Adapting assessment processes to consider cultural mistrust in forensic practices: An example with the MMPI instruments.

Objective: Our first goal in this study was to identify cultural mistrust critical items (CMCIs) on two versions of the Minnesota Multiphasic Personality Inventory (MMPI)-the MMPI-Second Edition-Restructured Form (MMPI-2-RF) and MMPI-Third Edition (MMPI-3)-that might be endorsed by people of color because of cultural mistrust rather than clinical paranoia. Our second goal was to determine whether CMCIs and items on the MMPI-2-RF/MMPI-3 Ideas of Persecution scale (Restructured Clinical Scale 6 [RC6]) were endorsed at different rates across cultural groups in a nonclinical college sample and a forensic inpatient sample.

Hypotheses: Our primary hypothesis was that expert raters would reliably identify a subset of MMPI-2-RF and MMPI-3 items as reflective of cultural mistrust.

Are TOPF and WRAT WR Interchangeable Measures among Psychiatric Inpatients?

Objective: To examine whether Test of Premorbid Functioning (TOPF) and Wide Range Achievement Test-Word Reading subtest (WRAT WR) are interchangeable measures, and the relationship between these measures and intelligence, among patients with schizophrenia.

Method: In this archival study, the authors examined neuropsychology referrals of an inpatient forensic state hospital. Patients with a schizophrenia spectrum disorder (SSD) who received the Wechsler Adult Intelligence Scale-Fourth Edition or the Wechsler Abbreviated Scale of Intelligence-Second Edition and either TOPF or WRAT WR were considered for inclusion.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting.

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS.

The association between clinicians' initial judgments of feigning and outcomes on symptom validity measures among pretrial forensic psychiatric inpatients.

Research suggests the use of validated symptom validity tests to detect feigning is imperative to increase accuracy over unaided clinical judgment, especially in forensic settings. This study examined performance on the Miller Forensic Assessment of Symptoms (M-FAST) and Structured Interview of Reported Symptoms (SIRS) during 297 assessments of forensic inpatients. The risk of being identified as feigning on the M-FAST or SIRS was similar for those who were referred for evaluation of feigning compared to those who were not, but individuals with malingering designations prior to the evaluation scored significantly higher than those without on the M-FAST and several SIRS subscales.

Specificity and item endorsement rates of personality assessment inventory over-reporting scales across ethnic, gender, and diagnostic groups in a forensic inpatient sample.

The accurate evaluation of response style, particularly with respect to overreporting, is imperative in forensic settings wherein an external incentive to feign exists. Given the high cost of false positive errors in this context, as well as the associated cost of false negative errors, evaluators need to ensure that overreporting methods are effective with the unique patient populations with whom they work. Complicating this issue is that forensic samples often differ in predictable ways from the normative samples upon which typical psychological assessment instruments were normed.

Association between MMPI-2-RF SUB items/scale and interview-reported substance abuse history among forensic psychiatric inpatients.

The purpose of this study was to examine associations between substance use disclosure during the clinical interview and on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Substance Abuse Scale (SUB) among forensic inpatients. Of the 223 archival reports reviewed that had MMPI-2-RF data, 69% of the MMPI-2-RF protocols were valid based on standard validity criteria, resulting in a final sample of 154 patients (98 men, 56 women). We found that patients who endorsed alcohol or marijuana use during the clinical interview often concurrently denied substance use on the MMPI-2-RF SUB scale (the opposite was found for prescription drug abuse).

Reasonable Accommodations for Meeting the Unique Needs of Defendants with Intellectual Disability.

The Americans with Disabilities Act has allowed for greater participation of individuals with disabilities across a variety of contexts, most notably in employment settings. Individuals with intellectual disability (ID) are still precluded, however, from full participation in other contexts, and they are often relegated to the forensic arena without sufficient support, including after being adjudicated incompetent to stand trial (IST). Frequently, individuals who are adjudicated IST due to ID are committed to inpatient psychiatric hospitals that are unable to meet their unique needs.

