Differentiating between schizophrenic and manic inpatients by means of the MMPI

2010 Bruno Klopfer Distinguished Contribution Award. Some considerations for enhancing psychological assessment

The field of psychological assessment appears to be bogged down in recent decades on refining existing measures and techniques to the detriment of real change. This article attempts to highlight some of the changes that need to take place in psychological assessment in the next few decades if real progress is to be achieved: (a) developing guidelines for psychological tests and measures; (b) establishing explicit criteria for training; (c) establishing guidelines for competencies; (d) recognizing the impact of marketing; (e) embracing electronic technology; and (f) implementing computer adaptive testing.

Trait versus state aspects of the MMPI during the early course of schizophrenia

Scores on the Minnesota Multiphasic Personality Inventory (MMPI)-168 item version were examined during periods of clinical remission and of psychosis for recent-onset schizophrenia patients (n = 19) and at comparable time intervals for demographically matched normal participants (n = 19). To determine diagnostic specificity, MMPIs for participants with bipolar affective disorder in remission (n = 12) were also examined. Methods for distinguishing between stable vulnerability indicators, mediating vulnerability factors and episode indicators of psychopathology were adapted from Nuechterlein and Dawson (1984). MMPI scales Pa, Sc and validity scale F showed a combination of trait and state qualities, characteristic of mediating vulnerability factors. These scales reflect changes that occur during psychotic episodes but also apparently tap personality characteristics that endure into periods of clinical remission. Unexpectedly, some MMPI scales that are not typically associated with psychotic disorders (i.e. Hs, D, and Hy) were significantly higher in schizophrenia patients across psychotic and clinically remitted states than in normal participants. In clinical remission, higher scores on scales Hs, D and Hy, showed some specificity to schizophrenia relative to bipolar disorder. While MMPI-168 scales Pd and Pt fit the pattern for vulnerability indicators, it was uncertain whether they belonged to the 'stable' versus 'mediating' subtype. MMPI scores that continue to be higher in remission than in a normal sample may reflect either enduring vulnerability factors or the impact of schizophrenia and the individuals' attempts to cope with the disorder. Studies of first-degree relatives will be needed to provide converging evidence that certain personality characteristics reflect genetic predisposition to schizophrenia.

Contributions of discriminant analysis to differential diagnosis by self-report

We used discriminant function analyses of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1983), Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), MCMI-II (Millon, 1987), and Symptom Checklist Ninety-Revised (SCL-90-R; Derogatis, 1983) profiles from a heterogenous group of 272 psychiatric inpatients to classify patients as depressed, manic, and/or psychotic. Most functions generated from these tests significantly discriminated depressed, manic (not MCMI-II), and psychotic (not MCMI) subjects from psychiatric controls. However, there was little improvement in diagnostic efficiency over the use of single scale elevations at specified cut scores. Functions derived from the MCMI for mania and the MCMI-II for psychosis show the most promise but require replication. The difficulty of using group profile differences for the diagnosis of individual psychiatric patients is discussed.

The clinical utility of the MMPI-2 in diagnosing unipolar depression among male alcoholics

The correspondence between Scale 2 elevations on the MMPI-2 and SCID-diagnosed unipolar depression (major depression and dysthymia) and alcohol-induced depression was evaluated among 106 consecutive male admissions to an inpatient alcohol treatment unit. Valid profiles were obtained from 87 subjects, 15% of whom were diagnosed with unipolar depression and another 4.5% with presumed alcohol-induced depression. The sensitivity of Scale 2 (the probability that a depressed subject would obtain an elevated score) ranged from .19 to .42. Positive predictive power (the probability that a subject who obtained an elevated score had a depressive disorder) ranged from .23 to .38. Neither Scale 2 alone nor Scale 2 paired in 2-point code types predicted the presence or absence of comorbid depressive disorders among male alcoholics.

The diagnosis and assessment of depression, mania, and psychosis by self-report

We examined the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI), the original and revised versions of the Millon Clinical Multiaxial Inventory (MCMI and MCMI-II), and the Symptom Checklist-90-R (SCL-90-R) for the diagnosis and assessment of depression, mania, and psychosis in a heterogeneous group of 272 psychiatric inpatients. We examined the following: diagnostic efficiency of single scales at specified cutoff scores for these conditions, multidimensional test profiles, MMPI high-point codes, and associated MCMI and MCMI-II personality disorders. The reported findings are discussed in terms of how these tests may and may not be used to answer particular assessment questions and what the self-report vantage contributes to the entire clinical assessment process.