Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients.

OBJECTIVE: The purpose of this study was to explore the value of patient self-report assessment in heart transplant candidacy evaluation, utilizing the Millon Behavioral Health Inventory (MBHI). Patient's MBHI measures were related to important pretransplant patient characteristics and posttransplant measures of health behavior, medical morbidity, and mortality. METHOD: Ninety heart patients with end-stage cardiac disease completed the MBHI during pretransplant candidacy evaluations, and also were interviewed concerning their coping effectiveness, support resources, and compliance history. Postransplant follow-up of 61 living and 29 deceased patients included measures of survival time, postsurgical medical care, rejection and infection episodes, and nurse ratings of medication compliance and problematic interpersonal health behaviors. RESULTS: The MBHI coping scales were found to significantly discriminate good and poor pretransplant compliance, and interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to these interview judgments in predicting posttransplant survival time and medical care used. Certain scales were also positively associated with physical parameters of pretransplant and posttransplant status. CONCLUSIONS: Patient self-report with the MBHI can contribute to identification of patients at risk for a problematic outcome with transplant, by providing information pertinent to clinical decision making and outcome management analysis with this special population of cardiac patients.

Brief neuropsychologic differentiation of demented versus depressed elderly inpatients.

Recent investigations have suggested the utility of brief, psychometric screening batteries in the early detection of abnormal mental decline. This study extended the investigation of one of these batteries, comprised of three tests (Controlled Oral Word Association, Visual Retention, Temporal Orientation), to the difficult issue of differentiating dementia from depression in a hospitalized sample composed of a group of depressed only patients (N = 50) vs an age-matched demented group (N = 50), some of whom presented mixed dementia/depression syndromes. Demented patients consistently performed more poorly as a group than depressed patients on each of the three measures. This was the case even when three-group (demented only, mixed demented/depressed, depressed only) comparisons were conducted. Impairment was more common on one or more tests with demented vs depressed patients. However, limitations for screening purposes and for the definitive detection of dementia were noted in view of only moderate predictive power of the tests with discriminant function analysis. Nevertheless, the potential clinical utility of the three tests in the general hospital and other primary care settings was apparent.

Comparison of two cognitive screening measures for efficacy in differentiating dementia from depression in a geriatric inpatient population.

The Folstein Mini-Mental State Examination (MMSE) and dementia screening measures developed by Benton (temporal orientation, oral word association, and visual reconstruction tasks) were compared for diagnostic efficacy with geriatric inpatients manifesting depression without dementia or mild or moderate dementias complicated by depression. Both instruments showed generally acceptable differentiation between dementia and depression-only cases overall. The MMSE was less sensitive in identifying mild and moderate multi-infarct dementias but showed better specificity than the Benton measures. The degree and type of dementia and the associated risk of classification error were found to be important factors in the choice of screening instruments.

Psychometric assessment of depression in an elderly general medical population. Over- or underassessment?

A total of 247 consecutively evaluated geriatric medical patients was administered a battery of neuropsychological and psychological tests as part of their diagnostic workup for unexplained deterioration in their functioning. Depression was assessed with a short form of the MMPI, the Brief Symptom Inventory, and the Geriatric Depression Scale. By Research Diagnostic Criteria, most suffered from major (59%) or minor (21%) depressions; some degree of cognitive impairment was seen in 80% of the patients, defining a population of "vulnerable" geriatric patients typical of referrals to a general medical hospital setting. Using both conventional score cutoff criteria and discriminant analyses, false-negative rates up to 53% for major depression and 100% for minor depression were found. Psychometric misrecognition of depression was not related to degree of dementia or education but on some measures was positively associated with verbal intelligence level and patient age. Contrary to previous suggestions that psychometric measures overestimate depression in the elderly, these findings suggest that there may be a subgroup of elderly in which treatable affective distress is not appreciated.