Biomedical subjects

Kevin W Greve

Publications and source records attributed to Kevin W Greve.

At least 19 recordsLinked to original sources

PubMed2006

Effects of a community toxic release on the psychological status of children.

This study sought to determine the emotional effects of a major community toxic release on children in the exposed community while controlling for the potential effects of response bias. Controlling for the response bias inherent in litigated contexts is an advance over previous studies of toxic exposure in children. A randomly selected representative sample of Exposed children (n = 31) was compared to a matched Control group (n = 28) from a nearby, unexposed community. Symptoms and complaints were assessed via interview with the children and their guardians, surveys and checklists, and well-established psychological instruments. Even when biased responding was controlled the Exposed children experienced more psychological distress, more physical symptoms, and greater general concern over their physical functioning than the Controls. The Exposed children also reported some concern about their future health and cancer risk but usually only if asked. Limitations and future research directions are discussed.

Child↗

PubMed2006

Classification accuracy of the Test of Memory Malingering in persons reporting exposure to environmental and industrial toxins: Results of a known-groups analysis.

This study used a known-groups design to examine the classification accuracy of the Test of Memory Malingering in detecting cognitive malingering in patients claiming cognitive deficits due to exposure to environmental and industrial toxins. Thirty-three patients who met Slick et al. criteria for Malingered Neurocognitive Dysfunction were compared to 17 toxic exposure patients negative for evidence of malingering, 14 TBI patients and 22 memory disorder patients, both groups without incentive. The original cutoffs (<45) for Trial 2 and Retention demonstrated perfect specificity (0% false positive error rate) and impressive sensitivity (>50%). These findings indicate the TOMM can be used with confidence as an indicator of negative response bias in cases of cognitive deficits attributed to exposure to alleged neurotoxic substances.

Adult↗

PubMed2006

The prevalence of cognitive malingering in persons reporting exposure to occupational and environmental substances.

OBJECTIVE: Directly estimate the prevalence of cognitive malingering in persons claiming exposure to occupational and environmental substances. METHODS: Retrospective review of 128 neuropsychological cases with financial incentive. Estimates were based on two methods: (1) clinical identification using the Slick, Sherman and Iverson criteria for malingered neurocognitive dysfunction (MND), and (2) statistical modeling based on patient performance on several individual psychometric indicators of malingering. RESULTS: The prevalence based on the clinical method was 40%. The statistically based estimates ranged from 30% to more than 45% depending on model parameters. Different incentive parameters may influence prevalence. CONCLUSIONS: Cognitive malingering in toxic exposure is common and must be adequately addressed in the clinical neuropsychological assessment of toxic exposure and in research on its neurocognitive effects or findings will likely over-estimate the degree of cognitive impairment and related disability.

Adolescent↗

PubMed2006

Classification accuracy of the test of memory malingering in traumatic brain injury: results of a known-groups analysis.

This study used a known-groups design to determine the classification accuracy of the Test of Memory Malingering (Tombaugh, 1996, 1997) in detecting cognitive malingering in traumatic brain injury (TBI). Forty-one of 161 TBI patients met Slick, Sherman, and Iverson (1999) criteria for Malingered Neurocognitive Dysfunction. Twenty-two no-incentive memory disorder patients were also included. The original cutoffs (<45) for Trial 2 and Retention demonstrated excellent specificity (less than a 5% false positive error rate) and impressive sensitivity (greater than 45%). However, these cutoffs are actually conservative in the context of mild TBI. Over 90% of the non-MND mild TBI sample scored 48 or higher on the Retention Trial and none scored less than 46 while 60% of the MND patients claiming mild TBI were detected at those levels. Trial 1 also demonstrated excellent classification accuracy. Application of these data to clinical practice is discussed.

Adult↗

PubMed2006

Pain, malingering, and performance on the WAIS-III Processing Speed Index.

Pain patients often report cognitive symptoms and many will include them in their claims of disability. The Processing Speed Index (PSI) of the WAIS-III was investigated as one aspect of cognitive functioning in six groups. Slight impairment was found for PSI and Digit Symbol subtest performance, but not for Symbol Search, in a Laboratory-induced Pain group and a Clinical Pain group. The lowest scores were found in a Simulator group instructed to fake cognitive impairment and a Clinical Pain group diagnosed as Malingering. Results suggest that PSI scores are only slightly reduced by laboratory-induced pain or chronic pain, and that unexpectedly low scores in the absence of significant/documented brain dysfunction suggest poor effort or deliberate misrepresentation.

