Use of MMPI-2 to predict cognitive effort: A hierarchically optimal classification tree analysis

Smart, Colette M.; Nelson, Nathaniel W.; Sweet, Jerry J.; Bryant, Fred B.; Berry, David T. R.; Granacher, Robert P.; Heilbronner, Robert L.

doi:10.1017/s1355617708081034

Cited by 16 publications

(7 citation statements)

References 44 publications

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“…The source data did not satisfy the assumptions underlying analytical methods that are based on the general linear model or maximum likelihood function ( Grimm & Yarnold, 1995 , 2000 ). Accordingly, all analyses used optimal discriminant analysis, an exact, non-parametric statistical method ( Arozullah et al, 2003 ; Belknap et al, 2008 ; Nebeker et al, 2007 ; Smart et al, 2008 ) to model ED, low libido, and PED. Use of these non-parametric methods simplifies and standardizes presentation and interpretation of statistical findings, avoids certain ambiguities that arise with alternative multivariable analytic methods, ensures valid p -values, and also identifies models that maximize predictive accuracy (i.e., as opposed to models that maximize explained variation or that maximize the value of the likelihood function; Grimm & Yarnold, 1995 , 2000 ; Linden & Yarnold, 2016a , 2016b , 2016c , 2016d , 2016e ; Linden, Yarnold & Nallamothu, 2016 ; Yarnold & Soltysik, 2005 ).…”

Section: Methodsmentioning

confidence: 99%

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride

Kiguradze

Temps

Yarnold³

et al. 2017

PeerJ

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ImportanceCase reports describe persistent erectile dysfunction (PED) associated with exposure to 5α-reductase inhibitors (5α-RIs). Clinical trial reports and the manufacturers’ full prescribing information (FPI) for finasteride and dutasteride state that risk of sexual adverse effects is not increased by longer duration of 5α-RI exposure and that sexual adverse effects of 5α-RIs resolve in men who discontinue exposure.ObjectiveOur chief objective was to assess whether longer duration of 5α-RI exposure increases risk of PED, independent of age and other known risk factors. Men with shorter 5α-RI exposure served as a comparison control group for those with longer exposure.DesignWe used a single-group study design and classification tree analysis (CTA) to model PED (lasting ≥90 days after stopping 5α-RI). Covariates included subject attributes, diseases, and drug exposures associated with sexual dysfunction.SettingOur data source was the electronic medical record data repository for Northwestern Medicine.SubjectsThe analysis cohorts comprised all men exposed to finasteride or dutasteride or combination products containing one of these drugs, and the subgroup of men 16–42 years old and exposed to finasteride ≤1.25 mg/day.Main outcome and measuresOur main outcome measure was diagnosis of PED beginning after first 5α-RI exposure, continuing for at least 90 days after stopping 5α-RI, and with contemporaneous treatment with a phosphodiesterase-5 inhibitor (PDE5I). Other outcome measures were erectile dysfunction (ED) and low libido. PED was determined by manual review of medical narratives for all subjects with ED. Risk of an adverse effect was expressed as number needed to harm (NNH).ResultsAmong men with 5α-RI exposure, 167 of 11,909 (1.4%) developed PED (persistence median 1,348 days after stopping 5α-RI, interquartile range (IQR) 631.5–2320.5 days); the multivariable model predicting PED had four variables: prostate disease, duration of 5α-RI exposure, age, and nonsteroidal anti-inflammatory drug (NSAID) use. Of 530 men with new ED, 167 (31.5%) had new PED. Men without prostate disease who combined NSAID use with >208.5 days of 5α-RI exposure had 4.8-fold higher risk of PED than men with shorter exposure (NNH 59.8, all p < 0.002). Among men 16–42 years old and exposed to finasteride ≤1.25 mg/day, 34 of 4,284 (0.8%) developed PED (persistence median 1,534 days, IQR 651–2,351 days); the multivariable model predicting PED had one variable: duration of 5α-RI exposure. Of 103 young men with new ED, 34 (33%) had new PED. Young men with >205 days of finasteride exposure had 4.9-fold higher risk of PED (NNH 108.2, p < 0.004) than men with shorter exposure.Conclusion and relevanceRisk of PED was higher in men with longer exposure to 5α-RIs. Among young men, longer exposure to finasteride posed a greater risk of PED than all other assessed risk factors.

