The Clinical neuropsychologist
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Clinical myths and lore are unfounded beliefs that still influence practice decisions. I examine the validity of six beliefs commonly encountered in forensic neuropsychology practice: the admissibility of test batteries; avoidance of practice effects; forewarning insures good effort; average deficits in bright persons; 15% chronic impairment in mild brain injury; and examiner bias causing malingering. I show these beliefs are invalid because of material misunderstandings of case law and literature, falsification by empirical findings, and lack of authoritative sources. The benefits, costs, and persistence of clinical myths are discussed.
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The Postconcussive Symptom Questionnaire (PCSQ) was developed to assess the symptoms associated with the controversial diagnosis of postconcussion syndrome. We examined item endorsement on the PCSQ in two groups. The first group was made up of individuals diagnosed with moderate to severe traumatic brain injury. ⋯ Significant differences in item endorsement were found the majority of individual items as well as on the PCSQ indices. The poor effort mild traumatic brain injury group consistently reported more symptoms with greater severity. The results raise further questions about the validity of postconcussion symptoms.
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Controlled Clinical Trial
MMPI-2 patterns in electrical injury: a controlled investigation.
The psychological consequences of electrical injury (EI) are many. Depression, posttraumatic stress disorder, anxiety, and somatic preoccupation are often concomitant with this type of injury (Kelley, Pliskin, Meyer, & Lee, 1994). The present study utilized the MMPI-2 as a tool for characterizing profiles of psychological distress in EI. ⋯ No statistically significant differences emerged between the EI and TBI groups. However, TBI patients showed significant elevations on Hy and D compared to CP, and EI patients endorsed more somatic symptoms than CP patients. Implications of these findings and future directions will be discussed.
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A recent Supreme Court decision--Atkins v. Virginia, 536 U. S. 304 (2002)--prohibiting the execution of mentally retarded (MR) defendants may have raised the attractiveness of feigning this condition in the criminal justice system. ⋯ Although neurocognitive malingering tests were more accurate, their reduced specificity in MR participants was of potential concern. Revised cutting scores, set to maintain a Specificity rate of about .95 in MR clients, were identified, although they require cross-validation. Overall, these results suggest that new cutting scores will likely need to be validated to detect feigned MR using current malingering instruments.
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Comparative Study
Sensitivity and specificity of MMPI-2 validity scales and indicators to malingered neurocognitive dysfunction in traumatic brain injury.
The present study used a known-groups design to determine the classification accuracy of 10 MMPI-2 validity scales and indicators in the detection of cognitive malingering in traumatic brain injury. Participants were 259 traumatic brain injury and 133 general clinical patients seen for neuropsychological evaluation. ⋯ Specificity was good even in stroke, memory disorder, and psychiatric patients without incentive. The results of this study are presented in frequency tables that can be easily referenced in clinical practice.