Clinical procedures for the neuropsychological evaluation of U.S. Air Force pilots.

The neuropsychological assessment of U.S. Air Force pilots presents several unique problems given their relatively high cognitive functioning. The U.S. Air Force currently has a baselining procedure whereby student pilots undergo computerized cognitive assessment. The intent of this assessment is to archive premorbid data against which to compare potential future postinsult performance. The current work provides the background, clinical methods, and data needed to assess pilots who have suffered cortical insult such as trauma, disease, or exposure to toxins. Methods are delineated for pilots with premorbid testing and for pilots without such testing.

Revised NEO Personality Inventory profiles of male and female U.S. Air Force pilots.

The study of pilot personality characteristics has a long and controversial history. Personality characteristics seem to be fairly poor predictors of training outcome; however, valid personality assessment is essential to clinical psychological evaluations. Therefore, the personality characteristics of pilots must be studied to ensure valid clinical assessment. This paper describes normative personality characteristics of U.S. Air Force pilots based on the Revised NEO Personality Inventory profiles of 1,301 U.S. Air Force student pilots. Compared with male adult norms, male student pilots had higher levels of extraversion and lower levels of agreeableness. Compared with female adult norms, female student pilots had higher levels of extraversion and openness and lower levels of agreeableness. Descriptive statistics and percentile tables for the five domain scores and 30 facet scores are provided for clinical use, and a case vignette is provided as an example of the clinical utility of these U.S. Air Force norms.

Development of the Tower of London-Revised.

The objective of this work was to reconstruct the Tower of London (TOL) test in order to increase its reliability. A three-phase process was undertaken to accomplish this goal. In Phase 1, the TOL item pool was increased, the task was administered to a sample of college students (N = 50), and item-total correlations were calculated in order to identify the items that had the highest correlation with the total score. In Phase 2, the revised 30-item TOL (TOL-R) was administered to a second sample (N = 50) and the internal consistency reliability (Chronbach alpha) was estimated at. 794. Finally, Phase 3 examined the test-retest reliability of the TOH-R on a new sample (N = 34) and the stability was found to be acceptable at r =.70.

A comparison of two U.S. Air Force pilot aptitude tests.

BACKGROUND: The Air Force Officer Qualifying Test (AFOQT) and Multidimensional Aptitude Battery (MAB) were administered to 2233 U.S. Air Force pilot candidates to investigate the common sources of variance in those batteries. The AFOQT was operationally administered as part of the officer commissioning and aircrew selection testing requirement. The MAB is a clinical test battery and was administered to provide an intellectual baseline to assist clinicians when it becomes necessary to evaluate pilots with cognitive referral questions. RESULTS: A joint factor analysis of the AFOQT and MAB revealed that each battery had a hierarchical structure. The higher-order factor in the AFOQT previously had been identified as general cognitive ability (g). The intercorrelation between the higher-order factors from the batteries was 0.981, indicating that both measured g. Although both batteries measured g and included verbal, spatial, and perceptual speed tests, the AFOQT also included tests of aviation knowledge not found in the MAB. CONCLUSION: Additional studies are required to evaluate the utility of the AFOQT for clinical assessment and the MAB for officer and aircrew selection.

Female United States Air Force pilot personality: the new right stuff.

With increasing numbers of female military pilots, it is important to understand the psychological and psychiatric gender differences of pilots. Using the "big five" personality structure (neuroticism, extraversion, openness to new experiences, agreeableness, and conscientiousness), female United States Air Force pilots were compared with both male Air Force pilots and to a female comparison group. Female Air Force pilots were higher on the Extraversion, Agreeableness, and Conscientiousness scales than male pilots. Female pilots were also higher on these scales than the female comparison group and lower on the Neuroticism and Openness scales than that comparison group. It is suggested that these traits are highly adaptive for Air Force pilots, given the nature of modern military operational requirements.

Female United States Air Force (USAF) pilots: themes, challenges, and possible solutions.

BACKGROUND: Identification of stresses of mixed-gender squadrons, attention to the psychological concerns of pilots in combat, and recognition of the difficulties of balancing a career and family are important in today's United States Air Force (USAF). What qualities are desirable in male and female pilots in combat situations, how do men and women view their career and family goals, and how do men and women work together in day-to-day squadron activities versus deployment and combat situations? METHODS: A semi-structured clinical interview sought in formation about personal/family health, squadron relationships, and career/deployment stresses. The interview covered the effect of grounding for more than 30 d, motivation to fly, health decrements due to aircraft design, teamwork difficulties and blocks to success, career demands, combat and prisoner of war (POW) concerns, stress and coping styles, flying goals, and family/health concerns. There were 114 (64 male and 50 female) pilots who participated in the study. RESULTS: The majority of male pilots interviewed asserted that they would be more protective of a woman in combat than a man and were concerned about their reaction to a female POW. Many women were concerned about being used to exploit men in a POW camp. The majority of pilots believed women were well integrated into their squadrons. Those interviewed reported that the squadron members with the most difficulty dealing with women were older males, including enlisted crew and some commanders. CONCLUSION: The information gained from this study will assist the USAF in understanding and coping with the psychological stresses associated with combat, deployment, and mixed-gender squadrons.

