This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.

The purpose of this study was to determine if attention-deficit/hyperactivity disorder (ADHD) subtypes (predominantly hyperactive/impulsive, ADHD-HI; predominantly inattentive, ADHD-IA; combined, ADHD-C) exhibit distinct neuropsychological profiles, using the Attention and Executive Function subtests of the Developmental Neuropsychological Assessment, (NEPSY) and the omission and commission scores obtained on the Conners' Continuous Performance Test-II (CPT-II), a test that assesses attention processes. The sample was selected using archival data collected in a neurodevelopmental clinic over the past decade and consisted of 138 children between the ages of 6 and 12 years old. Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) criteria, the children were placed in either the ADHD-HI (n = 40), ADHD-IA (n = 35), or ADHD-C (n = 36) group, or a symptom free comparison group (n = 27). It was hypothesized that children with elevations on the impulsivity/ hyperactivity (ADHD-HI and ADHD-C) scale would be impaired on measures of inhibition and those with elevations on the inattention scale (ADHD-IA and ADHD-C) would be impaired on tests of attention, vigilance, and other executive functions. A one-way multivariate analyses of variance (MANOVA) was conducted (Group X Task), with significant results for overall main effect for group on the 7 …

Individuals undergoing forensic neuropsychological evaluation frequently stand to gain in some manner if neurocognitive dysfunction is diagnosed. As a result, neuropsychologists are customarily asked to test for neurocognitive feigning during the assessment. The current study employed an analogue design with a clinical comparison group to examine the utility of the TOCA (Rogers, 1996) as a measure of feigned neurocognitive impairment. Two groups of simulators (one cautioned about the presence of detection strategies and one not cautioned) were compared to clinical and normal control groups. Fourteen scales were developed based on five detection strategies: symptom validity testing, performance curve, magnitude of error, response time, and floor effect. Each was employed during both verbal and nonverbal tasks. Significant differences were revealed among groups when subjected to ANOVA. Classification rates from subsequent utility estimates and discriminant function analyses on the scales ranged from 58.8% to 100%. Combining strategies yielded a classification rate of 95.7%. The effect of cautioning simulators was modest; however, a trend was noted on some scales for cautioned simulators to appear less obviously impaired than noncautioned. Although the results require crossvalidation, preliminary data suggest that the TOCA is a sensitive and specific measure of feigned neurocognitive performance. Strengths and weaknesses …

The current study utilized structural equation modeling (SEM) to examine the factor-to-factor relations and temporal associations between disturbances in negative affect (NA) and positive symptoms of psychosis (PP). Data were drawn from a large, public-domain data set (MacArthur Violence Risk Assessment Study). A dimensional approach was used to conceptualize and identify latent variables of NA (depression, anxiety, and guilt) and PP (hallucinations, delusions, and thought disorder) among individuals with a diagnosis of primary psychotic disorder. Results showed that anxiety, guilt, and depressed mood modeled an NA latent variable, and that hallucinations and unusual thought content modeled a PP latent variable. As predicted, results revealed strong, significant cross-sectional (synchronous) associations between NA and PP at each measured time-frame, suggesting that NA and PP occurred concurrently within the sample. Contrary to predictions, no significant cross-lagged effect between NA and PP was identified (10 weeks and 20 weeks respectively).

In 1824 a young Virginia aristocrat named Richard Thompson Archer migrated to Mississippi. Joining in the boom years of expansion in the Magnolia State in the 1830s, Archer built a vast cotton empire. He and his wife, Ann Barnes, raised a large family at Anchuca, their home plantation in Claiborne County, Mississippi. From there Richard Archer ruled a domain that included more than 500 slaves and 13,000 acres of land. On the eve of the Civil War he was one of the wealthiest men in the South. This work examines the life of Richard Archer from his origins in Amelia County, Virginia, to his death in Mississippi in 1867. It takes as its thesis the theme of Archer's life: his burdens as proprietor of a vast cotton empire and as father figure and provider for a large extended family. This theme weaves together the strands of Archer's life, including his rise to the position of great planter, his duties as husband and father, and his political beliefs and activities. Archer's story is told against the background of the history of Mississippi and of the South, from their antebellum heyday, through the Civil War, and into the early years of Reconstruction. …

Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.

