Prospects for faking believable deficits on neuropsychological testing.
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Adult↗
Biomedical subjects
R K Heaton
Publications and source records attributed to R K Heaton.
Using neuropsychological and personality tests to assess the likelihood of patient employment.
This study assessed the ability deficits and personality disturbances associated with three levels of employment in patients referred for neuropsychological testing. Highly significant group differences were found, with the unemployed group consistently showing greatest pathology on the tests, the full time employed group performing relatively normally, and the part time employed group earning intermediate scores. A discriminant function which used both neuropsychological and personality measures was found to discriminate unemployed from full time employed patients satisfactorily. Classification rates achieved by the function for validation and cross-validation samples support its clinical utility in identifying new patients who are at high risk for unemployment. It appears that psychological tests commonly used in neurological and psychiatric diagnosis can also help predict some aspects of patients' abilities to function in everyday life.
Adolescent↗
Neuropsychological findings with pseudoxanthoma elasticum.
It has been reported that the disease pseudoxanthoma elasticum (PXE) is associated with a high incidence of neurologic and psychiatric symptoms, which are possibly due to cerebrovascular ischemia. These reports are based mainly upon clinical observations made without reference to control group data. We have compared the results of 27 PXE patients with results of a control group on a battery of objective neuropsychological and personality tests. The PXE group showed only very mild deficits on extensive neuropsychological testing, a finding which argues against any marked involvement of cerebral vessels in these patients. Similarly, the personality test results did not reveal significant psychiatric disturbances which could be attributed to PXE. Possible reasons for the descrepancy with previous reports include the subjective data and much older PXE patients on which those reports are based. The need for systematic neuropsychological research with older PXE patients and control groups is suggested.
Adult↗
Neuropsychological and MMPI correlates of patients' future employment characteristics.
Previous research has suggested that patients' neuropsychological test scores correlate not only with neurologic status but also with their success in coping with some of the demands of daily living. This study investigated the utility of such laboratory test scores in predicting several vocational variables. Patients who had recieved neuropsychological evaluations were recontacted and questioned about their employment over the previous 6 mo. Of the 78 individuals who participated, 25 had been chronically unemployed. The remaining 53 were asked about job stability, hours worked, and wages earned, and were administered the Minnsota Job Requirements Questionnaire. Patients' scores on the Halstead-Reitan Battery, the WAIS and the MMPI were highly correlated with employment status (employed or chronically unemployed), income, and skills required on the jobs held. The results suggest that these tests may have clinical utility in assessing patients' employability, as well as the types of jobs for which they are suited.
Adult↗
Neuropsychological test results associated with psychiatric disorders in adults.
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Acute Disease↗
Comparison of Wechsler Adult Intelligence Scale indices of cerebral disfunction.
This study assessed and compared the diagnostic accuracies of eight cerebral dysfunction indices based upon the Wechsler Adult Intelligence Scale (WAIS). Patients with extreme values of the Halstead Impairment Index were used to compose Impaired and Not Impaired groups. The Impaired group did significantly worse than the Not Impaired group on all 11 WAIS subtests, and there was little overlap between the groups in Full Scale IQ. The WAIS cerebral dysfunction indices ignore such differences in over-all level of performance and instead use the eight indices predicted impairement status at levels which exceed chance, but the total correct classification rates were quite modest. Statistical correction for group age differences reduced classification rates even more. Deviation score analyses were employed to assess relative strengths and deficits on the WAIS subtests, controlled for over-all level of performance. Compared to the Not-impaired group, Impaired subjects did relatively poorly on Block Design and Object Assemby, and relatively well on Information, Comprehension, Vocabular, and Picture Completion. Significant education effects and education by impairment status interactions also occurred for several subtests. It was concluded that the WAIS indices have limited value in screening for cerebral dysfunction, and reasons for this were discussed.
Adult↗
Personality characteristics associated with psychedelic flashbacks in natural and experimental settings.
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Adult↗
Lateralized neurologic deficits and psychopathology in a Turner syndrome patient.
A Turner syndrome patient has been studied by more extensive neuropsychological testing than has previously been reported with such patients. Testing indicates impairment of a variety of functions normally subserved by the right cerebral hemisphere. If replicated with other Turner patients, a lateralized neurologic deficit is implicated as part of the syndrome. Also, this case illustrates the importance of family support and sensitive professional treatment in determining the psychological outcome of this disorder. As an important therapeutic consideration, we describe psychologically detrimental effects of delayed estrogen treatment with an older Turner syndrome patient.
Adult↗
A-B therapist characteristics vs. psychotherapy outcome: current status and prospects.
