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1.  Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease 
Few studies have examined the neuropsychological sequelae associated with end-stage pulmonary disease. Neuropsychological data are presented for 47 patients with end-stage chronic obstructive pulmonary disease (COPD) who were being evaluated as potential candidates for lung transplantation. Although patients exhibited a diversity of neurocognitive deficits, their highest frequencies of impairment were found on the Selective Reminding Test (SRT). Specifically, over 50% of the patients completing the SRT exhibited impaired immediate free recall and consistent long-term retrieval deficits, while more than 44% of these individuals displayed deficient long-term retrieval. Deficient SRT long-term storage strategies, cued recall, and delayed recall were exhibited by between 26% and 35% of these patients, while more than 32% of this sample displayed elevated numbers of intrusion errors. Over 31% of the patients completing the Wisconsin Card Sorting Test (WCST) failed to achieve the expected number of categories on this measure, while more than 23% of these individuals demonstrated elevated numbers of perseverative errors and total errors. Clinically notable frequencies of impairment (greater than 20% of the sample) were also found on the Trail Making Test (TMT): Part B and the Wechsler Memory Scale-R (WMS-R) Visual Reproduction II subtest. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality assessments indicated that patients were experiencing a diversity of somatic complaints and that they may have been functioning at a reduced level of efficiency. These findings are discussed in light of patients’ end-stage COPD and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also included.
PMCID: PMC2714268  PMID: 14589783
Neuropsychological dysfunction; Chronic obstructive pulmonary disease; Lung transplantation
2.  The thyroid function of Graves' disease patients is aggravated by depressive personality during antithyroid drug treatment 
We previously reported that depressive personality (the scores of hypochondriasis, depression and psychasthenia determined by the Minnesota Multiphasic Personality Inventory (MMPI)) and daily hassles of Graves' disease (GD) patients treated long trem with antithyroid drug (ATD) were significantly higher in a relapsed group than in a remitted group, even in the euthyroid state. The present study aims to examine the relationship among depressive personality, emotional stresses, thyroid function and the prognosis of hyperthyroidism in newly diagnosed GD patients.
Sixty-four untreated GD patients responded to the MMPI for personality traits, the Natsume's Stress Inventory for major life events, and the Hayashi's Daily Life Stress Inventory for daily life stresses before and during ATD treatment.
In the untreated thyrotoxic state, depressive personality (T-scores of hypochondriasis, depression or psychasthenia greater than 60 points in MMPI) were found for 44 patients (69%). For 15 (23%) of these patients, the scores decreased to the normal range after treatment. However, depressive personality persisted after treatment in the remaining 29 patients (46%). Normal scores before treatment were found for 20 patients (31%), and the scores were persistently normal for 15 patients (23%). The remaining 5 patients (8%) had higher depressive personality after treatment. Such depressive personality was not associated with the severity of hyperthyroidism. Serum TSH receptor antibody activity at three years after treatment was significantly (p = 0.0351) greater in the depression group than in the non- depression group. The remission rate at four years after treatment was significantly (p = 0.0305) lower in the depression group than in the non- depression group (22% vs 52%).
The data indicate that in GD patients treated with ATD, depressive personality during treatment reflects the effect of emotional stress more than that of thyrotoxicosis and that it aggravates hyperthyroidism. Psychosomatic therapeutic approaches including antipsychiatric drugs and/or psychotherapy appears to be useful for improving the prognosis of hyperthyroidism.
PMCID: PMC3174109  PMID: 21827669
3.  The MMPI-2 in women with headache or facial pain. A comparative study 
The Journal of Headache and Pain  2000;1(2):105-110.