Diabetes is a disease with a deleterious pathology that currently impacts 4.5 million individuals within the United States. This study examined the ability of a specific neuropsychological battery to identify and classify dementia type, investigated the impact of diabetes on cognition and analyzed the ability of the memory measures of the 7 Minute Screen (7MS) and the Rey-Osterrieth Recall to correctly categorize dementia type when not used in combination with a full battery. The battery in addition to exhaustive patient history, medical chart review and pertinent tests were used in initial diagnosis. Results indicated the battery was sufficient in the identification and classification of dementia type. Within the sample, diabetes did not appear to significantly impact overall battery results whereby only two measures were minimally affected by diabetes. Finally, the memory measures of the 7MS and the Rey-Osterrieth Recall were sufficient to predict membership into the Alzheimer's (AD) and vascular dementia (VD) groups with 86.4% accuracy. The classification percentage dropped to 68.3% with addition of the mild cognitive impairment category. The full battery correctly classified AD and VD dementia 87.5% and appeared to be the most robust.

Intimate partner violence is endemic in the United States. According to the American Medical Association (1992), one-fifth to one-third of women will sustain violence from a partner or ex-partner in their lifetime. The relevant literature was organized by ICD-9-CM categories. This study examined the health consequences of partner abuse in a sample of community women using a sample consisting of 564 women in three ethnic groups. Because prior research has failed to account for variations by type of abuse on health consequences, this study assessed psychological abuse, violence and sexual aggression by women's partners. To determine whether or not different types of abuse had an effect on women's health, hierarchical regression analyses were conducted. The regression equations were calculated for women within each ethnic group to facilitate identification of similarities and differences and to control for ethnic differences in risk for specific diseases. The results were consistent with past research on health consequences of abuse and extended the prior literature by showing that psychological abuse had a pervasive effect on health conditions, distress and use of health care resources. Additionally, ethnic differences emerged. As expected, ethnicity appeared to function as a moderator. Clinical implications and recommendations are made for future …

During the early twentieth century, the Democratic party dominated the conservative political landscape of Texas. Through the 1920s, members of the Republican party focused on patronage and seemed content to maintain the position of minority party. A growing dissatisfaction with the liberal policies of the New Deal during the 1930s created opportunities for state Republicans to woo dissenting Democrats to their side. With a change of leadership within the state GOP after 1950, the Republicans waged serious campaigns for offices for the first time. Republican men exercised their political yearnings through leadership positions. Women, on the other hand, were shut out of the leadership ranks, and, as a consequence, they chose a traditional female strategy. They organized clubs in order to support the new leadership and rising candidates. Against formidable odds, Republican women acted as foot soldiers and worked diligently to attain their objectives. As early as 1920, Texas Republican women began to organize. In 1938 they joined the newly chartered National Federation of Republican Women. In 1955 Texas women organized the Texas Federation of Republican Women (TFRW). Working through the TFRW, the women became the catalysts that broke the Republican party from its state of inertia, and they significantly …

The United States government began paying pensions to disabled Union veterans before the Civil War ended in April 1865. By 1890 its pension programs included any Union veteran who had fought in the Civil War, regardless of his financial means, as well as surviving family members, including mothers, fathers, brothers, and sisters. Union veterans did not hesitate to "wave the bloody shirt" in their attempts to liberalize pension laws. Pension programs for Confederate veterans were much slower to develop. Lacking any higher organization, each southern state assumed the responsibility of caring for disabled and/or indigent Confederate veterans and widows. Texas began paying Confederate pensions in 1899, Georgia in 1888 and Virginia in 1889. Unlike Texas, Georgia and Virginia provided artificial limbs for their veterans long before they started paying pensions. At the time of his enlistment in the 1860s, the typical future pensioner was twenty-five years of age, and fewer than half were married heads of households. Very few could be considered wealthy and most were employed in agriculture. The pensioners of Georgia, Texas, and Virginia were remarkably similar, although there were some differences in nativity and marital status. They were all elderly and needy by the time they asked …

The present study compared the responses of a group of simulating malingerers who were offered a monetary incentive to feign symptoms of a head injury, with the responses of head injured groups both with and without litigation, a forensic parole group, and an honest-responding control group. The following six neuropsychological measures were utilized: Rey 15-Item Memory Test, Controlled Oral Word Association Test, Finger Oscillation Test, WAIS-R Neuropsychological Instrument (Vocabulary, Information, and Similarities subtests), Booklet Category Test, and Wisconsin Card Sorting Test. The statistical concepts of floor effect, performance curve, and magnitude of error were examined. Additionally, the statistical differences in the responses of the five groups were analyzed to determine cutting scores for use in distinguishing malingerers from nonmalingerers.

