The use of the MMPI-2 for the assessment of depressive and psychotic disorders

Patient Factors Influencing Outpatient Retention in Patients with Affective and Anxiety Disorders: A Retrospective Study

OBJECTIVE

The aim of the present study is to identify the factors that affect retention in outpatients with psychiatric disorders as indicators of treatment adherence, including Minnesota Multiphasic Personality Inventory (MMPI) scores.

METHODS

The medical records of 146 patients diagnosed with major depressive disorder, bipolar disorder, or anxiety disorder for at least 10 years and discharged were retrospectively reviewed in the present study. The subjects were categorized based on the duration of outpatient treatment as < 6 months (L6) or ≥ 6 months (M6) groups and reclassified as < 36 months (L36) and ≥ 36 months (M36) groups. The demographic, clinical, and personality characteristics of the groups were compared.

RESULTS

Patients in M6 and M36 groups were more likely to have a higher educational level compared with those in the L6 and L36 groups, respectively. Patients in the M6 group showed significantly lower hypomania (Ma) scores on the MMPI test than did patients in the L6 group.

CONCLUSION

The association between high Ma score on the MMPI test and early discontinuation of treatment suggests that impulsivity, hostility, and disinhibition confer higher risk of nonadherence.

Identifying non-affective psychosis in first admission patients: MMPI-2, structured diagnostic interview, and consensus lifetime best estimate

PURPOSE

We aimed to evaluate the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as a potential means of improving on the SCID's diagnostic efficacy.

METHODS

76 first-admission patients were assigned DSM-IV consensus diagnoses by two experienced psychiatrists using all available information, then dichotomized into non-affective psychosis and other mental illness groups. The patients were also given the SCID and the MMPI-2. The diagnostic performance of the MMPI-2 was compared to that of the SCID to assess both diagnostic accuracy and incremental validity.

RESULTS

MMPI-2 scales 8 (Schizophrenia) and BIZ (Bizarre Mentations) correctly identified 58% and 56% respectively of non-affective psychotic patients. The Goldberg Index had an overall correct classification rate of 70%, but only identified 49% of the psychosis group. The SCID had a correct classification rate of 66% but correctly identified only 25% of the non-affective psychosis patients. Three MMPI-2 scales combined with the SCID resulted in an overall correct classification rate of 73%, and identification of 66% of the non-affective psychosis patients.

CONCLUSION

The results suggest that the MMPI-2 may identify early psychosis at least as well as the SCID. Furthermore, using a combination of the MMPI-2 and the SCID shows incremental validity over using the SCID alone.

A Comparison of Three Strategies for Scale Construction to Predict a Specific Behavioral Outcome

Using 65 items from a mental health screening questionnaire, the History Opinion Inventory–Revised (HOI-R), the present study compared three strategies of scale construction—(1) internal (based on factor analysis), (2) external (based on empirical performance) and (3) intuitive (based on clinicians’ opinion)—to predict whether 203,595 U.S. Air Force trainees would be discharged early for mental health or behavior-related reasons within a 4-year follow-up period. The external strategy significantly outperformed the internal strategy, which in turn outperformed the intuitive strategy. For all strategies, predictive accuracy was consistently higher when items and scales were scored using empirically derived weights rather than unit weights. These findings suggest that the external strategy of scale construction provides the highest accuracy when sample sizes are large and the aim is to predict a specific behavioral event. However, the internal strategy also yields valid results and can be a reasonable choice when outcome data are unavailable.

Cerebral connectivity and psychotic personality traits. A diffusion tensor imaging study

This study aims to investigate the relationship between regional connectivity in the brain white matter and the presence of psychotic personality traits, in healthy subjects with psychotic traits. Thirteen healthy controls were administered the MMPI-2, to assess psychotic traits and, according to MMPI results, a dichotomization into a group of "high-psychotic" and "low-psychotic" was performed. Diffusion tensor imaging (DTI) was used as a non-invasive measure, in order to obtain information about the fractional anisotropy (FA), an intravoxel index of local connectivity and, by means of a voxelwise approach, the between-group differences of the FA values were calculated. The "high-psychotic" group showed higher FA in the left arcuate fasciculus. Subjects with low scores for psychotic traits had significantly higher FA in the corpus callosum, right arcuate fasciculus, and fronto-parietal fibers. In line with previous brain imaging studies of schizophrenia spectrum disorders, our results suggest that psychotic personality traits are related to altered connectivity and brain asymmetry.

Hemispheric lateralization patterns and psychotic experiences in healthy subjects

The hypothesis that psychotic experiences in healthy subjects are associated with a dysfunction of the right hemisphere is supported by some, but not all, available studies. Differences in gender composition of study samples may explain in part the divergent findings. The present study was carried out in 42 healthy, right-handed university students. Scores on the Schizophrenia and Paranoia scales of the Minnesota Multidimensional Personality Inventory-2 were used in correlation analyses and to define a High- and a Low-Psychotic group. Brain Electrical Microstates and Low Resolution Electromagnetic Tomography (LORETA) source analyses of the auditory P300 (P3a and P3b) components of the event-related potential, as well as a battery of neuropsychological tests, were used to assess hemispheric functioning. Scores on the Paranoia scale were positively associated with a leftward shift of the P3a topographic descriptors in females but not in males. When comparing High-Psychotic and Low-Psychotic females, a leftward shift of P3a descriptors and an increased cortical activation in left fronto-temporal areas were observed in the High-Psychotic group. Our results demonstrated gender-related differences in the pattern of hemispheric imbalance associated with psychotic experiences in healthy subjects.