Our purpose was to apply the Minnesota Multiphasic Personality Inventory (MMPI-2) to groups of women with different types of headache and facial pain. 117 women with tension-type headache (TTH), migraine (M), facial pain disorder as somatoform disorder (FP), myogenous facial pain (MP), or temporomandibular joint disorder (TMJ) were given in the Italian version of the MMPI-2. The level of pain was assessed with the visual analogue scale (VAS). A configural analysis of the MMPI profiles was also performed. Data were analysed with one-way ANOVA, chi-square analysis and Pearson's correlation coefficient. FP and TH patients showed the highest scale elevation and TMJ patients the lowest. The TMJ group had the highest prevalence of “coper” configuration and the FP group the lowest. A correlation was found between VAS and MMPI-2 scores for hypochondria, hysteria and paranoia. We conclude that: chronic pain may alter the patient's personality characteristics; patients with facial pain disorder show the highest tendency to neurotism and psychoticism; and in patients with migraine, TTH and MP, the psychological component may vary conspiquously. These factors should be taken into account when selecting the treatment options.
PMCID: PMC3611779
Key words MMPI-2; Headache; Facial pain; Personality traits
4.  Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury 
We determined whether the relationship between the neuropsychological performance of patients with mild traumatic brain injury (TBI) and their psychopathological characteristics measured by disability evaluation are interrelated. In addition, we assessed which psychopathological variable was most influential on neuropsychological performance via statistical clustering of the same characteristics of mild TBI.
A total of 219 disability evaluation participants with mild brain injury were selected. All participants were classified into three groups, based on their psychopathological characteristics, via a two-step cluster analysis using validity and clinical scales from the Minnesota Multiphasic Personality Inventory (MMPI) and Symptom Checklist-90-revised (SCL-90-R). The Korean Wechsler Adult Intelligence Scale (K-WAIS), Korean Memory Assessment Scale (K-MAS) and the Korean Boston Naming Test (K-BNT) were used to evaluate the neurocognitive functions of mild TBI patients.
Over a quarter (26.9%) experienced severe psychopathological symptoms and 43.4% experienced mild or moderate psychopathological symptoms, and all of the mild TBI patients showed a significant relationship between neurocognitive functions and subjective and/or objective psychopathic symptoms, but the degree of this relationship was moderate. Variances of neurocognitive function were explained by neurotic and psychotic symptoms, but the role of these factors were different to each other and participants did not show intelligence and other cognitive domain decrement except for global memory abilities compared to the non-psychopathology group.
Certain patients with mild TBI showed psychopathological symptoms, but these were not directly related to cognitive decrement. Psychopathology and cognitive decrement are discrete aspects in patients with mild TBI. Furthermore, the neurotic symptoms of mild TBI patients made positive complements to decrements or impairments of neurocognitive functions, but the psychotic symptoms had a negative effect on neurocognitive functions.
PMCID: PMC3873351  PMID: 24379945
Disability evaluation; Mild traumatic brain injury; Neuropsychological performance; Post-concussion syndrome
5.  A Pessimistic Explanatory Style is Prognostic for Poor Lung Cancer Survival 
Several studies have demonstrated the importance of personality constructs on health behaviors and health status. Having a pessimistic outlook has been related to negative health behaviors and higher mortality. However, the construct has not been well explored in cancer populations.
Survival time of 534 adults, who were diagnosed with lung cancer and had a pessimistic explanatory style, was examined. The patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) approximately 18.2 years prior to receiving their lung cancer diagnosis. MMPI Optimism-Pessimism (PSM) scores were divided into high (60 or more) and low scores (less than 60), and log-rank tests and Kaplan-Meier curves were used to determine survival differences. Multivariate Cox models were used for assessing prognostic values of pessimism along with other known predictors for lung cancer survival outcome. Booting strapping of the survival models was used as a sensitivity analysis.
At the time of lung cancer diagnosis, patients were on average 67 years old; 48% were female; 85% had non-small cell lung cancer (NSCLC); 15% had small cell lung cancer (SCLC); 30% were stage I; 4% were stage II; 31% were stage III/limited; and 35% were stage IV/extensive. Patients who exhibited a non-pessimistic explanatory style survived approximately six months longer than patients classified as having a pessimistic explanatory style.
Among lung cancer patients, those having a pessimistic explanatory style experienced less favorable survival outcome, which may be related to cancer treatment decisions. Further research in this area is warranted.