Failure to acknowledge their mental illness occurs in approximately half of all psychotic patients. Interest has been recently been refocused on insight (i.e., awareness of mental illness), and its associations with treatment compliance and better prognosis. Researchers have called into question the traditional factor structure of insight, instead viewing and defining it as a multidimensional and continuous construct. While factor analytic research has suggested that insight is an independent feature of psychotic disorders rather than a secondary manifestation of psychotic symptoms, several factor analytic studies have identified only one higher-order factor. Furthermore, a significant amount of the research literature has assessed insight or analyzed its relationships using only a single insight score. The current study evaluated the structural model of insight and assessed the associations between the different proposed dimensions of insight and psychotic symptoms. One hundred and six participants recruited from both inpatient and outpatient settings with a diagnosis of schizophrenia, schizoaffective disorder, psychotic disorder NOS, or bipolar disorder with psychotic features were rated on David's Schedule for Assessing Insight-Expanded Version (SAI-E), Birchwood's Insight Scale (IS), and the Brief Psychiatric Rating Scale (BPRS) or the Positive and Negative Syndrome Scale (PANSS). Structural equation modeling (SEM) was utilized to provide …

Acute lymphocytic leukemia (ALL) is one of the most common types of pediatric cancers. Improvements in treatment within the last 20 years have resulted in reduced mortality and a greater focus upon quality of life. Several researchers have documented neuropsychological impairments in children following treatment for ALL; however, there have not been any comparative studies documenting differences in neuropsychological functioning based upon treatment modality despite the documented effects of radiation therapy and combined radiation/chemotherapy upon the developing brain. In addition, past studies have focused on unitary measures, ignoring the hierarchical relationship between basic cognitive functions and more abstract skills. This study examined the neuropsychological functioning of 81 children who were treated for ALL at a metropolitan children's hospital. All children were tested a minimum of two years after the final treatment session and were administered the NEPSY. Results do not support any interactions or main effects with the exception of the age of the child at diagnosis. Children diagnosed prior to the age of 5 showed greater impairments on tasks measuring attention, memory, and visuospatial reasoning in comparison to peers diagnosed after age 6.

In October 1863 the United States Army's Rio Grande Expedition left New Orleans, bound for the Texas coast. Reacting to the recent French occupation of Mexico, President Abraham Lincoln believed that the presence of U.S. troops in Texas would dissuade the French from intervening in the American Civil War. The first major objective of this campaign was Brownsville, Texas, a port city on the lower Rio Grande. Its capture would not only serve as a warning to the French in Mexico; it would also disrupt a lucrative Confederate cotton trade across the border. The expedition had a mixed record of achievement. It succeeded in disrupting the cotton trade, but not stopping it. Federal forces installed a military governor, Andrew J. Hamilton, in Brownsville, but his authority extended only to the occupied part of Texas, a strip of land along the coast of the Gulf of Mexico. The campaign also created considerable fear among Confederate soldiers and civilians that the ravages of civil war had now come to the Lone Star State. Although short-lived, the panic generated by the Rio Grande Expedition left an indelible mark on the memories of Texans who lived through the campaign. The expedition achieved its greatest …

Traumatic brain injury (TBI) is the leading cause of death and disability among children and adolescents in the US. Children and adolescents who sustain moderate and severe head injuries are much more likely to evidence significant deficits in neuropsychological functioning when compared with children with mild head injuries. Information about the recovery process and functional sequelae associated with moderate and severe head injuries remains limited, despite clear indications that children who experience such injuries typically exhibit notable deficits in intellectual functioning, particularly during the acute phase of recovery. Thus, the present study was conducted to augment research on intellectual functioning in children with moderate or severe head injuries. To accomplish this, the study first examined the proposed factor model of the WISC-III in children with moderate and severe TBI. Given high prevalence rates and similar trends in cognitive impairment, particularly within the frontal lobe structures (e.g., disrupted cognitive flexibility and divided attention), the study also examined this same factor model for a group of children with attention-deficit/hyperactivity disorder (ADHD) and compared it with the model fit from the TBI group. In the second phase of the study, both the TBI and AHDH groups were evaluated to determine if distinct WISC-III …

The results of neuropsychological tests are often used by clinicians to make important decisions regarding a demented patient's ability to competently and/or independently perform activities of daily living. However, the ecological validity of most neuropsychological instruments has yet to be adequately established. The current study examined the relationship between neuropsychological test performance and functional status in 42 individuals diagnosed with Alzheimer's Disease. A comprehensive battery of cognitive tests was employed in order to assess a wide range of neuropsychological abilities. Functional status was measured through the use of both a performance-based scale of activities of daily living (The Direct Assessment of Functional Status; Loewenstein et al., 1989) as well as by a caregiver/informant-based rating scale (Instrumental Activities of Daily Living; Lawton & Brody, 1969). Findings suggest that neuropsychological functioning is moderately predictive of functional status. Memory performance was the best predictor of functional status in most ADL domains, followed by executive functioning and visuospatial abilities.

