Diagnostic Group Membership Research Articles

The Pattern of Neuropsychological Deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND)

We examined the pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND) by comparing the cognitive and behavioral performance of 41 post-stroke Vascular CIND patients to that of 62 post-stroke patients with no cognitive impairment (NCI). Neuropsychological test scores were grouped into seven cognitive and four behavioral domains, then converted to standardized, weighted principle component scores (PCS) for each domain. Multivariate logistic regression models built on cognitive domains found the immediate recall and psychomotor domains to best predict diagnostic group membership. In a separate model limited to behavioral data, the depressed mood domain best predicted group membership. The combination of immediate memory deficits, psychomotor slowness and depression have also been found in Vascular Dementia (VaD), suggesting that the pattern of deficits in Vascular CIND and VaD neuropsychological deficits are similar. This cognitive and behavioral pattern similarity supports the hypothesis that Vascular CIND lies on a continuum between NCI and VaD.

Recovery in first episode schizophrenia

The early course of first-episode mania with psychotic features (FEMP) is under-studied. Accumulating evidence suggests that FEMP is associated with substantial functional impairment. Very few studies were conducted to directly compare clinical and functional outcomes between FEMP and first-episode schizophrenia (FES).Four-hundred-twenty patients aged 15–25 years who presented with FEMP or FES to a territory-wide early intervention service in Hong Kong from July 2001 to August 2003 and completed 3-year follow-up were studied. Baseline and follow-up variables were collected via systematic medial file review. Functional remission was operationalized as attaining sustained employment, and Social and Occupational Functioning Assessment Scale (SOFAS) score >60 in the last 12 months of follow-up.At baseline, FEMP patients were younger, more likely to be hospitalized, had shorter duration of untreated psychosis, more severe positive symptoms and lower SOFAS score than FES patients. By the end of 3-year follow-up, FEMP patients had significantly milder positive symptom severity, higher SOFAS score, and higher rates of sustained employment (45.7%) and functional remission (36.9%) than FES patients. Regression analyses showed that diagnostic group membership of FEMP (vs. FES) independently predicted better clinical and functional outcomes.Our results indicate that FEMP patients had better clinical and functional outcomes than FES patients in the initial 3 years of treatment. Yet, only approximately 37% of FEMP patients attained functional remission at 3 years. This underscores the need to develop specialized early intervention for FEMP populations to promote functional recovery in the early stage of illness.

Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release

Recently, we developed a validated computer program based on polychotomous logistic regression analysis using bronchoalveolar lavage fluid (BALF) results to distinguish between the three most common interstitial lung diseases (ILD): sarcoidosis, idiopathic pulmonary fibrosis (IPF) and extrinsic allergic alveolitis (EAA) or drug-induced pneumonitis. One of the limitations of this program was that it was not useful in discriminating between infectious disorders and non-infectious disorders. Therefore, we added BALF samples obtained from patients with a confirmed bacterial pulmonary infection based on culture results ⩾104cfuml−1(group I: n=31) to the study population mentioned above (group II:n =272). Notably, just one variable, i.e. the percentage of polymorphonuclear neutrophils, allowed us to distinguish between infectious and non-infectious disorders. The agreement of predicted with the actual diagnostic group membership was 99·67% (groups I and II). Additionally, 91·2% of the cases with ILD were correctly classified. In conclusion, this updated Windows version 2000 of the validated computer program provides a very reliable prediction of the correct diagnosis for an arbitrary patient with suspected pneumonia or with ILD given information obtained from BALF analysis results, and is thought to improve the diagnostic power of BALF analysis.

Electrophysiological evidence for reduced latent inhibition in schizophrenic patients

The present study examined latent inhibition (LI) effects in 17 acute and 16 partially remitted schizophrenic patients, and in 20 healthy controls, by measuring manual response latencies and event-related potentials (ERPs) during an association learning task. ERPs were recorded to elucidate the role of attention in the LI effect. Subjects performed a go/no-go task with an auditory conditional stimulus predicting a visual go command. Half of the subjects in each diagnostic group were pre-exposed to the conditional stimulus which had been used as an irrelevant distractor in a preceding discrimination task. Independent of diagnostic group membership, pre-exposed subjects showed slower manual responses to go stimuli than non-pre-exposed subjects, reflecting a robust LI effect. The N100 wave after the conditional stimuli, however, showed a differential pattern: pre-exposure increased N100 amplitudes in acute schizophrenics, whereas pre-exposed control subjects showed a trend for decreased N100. The amplitude of the contingent negative variation (CNV) was unaffected by pre-exposure. The ERP results suggest that acute schizophrenics have a deficit in learned inattention to irrelevant stimuli. However, the intact LI effect in schizophrenics at the motor speed level shows that human LI is a complex phenomenon depending on the tasks and measures used.

Trajectories of adaptation in pediatric chronic illness: the importance of the individual.

This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.

A review of neuropsychological differences between paranoid and nonparanoid schizophrenia patients.

This review examines the literature on neuropsychological differences between paranoid and nonparanoid schizophrenia subjects. Thirty-two studies related to intellectual functioning, attention, memory, language, visual-spatial, and motor functions are discussed. Subjects with paranoid schizophrenia did not demonstrate higher intellectual functioning than those with nonparanoid schizophrenia, and both groups performed similarly on tests of verbal ability and visual-spatial functions. Several studies suggest that the paranoid subtype is associated with higher performance on tests of executive functions, attention, memory, and motor skills. However, the findings are inconsistent. Methodological issues in the literature are examined, including varying degrees of participants' chronicity and severity of illness among studies, criteria for diagnostic group membership, medication effects, reliability and validity of the neuropsychological measures, and statistical power.