Examining false-positive rates of Wechsler Adult Intelligence Scale (WAIS-IV) processing speed-based embedded validity indicators among individuals with schizophrenia spectrum disorders.

Recent research (Erdodi et al., 2017) indicated that certain Wechsler Adult Intelligence Scale (WAIS-IV) Processing Speed Index (PSI)-based indices may have some utility as embedded validity indicators (EVIs) among a diagnostically diverse sample of neuropsychology referrals. Individuals with schizophrenia spectrum disorders (SSD) are often evaluated in forensic contexts in which there is incentive to exaggerate deficits.

The Role of Dimensional Personality Psychopathology in a Forensic Inpatient Psychiatric Setting.

The Minnesota Multiphasic Personality Inventory-2 Restructured Form is a widely used measure of psychopathology and includes the Personality Psychopathology Five (PSY-5) scales, which measure dimensional maladaptive personality traits similar to those in the DSM-5 alternative model for personality disorder (PD) diagnosis. The current study evaluated the role of these dimensional personality psychopathology characteristics in a sample of 1,110 inpatients in a forensic psychiatric setting, where personality psychopathology plays a significant but understudied role. The authors examined the extent to which dimensional personality psychopathology characteristics (as measured by the PSY-5) were associated with borderline and antisocial PD diagnoses and institutional aggression.

The MacArthur Competence Assessment Tool-Criminal Adjudication: Factor structure, interrater reliability, and association with clinician opinion of competence in a forensic inpatient sample.

Adjudicative competence is the most frequently referred evaluation in the forensic context, and it is because of this that periodic evaluation of competence assessment instruments is imperative. Among those instruments, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) has demonstrated adequate psychometric properties suggesting its utility in informing the forensic inquiry. The purpose of the current study was to further investigate the psychometric properties and ultimate utility of subscale scores using archival data from a sample of 103 male and female forensic patients who were hospitalized for competence restoration treatment.

Mapping the MMPI-2-RF Substantive Scales Onto Internalizing, Externalizing, and Thought Dysfunction Dimensions in a Forensic Inpatient Setting.

Contemporary models of psychopathology-encompassing internalizing, externalizing, and thought dysfunction factors-have gained significant support. Although research indicates the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 /2011) measures these domains of psychopathology, this study addresses extant limitations in MMPI-2-RF diagnostic validity research by examining associations between all MMPI-2-RF substantive scales and broad dichotomous indicators of internalizing, externalizing, and thought dysfunction diagnoses in a sample of 1,110 forensic inpatients. Comparing those with and without internalizing diagnoses, notable effects were observed for Negative Emotionality/Neuroticism-Revised (NEGE-r), Emotional/Internalizing Dysfunction (EID), Dysfunctional Negative Emotions (RC7), Demoralization (RCd), and several other internalizing and somatic/cognitive scales.

Introduction of a conceptual model for integrating the MMPI-2-RF into HCR-20V3 violence risk assessments and associations between the MMPI-2-RF and institutional violence.

Reflecting the need to prevent violence, structured professional judgment assessment tools have been developed specifically to assess the likelihood of future violence. These tools typically integrate data from clinical interviews and collateral records to assist in the conceptualization of violence risk, but objective psychological testing may also be useful in completing the instruments. The authors describe the advantages of using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in this manner with the Historical Clinical Management-20 Version 3 (HCR-20).

Evaluating item endorsement rates for the MMPI-2-RF F-r and Fp-r scales across ethnic, gender, and diagnostic groups with a forensic inpatient sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) (Infrequency-Psychopathology) scale was developed to measure overreporting in a manner that was minimally confounded by genuine psychopathology, which was a problem with using the MMPI-2 F (Infrequency) scale among patients with severe mental illness. Although revised versions of both of these scales are included on the MMPI-2-Restructured Form and used in a forensic context, no item-level research has been conducted on their sensitivity to genuine psychopathology among forensic psychiatric inpatients. Therefore, we examined the psychometric properties of the scales in a sample of 438 criminally committed forensic psychiatric inpatients who were adjudicated as not guilty by reason of insanity and had no known incentive to overreport.