Neuropsychological rehabilitation following acquired brain injury is increasingly recognized as essential with the advancements in research evidence of its effectiveness, particularly as current estimates of disability following the most common forms of brain injury (traumatic brain injury and cerebrovascular accident) are so high. Improvements in predictive capabilities of researchers and clinicians are paramount in designing effective interventions. As many variables associated with outcome following brain injury are not controllable (e.g. severity of the injury, age, education), it is essential that rehabilitation programs design interventions to target those variables that are susceptible to amelioration. While personality factors have been shown to affect outcome in other medical illnesses, only a few studies have examined the influence of personality on outcome following neurorehabilitation for acquired brain injury. The results of these studies have been mixed. This study used the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcome as measured by the Mayo-Portland Adaptability Index (MPAI-4) following brain injury rehabilitation in a heterogeneous sample of persons with acquired brain injuries (N = 50). It was hypothesized that specific coping styles scales from the MBMD (Introversive, Dejected, Oppositional), which are based on Millon's personality system, would predict outcome. Results indicated that both the Introversive and …

This study proposed a look at the importance and challenges of knowledge management in times of great change. In order to understand the information phenomena of interest, impacts on knowledge workers and knowledge documents in times of great organizational change, the study is positioned in a major consolidation of state agencies in Texas. It pays special attention to how the changes were perceived by the knowledge workers by interviewing those that were impacted by the changes resulting from the reorganization. The overall goal is to assess knowledge management in times of great organizational change by analyzing the impact of consolidation on knowledge management in Texas's Health and Human Services agencies. The overarching research question is what happened to the knowledge management structure during this time of great change? The first research question was what was the knowledge worker environment during the time of change? The second research question was what was the knowledge management environment of the agencies during the time of change? The last research question was did consolidation of the HHS agencies diminish the ability to transition from tacit to explicit knowledge? Additionally, the study investigates how the bill that mandated the consolidation was covered in the local …

Although most people have experienced word-finding difficulty at one time or another, there are no clinical instruments able to reliably distinguish normal age-related effects from pathology in word-finding impairment. Two experiments were conducted to establish a modified version of the Boston Naming Test (BNT) that includes latency times, the Boston Naming Test of Latencies (BNT-L), in order to improve the instrument's sensitivity to mild to moderate word-finding impairment. Experiment 1: Latency times on the 60-item BNT (Goodglass et al., 2001) for 235 healthy adults' ages 18-89 years were collected on a representative sample. Qualitative features of the BNT items, statistical analyses, IRT, and demographic considerations of age, gender, education, vocabulary, race and culture, helped create a reduced BNT-L version with 15 of the most discriminating items. Statistically sound and sophisticated normative tables are provided that adjust for unseen covariates. Response latencies did not indicate earlier age-related decline in an optimally healthy sample. Experiment 2: Twenty-three patients referred for neuropsychological testing were administered the BNT-L. Patients referred for evaluation of mild cognitive impairment or possible dementia produced significantly different response BNT-L latencies from the healthy sample whereas patients referred for mild brain injury evaluation did not. Normal word-finding problems were discussed …

This study employed a new model of mild-to-moderate head trauma to specifically identify the role of dural mast cell (MC) histamine in trauma-induced increased permeability in the blood-brain barrier (BBB). A single line was scored partially through the left dorsal parietal skull. Immediately following the trauma, degranulation was seen in 39% of the MCs on the left and in 2% on the right. After a 20 min survival period, left duras showed 55% with MC degranulation (fewer with complete degranulation) compared to 34% on the right. In the other experiments two parallel lines were scored following the injection of Evan's blue. Histamine assay showed histamine increased in the left cortex to 154% at 5 min, 174% at 10 min, and 151% at 20 min. Fluorescent quantitation of extravasated Evan's blue at 20 min following the trauma gave an increase of 1385% over the value measured for the right cortex. Zolantidine, a selective histamine H2 receptor antagonist, administered at 10- and 20- mg/kg 30 min before the trauma blocked 65% of the Evan's blue extravasation compared with the control and 2.5 mg group.