Evidence-based assessment of depression in adults

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and suicidality; (d) an approach to suicidality that distinguishes between resolved plans and preparations and desire and ideation; (e) assessment of the atypical, seasonal, and melancholic subtypes; (f) parameters of course and chronicity; and (g) comorbidity and bipolarity. These complexities need to be accounted for when certain assessment approaches are preferred, and when ambiguity exists regarding the categorical versus dimensional nature of depression, and whether and when clinician ratings outperform self-report. The authors conclude that no one extant procedure is ideal and suggest that the combination of certain interviews and self-report scales represents the state of the art for evidence-based assessment of depression.

Giving the Self a Voice in MMPI Self-report: Jerry Wiggins and the Content Scales

This article places one of Jerry Wiggins' contributions to the Minnesota Multiphasic Personality Inventory (MMPI), his content scales, in the twin contexts of past and recent research, and of Wiggins' own preoccupations growing out of the interpersonal point of view. It highlights Wiggins' perspective on the position of the person in the process of personality assessment, with special reference to the means by which the person's communication with the assessor may become accessible as a voice to be heard in the total pattern of assessment findings. Finally, one of the newer trends in personality assessment, one highly congenial to Wiggins' interpersonal outlook, is discussed with reference to the role that the MMPI-2 Content Scales may play in its future development.

Assessing depression with the MMPI and MMPI-2

The usefulness of the MMPI (Hathaway & McKinley, 1951 ) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) for diagnosing and assessing symptomatic depression has been the subject of considerable debate for a number of years. In this article, we review the relative contributions of the MMPI and MMPI-2 clinical and content scales in predicting depression. Positive predictive power, negative predictive power, and overall classification rate were computed for Scale 2 (D) of the MMPI and MMPI-2 and the Depression content scale (DEP) of the MMPI-2. Scale 2 (D) of both the MMPI and MMPI-2 appears to be moderately accurate in predicting depression. Although some studies suggest that the content scale DEP provides incremental validity over Scale 2 (D) of the MMPI-2, the results of this review indicate that the content scale DEP of the MMPI-2 does not exceed the diagnostic efficiency of Scale 2 in predicting depression.

On the science of Rorschach research

Wood et al.'s (1999b) article contained several general points that are quite sound. Conducting research with an extreme groups design does produce effect sizes that are larger than those observed in an unselected population. Appropriate control groups are important for any study that wishes to shed light on the characteristics of a targeted experimental group and experimental validity is enhanced when researchers collect data from both groups simultaneously. Diagnostic efficiency statistics--or any summary measures of test validity--should be trusted more when they are drawn from multiple studies conducted by different investigators across numerous settings rather than from a single investigator's work. There should be no question that these points are correct. However, I have pointed out numerous problems with specific aspects of Wood et al.'s (1999b) article. Wood et al. gave improper citations that claimed researchers found or said things that they did not. Wood et al. indicated my data set did not support the incremental validity of the Rorschach over the MMPI-2 when, in fact, my study never reported such an analysis and my data actually reveal that the opposite conclusion is warranted. Wood et al. asserted there was only one proper way to conduct incremental validity analyses even though experts have described how their recommended procedure can lead to significant complications. Wood et al. cited a section of Cohen and Cohen (1983) to bolster their claim that hierarchical and step-wise regression procedures were incompatible and to criticize Burns and Viglione's (1996) regression analysis. However, that section of Cohen and Cohen's text actually contradicted Wood et al.'s argument. Wood et al. tried to convince readers that Burns and Viglione used improper alpha levels and drew improper conclusions from their regression data although Burns and Viglione had followed the research evidence on this topic and the expert recommendations provided in Hosmer and Lemeshow's (1989) classic text. Wood et al. oversimplified issues associated with extreme group research designs and erroneously suggested that diagnostic studies were immune from interpretive confounds that can be associated with this type of design. Wood et al. ignored or dismissed the valid reasons why Burns and Viglione used an extreme groups design, and they never mentioned how Burns and Viglione used a homogeneous sample that actually was likely to find smaller than normal effect sizes. Wood et al. also overlooked the fact that Burns and Viglione identified their results as applying to female nonpatients; they never suggested their findings would characterize those obtained from a clinical sample. Wood et al. criticized composite measures although some of the most important and classic findings in the history of research on personality recommend composite measures as a way to minimize error and maximize validity. Wood et al. also were mistaken about the elements that constitute an optimal composite measure. Wood et al. apparently ignored the factor-analytic evidence that demonstrated how Burns and Viglione created a reasonable composite scale, and Wood et al. similarly ignored the clear evidence that supported the content and criterion related validity of the EMRF. With respect to the HEV, Wood et al. created a z-score formula that used the wrong means and standard deviations. They continued to use this formula despite being informed that it was incorrect. Subsequently, Wood et al. told readers that their faulty z-score formula was "incompatible" with the proper weighted formula and asserted that the two formulas "do not yield identical results" and "do not yield HEV scores that are identical or even very close." These published claims were made even though Wood et al. had seen the results from eight large samples, all of which demonstrated that their wrong formula had correlations greater than .998 with the correct formula. At worst, it seems that Wood et al. (199