Cultural accommodations for cutoff scores of embedded performance validity tests in a Spanish college population.

OBJECTIVE: The objective of this study was to identify specific cutoff scores for three commonly used embedded performance validity tests (PVTs) for a Spanish speaking population. Culturally adapted cutoff scores for embedded PVTs were established using an analog study design. In addition, the psychometric properties of these measures when applying culturally adapted scores as compared to non-adapted scores were analyzed. METHOD: Participants (N = 114) were administered three embedded PVTs (Reliable Digit Span, Phonetic Fluency Test, and Animal Semantic Fluency Test) in a randomized order. Following an analog design, control participants were instructed to perform to the best of their abilities and the analog group was instructed to simulate cognitive impairment. RESULTS: In keeping with guidelines for specificity and sensitivity, the most culturally appropriate scores of ≤6, ≤27, and ≤16 were determined for the Reliable Digit Span, Phonetic Fluency Test, and the Semantic Fluency Test, respectively. CONCLUSIONS: This the first study addressing culturally sensitive cutoffs for commonly used embedded validity measures using a European Spanish population. While these findings cannot be generalized to forensic or clinical populations at the present time, they support the claim that specific cutoff scores that are sensitive to cultural variables are necessary in addressing embedded validity measures of the Reliable Digit Span, Phonetic Fluency Test, and Semantic Fluency Test.

Frontal behavioral and emotional symptoms in Spanish individuals with acquired brain injury and substance use disorders.

INTRODUCTION: Patients with acquired brain injury affecting the frontal cortex and individuals with substance use disorders share a range of behavioral problems, including apathy, poor self-control, and executive dysfunction. The Frontal Systems Behavioral Scale (FrSBe) is a self-report instrument designed to measure behavioral problems resulting from damage to the frontal-striatal neural systems, involved both in brain insult and addiction. The aim of this study was twofold: (1) to compare the scores from the Spanish version of the FrSBe with the norms collected for American, English-speaking population; and (2) to examine the ability of the FrSBe to discriminate between two clinical populations (acquired brain injury (ABI) and addiction) with putative frontal dysfunction, as compared to a group of healthy participants. PATIENTS AND METHODS: A total of 139 volunteers participated including 46 patients with frontal ABI (F-ABI), 57 abstinent substance abusers, and 36 healthy controls from the Spanish population. A Spanish version of the FrSBe was administered to all participants. We conducted multivariate analyses of variance to examine group differences across the three subscales: apathy, disinhibition, and executive dysfunction; and in the FrSBe total score. RESULTS: F-ABI and substance abusers had higher scores (i.e., greater impairment) than controls on the FrSBe total score; F-ABI patients scored significantly higher than substance abusers, and substance abusers significantly higher than controls. For specific subscales, F-ABI patients had higher scores than substance abusers and controls in the subscales of apathy, disinhibition and executive dysfunction, whereas substance abusers had greater executive dysfunction than controls. CONCLUSIONS: The Spanish version of the FrSBe is a useful instrument for the detection of behavioral problems associated with frontal systems dysfunction in two clinical samples of Spanish-speakers.

Bone mineral density in premenopausal women receiving levothyroxine suppressive therapy.

Osteoporosis is a well-known complication of thyrotoxicosis. Prolonged subclinical hyperthyroidism due to L-thyroxine treatment has been associated with reduced bone mass and thus with the potential risk of premature development of osteoporosis. The aim of this study was to assess the effect of a chronic L-thyroxine suppressive treatment on bone mineral density (BMD) in a group of premenopausal women. Forty consecutive patients (mean age +/- SE = 40.95 +/- 1.56 years) affected by non-toxic goiter underwent bone mineral densitometry (dual energy X-ray absorptiometry; DEXA) of the lumbar spine (L1-L4) and right femoral neck. At the time of the study the patients had been under thyroid stimulating hormone (TSH) suppressive therapy for 74.95 +/- 10.34 months (range 17-168 months). Baseline levels of free thyroxine (fT4), free triiodothyronine (fT3), TSH, calcium and phosphorus were measured and correlated with BMD. The age of starting, duration of treatment, main daily dose, cumulative dose of treatment and body mass index (BMI) were also correlated with BMD. Statistical analysis was performed by multiple linear regression. BMD among female patients was not significantly different from that of the general population matched for age and sex. With the use of the regression model, no significant correlation was found between BMD and the variables considered. In conclusion, our data suggest that L-thyroxine suppressive therapy, if carefully carried out and monitored, has no significant effect on bone mass.

