Investigating associations between cortisol and cognitive reactivity to sad mood provocation and the prediction of relapse in remitted major depression.

OVERVIEW: In remitted depressed patients, an increase in dysfunctional thoughts following a sad mood induction can predict relapse over 18 months. The current analysis examined whether salivary cortisol levels could also predict relapse in these same individuals. METHOD: 99 subjects with major depression were first treated to full remission using either antidepressant medication or cognitive behavioural therapy. While in the remitted state, subjects were exposed to sad music to trigger dysfunctional thoughts. In a subset of 55 subjects, salivary cortisol levels taken before and after the mood challenge were also obtained. RESULTS: Unexpectedly, cortisol levels tended to decrease rather than increase following the mood challenge, suggesting that anticipation of the mood challenge was more stressful than the challenge itself. We thus used pre-challenge cortisol levels as the main grouping variable. Based on Kaplan-Meier survival curves, among subjects with low pre-challenge cortisol levels, those with a history of three or more prior episodes had significantly higher rates of relapse than did subjects with two or less prior episodes. In subjects with high pre-challenge cortisol levels, there was no significant difference in rates of relapse based on the number of prior episodes. CONCLUSION: In depressed patients with few prior episodes, assessing risk of relapse and thus establishing the duration for treatment can be a difficult clinical problem. Pending replication, the current results suggest that high anticipatory cortisol levels may have utility in predicting relapse even in patients with few prior episodes.

Can the MMPI-2 validity scales detect depression feigned by experts?

Major depression is one of the most frequently presented disorders for claims of psychiatric disability. Evidence also suggests that many individuals making claims of disability exaggerate or even fabricate mental illness. These facts suggest that the detection of feigned depression is an important task in psychiatric disability claim assessments. In this study, the capacity of a number of MMPI-2 validity scales and indicators to detect feigned depression was examined. Twenty-three mental health professionals with specific expertise and significant experience in assessing and treating major depression were asked to complete the MMPI-2 as if they were suffering from major depression. The MMPI-2 protocols of this sample were compared to those of a sample of patients diagnosed with major depression. Results indicated that the validity scales F, back F (FB), and the Dissimulation scale (Ds) were highly successful at distinguishing MMPI-2 protocols of feigned depression from bona fide depression. Replicating results from previous studies, however, FB proved most effective, outperforming all other validity scales and indicators, including F and Ds. These findings suggest that even experts are unable to feign major depression successfully on the MMPI-2, and that the FB scale might be the most effective indicator for detecting feigned depression.

Utility of the Deceptive-Subtle items in the detection of malingering.

The aim of this study was to assess the capacity of a recently developed set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) subtle items--the Deceptive Subtle scale (DS)--to detect fake-bad responding on the MMPI-2, relative to the capacity of the F scale and the sum of obvious items (Ob) and sum of subtle items (Su) scales. The MMPI-2 was administered to a sample of research participants asked to fake-bad (n=74), and compared to psychiatric outpatients (n=100) and nonclinical participants (n=100) asked to respond honestly. Although the DS scale proved to be a better predictor of fake-bad response style than Su,and comparable to that of Ob, its predictive capacity was substantially less than that of F. Future research is needed to explore the potentially unique contribution of both DS and Ob to assess different strategies of faking-bad.

Detecting feigned depression and schizophrenia on the MMPI-2.

Increasingly, investigations evaluating the effectiveness of the MMPI-2 in the assessment of malingering employ methodologies whereby research participants are asked to feigned specific disorders rather than just to "fake bad." Yet there is little research addressing the issue of whether different validity scales and indicators work differently in the detection of different feigned disorders. In this study the comparative effectiveness of a number of validity scales and indicators on the MMPI-2 to assess feigned depression and feigned schizophrenia were evaluated. Overall, the validity scales and indicators were better at detecting feigned schizophrenia than they were in detecting feigned depression, attributable, most likely, to closer familiarity with depressive experiences. The validity scales F, Fb, and F(p) best distinguish patients with schizophrenia from participants feigning schizophrenia, and F and Fb best distinguish patients with depression from participants feigning depression.

Detecting malingered and defensive responding on the MMPI-2 in a forensic inpatient sample.

The purpose of this study was to examine the effectiveness of the various validity scales and indices on the MMPI-2 to detect malingered (fake-bad), and defensive (fake-good) responding. The entire sample consisted of 165 college students who completed the MMPI-2 under one of three conditions--fake-bad, fake-good, or respond honestly--and 173 forensic inpatients who completed the test as part of a routine evaluation. To detect faking-good and faking-bad, cutting scores for the validity scales and indices were established from the fake-good and fake-bad groups and were compared to the honest and patient groups. Corresponding sensitivity and specificity rates were then determined. Four validity indicators appeared to be moderately effective-at detecting fake-bad profiles: F, F--K, the MMPI-2 version of revised Gough Dissimulation Scale, and Wiener's Obvious-Subtle index, whereas the fake-good indicators were much less effective--only F--K and the Obvious-Subtle index appeared to have moderate utility.