PMCID: PMC2854019  PMID: 20139778
Explanatory Style; Optimism; Pessimism; Lung Cancer; MMPI; Survival
6.  In-patient, short-term group psychotherapy – a therapeutic option for Bundeswehr soldiers? 
Objective: This study is to assess the efficacy of short-term group psychotherapy rooted in depth psychology for Bundeswehr soldiers suffering from depressive, neurotic, stress, or personality disorders.
Method: 103 participants in the in-patient, closed group setting were evaluated prospectively and compared with a non-randomized waitlisted control group.
Results: In all relevant SCL-90-R (Symptom-Check-List-90) and MMPI-K (Minnesota-Multiphasic-Personality-Inventory short-form) scales therapy resulted in significant improvements as compared with the initial values. The control group did not show any significant changes, the therapy group was significantly superior to the control group in the scales of MMPI-K and the GSI-Scale of the SCL-90-R. For soldiers with a stress-reactive disorder (F43), no differences in efficacy could be identified compared with the other diagnosis groups.
Conclusion: The results were considered to indicate that in-patient, short-term group psychotherapy may, in combination with additional setting components, be helpful in improving psychological symptoms in German soldiers. The indication range of group therapy offered to Bundeswehr soldiers should be expanded to also include primary prophylaxis and the treatment of mental-health problems following deployments abroad, if applicable.
PMCID: PMC2736515  PMID: 19742280
Bundeswehr soldiers; short-term group psychotherapy; efficacy; stress-reactive disorders
7.  Novelty seeking and introversion do not predict the long-term risk of Parkinson disease 
Neurology  2010;75(4):349-357.
It has been suggested that people who develop Parkinson disease (PD) may have a characteristic premorbid personality. We tested this hypothesis using a large historical cohort study with long follow-up.
We conducted a historical cohort study in the region including the 120-mile radius centered in Rochester, MN. We recruited 7,216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 through 1965 and we considered 5 MMPI scales to measure sensation seeking, hypomania, positive emotionality, social introversion, and constraint. A total of 6,822 subjects (94.5% of the baseline sample) were followed over 4 decades either actively (via interview and examination) or passively (via medical records).
During follow-up, 227 subjects developed parkinsonism (156 developed PD). The 3 MMPI scales that we selected to measure the extroverted personality construct (sensation seeking, hypomania, and positive emotionality) did not show the expected pattern of higher scores associated with reduced risk of PD. Similarly, the 2 MMPI scales that we selected to measure the introverted personality construct (social introversion and constraint) did not show the expected pattern of higher scores associated with increased risk of PD. However, higher scores for constraint were associated with an increased risk of all types of parkinsonism pooled together (hazard ratio 1.39; 95% CI 1.06–1.84; p = 0.02).
We suggest that personality traits related to introversion and extroversion do not predict the risk of PD.
= confidence interval;
= hazard ratio;
= Minnesota Multiphasic Personality Inventory;
= MMPI Sensation Seeking Scale;
= Parkinson disease;
= Personality Psychopathology Five Scales.
PMCID: PMC2918889  PMID: 20660865
8.  Chronic daily headache: personality study by means of computerized MMPI-2 
The Journal of Headache and Pain  2000;1(Suppl 1):S67-S70.
Unresolved questions in headache research are the roles of drug abuse and psychopathology in headache disorder, especially in chronic daily headache. We investigated the utility of the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2) for assessing psychopathology in chronic daily headache patients. Chronic headache sufferers gave characteristic responses on Hy (hypochondria), D (depression) and Hs (hysteria) scales which are known as the “neurotic triad”. Although our data suggest that the MMPI profile types do not discriminate between different diagnosis groups and fail to determine whether psychopathological traits predispose to drug abuse, they nonetheless confirm the importance of psychological assessment as an essential step in the decision to seek medical help for headache.
PMCID: PMC3611794
Key words MMPI-2; Chronic daily headache; Personality inventory
9.  Relation between vascular risk factors and neuropsychological test performance among elderly persons with Alzheimer's disease 
Journal of the neurological sciences  2007;257(1-2):194-201.
Vascular risk factors increase the risk of Alzheimer's disease (AD). The mechanisms for these associations are unclear, and may be due to misdiagnosis of a vascular dementia syndrome as AD.
To examine differences in neuropsychological profile among persons diagnosed clinically with AD with and without vascular risk factors or stroke.