Neuropsychological evaluation of everyday memory.

The evaluation of everyday memory (EM) was reviewed and reconceptualized. EM has established new objectives of study and the development of new methods to reach these objectives. At the basic level, this approach has already produced important discoveries and the development of new principles about memory and functioning. At the clinical level, this new area of investigation has resulted in evaluating deficits of EM, which is defined as what daily life functions remain impaired after a deficit pathology has occurred. A type of evaluation has evolved that is oriented toward treatment and extremely useful in designing rehabilitation programs for individuals with alterations in memory.

Performance of normal adults on the Luria-Nebraska Neuropsychological Battery, form I.

To examine three problems in the interpretation of the Luria-Nebraska Neuropsychological Battery (LNNB), the normal participants from four different studies were pooled to form a sample of 241 LNNB profiles. The first problem addressed was the LNNB's false positive rate. All five yes/no decision rules were applied simultaneously. Each individual rule had a 0% to 8% false positive rate: combining the rules in four different ways increased the false positive rate by 0% to 6%. When divided into over and under 65 years old groups, each rule applied to the younger group had a 0% to 5% false positive rate: combining them increased the rate to 6-8%. When applying the rules to the older group, each rule had a 0 to 27% false positive rate: combining all rules but the one with the highest error rate produced a false positive rate of 27%. The false positive rate for the entire sample was 12%. To solve the second problem of interpretation, making qualitative item analyses easier, the difficulty level (i.e., percentage of normals missing the item) for each item was calculated. The third problem was the LNNB's malingering formula's accuracy. The formula was applied to the sample: as expected, the normal profiles had an inaccuracy rate of 26%. The few mildly impaired profiles had a 6% inaccuracy rate. When applied to the entire sample of normals and using the appropriate interpretive guidelines, the formula had a false positive rate of 1%.

Relations of left ventricular geometry and function to body composition in children with high casual blood pressure.

To determine whether abnormal casual blood pressure (BP) is associated with left ventricular (LV) abnormalities in children, 190 6- to 11-year-old children (77 girls, 113 boys) were studied at a school site in Naples, Italy, by limited echocardiography and bioelectric impedance to calculate fat-free body mass (FFM). Single-visit BP measurements (defined as casual BP) were high (based on the Italian tables of BP) in 34 children (18%; 9 girls, 25 boys; 133+/-8/81+/-10 mm Hg) and obesity was present in 44 (23%; 15 girls, 29 boys). Sex- and age-independent risk of high casual BP value was 2.9-fold (odds ratio) greater in obese than in normal-weight children (95% confidence interval, 1.3 to 6.5; P<.01). LV mass (as both absolute value and normalized for height or FFM) was higher and relative wall thickness increased in children with high casual BP (all P<.01). Prevalence of LV hypertrophy was 21% among children with high casual BP (P<.004 versus 4.3% in normal group). Risk of LV hypertrophy was 5.5-fold higher in the presence of high casual BP (P<.004), whereas obesity, age, and sex did not have independent effects. Endocardial shortening was slightly higher in children with high casual BP (36.8+/-8.2%) than in children with normal BP (34.3+/-4.8%, P<.02), whereas midwall shortening was identical in the two groups (20%). Both endocardial shortening and midwall shortening were negatively related to end-systolic stress (r=-.62, SEE=3.8% and r=-.32, SEE=2.4% in normal children). Shortening as a percentage of predicted from wall stress was increased in children with high casual BP at the endocardial level (P<.001), whereas it was normal at the midwall. Therefore, (1) casual detection of high BP in school children is associated with LV geometric abnormalities similar to those found in adults with sustained hypertension (LV hypertrophy, concentric pattern); (2) similar to in adult hypertension, endocardial chamber function in children is supranormal; and (3) in contrast to findings in adults, midwall shortening is normal in children with high casual BP.