Malingered and Defensive Response Styles on the MMPI-2: An Examination of Validity Scales

The MMPI and more recently the MMPI-2 have been held to be the clinical standard for assessing both fake-good and fake-bad response styles. In a contrasted-groups design, we compared simulators under fake-good (n = 67) and fake-bad (n = 58) instructions to controls (n = 90) and psychiatric patients (n = 95) under standard instructions. For fake-good profiles, we found that F-K < -12 had a hit rate of 80.6% and was partly supported by earlier research (Austin, 1992). For fake-bad profiles, F > 89 and F-K > 7 were the optimum cutting scores with hit rates of 86.2% and 87.0%, respectively. Unfortunately, previous research fails to confirm these cutting scores and leading proponents of the MMPI-2 substantially disagree on what methods to employ. Therefore, we recommend in cases of suspected malingering that the MMPI-2 be used only for screening purposes.

Reconstruction and Validation of the Depressive Experiences Questionnaire

The Depressive Experiences Questionnaire (DEQ) was constructed to assess two distinct characterological configurations associated with depression--the anaclitic (dependent) and introjective (self-critical). Although the DEQ is widely used as a measure of these two personality constructs, its validity in actually measuring them is questionable. In this study we subjected a correlation matrix comprised of DEQ responses from a large sample of normal adults (N = 404) to confirmatory factor analysis to assess formally whether the DEQ is congruent with the theoretical parameters outlined by the model. Results indicated that neither the two-factor (Dependency, Self-Criticism) nor the three-factor (Dependency, Self-Criticism, Efficacy) models represented good approximations of the data. Using a series of exploratory factor analyses, we identified 19 items (9 dependency, 10 self-critical) from the original DEQ that were an excellent fit to the data for the two-factor model from "normal" adult, depressed outpatient, and student samples. Parameter estimates of the relationship between the two factors indicated only a modest association. Test-retest reliabilities for both the Dependency and Self-Criticism scales indicated excellent temporal stability. There were diagnostically meaningful variations in the mean scores between the "normal" sample and patient sample.

Fast and sensitive laser-based enzymatic detection of the lactose operon in microorganisms.

This work investigates the ability of laser-based, time-resolved fluorometry to detect the lactose operon genetic marker in microorganisms and to study protein-DNA interactions. In the first study, rapid detection of the Escherichia coli lacZY operon inserted in two strains of Pseudomonas proposed as fungal biological control organisms was achieved. Optimization of incubation time, immobilization apparatus size, and reagent volumes, along with the laser-based instrumentation, yielded an assay capable of detecting 10(4) immobilized lac+ Pseudomonas fluorescens cells within a 30-min incubation time. In the second study, the synthesis of E. coli beta-galactosidase was monitored in "real-time" with observable enzymatic activity beginning 4 to 5 min after induction with isopropylthiogalactoside.

The arterial switch operation. An eight-year experience.

Sixty-six patients (23 neonates with transposition of the great arteries and intact ventricular septum, 33 infants and children with transposition and a large ventricular septal defect, and 10 with double-outlet right ventricle with a subpulmonary ventricular septal defect have received an arterial switch repair since 1977. Eight (one with transposition and intact ventricular septum, six with transposition and ventricular septal defect, and one with double-outlet right ventricle with subpulmonary ventricular septal defect) died in the hospital. All other patients have had follow-up as of June, 1985. Including the hospital deaths, the 11 month actuarial survival rate for the entire group was 81%, and no deaths have occurred among the 33 patients alive at that time and traced as long as 8 years. The hazard function for death has only a single early phase, and its 70% confidence limits overlap the hazard function of a matched general population by 12 months after the operation. Incremental risk factors for death included low birth weight (but not weight or age at operation), transposition of the great arteries with large ventricular septal defect, double-outlet right ventricle with subpulmonary ventricular septal defect, and presence of a patent ductus arteriosus. Coronary artery morphology and position of the great arteries were not risk factors. Long aortic cross-clamp time was possibly (p = 0.11) a risk factor. Early date of operation was a risk factor (p = 0.004); thus, predicted 1 year survival rate, including hospital deaths, after the arterial switch operation in 1985 is 99.9% (70% confidence limits 99.0%-100%) for neonates with transposition and intact ventricular septum and 99.7% (98.4%-99.9%) for those with transposition and a large ventricular septal defect or double-outlet right ventricle. The late functional status was excellent, and the rhythm was sinus in 96% of the 55 surviving patients. A formal comparison with the results of the atrial switch repair indicates that the arterial switch repair is superior.