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Section: Methodsmentioning

confidence: 99%

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride

Kiguradze

Temps

Yarnold³

et al. 2017

PeerJ

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“…Logistic regression illustrated that the combination of FBS and RBS accounted for the maximum variance in group membership and optimally classified 85.3% of subjects. Smart et al (2008) used classification tree methodology to examine the ability of the standard MMPI-2 validity and clinical scales, additional MMPI-2 validity scales and indices, and an earlier 41-item version of the RBS (Gervais, 2005) to predict cognitive effort in a sample of 307 individuals seen in either a secondary gain context (n ϭ 198) or nonsecondary gain setting (n ϭ 109). Their results revealed that the RBS was used first in classification of cognitive effort, followed by Hysteria.…”

Section: Development Of the Rbsmentioning

confidence: 99%

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: Findings from disability and criminal forensic settings.

Wygant

Sellbom

Gervais

et al. 2010

Psychological Assessment

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The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.

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“…Highly elevated conversion V profiles in particular have been correlated with SVT failure (Boone & Lu, 1999;Larrabee, 1998;Smart et al, 2008). With respect to the MMPI-2 validity scales, the FBS (Lees-Haley, English, & Glenn, 1991) has proven particularly useful for identifying exaggeration or feigning of physical symptoms and disability (Greiffenstein, Fox, & Lees-Haley, 2007) and is closely associated SVT failures (Larrabee, 1998;Nelson, Sweet, Berry, Bryant, & Granacher, 2007;Nelson, Sweet, & Demakis, 2006).…”

Section: Mmpi-2 In Forensic Traumatic Brain Injury Settingsmentioning

confidence: 99%

Let's Not Get Hysterical: Comparing the MMPI-2 Validity, Clinical, and RC Scales in TBI Litigants Tested for Effort

Michael

Youngjohn

2009

The Clinical Neuropsychologist

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The MMPI-2 restructured clinical (RC) scales replace the traditional clinical scales in the MMPI-2 restructured form (MMPI-2-RF). Few studies to date have examined the MMPI-2 RC scales in traumatic brain injury (TBI) litigants. We compared MMPI-2 validity, clinical, and RC scales profiles of 83 mild, complicated mild, and moderate/severe TBI litigants who were tested for effort. Past research shows that patients referred for neuropsychological evaluations with mild TBIs paradoxically have higher MMPI-2 clinical scale elevations than patients with moderate/severe TBIs. Failure on cognitive symptom validity tests (SVTs) has also been associated with elevated validity and clinical scales profiles. The "conversion V" (elevated Hs and Hy, followed by D) is the most frequent elevated profile configuration in mild TBI and/or SVT failure. We sought to determine if these patterns of symptom reporting would replicate on the RC scales profile. Archival data from independent neuropsychological examinations were used to correlate TBI severity, cognitive test effort as indicated by SVTs, and MMPI-2 profiles. Results suggest that the validity, clinical, and RC scales profiles all correlate well with indices of cognitive test effort (namely that failure on SVTs is correlated with elevated symptom reporting). In addition, the validity scales profile, but not the clinical or RC scales profiles, was significantly inversely related to TBI severity. Discriminant function analyses suggest that the MMPI-2 RC scales can aid in the diagnosis of over-reported TBI symptomatology. However, RC3-the RC equivalent of the Hy scale-no longer appears to serve as a marker of somatization and/or malingering.

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Use of MMPI-2 to predict cognitive effort: A hierarchically optimal classification tree analysis

Cited by 16 publications

References 44 publications

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: Findings from disability and criminal forensic settings.

Let's Not Get Hysterical: Comparing the MMPI-2 Validity, Clinical, and RC Scales in TBI Litigants Tested for Effort

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