Community based cohort study. Individual and composite scores of neuropsychological tests at the time of clinical diagnosis of incident AD were compared among 243 persons with and without vascular risk factors or stroke.
Among subjects with incident AD, diabetes was associated with lower performance in Delayed Recall of the Selective Reminding Test (SRT), while persons diagnosed with hypertension scored lower in consistent long term recall (CLTR) of the SRT and current smokers scored lower in Category Fluency. None of the risk factors was associated with differences in composite scores in memory, abstract/visuospatial or language domain, nor was the number of risk factors per person. Persons with stroke had a higher delayed recall score at the time of AD diagnosis.
The presence of vascular risk factors among persons with clinically diagnosed AD was associated with subtle differences in neuropsychological profile at the time of diagnosis. This study needs to be replicated in samples with brain imaging, a comprehensive executive abilities battery, and pathological diagnosis of AD.
PMCID: PMC2725022  PMID: 17328914
Vascular risk factors; Stroke; Neuropsychological test performance
10.  Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors 
Psychiatry Investigation  2011;8(4):297-304.
This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder.
A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI).
1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R2=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R2=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (β=0.419) and BDI item 9 (β=0.600) appear to be risk factors in predicting MMPI-PTSD scores.
The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.
PMCID: PMC3246136  PMID: 22216038
North Korean defectors; Post-traumatic stress disorder; Suicide; Heart rate variability; Depression
11.  Evidence Against a Link Between Hyperemesis Gravidarum and Personality Characteristics from an Ethnically Diverse Sample of Pregnant Women: A Pilot Study 
Journal of Women's Health  2011;20(1):137-144.
Hyperemesis gravidarum (HG), a pregnancy-related condition marked by extreme nausea and vomiting, has been considered a psychosomatic illness associated with long-standing personality characteristics (e.g., hysteria). In this pilot study, we examined personality, somatic, and psychological variables with ethnically diverse samples of women with HG and women with typical levels of nausea and vomiting of pregnancy (NVP).
Personality (Minnesota Multiphasic Personality Index-2 [MMPI-2] and MMPI-2RF), somatic (MMPI-2RF), and psychological (Beck Depression Inventory-II [BDI-II] and NVP-related quality of life) variables collected during the first trimester of pregnancy were compared between 15 women with HG and 15 women with normal levels of NVP matched for age, education, marital status, insurance source, and race/ethnicity. A secondary analysis was performed comparing these variables among a group of 9 asymptomatic pregnant women to the HG and NVP groups.
No significant differences were found between the HG and NVP groups on any personality, somatic, or psychological variables. Both groups had clinically significant elevations on the MMPI-2 hypochondriasis scale, which incorporates somatic symptoms. The NVP group had a clinically significant elevation on the MMPI-2RF gastrointestinal complaints scale. Both groups had significantly higher means on the MMPI-2 and MMPI-2RF scales than the asymptomatic group. Predominantly Spanish speakers appeared particularly vulnerable to psychological distress associated with somatic complaints.
The results of this pilot study suggest that research with HG patients is feasible and that psychological distress expressed by women with HG and NVP may reflect reactions to somatic symptoms. No evidence was found to support an association between HG and personality characteristics. Recommendations for future research are provided, such as examining the potential benefits of translation services for Spanish-speaking HG patients.
PMCID: PMC3026647  PMID: 21194308
12.  Gastric accommodation in non-ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function 
Gut  1999;44(1):55-64.
Background—The pathophysiological mechanisms in non-ulcer dyspepsia are incompletely understood. 
Aims—To compare gastric motor and sensory functions in Helicobacter pylori positive or negative patients with non-ulcer dyspepsia. 
Patients—Seventeen patients with non-ulcer dyspepsia and 16 asymptomatic controls. 
Methods—The following were evaluated: gastrointestinal symptoms; gastric emptying and orocaecal transit of solids; abdominal vagal function; gastric compliance; fasting and postprandial gastric tone and phasic contractions; symptoms during ingestion of cold water and during the distension of an intragastric bag; and somatic sensitivity and personality profile (Minnesota Multiphasic Personality Inventory, MMPI). 
