A neurocorrective approach for MMPI-2 use with brain-damaged patients.

Conventional administration of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) to aetiologically distinct brain-damaged out-patients (n = 137) revealed significant indications of psychological maladjustment. An adjustment for the endorsement of aetiology-specific items pertaining to traumatic brain injury (TBI), stroke, and whiplash was considered necessary, however, because these items may represent potentially valid symptoms or manifestations of neurological damage or dysfunction. These so-called neurologically relevant items (NRIs) were identified in a previous study. With this corrective approach, based on the complete MMPI-2 item pool, it was shown that T-score elevations could at least in part be attributed to symptoms associated with brain injury, regardless of the type of brain damage. Similarly, after prorated correction for the endorsement of NRIs, code-typing appeared to be substantially changed with respect to both occurrence and content of the MMPI-2 defined code-types. The validity of the NRI concept was supported by comparing NRI/non-NRI endorsement ratios of traumatically brain-injured patients with those of non-neurological patients, and with those having anxiety and somatoform disorders. To prevent unjustified interpretations when administering the MMPI-2 to brain-damaged patients, an adjustment procedure for NRI-endorsement is proposed, and difficulties in interpretation are discussed.

The identification of neurologically relevant items in the MMPI-2.

The assessment of personality and (mal) adjustment after brain damage is regarded as an important aspect of rehabilitation. However, the administration of widely used self-report questionnaires, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), is restricted because of the danger of overscoring psychopathology and personality disorders. This is due to the inclusion of items reflecting manifestations of neurological dysfunction. Earlier investigations revealed variable neurologically relevant items (NRIs), within and between discrete cerebral aetiologies for the MMPI as well as the first part of the MMPI-2. In this study, 10 neuropsychologists, 10 neurologists, 10 psychiatrists, and 10 physiatrists identified NRIs in the complete MMPI-2. An item was considered to be an NRI based on professional expertise as well as type of brain damage. Based on a substantial inter-rater agreement index, four sets of clinical relevant NRIs were selected: one for brain damage in general and three partially overlapping sets for stroke, traumatic brain damage, and whiplash. Thus, the findings of this study unveil items which may indicate bona fide symptoms or manifestations related to neurological damage or dysfunction, rather than just reflecting psychopathology or personality disorders. It is advocated to develop an interpretative approach to correct for the impact of these NRIs on MMPI-2 scores.

Towards a disability-oriented epidemiology of traumatic brain injury.

The aim of this study was to investigate the value of using a disability-oriented approach to the epidemiology of traumatic brain injury (TBI) in order to improve health administration by preventing long-term sequelae. The epidemiology of disease was established by registration system of inpatients which covers more than 99% of all hospital admissions in The Netherlands. Some international differences and national trends are discussed. The disability-related epidemiology was investigated by means of structured interviews, 3-7 years after the injury, in a clustered sample of 51 patients with major TBI according to the ICD-9-CM. The survey included evaluation scales such as the Sickness Impact Profile, the Barthel Index, and a Disability Rating Questionnaire. Concerning the disease-related epidemiological data, the overwhelming majority of all TBI patients went home, which suggests good recovery. Nevertheless, the disability-oriented research revealed long-term situational, cognitive and behavioral disabilities in at least 67% of the major-TBI population, whereas only 10% received any rehabilitation services at all after the acute-care period. It is concluded that preventive measures and a comprehensive service for brain injury survivors should be based both on disease and disability-oriented data.