Evaluation of teleneuropsychology services in veterans during COVID-19.

This study evaluated the quality of direct-to-home teleneuropsychology (teleNP) services that offered patients choice of service modality. We conducted a quality assurance project in a sample of Veterans (N = 143) referred for a variety of referral reasons from a Midwestern Veteran Affairs Hospital. Neuropsychological evaluations were conducted between February and June 2021 during the second wave of the COVID-19 pandemic. We evaluated teleNP rate of use, factors influencing acceptability and feasibility, and cost savings. Approximately 40% of our scheduled patients completed full direct-to-home teleNP, with about 80% of our sample choosing at least one telehealth encounter as part of their evaluation. Age was a significant factor in predicting full teleNP use, with older adults preferring in-person testing. Digital divide consults (i.e., loaned tablets) led to an increase in teleNP use. Those utilizing full teleNP (interview, assessment, feedback) benefited from cost and travel distance savings. Most Veterans in our Midwestern Veteran Affairs Hospital used teleNP services during the second wave of the COVID-19 pandemic, with utilization influenced by specific patient demographics (i.e., age) and access to technology. Offering Veteran choice of assessment modality (in-person or video teleNP) was associated with significant cost reduction due to mileage savings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Performance on the African neuropsychology battery using the learning ratio in a sample of healthy Congolese.

OBJECTIVE: Using the African Neuropsychology Battery (ANB), we seek to develop normative data by examining the demographic effects for two learning process scores: initial learning (Trial One) and learning ratio (LR, the percentage of items learned relative of to-be-learned material following Trial 1). METHODS: Healthy participants from the Democratic Republic of Congo completed the four memory tests of the ANB: the African Story Memory Test (ASMT), African List Memory Test (ALMT), African Visuospatial Memory Test (AVMT), and African Contextual Visuospatial Memory Test (ACVMT). We developed indices of learning for each subtest, as well as aggregate learning indices for Trial 1 and LR, and composite indices examining verbal, visual, contextual, and noncontextual learning, and grand indices comprising all four subtests. RESULTS: Trial 1 and LR scores each demonstrated acceptable intercorrelations across memory tests. We present normative data for Trial 1 and LR by age and education. CONCLUSION: These data provide normative standards for evaluating learning in Sub-Saharan Africa.

A quantitative review of competing learning slope metrics: effects of age, sex, and clinical diagnosis.

INTRODUCTION: In learning and memory tests that involve multiple presentations of the same material, learning slope refers to the degree to which examinees improve performances over successive learning trials. We aimed to quantitatively review the traditional raw learning slope (RLS), and the newly created learning ratio (LR) to understand the effects of demographic variables and clinical diagnoses on learning slope (e.g., limited improvement over multiple trials), and to develop demographically sensitive norms. METHOD: A systematic literature search was conducted to evaluate the potential for these aims to be examined across the most popular contemporary multi-trial learning tests. Two databases were searched. Following this, hierarchical linear modeling was used to examine how demographic variables predict learning slope indices. These results were in turn used to contrast the performance of clinical groups with the predicted performance of demographically similar healthy controls. Finally, preliminary normative estimates for learning slope indices were presented. RESULTS: A total of 82 studies met criteria for inclusion in this study. However, the Rey Auditory Verbal Learning Test (RAVLT) was the only test to have sufficient trial-level learning and demographic data. Fifty-eight samples from 19 studies were quantitatively examined. Hierarchical linear models provided evidence of sex differences and a curvilinear decline in learning slope with age, with strongest and most consistent effects for LR relative to RLS. Regression-based norms for demographically corrected RLS and LR scores for the RAVLT are presented. The effect of clinical diagnoses was consistently stronger for LR, and Alzheimer's disease had the strongest effect, followed by invalid performances, severe traumatic brain injury, and seizures/epilepsy. CONCLUSION: Overall, LR enjoys both conceptual and demonstrated psychometric advantages over RLS. Replication of these findings can be completed by reanalyzing existing datasets. Further work may focus on the utility of using LR in diagnosis and prediction of clinical prognosis.

Effects of High Definition-Transcranial Direct Current Stimulation on Local GABA and Glutamate Levels Among Older Adults with and without Mild Cognitive Impairment: An Exploratory Study.

BACKGROUND: Prior research, primarily with young adults, suggests transcranial direct current stimulation (tDCS) effects are driven by the primary excitatory and/or inhibitory neurotransmitters, glutamate, and gamma-aminobutyric acid (GABA), respectively. OBJECTIVE: We examined the neurometabolic mechanisms of tDCS in older adults with and without mild cognitive impairment (MCI). METHODS: We used data from a double-blind, cross-over, randomized controlled trial (NCT01958437) in 32 older adults to evaluate high definition (HD)-tDCS-induced changes in glutamate and GABA via magnetic resonance spectroscopy (MRS). Participants underwent MRS following two counterbalanced HD-tDCS sessions (one active, one sham) that targeted the right superior parietal cortex (center anode at P2) and delivered 2mA for 20 minutes. RESULTS: Relative to sham, and when co-varying for MRS voxel overlap and right superior parietal volume, active HD-tDCS significantly increased GABA and decreased the ratio of glutamate to GABA. No changes were observed in a left prefrontal control MRS voxel. Although we did not find a significant correlation between strength of delivered current (measured via MRI-based computational modeling) and neurometabolite change, there was a robust positive relationship between the volume of right superior parietal cortex and neurometabolite change. CONCLUSION: Our preliminary findings of increased GABA and reduced glutamate/GABA ratio raise the possibility that (HD-)tDCS effects differ by age. Moreover, age- and disease-related regional brain volume loss may be especially important to consider when planning future studies. Replication would emphasize the importance of developing population-specific tDCS parameters that consider structural and physiologic changes associated with "normal" and pathological aging.

