Effort has a greater effect on test scores than severe brain injury in compensation claimants.

Nine-hundred and four consecutive patients, including 80 neurological patients and 470 with head injuries, were given neuropsychological tests. All 43 test scores were converted to normative Z-scores and averaged, giving an Overall Test Battery Mean (OTBM). A variable measuring effort correlated 0.73 with the OTBM. The OTBM mean score was 1.20 SD lower in those who failed the Word Memory Test (WMT) than in those who passed the WMT. Sub-optimal effort suppressed the OTBM 4.5 times more than did moderate-severe brain injury. When only those making a good effort were included, patients with severe brain injuries and neurological diseases scored significantly lower than groups presumed to have no neurological impairment, but these group differences were not seen when all cases were analysed together. These data illustrate the importance of measuring and controlling for sub-optimal effort in individual neuropsychological evaluations, as well as in empirical research with similar groups of patients.

A statistical interpretive method for neuropsychological test data.

The accurate interpretation of large numbers of neuropsychological tests within a flexible battery approach is a difficult and sometimes controversial process. We present a statistically based method of interpretation (Rohling's Interpretive Method or RIM) and evaluation of neuropsychological data that allows for varying numbers of tests along a varying number of cognitive domains, yet remains psychometrically based. This method requires informed clinical judgment in that the level of confidence for tests, cognitive domains, and global indices are used as the backdrop for interpretive decisions. Specific procedures for use are presented in a systematic, detailed fashion to allow the interested reader to replicate the method. Two case examples are presented: a straightforward case of cerebrovascular insult and a more complicated case of mixed etiology. Examples include a variety of different neuropsychological tests commonly used in a flexible battery approach. A discussion of the practicality, ease of use, and potential limitations of this method are further presented.

Breaking up is hard to do: unwanted pursuit behaviors following the dissolution of a romantic relationship.

This study investigated the prevalence and predictors of unwanted pursuit behaviors among college students. Participants (n = 282) had experienced the termination of a meaningful romantic relationship. Two questionnaires were administered. One assessed unwanted pursuit behaviors that were perpetrated by individuals who had not initiated the relationship breakup (breakup sufferers; n = 120); the other assessed individuals who had initiated the relationship breakup (relationship dissolvers; n = 162). Results indicated that most breakup sufferers had engaged in at least one act of unwanted pursuit (i.e., unwanted phone calls, unwanted in-person conversations) after the breakup. Breakup sufferers were more likely than relationship dissolvers to perceive a positive impact from their unwanted pursuit behavior. Partner-specific attachment experiences and love styles emerged as significant predictors of unwanted pursuit behavior perpetration, according to both victims and perpetrators of unwanted pursuit. However, only victims of unwanted pursuit revealed an association between levels of relationship violence and unwanted pursuit behavior perpetration. Victims also reported that their unwanted pursuit was related to a lack of friendship between themselves and their expartners. In contrast, there was a positive association between feelings of friendship and unwanted pursuit for perpetrators. The implications of these findings and their application to the stalking literature are discussed.

Confirmatory factor analysis of the nurses' observation system for geriatric referrals.

The Nurses' Observation System for Geriatric Referrals is a 30-item observational scoring system for geriatric inpatients. As constructed, it is scored into six subscales of five items each; however, these six factors have not been empirically validated. A confirmatory factor analysis, performed on a sample of 218 completed forms for 218 geriatric inpatients, did not support the six original factors. Exploratory factor analysis gave a five-factor solution that partially replicated the scale's original factors but which also indicated important differences for interpretation and clinical use.

A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies.