Lack of relationship of neuroleptic dose and blood serum levels to neuropsychological performance on the LNNB in chronic schizophrenia.

The relationship of neuroleptic dose and blood serum levels to performance on the Luria Nebraska Neuropsychological Battery in chronic schizophrenics was assessed. Thirty chronic schizophrenics were individually administered the LNNB and a small sample of blood was obtained. No significant correlation between neuroleptic serum levels and test performance in these subjects was found although different conversion formulas related differentially to the blood serum levels.

Effects of bilingualism on verbal learning and memory in Hispanic adults.

The effect of bilingualism on qualitative aspects of verbal learning and memory was investigated. Equivalent list learning tests in English and Spanish were carefully constructed, and compared across two bilingual Hispanic groups of Mexican origin that differed in their level of English proficiency ("balanced" and "nonbalanced" bilinguals) and a group of monolingual English-speaking non-Hispanic subjects. Groups were matched for age, education, and gender composition. Nonbalanced bilinguals assessed in English utilized semantic clustering to the same extent as monolinguals, but learned fewer words overall, and demonstrated lower retention scores compared to monolinguals. Comparisons of groups assessed in their dominant languages, however, revealed no significant differences on any of the learning and memory indices examined. In addition to comparisons with standard clinical memory indices, assessment issues concerning bilingual individuals are addressed.

P300 latency and amplitude in the diagnosis of dementia.

P300 latency and amplitude were investigated in 10 normal elderly individuals, 10 institutionalized elderly persons with dementia not of the Alzheimer's types, and 10 elderly people with Alzheimer's disease. Significant differences between control and dementia groups (but not between dementia groups) were noted in the P300 latency, but not amplitude. Such differential latencies were observed in the anterior and in the left temporal and parietal areas of the brain.

Discrimination between and among schizophrenics and other pathologies using a Spanish version of the Whitaker Index of Schizophrenic Thinking.

A Spanish version of Forms A and B of the Whitaker Index of Schizophrenic Thinking (WIST) was administered to two sets of subjects. In the first study, the WIST was administered to 147 subjects of both sexes grouped into one of six categories: acute paranoid schizophrenic, acute nonparanoid schizophrenic, chronic paranoid schizophrenic, chronic nonparanoid schizophrenic, normal, and university student. Results revealed significant group differences; schizophrenics scored significantly higher. Further, chronic schizophrenics, regardless of the existence of paranoia, scored higher than acute subjects. In the second study, a heterogenous group of schizophrenics was compared to heroin addicts and depressed subjects (total N = 93). Significant group differences again were noted; the schizophrenics scored higher than the two other clinical samples.

Neuropsychological differentiation of chronic schizophrenia.

Four groups of 20 each (chronic brain-damaged schizophrenics, chronic non-brain-damaged schizophrenics, chronic non-brain-damaged with "acute" exacerbation, and control subjects) were individually administered Form I of the Luria Nebraska Neuropsychological Battery (LNNB). Control subjects scored significantly lower than all clinical groups on all scales except for the chronic non-brain-damaged schizophrenics on the Reading Scale. "Acute" schizophrenics scored higher on Motor, Visual, Receptive Speech, Intellectual Processes, Pathognomonic, Right Hemisphere and Profile Elevations scales than the other clinical groups. Chronic brain-damaged schizophrenics scored significantly higher than chronic non-brain-damaged schizophrenics on the Profile Elevation scale. To examine the possibility that LNNB performance of the schizophrenic groups may have been related to neuroleptic medication, analyses were completed on the relationship between medication levels and LNNB scores. These results suggested that while the three clinical groups differed in their chlorpromazine equivalents (CPZE), LNNB scores were not related to CPZE dosage.

Auditory discrimination, attention, learning, and memory in paranoid schizophrenics.