Adolescent↗

PubMed2006

Classification accuracy of the Portland Digit Recognition Test in traumatic brain injury: results of a known-groups analysis.

The present study used a known-groups design to examine the accuracy of the Portland Digit Recognition Test (PDRT) in the detection of malingering in traumatic brain injury (TBI). Data were derived from 262 TBI patients who were classified as not malingering, possibly malingering, and malingering based on the Slick, Sherman, and Iverson (1999) criteria. The original PDRT cutoffs detected between 20 and 50% of malingering TBI patients with a false positive error rate of 5% or less. When the false positive error rate was held at 5%, across all item sets, sensitivity was as high as 70%. The results show that the original PDRT cutoffs are conservative and that higher scores detect more MND patients without causing the false positive error rate to become unacceptably high. Clinical application and future research needs are discussed.

Adult↗

PubMed2006

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. The TBI patients were subdivided into groups based on a comprehensive examination of effort following Slick, Sherman, and Iverson's (1999) criteria. More extreme scores demonstrated excellent specificity; often impressive sensitivity was seen even while maintaining a low false positive error rate. 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.

Adult↗

PubMed2006

Compensation and malingering in traumatic brain injury: a dose-response relationship?

The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.

Adult↗

PubMed2006

California verbal learning test indicators of Malingered Neurocognitive Dysfunction: sensitivity and specificity in traumatic brain injury.

The present study used well-defined traumatic brain injury (TBI) and mixed neurological (other than TBI) and psychiatric samples to examine the specificity and sensitivity to Malingered Neurocognitive Dysfunction (MND) of four individual California Verbal Learning Test (CVLT) variables and eight composite CVLT malingering indicators. Participants were 275 traumatic brain injury and 352 general clinical patients seen for neuropsychological evaluation. The TBI patients were assigned to one of five groups using the Slick, Sherman, and Iverson (1999) criteria: no incentive, incentive only, suspect, and malingering (both Probable MND and Definite MND). Within TBI, persons with the strongest evidence for malingering (Probable and Definite) had the most extreme scores. Good sensitivity (approximately 50%) in the context of excellent specificity (> 95%) was found in the TBI samples. Issues related to the appropriate clinical application of these data are discussed.

Brain Injuries↗

PubMed2005

Should the Retention trial of the Test of Memory Malingering be optional?

The present study examined the false negative error rate associated with the optional use of the Retention trial the Test of Memory Malingering (TOMM). TOMM scores from 150 traumatic brain injury and 150 chronic pain patients were examined. Results indicated that early termination of the TOMM resulted in 3% of patients going undetected by the TOMM. The practical cost of this error was minimized by the inclusion of at least one other SVT. Clinical implications are discussed.

Brain Injuries↗

PubMed2005

Detection and diagnosis of malingering in electrical injury.

This paper sought to demonstrate that diagnosable malingering does occur in Electrical Injury (EI) and examine the relationship of malingering to potential indicators of the presence and severity of neurological injury. Eleven consecutive EI patients seen for neuropsychological evaluation were presented. Over half the patients met the Slick et al. (1999) criteria for at least Probable MND. Most of the MND patients lacked evidence of a biologically meaningful exposure to electrical current. These findings highlight the importance of considering biological markers of neurological injury and of non-neurological factors, including effort/malingering, in the study of the neurocognitive consequences of EI.

Adult↗

PubMed2005

Latent structure of the Wisconsin Card Sorting Test: a confirmatory factor analytic study.

The present study represents the first large scale confirmatory factor analysis of the Wisconsin Card Sorting Test (WCST). The results generally support the three factor solutions reported in the exploratory factor analysis literature. However, only the first factor, which reflects general executive functioning, is statistically sound. The secondary factors, while likely reflecting meaningful cognitive abilities, are less stable except when all subjects complete all 128 cards. It is likely that having two discontinuation rules for the WCST has contributed to the varied factor analytic solutions reported in the literature and early discontinuation may result in some loss of useful information. Continued multivariate research will be necessary to better clarify the processes underlying WCST performance and their relationships to one another.

Adolescent↗

PubMed2005

Test of Memory Malingering Performance is unaffected by laboratory-induced pain: implications for clinical use.