Discriminant Validity of the MMPI Depression Subtle (D-S) and Depression Obvious (D-O) Scales

This study examined the relationship between diagnostic group membership (i.e., life-time depressed, n = 367; lifetime mixed psychiatric, n = 367; and nonpsychiatric, n = 367) and scores on the Wiener-Harmon Subtle-Obvious scales (Depression Subtle, D-S, and Depression Obvious, D-O) for the Depression ( D) scale of the Minnesota Multiphasic Personality Inventory (MMPI). Additionally, the impact of current versus past depressive symptomatology on D-S and D-O scores was examined. As expected, D-O scores were significantly related to diagnostic group membership, with higher mean scores found in the depressed groups. However, D-S scores were either unrelated or inversely related to the presence or history of depression. The results are discussed in the context of current empirical literature and clinical practice.

Callosal Transfer of Finger Localization Information in Phonologically Dyslexic Adults

Dyslexia, particularly phonological dyslexia, has been hypothesized to be associated with deficits in interhemispheric interactions mediated by the corpus callosum. Twenty-one dyslexic subjects were compared to 21 controls on the Finger Localization Test in order to observe patterns of tactile-motor integration and interhemispheric collaboration. When compared to control subjects, dyslexics showed consistent deficits in finger localization, particularly when more complex trials had to be completed. When subjects were re-grouped according to phonological processing ability (regardless of diagnostic group membership), subjects with lower phonological processing scores were found to perform poorly on complex trials of finger localization, particularly on those trials which reflect callosal transfer of finger localization information from one hemisphere (hand) to the other. These results suggest that interhemispheric transfer of information is critical to efficient phonological processing.

(Hu)man versus mean revisited: MMPI group data and psychiatric diagnosis.

A meta-analysis of Minnesota Multiphasic Personality Inventory (MMPI) data from 403 control and psychiatric samples was used to (a) examine demographics associated with previously published MMPI studies, (b) test Goldberg's (1972) indexes for predicting normal versus deviant and neurotic versus psychotic group membership, (c) compare multiple regression, discriminant function, and logistic regression analyses commonly used to study the relation between the MMPI and diagnostic group membership, and (d) examine the signal within the MMPI as it relates to current psychiatric diagnosis. Group data were found to be efficient indicators of the relation between the MMPI and diagnosis, although efficiency is compromised by within-sample heterogeneity. The 3 statistical methods examined obtained equivalent results. Regression models related to group prediction are presented.

The McGilI‐Melzack Pain Questionnaire in the Diagnosis of Headache

The McGill-Melzack Pain Questionnaire (MMPQ), comprised primarily of adjectives descriptive of pain, was administered to 100 patients seeking treatment for headache. Diagnostic classification of patients into migraine or muscle contraction headache groups was conducted by a screening neurologist using information other than pain description. Reliability determinations were made following independent diagnosis by two other neurologists using a headache pain history and symptom form (HPHSF) devoid of pain adjectives. Comparison of 30 subjects HPHSF's revealed that the screening neurologist's diagnosis and that of two other neurologists, (tau = .87, rho < .01) and (tau = .48, rho < .05), indicate high agreement between three physicians in headache diagnosis devoid of pain description. Results show that migraine headache patients report significantly more affective words (t 99 = 3.89, rho < .001) than do muscle contraction headache sufferers; however, no significant differences existed between the groups' use of sensory or evaluative works. Migraine sufferers, while not reporting their headache as more severe "generally," did report more intense pain when recalling headache at its "worst" (t99 = 2.69, rho < .01) and at its "least" (t99 = 1.74, rho < .05) compared to the muscle contraction headache 'group. Discriminant analyses were conducted on one-half of the sample to determine diagnostic group membership on the basis of pain description alone. Findings revealed that group membership could be predicted at a 90% rate (chi2 145 = 33.06, rho < .001). A cross validation on the second half of the sample confirmed these findings (chi2 1.48 = 13.08, rho < .05) suggesting that the MMPQ is of value in headache diagnosis. Differences between electromyographic studies and headache pain report are discussed as well as suggestions concerning modification of the MMPQ for headache assessment.

Utilization of the Goldberg MMPI profile classification rules for the assessment of psychopathology in different clinical populations.

MMPI profiles of 545 psychiatric inpatients and 560 incarcerated offenders were separated sequentially into normal, sociopathic, neurotic and psychotic groups by means of Goldberg's profile classification rules. Patient-prisoner differences in both rates of classification and profile patterns of groups within diagnostic categories were assessed quantitatively, and profiles were interpreted by use of standard MMPI codebooks. For the hospitalized Ss comparisons also were made between clinical diagnoses and Goldberg-MMPI classifications. The resulting differences in classification rates, similarities of profiles within diagnostic categories, correspondence between obtained and codebook-expected profiles, and agreement between clinical and Goldberg-MMPI classifications were not such that this approach could be used with confidence as a basis for establishing diagnostic group membership. Although Goldberg's system appears to represent certain improvements over previous criterion-related methods of profile classification, it was concluded that its value nonetheless is limited by the assumption of an invariant relationship between test patterns and nontest variables.