The present research was designed to assess auditory discrimination, attention, memory, and learning in paranoid schizophrenic patients using a dichotic listening procedure consisting of attending to a signal or a story channeled only to one ear. A sample of 24 paranoid schizophrenics and 24 normal controls volunteered. In Experiment 1, 12 schizophrenics and 12 controls attended to the signal while shadowing the story. The task of the other 12 clinical and 12 normal subjects in Experiment 2 was identical to Experiment 1 with the exception that the subjects did not shadow the story. In each experiment, subjects completed three trials as well as three evaluations of the story. The results indicated that schizophrenics showed substantial attentional deficits in comparison to normal controls.

Mini-mental state examination and brain age quotient--short form: relationship and demographic correlates.

Modest intercorrelations between scores on the Mini-Mental State Examination and the Brain Age Quotient were obtained for 30 men in a VA medical program for alcoholic dependency, rs with age and education were small. As the two measures are reasonably different, they may be applied to advantage in studies of behavioral intervention.

Relative efficacy of the Sc-O, P-O, P-N, and Sc MMPI scales in differentiating brain-damaged, brain-damaged schizophrenic, schizophrenic, and somatoform disorders in an outpatient setting.

This study examined the efficacy of the Schizophrenic-Organicity (Sc-O), Psychiatric-Organic (P-O), the Pseudo-Neurological (P-N), and the Schizophrenia (Sc) MMPI subscales in differentiating the following four groups of outpatients: brain-damaged (n = 35), brain-damaged schizophrenics (n = 10), non-brain-damaged schizophrenics (n = 15), and somatoform disorders (n = 45). Both unmatched and matched samples were used in the analysis, and cut-off scores were obtained. In an unmatched sample, results suggested that the Sc scale was useful in differentiating brain-damaged schizophrenics from brain-damaged and somatoform disorders. With matched samples, the Sc differentiated brain-damaged schizophrenics well from other clinical groups, while the P-O scale differentiated the non-brain-damaged schizophrenics from brain-damaged and somatoform disorders. Furthermore, the P-N scale discriminated brain-damaged schizophrenics from non-brain-damaged schizophrenics, while the Sc-O scale was no longer significant. Results suggest that caution should be used in generalizing from previous studies (which used inpatient samples) to outpatient populations.

Effects of relaxation response training on attentional deficits in schizophrenics.

Four groups of six male patients each (12 = schizophrenic; 12 = antisocial personality) volunteered. One group from each diagnostic category were instructed in the Relaxation Response while the other two groups were instructed with a placebo exercise. After training, subjects were exposed to an attentional task involving manual responding to visual stimuli. Analyses of several dependent measures including mean correct responses yielded no significant group differences.

Personality characteristics of individuals with chronic rheumatoid arthritis.

MMPI profiles of 22 chronic arthritic patients were compared to 22 control pain (nonorganic) patients. While elevations were noted in the HS, D, and Hy scales for the rheumatoid patients, the over-all profiles differed from controls on the PA scale.

Diagnostic parameters of an odd-even item short-form of the Luria-Nebraska Neuropsychological Battery.

The current study examined the concurrent validity of a new short form of Luria-Nebraska Neuropsychological Battery (LNNB). LNNB profiles of 100 subjects of a mixed brain damaged, psychiatric and normal pool were obtained from previously published sources. Levy corrected correlations among both the odd and even number short-forms with the full test ranged from.81 to.90. For the entire sample, absolute numbers of scales above the critical level, number of cases following within a given range of the critical level, and number of cases within each subscale exceeding the critical level were computed. Chi square values revealed significant differences only for the visual, reading, and memory subscales exceeding the critical level.

Schizophrenic thinking and neuroleptic dosage.

Three groups (N = 60) of schizophrenics (with varying levels of chronicity and drug dosages) were administered the Whitaker Index of Schizophrenic Thinking, the Mini-Mental State, and the Self-Conscious Scale. The results indicated that no differences existed between the chronic and acute groups on the dependent measures. Furthermore, no significant differences emerged between 21 of the acute patients who were discharged and 9 patients of the acute group who were not discharged (follow-up). No significant differences on any of the dependent measures were observed when subjects were grouped according to level of schizophrenic thinking and of neuroleptic dose. Also, no relationship between neuroleptic drug dosage and thinking for any of the three groups was observed.