Results—Gastric accommodation was reduced in H pylori negative dyspeptics relative to controls; the degree of accommodation was unrelated to H pylori status in dyspeptics. Increased postprandial gastric sensation was more frequent among H pylori positive patients (4/5 H pylori positive versus 4/12 H pylori negative patients). Intragastric meal distribution and orocaecal transit were normal; gastric emptying at four hours was abnormal in 4/17 patients. Vagal dysfunction was rare. Eight of 17 patients had somatisation or depression on MMPI. 
Conclusion—Impaired gastric accommodation is frequent in non-ulcer dyspepsia and seems to be unrelated to vagal efferent dysfunction. H pylori infection does not seem to influence gastric accommodation, but is associated with heightened sensitivity in dyspeptics. Therapeutic approaches that restore normal postprandial accommodation and gastric sensitivity should be tested in non-ulcer dyspepsia. 

Keywords: non-ulcer dyspepsia; Helicobacter pylori; vagal function
PMCID: PMC1760076  PMID: 9862826
13.  Psychopathology and treatment outcome of drug dependent women in a perinatal program 
Addictive behaviors  2004;29(4):731-741.
One hundred and five drug-dependent women in outpatient perinatal addiction treatment were classified by cluster analysis of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles into high and low psychopathology (HP and LP) groups that differed on three validation measures. The HP group (n = 29, 27.6%) had elevations on MMPI-2 Scales F, 2, 4, 6, 7, and 8, while the LP group (n = 76, 72.4%) generated a normal range profile with elevations on Scales F and 4. Psychological outcomes differed by group. HP participants showed reduced alcohol, family, and psychiatric severity, and reduced depressive symptoms, while LP subjects showed reduced drug, self-debasing, and acting-out problems. Data suggest the need for lower intensity services for the majority of the perinatal drug dependent population with LP.
PMCID: PMC2868062  PMID: 15135555
14.  Psychopathological features of anorectic patients who dropped out of inpatient treatment as assessed by the Minnesota Multiphasic Personality Inventory 
Anorexia nervosa often requires inpatient treatment that includes psychotherapeutic intervention in addition to physical and nutritional management for severe low body weight. However, such patients sometimes terminate inpatient treatment prematurely because of resistance to treatment, poor motivation for treatment, unstable emotions, and problematic behaviors. In this study, the psychopathological factors related to the personality of anorexic patients that might predict discontinuation of inpatient treatment were investigated using the Minnesota Multiphasic Personality Inventory (MMPI).
Subjects were 75 consecutive anorectic inpatients who received cognitive behavioral therapy with a behavior protocol governing privileges in a university hospital based general (not psychiatric) ward. The MMPI was done on admission for all patients. A comparison was done of patients who completed the process of inpatient treatment, including attainment of target body weight (completers), and patients who dropped out of inpatient treatment (dropouts). Results: No significant differences between completers (n = 51) and dropouts (n = 24) were found in the type of eating disorder, age of onset, duration of illness, age, or BMI at admission. Logistic regression analysis found the MMPI scales schizophrenia (Sc), hypomania (HYP), deviant thinking and experience, and antisocial attitude to be factors predicting completion or dropout.
Dropouts have difficulty adapting to inpatient treatment protocols such as our behavior protocol governing privileges because they have social and emotional alienation, a lack of ego mastery (Sc), emotional instability (HYP) and an antisocial attitude. As a result, they have decreased motivation for treatment, leave the hospital without permission, attempt suicide, or shoplift, which leads them to terminate inpatient treatment prematurely. Treatments based on cognitive behavioral therapy with a behavior protocol governing privileges should be carefully adopted for anorectic patients who exhibit the psychopathological elements identified in this study.
PMCID: PMC1971270  PMID: 17651492
15.  Hemispheric asymmetries of affective processing as determined by the Minnesota Multiphasic Personality Inventory. 
Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.