We conducted a meta-analytic review of neuropsychological studies of mild head trauma (MHT). Studies were included if they met these criteria: patients studied at least 3 months after MHT; patients selected because of a history of MHT rather than because they were symptomatic; and attrition rate of less than 50% for longitudinal studies. Studies of children were not considered. We found a total of 8 published papers with 11 samples that met these criteria. Using the g statistics, the overall effect size of 0.07 was nonsignificant, but the d statistic yielded an effect size of 0.12, p < .03. Measurers of attention had the largest effect, g = 0.17. p < .02 and d = 0.20, p < .006. Severity of injury accounted for far more variance than did specific neuropsychological domain, however. The small effect size suggests that the maximum prevalence of persistent neuropsychological deficit is likely to be small and neuropsychological assessment is likely to have positive predictive value of less than 50%. Consequently, clinicians will more likely be correct when not diagnosing brain injury than when diagnosing a brain injury in cases with chronic disability after MHT.

Money matters: a meta-analytic review of the effects of financial incentives on recovery after closed-head injury.

OBJECTIVE: The authors evaluated the impact of financial incentives on disability, symptoms, and objective findings after closed-head injury. METHOD: Meta-analysis was used to review the literature. Seventeen reports, covering 18 study groups and a total of 2,353 subjects, contained data from which effect sizes could be calculated. Effect sizes were aggregated after weighting for group size. After discussion, there was 100% agreement between the authors on all calculations. RESULTS: A moderate overall effect size, 0.47, was found. The effect was particularly strong for mild head trauma. The data showed more abnormality and disability in patients with financial incentives despite less severe injuries. CONCLUSIONS: Clinical evaluation of patients after closed-head injury, particularly mild head trauma, must include consideration of the effect of financial incentives on symptoms and disability.

Money matters: A meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain.

Meta-analytic procedures were used to determine the relation between disability compensation and pain. Of the 157 relevant identified studies, only 32 contained quantifiable data from treatment and control groups. The majority of these exclusively examined chronic low back pain patients (72%). Overall, 136 comparisons were obtained, on the basis of 3,802 pain patients and 3,849 controls. Liberal procedures for estimating effect sizes (ESs) yielded an ES of .60 (p < .0002). Conservative procedures yielded an ES of .48 (p < .0005). Both ESs differed from zero, indicating that compensation is related to increased reports of pain and decreased treatment efficacy. These results are interpreted in light of current models of pain. Health policy implications are also discussed.

Automatic and effortful memory processes in depressed persons.

Clinical lore has held that depression results in memory dysfunction, particularly in older adults. Some believe that memory loss due to depression is indistinguishable from an organic dementia and label such dysfunction pseudodementia. Previous literature has inconclusively supported the relation between depression and memory deficits. This research assessed three groups of subjects: (a) 30 depressed patients, (b) 20 psychiatric controls, and (c) 30 normal controls. Dependent memory tasks were designed to vary along the automatic and effortful memory encoding continuum defined by Hasher and Zacks (1979). Two tasks were designed to be effortful (free recall and paired associates) and two tasks were designed to be automatic (memory for frequency and location). Contrary to predictions, depression was not related to memory deficits. However, post-hoc analyses indicated that psychiatric hospitalization and psychotropic medication had a greater negative impact on memory than did depression. As predicted, age resulted in effortful encoding deficits whereas age resulted in minimal deficits on the automatic tasks. There was no evidence of an interaction between depression and age that would be consistent with the descriptive label of pseudodementia.

Automatic and effortful memory processes in elderly persons with organic brain pathology.

This study investigated the automatic and effortful memory encoding model of Hasher and Zacks (1979) and the potential it may hold for aiding in the differentiation between aging-related memory decline and dementia. College students, normal elders, and dementia patients were compared on a 96-item picturebook task utilizing measures of free recall, recognition accuracy, memory for location, and memory for frequency. There were no differences between students and elders on any of the dependent measures. However, differences were found between elders and patients on each measure, and a discriminant function correctly classified the two groups with 93.3% accuracy. Subsequent discriminant analysis found patients could be correctly classified into diagnostic subgroups, i.e., dementia of the Alzheimer's type (DAT), multi-infarct dementia (MID), and Korsakoff's disease (KD) with 80.8% accuracy. The model holds promise as a guide for clinicians who are asked to make differential diagnoses of memory-impaired individuals.