The Test of Memory Malingering (TOMM) is a well-validated and widely used forced-choice symptom validity test. However, little is known about how TOMM performance is affected by pain. The present study evaluated the sensitivity of the TOMM to pain induced in healthy participants via the cold-presser test. Participants (n=20 per group) were administered the TOMM under one of three conditions: (1) standard instructions; (2) instructions to simulate pain-related memory deficit in pursuit of personal injury litigation; (3) while experiencing cold-induced pain. Results indicate that TOMM performance was unaffected by laboratory-induced moderate to severe pain and support the TOMM's use in evaluating clinical patients with pain.

Adolescent↗

PubMed2005

A comparison of anticonvulsants in the treatment of impulsive aggression.

This study compared the behavioral effects of 3 anticonvulsants in impulsive aggressive men. In a double-blind, placebo-controlled, parallel groups design, participants were randomly assigned to 1 of 4 6-week treatments: phenytoin (n = 7), carbamazepine (n = 7), valproate (n = 7), or placebo (n = 8). The efficacy measure was the average aggression score, a global severity index from the Overt Aggression Scale (J. M. Silver & S. C. Yudofsky, 1991). Analysis showed a significant reduction in impulsive aggression during all 3 anticonvulsant conditions compared with placebo. However, the treatment effect during carbamazepine administration was slightly delayed compared with phenytoin and valproate. These findings suggest that increased use of anticonvulsants could make a significant impact in the control of impulsive aggression in both mental health and criminal justice settings.

Adult↗

PubMed2005

Agreement between the abbreviated and standard portland digit recognition test.

This study sought to determine the classification agreement between the standard and abbreviated forms of the Portland Digit Recognition Test (PDRT), a well-established symptom validity test. PDRTs (N=200: 100 traumatic brain injury, 100 chronic pain) were randomly selected from case manager and attorney referrals for psychological assessment. Only three cases were misclassified and agreement was as high as 99.5%. This study demonstrated that when using the abbreviated PDRT there is little risk of false negative errors.

Brain Injuries↗

PubMed2005

Psychological evaluation of the emotional effects of a community toxic exposure.

OBJECTIVE: We sought to assess the emotional effects of a major community toxic release while controlling the potential effects of response bias associated with litigation. METHODS: Participants included 152 exposed adult litigants and a matched unexposed comparison group (n = 76). Psychological assessment methods included: (1) Minnesota Multiphasic Personality Inventory-2; (2) Symptom Checklist-90-Revised; and (3) Impact of Event Scale-Revised. RESULTS: Ten to 40% of the exposed group demonstrated emotional distress (compared with a 5% comparison baseline) depending on indicator and cutoff score used. CONCLUSIONS: The psychological consequences of a community toxic exposure were present even when exaggeration was carefully controlled. Accounting for exaggeration in the assessment of subjective psychological complaints provides a more accurate view of the subjective emotional state of persons who have experienced toxic exposure thereby facilitating appropriate clinical management of their mental health needs.

Accidents↗

PubMed2005

Detection of feigned tactile sensory loss using a forced-choice test of tactile discrimination and other measures of tactile sensation.

OBJECTIVE: Intentional exaggeration of disability is a risk in work injuries but is hard to reliably detect clinically. This study examined the accuracy of tactile sensory threshold and forced-choice discrimination measures in detecting feigned sensory loss. METHODS: Participants (n = 80) were randomly assigned to one of four sensory loss groups: (1) none; (2) partial; (3) full; or (4) feigned. Sensory data were collected for the upper extremities. RESULTS: Tactile thresholds greater than 0.5 g, discriminability less than 0.50, or forced-choice scores less than 90% were associated with a very low probability of false-positive errors. CONCLUSIONS: Below-chance scores are definitive evidence that the sensory loss is intentionally feigned. Scores beyond cut-offs should raise the clinician's suspicion of malingering if there is no physical basis for sensory loss.

Adult↗

PubMed2005

Reliable digit span is unaffected by laboratory-induced pain: implications for clinical use.

Reliable Digit Span (RDS) is an indicator used to assess the validity of cognitive test performance. Scores of 7 or lower suggest poor effort or negative response bias. The possibility that RDS scores are also affected by pain has not been addressed thus potentially threatening RDS specificity. The current study used cold pressor-induced pain to investigate the effect of pain on RDS scores. Sixty undergraduate volunteers randomly assigned to one of three conditions (control, simulator, pain) completed the Digit Span subtest from the Wechsler Adult Intelligence Scale-III from which the RDS is derived. No differences in RDS scores were found between the control and pain groups, and neither group scored below 8. Sixty-five percent of the simulator group scored 7 or below. These results suggest that RDS is not affected by pain, and scores of 7 or less in persons with pain can be more confidently attributed to negative response bias.

Adolescent↗