Are malignant self-regard and vulnerable narcissism different constructs?

In the clinical and empirical literature, vulnerable narcissism and malignant self-regard (MSR) have been found to be highly interrelated and associated with theoretically related personality constructs, suggesting that the two constructs may be much more similar than different. The present study set out to test this hypothesis by examining the relationship of vulnerable narcissism and MSR to experiences and expressions of anger, the factor structure of grandiose and vulnerable narcissism with MSR, the associations of MSR and vulnerable narcissism to the five factor model of personality, and to global self-esteem in self-report measures within 1168 undergraduate students. A separate study of 158 undergraduates also assessed how MSR and vulnerable narcissism predicted state and trait anxiety and anger after receiving positive or negative feedback, and the extent to which negative feedback interacted with MSR and vulnerable narcissism. Overall, compared with grandiose narcissism, both MSR and vulnerable narcissism were more associated with experiencing anger internally, self-reports of state and trait anger, high levels of neuroticism and openness, and lower levels of extraversion and global self-esteem. Both vulnerable narcissism and MSR uniquely predicted trait levels of anger and anxiety and state levels of anger after receiving negative feedback. It is concluded that MSR and vulnerable narcissism are likely identical constructs.

Object relations predicts borderline personality disorder symptoms beyond emotional dysregulation, negative affect, and impulsivity.

Many studies have determined that the traits of emotional dysregulation, negative affect, and impulsivity are the strongest predictors of borderline personality disorder (BPD). Although psychodynamic, empirically supported BPD treatments (i.e., transference-focused, mentalization based) focus upon changing the internal representations of self and other, no studies have simultaneously evaluated the contribution of object relations in relation to these traits in predicting BPD symptoms. This study sought to determine the combined effects of emotional dysregulation, negative affect, impulsivity, and object relations in the prediction of BPD through the use of mediation modeling in 4 a priori hypothesized relationships among these variables. One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were evaluated with self-reported trait and object relations measures and were administered 2 semistructured diagnostic interviews for BPD. Although all trait and object relations measures were correlated with BPD symptoms, the best fitting model was one in which object relations partially mediated the relationship of negative affect and impulsivity with BPD symptoms. Direct effects of the traits were also observed in mediation. Self-reported object relational quality had more of an effect on the prediction of BPD than previously recognized within a trait-framework, thus further supporting the model explicated in psychodynamic and relationally based treatments for BPD. (PsycINFO Database Record

Sensitivity to criticism differentially mediates the relationship between interpersonal problems and state and trait depression.

Both state- and trait-like manifestations of depression have been associated with poor interpersonal functioning. One mechanism by which this could occur is through individuals' sensitivity to criticism. In the present study, 414 undergraduates were assessed with the Beck Depression Inventory-II (Beck et al. 1996) and Depressive Personality Disorder Inventory (Huprich et al. 1996) as representative measures of state and trait depression respectively. They also were assessed with self-report measures of sensitivity to criticism and interpersonal problems. Sensitivity to criticism significantly mediated the relationship between state and trait depression within five dimensions of interpersonal problems. However, sensitivity to criticism was more strongly related to the trait depression-interpersonal problems relationship than the state depression-interpersonal problems relationship, when controlling for state depression and trait depression respectively. Copyright © 2016 John Wiley & Sons, Ltd.

Interpersonal Problems and Their Relationship to Depression, Self-Esteem, and Malignant Self-Regard.

DSM-5 Section III recommends that level of personality functioning be assessed. This requires an assessment of self and other representations. Malignant self-regard (MSR) is a way of assessing the level of functioning of those with a masochistic, self-defeating, depressive, or vulnerably narcissistic personality. In Study 1, 840 undergraduates were assessed for MSR, depressive symptoms, self-esteem, anaclitic and introjective depression, and interpersonal problems. MSR, self-esteem, depressive symptoms, and anaclitic and introjective depression were correlated with multiple dimensions of interpersonal problems, and MSR predicted the most variance in interpersonal scales measuring social inhibition, nonassertion, over-accommodation, and excessive self-sacrifice. MSR, anaclitic, and introjective depression predicted unique variance in six of the eight domains of interpersonal problems assessed. In Study 2, 68 undergraduates were provided positive or negative feedback. Consistent with theory, MSR predicted unique variance in state anxiety but not state anger. Results support the validity of the MSR construct.

Expanding the utility of the malignant self-regard construct.

The empirical and theoretical literature suggest that several proposed personality disorders (PDs) - Masochistic/Self-Defeating, Depressive, and Vulnerably Narcissistic - may be related through a common self-representation know as Malignant Self-Regard (MSR). To assess this construct, the MSR Questionnaire (MSRQ) was developed. Though its initial psychometric properties were very strong, the present study extended these findings by examining the relationship of the MSRQ with measures of other PDs and depressive subtypes, and by establishing four-week and eight-week test-retest reliability in two samples (Ns=840, 911) of undergraduate students. The MSRQ was internally consistent and temporally stable over four and eight weeks. It was positively correlated with measures of introjective and anaclitic depression, measures of Self-Defeating, Depressive, and Vulnerably Narcissistic personalities (rs ranging between 0.60 and 0.82), and other select PDs. After controlling for depressive symptoms and self-esteem, the highest remaining partial correlations were with Vulnerably Narcissistic, Self-Defeating, Depressive, and Avoidant personalities. A factor analysis of the MSRQ with measures of other PDs yielded a two-factor solution, with MSR loading most strongly on one factor, along with Vulnerably Narcissistic, Avoidant, Depressive, and Self-Defeating personalities. It is concluded that MSR is a psychometrically supported construct that might have good clinical utility in explaining personality pathology that has historically been difficult to assess.