PMCID: PMC493058  PMID: 660213
16.  Gender Identity and Gender Role in DSD Patients Raised as Females: A Preliminary Outcome Study 
Gender identity and gender role are expected to be consistent with gender assignment for optimal DSD management outcome. To our knowledge, our study is the first to attempt evaluation of gender related outcomes in Turkish DSD patients. After receiving institutional ethical board approval and subject (or parent) informed consent, subjects with DSD raised as girls (22 patients 46 XX DSD, 11 patients 46 XY DSD) answered 566 questions of the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire including 60-item Masculinity-Femininity (MF) subscale which was the focus in this study. Controls (n: 50) were females similar to the probands in age, level of education, relationship status, and having a job or not also answered all questions. The answers were evaluated by a trained psychologist (Derya Inceoglu) on MMPI. For statistical purposes, seven findings were obtained from the data related to the MF subscale from the patients and controls. Of these seven findings (S1–S7), two were associated with masculinity (S3–S4) and another two were associated with femininity (S5–S6). In DSD patients, the percentages of masculinity findings were significantly higher when compared to controls (p < 0.001 and p < 0.001 for S3 and S4, respectively). In controls, the percentages of femininity findings were significantly higher when compared to DSD females (p < 0.001 and p < 0.001 for S5 and S6 respectively). There was no significant difference between 46 XX DSD patients and 46 XY DSD patients with respect to the percentage of any of the seven findings. Two patients requested gender change to male; only these two patients had the finding stating that sexual impulses could come to existence as actions (S7). In conclusion efforts to identify modifiable factors with negative impact and thus modifying them, and professional guidance may be important in minimizing the encountered gender related problems in DSD patients.
PMCID: PMC3711069  PMID: 23874323
gender role in DSD; gender identity in DSD; outcome in DSD; females with DSD; psychosexual development in DSD
17.  DSM-IV-TR “pain disorder associated with psychological factors” as a nonhysterical form of somatization 
Elevated Minnesota Multiphasic Personality Inventory (MMPI) scores on the hysteria (Hy) scale are reported in several forms of pain. Previous results were possibly biased by diagnostic heterogeneity (psychogenic, somatic and mixed pain syndromes included in the same index sample) or Hy heterogeneity (failure to differentiate Hy scores into clinically meaningful sub-scales, such as admission of symptoms [Ad] and denial of symptoms [Dn]).
To overcome this drawback, 48 patients diagnosed as having a Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR) diagnosis of “pain disorder associated with psychological factors” were compared with 48 patients experiencing somatic pain excluding psychological factors, and 42 somatic controls without pain.
MMPI Hy and hypochondriasis (Hs) scores were significantly higher in the pain disorder group than in control groups, who scored similarly. MMPI correction (K) scores and Dn scores were similar in the three groups, whereas Ad was significantly higher in the pain disorder group and lower and similar in the two control groups, respectively. In the pain disorder group, Ad and Dn were negatively correlated, whereas in control groups they were unrelated.
These findings suggest that whereas a pattern of high Hs and Hy scores together with a normal K score might characterize patients with a pain disorder associated with psychological factors, elevated Hy scores per se do not indicate hysterical traits. In the pain disorder group, elevated Hy scores reflected the Ad subscale alone, indicating a strikingly high frequency of distressing somatic symptoms. They tend not to repress or deny the emotional malaise linked to symptoms, as the hysterical construct expects. The pain disorder designation should be considered a nonhysterical form of somatization.
PMCID: PMC2670805  PMID: 18301811
Chronic pain; Hysteria; Idiopathic pain; Psychogenesis; Psychogenic pain; Somatoform pain
18.  Associations of Preexisting Depression and Anxiety With Hospitalization in Patients With Cardiovascular Disease 
Mayo Clinic Proceedings  2011;86(11):1056-1062.
OBJECTIVE: To determine the risk of hospitalization and death in relation to preexisting depression and anxiety among patients with cardiovascular disease (CVD).
PATIENTS AND METHODS: The cohort consisted of 799 Olmsted County, MN, residents diagnosed with CVD (myocardial infarction or heart failure) from January 1, 1979, to December 31, 2009, who completed a Minnesota Multiphasic Personality Inventory (MMPI) prior to their event. The MMPI was used to identify depression and anxiety, and participants were followed up for hospitalizations and death during an average of 6.2 years.