Medication non-compliance has become one of the most prevalent reasons for hospitalization and doctor's visits by the elderly. As the elderly population is more likely to have decreased cognitive abilities, it is suggested that neuropsychological factors, especially executive function, are more influential in medication non-compliance than once thought. This study looked at executive function performance on a traditional battery of neuropsychological tests, self-report of perceived ability to perform executive function tasks, and the newly developed Pillbox Test, a performance based IADL measure. The Pillbox Test is designed to replicate a type of medication-management specific IADL as a means to asses executive function. Standard executive function measures only tap a portion of executive function, but it is believed that the Pillbox Test incorporates all four theoretical domains of executive function. The multiple measures of executive function performance were compared in three prevalent subgroups of the elderly population (mixed neurological group, cardiac medical-control group, and healthy community-control group). Results found significant differences, where the community-control and cardiac groups outperformed the mixed neurological group on the large majority of executive function tasks. Smaller differences were also noted between the community-control and cardiac groups and between the cardiac and mixed neurological groups. Together, these …

Early detection of Alzheimer's disease (AD) and related dementias in the elderly is critical for improving treatment methods and is a necessary component for improving public health interventions. One of the earliest and most common behavioral syndromes of AD is apathy and is associated with executive dysfunction. Apathy in AD is often misdiagnosed as depression due to an overlap in symptoms. Studies that have found depression to be associated with executive dysfunction have not always controlled for the presence of apathy. The Geriatric Depression Scale (GDS) is a widely used instrument designed to assess depression in the elderly. This study utilized the GDS and a set of standard neuropsychological instruments to investigate the relationship between apathy, depression, and executive functions in individuals with AD and related dementias. The first objective of this study was to determine if apathy has a greater impact on executive functions compared to depression in AD and related dementias. The second objective was to determine the effectiveness of the GDS as a screen for apathy. The results of the analyses did not support the hypotheses. However, exploratory analyses suggested a possible non-linear relationship with apathy and various levels of dementia severity. Exploratory analysis also suggested mean …

Individuals diagnosed with schizotypal personality disorder (SPD) exhibit patterns of cognitive deficits, neuromotor disturbances, and behavior problems similar to individuals with schizophrenia, and thus SPD is thought to represent one point on the continuum of schizophrenia spectrum disorders (SSDs). Deficits in behavior, cognition, and motor functioning have been implicated as childhood precursors of SSDs and appear to also vary as a function of gender and family history of psychopathology. As such, studies of youth may help in further identification of individuals at risk for SSDs. The current study examined the prospective associations between problem behaviors, neuromotor and neurocognitive functioning, as well as SSD symptoms, at baseline and 2-year follow-up in youth meeting criteria for SPD, other personality disorders, or healthy controls. The neuromotor and neurocognitive measures were able to significantly predict SSD symptoms and behavior problems above and beyond baseline predictors. Overall, the findings provide further support for the role of subcortical motor centers operating together with prefrontal cortical areas in the regulation of higher-order cognitive functioning and in producing the psychiatric features of SSDs. Significant correlations between gender, family history of schizophrenia, and history of head injury with symptoms, behavior, cognition, and motor functioning were also found and highlight …

The purpose of this study was to examine the ability of the Cognitive Assessment System (CAS) and the NEPSY, A Developmental Neuropsychological Assessment, to differentiate between the subtypes of Attention Deficit/ Hyperactivity Disorder (AD/HD). The CAS and NEPSY are neuropsychological instruments which provide norms for AD/HD children in general. This study examined the performance of the two subtypes of AD/HD on the CAS and NEPSY. In addition, this study examined the performance of the two AD/HD groups on the Screening Test for Auditory Processing Disorders (SCAN). Since AD/HD children tend to have difficulty with language, the SCAN was used to determine if any of the AD/HD subjects had auditory processing difficulties that might impact their performance on the CAS and/or NEPSY subtests. The sample consisted of 118 children between the ages of 8 and 12 years of age. Using the DSM-IV criteria, the children were diagnosed as having three types of AD/HD: A Predominantly Hyperactive-Impulsive Type (AD/HD-HI), a Predominantly Inattentive Type (AD/HD-I) and a Combined Type The subtypes were also identified by the Attention Deficit Disorders Evaluation Scale-Home Version (ADDES-H). Only two subtypes, AD/HD-I and AD/HD-C, were identified by the ADDES-H. There were not enough AD/HD-HI subjects to include in …