. Reliability estimates of .94 demonstrate that the PSM scale can accurately assess explanatory style in adolescents. These norms may identify a personality factor associated with poorer physical and mental health and lower levels of achievement.

Mental retardation in a birth cohort, 1976-1980, Rochester, Minnesota.

The cumulative incidence of mental retardation in a birth cohort of children born from 1976 through 1980 in Rochester, Minnesota (n = 5,919) was estimated. Rochester is the site of the Rochester Epidemiology Project, which captures virtually all medical care delivered locally. Passive follow-up through school and community medical records for criteria diagnostic of mild or severe mental retardation was undertaken. Thirty children were classified with mental retardation. The cumulative incidence of mental retardation by age 8 years was 9.1 per 1,000 (95% confidence interval = 6.2, 13.0) and was similar for boys and girls (8.3 vs. 10.0 per 1,000, respectively). The cumulative incidence for severe mental retardation in girls was more than twice that in boys; for mild retardation it was the opposite. The cumulative incidence among boys was 1.7 times greater than the cumulative incidence for girls. Results suggest that although the overall incidence of mental retardation by gender was similar, the severity may differ somewhat.

PSM-R: Revised Optimism-Pessimism Scale for the MMPI-2 and MMPI.

The Revised Optimism-Pessimism (PSM-R) scale was developed for use with either the MMPI-2 or the MMPI. The scale measures explanatory style on a continuum from optimistic to pessimistic by using 263 MMPI items of the original 298-item Optimism-Pessimism (PSM) scale. These 263 items are common to both the MMPI-2 and MMPI. PSM-R norms are based on a random sample of 1,408 normal adults who also were used for developing norms for the original PSM scale. Reliability estimates (.93 for men; .94 for women) indicate that the PSM-R scale is as accurate as the original PSM scale.

The Common Alcohol Logistic-Revised scale (CAL-R): a revised alcoholism scale for the MMPI and MMPI-2.

The Common Alcohol Logistic-Revised (CAL-R) scale was developed for use with MMPI or MMPI-2 with medical patients. It was derived from the Common Alcohol Logistic (CAL) scale and developed by (1) dropping the six CAL items deleted from the MMPI during construction of the MMPI-2 and recomputing item weights (using logistic regression); (2) calculating norms; and (3) repeating the validation procedure used in developing CAL. We used the same criterion group (1,221 alcoholics) and same contrast sample (7,621 nonalcoholic medical patients) used for CAL. Comparison of receiver operating characteristic curves, positive predictive value, and negative predictive value for CAL and CAL-R indicates that the latter has the same favorable ability to screen medical patients for alcoholism as the former.

The MMPI/MMPI-2 Personality Disorder scales: contemporary norms for adults and adolescents.

Eleven personality disorder scales for the MMPI, as described in DSM-III, were derived by Morey and his colleagues from the original MMPI item pool through a combination of rational and empirical strategies. These new scales have enjoyed popularity among clinicians. Normative tables for each of these scales, with and without overlapping items, were constructed from MMPI responses from a large contemporary normal reference sample of adults and adolescents without any physical or mental handicaps who were selected randomly from a three-state area in the Midwest. Some items from the Morey Personality Disorder scales were deleted during development of the MMPI-2; separate normative tables have been prepared for the scales so affected, which allows clinicians who are using the MMPI-2 to continue to use these slightly modified scales.

CAVEing the MMPI for an Optimism-Pessimism Scale: Seligman's attributional model and the assessment of explanatory style.

Research based on Seligman's model indicates that a pessimistic explanatory style predicts increased frequency of depression, poorer physical health, and lower levels of achievement. The data show that persons who have a pessimistic outlook on life are more frequent users of the medical and mental health care delivery systems. This paper describes the development of a bipolar MMPI Optimism-Pessimism (PSM) scale that is based on the results of a technique--Content Analysis of Verbatim Explanation (CAVE)--applied to the MMPI. Reliability and validity indices show that the PSM scale is highly accurate and consistent with Seligman's theory. Identification of the patient's explanatory style may lead to improved management because intervention measures can be directed more accurately according to the patient's personality style. The new scale also will allow researchers to use existing MMPI data to explore relationships between explanatory style and various outcome variables and behavioral correlates.

Keeping hostility in perspective: coronary heart disease and the Hostility Scale on the Minnesota Multiphasic Personality Inventory.

Three prospective studies from the early 1980s found that high scores on the Hostility (Ho) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) were associated with an increased incidence of coronary heart disease (CHD) and mortality from CHD and other causes. In the current study, the association between the Ho score and subsequent health status was examined in a 20-year follow-up of 620 general medical patients who completed the MMPI between 1962 and 1965. Univariately, the Ho score from the MMPI was a significant factor for predicting the development of CHD, CHD-related mortality, and total mortality. When two simple risk factors for CHD--age and sex--were also considered, however, the MMPI Ho score was no longer a significant predictive factor.

Age, stage, and the MMPI: changes in response patterns over an 85-year age span.

Statistically significant and clinically relevant age-related changes in MMPI response patterns have long been known to clinicians. Graphic representations of mean scores that cover an 85-year age span, separately by sex, for each of the 13 basic MMPI validity and clinical scales support the use of adolescent norms and indicate that clinicians should give greater acknowledgement to age-related MMPI changes in adults and their interpretation, particularly among geriatric patients.