RESULTS: Depression and anxiety were identified in 282 (35%) and 210 (26%) participants, respectively. After adjustment, depression and anxiety were independently associated with a 28% (95% confidence interval [CI], 8%-51%) and 26% (95% CI, 3%-53%) increased risk of being hospitalized, respectively. Depression also conferred an increased risk of all-cause mortality of similar magnitude, whereas the hazard ratio for anxiety was not statistically significant. The combined occurrence of depression and anxiety led to a 35% (95% CI, 8%-71%) increase in the risk of hospitalizations.
CONCLUSION: Among patients with CVD, both preexisting depression and anxiety, occurring on average 17 years before the CVD event, independently predict hospitalizations. In addition, the 2 conditions may act synergistically on increasing health care utilization in patients with CVD.
PMCID: PMC3202995  PMID: 22033250
19.  The MMPI Assistant: A Microcomputer Based Expert System to Assist in Interpreting MMPI Profiles 
The Assistant is an MS DOS program to aid clinical psychologists in interpreting the results of the Minnesota Multiphasic Personality Inventory (MMPI). Interpretive hypotheses are based on the professional literature and the author's experience. After scores are entered manually, the Assistant produces a hard copy which is intended for use by a psychologist knowledgeable about the MMPI. The rules for each hypothesis appear first on the monitor, and then in the printed output, followed by the patient's scores on the relevant scales, and narrative hypotheses for the scores. The data base includes hypotheses for 23 validity configurations, 45 two-point clinical codes, 10 high scoring single-point clinical scales, and 10 low scoring single-point clinical scales. The program can accelerate the production of test reports, while insuring that actuarial rules are not overlooked. It has been especially useful as a teaching tool with graduate students. The Assistant requires an IBM PC compatible with 128k available memory, DOS 2.x or higher, and a printer.
PMCID: PMC2245731
20.  The MMPI-2 Restructured Clinical Scales in the Assessment of Posttraumatic Stress Disorder and Comorbid Disorders 
Psychological assessment  2008;20(4):327-340.
This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared to that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties along with patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared to the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs.
PMCID: PMC2605647  PMID: 19086756
Minnesota Multiphasic Personality Inventory-2; Restructured Clinical Scales; posttraumatic stress disorder; internalizing; externalizing
21.  Recording of dissimulation and denial in the context of the psychosomatic evaluation at living kidney transplantation using the Minnesota Multiphasic Personality Inventory (MMPI) 
Objective: Living organ donation involves interference with a healthy organism. Therefore, most transplantation centres ascertain the voluntariness of the donation as well as its motivation by means of a psychosomatic evaluation. The circumstance that the evaluation is compulsory and not a primary concern of the donor-recipient pair may occasion respondents to present only what they consider innocuous and socially adequate. Thus, the information value of the results can be considerably affected.
Methods: In the context of a psychosomatic evaluation prior to living kidney transplantation, 71 donor-recipient pairs were screened at the transplantation centre of Friedrich Schiller University, Jena. Using the validity scales of the Minnesota Multiphasic Personality Inventory (MMPI) (“infrequency” (F), “lie” (L) and “correction-scales” (K)) and the Dissimulation Index according to Gough (“F-K”), we tried to find traits of dissimulation and denial.
Results: About 50% of the participants showed an infrequency raw score of zero. This means that at least half of the sample is apprehensive which may cause a cautious and controlled attitude towards the examination. The K-value (T≥59) and the Dissimulation Index (F-K≤–15) indicated dissimulation in 29% and 26% of the overall sample. Moreover, it affects the score of 11 respondents (8%) so profoundly that any significance regarding the personality traits is lost.
Conclusion: In the setup of the examination situation as well as in the interpretation of test-psychological findings, the occurrence and possible influence of dissimulation should be considered. The validity scale of the MMPI can help to obtain an objective clinical impression of dissimulation in problem cases.