For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the "A-B" variable. Various A-B scales have been used to predict differential process and outcome of A and B therapist with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapists-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors "make the difference" seems rather premature. A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled "schizophrenic" or "neurotic" in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-Bresearch, but it clearly demands greater specificity in hypotheses and in research design. The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become "extinct." To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significatly skewed in either the A or B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.
Female↗
Subject expectancy and environmental factors as determinants of psychedelic flashback experiences.
This study assessed the roles of expectancy and autonomic arousal in inducing psychedelic flashbacks under conditions of mild sensory deprivation. Subjects with and without previous flashbacks participated. During the first experimental session, subjects were given a drug which they were told would induce flashbacks, and during the second, a drug which was alleged to induce only autonomic arousal. Ephedrine sulfate (causing autonomic changes) or placebo actually was given in counterbalanced order. Subjects of both groups experienced many more psychedelic sensations when they expected flashbacks. Drug effect was nonsignificant. These findings support the view that flashbacks are not "caused" by psychedelic drugs, but by the tendency of some drug users to mislabel and selectively attend to relevant aspects of naturally occurring altered states of consciousness.
Ephedrine↗
Chronic neurological sequelae of acute organophosphate pesticide poisoning.
To evaluate the latent neurological effects of organophosphate pesticide poisoning, this epidemiologic study examined 100 matched-pairs of individuals with previous acute organophosphate pesticide poisoning and nonpoisoned controls. No significant difference between poisoned subjects and controls was found on audiometric tests, ophthalmic tests, electroencephalograms, or the clinical serum and blood chemistry evaluations. Of the more than 50 scores from the neurological examination, abnormalities were demonstrated among the cases only on measures of memory, abstraction, and mood, and on one test of motor reflexes. Differences between the two cohorts were much more apparent in the neuropsychological tests. The differences occurred on tests of widely varying abilities including intellectual functioning, academic skills, abstraction and flexibility of thinking, and simple motor skills. Twice as many cases as controls (24 vs. 12) had Halstead-Reitan Battery summary scores in the range characteristic of individuals with cerebral damage or dysfunction. Results from the Minnesota Multiphasic Personality Inventory and the Patient's and Relative's Assessment of Patient Functioning Inventories also revealed greater distress and complaints of disability for the poisoned subjects.
Acute Disease↗
Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center.
Individuals infected with the human immunodeficiency virus-Type 1 (HIV-1), are at increased risk for neurobehavioral impairment, particularly in later stages of the disease. Even patients in the medically asymptomatic or minimally symptomatic stages of infection may show mild deficits on comprehensive neuropsychological (NP) test batteries, although the clinical significance of such deficits remains uncertain. The present study used vocational difficulties as markers of clinical significance of NP impairment. In a sample of 289 HIV-infected, nondemented men, those who evidenced NP impairment had a higher unemployment rate (p < .001) than did their unimpaired counterparts. In HIV-positive subjects who remained employed, NP impairment was strongly associated with subjective decreases in job-related abilities. Neither depression nor medical symptoms could explain the relationship between the NP impairment and employment problems. These results are consistent with previous studies investigating other neuropsychiatric disorders, which suggest that even mild NP impairment can interfere with employment status. From this standpoint, such impairment in HIV-infected persons may be described as "clinically significant."
AIDS Dementia Complex↗
Validity of the Quality of Well-Being Scale for persons with human immunodeficiency virus infection. HNRC Group. HIV Neurobehavioral Research Center.
To evaluate the validity of the Quality of Well-Being Scale (QWB) for studies of patients with human immunodeficiency virus (HIV) disease, 514 men were studied who were divided among four categories: Centers for Disease Control and Prevention (CDC) Group A (N = 272), CDC-B (N = 81), CDC-C (N = 47), and uninfected male controls (N = 114). The QWB and a variety of medical, neuropsychological, and biochemical measures were administered to all participants. When QWB scores were broken down by HIV group, the CDC-C group was significantly lower (.614) than the CDC-B (.679), CDC-A (.754), or control group (.801). The difference between Groups CDC-C and CDC-A was about .14 units of well-being, which suggests that individuals lose 1/7 equivalents of 1 well year of life for each year they are in Group CDC-C in comparison to the asymptomatic group (Group CDC-A). In comparison to the controls, this would equal a 1-year of life loss for each seven infected individuals. The QWB was shown to be significantly associated with CD4+ lymphocytes (p < .001), clinician ratings of neuropsychological impairment (p < .04), neurologists ratings of dysfunction (p < .001), and all subscales of the Profile of Mood States. Baseline QWB scores were significant prospective predictors of death over a median follow-up time of 30 months. Multivariate models demonstrated high covariation between predictors of QWB. It was concluded that the QWB is a significant correlate of biological, neuropsychological, neurological, psychiatric, and mortality outcomes for male HIV-infected patients.
AIDS Dementia Complex↗