Cognitive assessment of USAF pilot training candidates.

BACKGROUND: Most intellectual and cognitive assessment of pilots is done with locally developed assessment devices. The United States Air Force currently uses the recently developed CogScreen (Aeromedical Edition) to assess these areas. HYPOTHESES: There will be differences on the CogScreen across USAF student pilot candidates and commercial pilots. METHODS: This paper presents the test scores of 512 USAF pilot training candidates who were tested with this commercially available, "off-the-shelf" product. Comparison data was abstracted from the test manual on commercial pilots. RESULTS: Data from the new CogScreen (Aeromedical Edition) is provided and shows consistent differences between pilot training candidates and commercial pilots across reaction time, accuracy, throughput, and process measures. DISCUSSION: The new CogScreen appears to be an appropriate device for the assessment of pilot candidates, student pilots, and pilots.

Event-related potentials during the Continuous Visual Memory Test.

The Continuous Visual Memory Test (CVMT; Trahan & Larrabee, 1988) is a recognition format assessment of figural memory. It includes 112 ambiguous designs presented sequentially, with a number of designs that recur through the 112 presentations. The patient's task is to identify the recurring figures by responding with the word "old" for recurring stimuli and "new" for non-recurring stimuli. This study examined cortical event-related potentials during discrimination of old vs. new stimuli. While no latency differences between stimuli were found, P300 amplitude was greater during recognition of old stimuli and increasingly prominent at anterior sites. A stimulus by electrode site interaction suggests greater functional involvement in the discrimination by the frontal areas. This points to a degree of psychophysiological validation of the CVMT and cortical specificity of the task.

Psychopathology in caregivers of the chronically ill: personality and clinical syndromes.

The purpose of this study was to examine the caregivers of the chronically physically ill across personality and clinical psychopathology dimensions. The MCMI-II inventories of 30 caregivers and 28 matched controls were analyzed. Differences between the two groups were found on the clinical scales of anxiety, somatoform, dysthymia, and major depression. This suggests that differences exist between caregivers and non-caregivers on several clinical syndromes including psychosomatic variables. Professional, paraprofessional, and lay hospice support personnel should be aware of these possibilities, actively assess for them, and be prepared to intervene.

MCMI-II high-point codes: severe personality disorder and clinical syndrome extensions.

The MCMI-II is becoming more widely used in both clinical practice and research settings. From a research perspective, one area that has not received a great deal of attention is high-point codes. While the MMPI has a very lengthy history of high-point code analysis and ancillary interpretative manuals, the MCMI-II has no such traditional data base. The present study determined the prevalence of single and two-point high codes in a large sample of VA patients. Additionally, associated severe personality scales and clinical syndrome scales are delineated as a function of the 20 most common profiles. These 20 common profiles accounted for 82% of the patients.

An MCMI-II item-level component analysis: personality and clinical factors.

The Millon Clinical Multiaxial Inventory, Version 2 (MCMI-II) was released to replace the MCMI-I. Research into the factor structure of the items of the MCMI-I showed components consistent with the underlying construction theory. No such work has been done with the new MCMI-II. For this study, we analyzed the personality disorder and clinical syndrome items across two subject samples. For 579 Veterans Administration patients and 492 normal college students, six personality factors were identified. The samples shared Hostility, Histrionic/Schizoid, Dependent, Compulsive, and a Sadistic variant. For the clinical syndrome items, eight factors were isolated for veterans and seven for normals. Depression, Alcohol Abuse, Drug Abuse, Crying, and Mania were shared factors. Most of the factors were found to be highly consistent with MCMI-II scale keyings.

A multi-test alcoholic taxonomy: canonical coefficient clusters.

Little convergence has been found in the area of subtyping alcoholic personalities. Prior work has suffered from the use of single inventories, inventories with large distress factors, or inventories that lack broad theoretical appeal. The present work (N = 89) transcends idiosyncratic cluster solutions through the use of canonical correlation of the Basic Personality Inventory and the Millon Clinical Multiaxial Inventory. The resulting global canonical variates are cluster analyzed to a six-cluster solution. These subtypes are described through their scores on the canonical variates and the underlying psychometric inventories.