PMCID: PMC2775195  PMID: 19911073
validity scales; dissimulation; denial; psychosomatic evaluation; living-kidney transplantation; Minnesota Multiphasic Personality Inventory (MMPI); response set
22.  Comparison of Memory Function and MMPI-2 Profile between Post-traumatic Stress Disorder and Adjustment Disorder after a Traffic Accident 
Differential diagnosis between post-traumatic stress disorder (PTSD) and adjustment disorder (AD) is rather difficult, but very important to the assignment of appropriate treatment and prognosis. This study investigated methods to differentiate PTSD and AD.
Twenty-five people with PTSD and 24 people with AD were recruited. Memory tests, the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and Beck's Depression Inventory were administered.
There were significant decreases in immediate verbal recall and delayed verbal recognition in the participants with PTSD. The reduced memory functions of participants with PTSD were significantly influenced by depressive symptoms. Hypochondriasis, hysteria, psychopathic deviate, paranoia, schizophrenia, post-traumatic stress disorder scale of MMPI-2 classified significantly PTSD and AD group.
Our results suggest that verbal memory assessments and the MMPI-2 could be useful for discriminating between PTSD and AD.
PMCID: PMC4022765  PMID: 24851120
Diagnosis, Differential; Post-traumatic stress disorders; Adjustment disorders; Memory deficits; MMPI-2
23.  Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center 
Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache.
An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse.
Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%).
In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73).
Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p < .0001), Hypomania (p = .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse.
The so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.
PMCID: PMC3620450  PMID: 23566048
Chronic daily headache; Medication overuse headache; Psychiatric comorbidity; MMPI-2
24.  Examination of categorical approach to symptom assessment: cross-validation of foulds’ Delusions-Symptoms-States Inventory with Korean non-patient and patient groups 
BMC Psychiatry  2013;13:251.
Foulds’ Delusions-Symptoms-State Inventory (DSSI) has been purported to be a reliable, systematic categorical measure to assess the patients with schizophrenia according to the degree of illness. However, further cross-validations using other clinical measures and diverse samples from other cultures have not been advanced recently. We aimed to examine the validity of the DSSI hierarchical class model using both Korean non-patient and patient (schizophrenia and depression) groups.
The hypothesis of inclusive, non-reflexive relationships among the DSSI classes was tested. The power of DSSI to detect presence of symptoms was assessed via cross-validation with other clinical measures, and the differences between the clinical features among the DSSI classes were examined using the Minnesota Multiphasic Personality Inventory (MMPI).
The high rate of model conformity (91.1%) across the samples and cross-validation with other criterion measures provided further support for the validity of DSSI.
DSSI is a reliable self-report measure that can be applied to both patient and non-patients to assess the presence and severity of psychiatric illness. Future studies that include more diverse clinical groups are necessary to lend further support for its utility in clinical practice.
PMCID: PMC3816604  PMID: 24103322
Schizophrenia; Self-report measure; Cross-validation; Delusion; Diagnose; Cluster analysis; Hierarchical class model; Power
25.  Preoperative psychological adjustment and surgical outcome are determinants of psychosocial status after anterior temporal lobectomy. 
This investigation evaluated the role of preoperative psychological adjustment, degree of postoperative seizure reduction, and other relevant variables (age, education, IQ, age at onset of epilepsy, laterality of resection) in determining emotional/psychosocial outcome following anterior temporal lobectomy. Ninety seven patients with complex partial seizures of temporal lobe origin were administered the Minnesota Multiphasic Personality Inventory (MMPI), Washington Psychosocial Seizure Inventory (WPSI), and the General Health Questionnaire (GHQ) both before and six to eight months after anterior temporal lobectomy. The data were subjected to a nonparametric rank sum technique (O'Brien's procedure) which combined the test scores to form a single outcome index (TOTAL PSYCHOSOCIAL OUTCOME) that was analysed by multiple regression procedures. Results indicated that the most powerful predictors of patients' overall postoperative psychosocial outcome were: 1) The adequacy of their preoperative psychosocial adjustment, and 2) A totally seizure-free outcome. Additional analyses were carried out separately on the MMPI, WPSI, and GHQ to determine whether findings varied as a function of the specific outcome measure. These results were related to the larger literature concerned with the psychological outcome of anterior temporal lobectomy.
PMCID: PMC1014907  PMID: 1619418

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