Differences between Structured Interview of Reported Symptoms (SIRS) and SIRS-2 sensitivity estimates among forensic inpatients: A criterion groups comparison.

The Structured Interview of Reported Symptoms (SIRS) underwent a major revision in 2010 yielding the SIRS-2. The new test has since been criticized for several potential problems, particularly in terms of its sensitivity to feigned psychopathology. For this reason, the purpose of this study was to examine the concordance between SIRS and SIRS-2 classifications and sensitivity estimates in an archival sample of 263 criminal defendants (215 males, 48 females) who were admitted to a high-security state psychiatric hospital for restoration of competency to stand trial.

Likelihood of obtaining Structured Interview of Reported Symptoms (SIRS) and SIRS-2 elevations among forensic psychiatric inpatients with screening elevations on the Miller Forensic Assessment of Symptoms Test.

The Miller Forensic Assessment of Symptoms Test (M-FAST) was designed as a screening measure for feigned psychiatric symptoms. When M-FAST Total Scores are elevated (raw score ≥6), the test manual recommends follow-up with a more comprehensive measure of feigning, such as the widely used and researched Structured Interview of Reported Symptoms (SIRS) or the revised version of the test (SIRS-2). The purpose of the current study was to evaluate how often M-FAST screening elevations are associated with subsequent elevations on the SIRS or SIRS-2.

Derivation and Cross-Validation of Cutoff Scores for Patients With Schizophrenia Spectrum Disorders on WAIS-IV Digit Span-Based Performance Validity Measures.

Two studies were conducted to identify and cross-validate cutoff scores on the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span-based embedded performance validity (PV) measures for individuals with schizophrenia spectrum disorders. In Study 1, normative scores were identified on Digit Span-embedded PV measures among a sample of patients (n = 84) with schizophrenia spectrum diagnoses who had no known incentive to perform poorly and who put forth valid effort on external PV tests. Previously identified cutoff scores resulted in unacceptable false positive rates and lower cutoff scores were adopted to maintain specificity levels ≥90%.

Specificity and false positive rates of the Test of Memory Malingering, Rey 15-item Test, and Rey Word Recognition Test among forensic inpatients with intellectual disabilities.

This study evaluated the specificity and false positive (FP) rates of the Rey 15-Item Test (FIT), Word Recognition Test (WRT), and Test of Memory Malingering (TOMM) in a sample of 21 forensic inpatients with mild intellectual disability (ID). The FIT demonstrated an FP rate of 23.8% with the standard quantitative cutoff score.

Evaluating the latent structure of the MMPI-2 F(p) scale in a forensic sample: a taxometric analysis.

P. A. Arbisi and Y.

Sensitivity and specificity of MMPI-2 neurologic correction factors: receiver operating characteristic analysis.

A number of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items have been hypothesized to reflect neurologic symptomatology, rather than psychopathology, among closed-head-injury (CHI) patients. Some investigators have proposed a correction factor interpretive approach, which involves the deletion of such items from the MMPI-2 profile, as a method of reducing the probability of artificial clinical scale elevations due to the symptoms of CHI. The present study employed receiver operating characteristic (ROC) analysis to evaluate the sensitivity and specificity of three correction factors.

Using the WMS-III faces subtest to detect malingered memory impairment.

The current study evaluated the utility of the WMS-III Faces I subtest (Faces) for the assessment of malingering. Thirty nonlitigating traumatic brain injury patients and 30 control participants were administered Faces under standard administration and instructed malingering conditions. Although the two groups obtained similar scores when taking the test under standard instructions, both groups produced significantly lower performances when instructed to malinger, indicating that Faces is sensitive to malingering, but less sensitive to traumatic brain injury.