Family assessment: toward DSM-III-R relevancy.

The assessment of family pathology never has been integrated into current individual diagnostic theory and DSM-III-R; it usually has followed idiosyncratic family treatment theories or has not been emphasized extensively. The purpose of the present study is to extend individual DSM-III-R personality disorder assessment to family assessment. The Personality Adjective Check List was given to 65 subjects along with a traditional family assessment inventory. The Personality Adjective Check List exhibited high reliabilities across all personality disorders and appropriate and substantial validity estimates against the traditional family assessment inventory.

Active-duty and veteran alcoholics: differences in psychopathology presentation.

The present study examines the differences in the presentation of psychopathology between active duty military and veteran patients enrolled in alcohol rehabilitation programs. The Millon Clinical Multiaxial Inventory was used to assess personality disorders, clinical syndromes, and substance abuse. Most veterans were seen as having avoidant and dependent personality disorders as well as a great deal of anxiety and depression. Forty-seven percent were above cutoff scores for alcohol abuse. Air Force patients were predominantly narcissistic and antisocial with much less distress. Only 9% were classified psychometrically as abusers. The results indicate that not only are veteran alcoholics more chronic but that active-duty alcohol abusers are underreporting abuse and care must be used in their assessment.

MCMI-II scoring: weighted and unweighted algorithms.

This brief report examines the relationship between the scale scores derived through weighted and unweighted item scoring on the Millon Clinical Multiaxial Inventory-II (MCMI-II). The inventories of 356 subjects across three samples were scored using weighted and unweighted algorithms. Correlations between the weighted and unweighted MCMI-II scales were found to approach unity. This casts doubt on whether the weighting system has substantial effect on the profiles that are generated or on reducing interscale correlations.

Factor-based special scales for the MCMI.

Factor analytic work with the Million Clinical Multiaxial Inventory (MCMI) has shown a remarkably stable factor structure. The eight Basic Personality scales have a three-factor structure: Aloof/Social, Submissive/Aggressive, and Labile/Restrained. These dimensions appear to be the same as those suggested by the DSM-III-R advisory committee on personality disorders. The MCMI as a whole has a five-factor structure: Detached, Submissive, Suspicious, High Social Energy, and General Distress. The present work operationalizes these two sets of factors into scales for use by clinicians and researchers. The resultant scales show excellent reliabilities across three subject samples (N = 253, N = 185, N = 184) and demonstrate appropriate convergent and divergent validity estimates against the MCMI itself.

An analysis of the MCMI-I at the item level.

The study reports on principal component analyses of the MCMI-1 at the item level. The 175 items of the MCMI were separated for analysis into 100 descriptive of personality and 75 that represent clinical symptoms. The data analyzed came from a sample of 253 psychiatric outpatients and a sample of 185 inpatient alcoholics. The scree test was applied to decide on the number of factors to retain. The factors retained in the four analyses were rotated by the Varimax and Direct Oblimin procedures. The results were similar across the two samples. The six personality dimensions isolated were interpreted as Social Introversion-Extraversion, Dependency on Others, Verbal Hostility, Need to Please Others, Self-Dramatization, and Orderliness. These have some resemblance to Millon's eight personality styles. Four of the five symptom factors were similar to Millon's clinical symptom scales. In addition to a very large Depression factor, there were factors of Manic Excitement, Drug Abuse, Alcoholic Misuse, and Suicidal Ideation.

Objective psychological testing of U.S. Air Force officers in pilot training.

Clinical psychologists are increasingly assisting flight surgeons in the assessment of students in pilot training. However, some psychological tests reported in the literature are ill-suited to efficient clinical evaluation of aviators. Recent advances in clinical psychometrics offer improvements in reliability, personality theory, and norms. We administered the Multidimensional Aptitude Battery, the Personality Research Form, and the Millon Clinical Multiaxial Inventory to 350 Air Force officers undergoing Undergraduate Pilot Training. We present normative data for use by practitioners assessing similar populations.

Factor structure of the MCMI basic personality scales and common-item artifact.

The eight basic personality scales of the Millon Clinical Multiaxial Inventory (MCMI) were derived from Millon's theory of personality, but the adequacy of the MCMI for measuring Millon's personality constructs has never been assessed. One major problem with using factor analysis to illuminate the structure of the MCMI personality scales is that artifactual structure may result from item overlap among the scales. To analyze this, item-overlap coefficients were factored and compared to the factor structures of five subject samples. For the eight basic personality scales, three factors emerged for the overlap matrix and each of the five sample matrices: Aloof-Social, Aggressive-Submissive, and Lability-Restraint. It was concluded that these three factors are inconsistent with Millon's theory and that they will be found artifactually across a wide variety of populations due to overlapping items.