More Diagnostic Testing: The MMPI, the MCMI, and MMSE

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More Diagnostic TestingThe MMPI, the MCMI, and
MMSE

• PSY 614
• Instructor Emily E. Bullock, Ph.D.

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DSM-IV-TR Diagnosis

• Axis I-Clinical Disorders
• Axis II-Personality Disorders Mental Retardation
• Axis II-General Medical Conditions
• Axis IV-Psychosocial Environmental Problems
• Axis V-Global Assessment of Functioning Scale
  (GAF)

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The MMPI-2

• The Minnesota Multiphasic Personality Inventory-2
• Standardized questionnaire that elicits a wide
  range of self-descriptions scored to give a
  quantitative measurement of an individuals level
  of emotional adjustment and attitude toward test
  taking
• Most widely used clinical inventory and has over
  10,000 published research references
• Original development of MMPI-1939 at the Univ. of
  Minnesota by Hathaway and McKinley
• MMPI revised to create MMPI-2 in 1989

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The MMPI-2The Basics

• 567 questions
• 13 Standard Scales (10 of which are
  clinical/personality scales)
• Other Scales Content, Harris-Lingoes subscales,
  critical items, supplementary scales
• Requires about 90 minutes to complete
• MMPI-2 for individuals 18 and over 8th grade
  reading level
• MMPI-A for adolescents 14-18

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The MMPIPsychometric Properties

• Reliability Complex due to of scales and
  different populations sampled
• Temporal stability and Internal Consistency
  .71-.84
• Split Half .05-.96 (.70 median)
• Test-Retest .58-.92
• Validity
• Normative Group 1,138 males 1,462 females from
  7 states

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MMPI-2Scaling and Scoring

• Type of scaling used original pool of questions
  developed theoretically final question pool
  determined empirically
• Scoring
• Mean50 Standard Deviation10
• Clinical significance T score of 65 (92nd
  percentile)
• Interpretation norm referenced
• Code types used in interpretation-good
  psychometric qualities

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MMPI-2 Limitations and Group Issues

• Provides more reliable information for abnormal
  rather than normal individuals
• Misleading labels for scales
• Higher reading level and psychological
  sophistication necessary
• No consistent patterns have been found across
  different populations for African Americans,
  Native Americans, Hispanics, and Asian Americans
• Card version for those with concentration issues
• Audio version for issues of blindness,
  illiteracy, or aphasia

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MMPI-2The 3 Main/Original Validity Scales

• L (Lie) scale attempt to which a person is
  attempting to describe himself or herself in an
  unrealistically positive manner
• F (Infrequency) scale extent to which person
  answers in an atypical and deviant manner
• K (Correction) scale detects persons describing
  themselves in overly positive terms more subtle
  and effective than L scale

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MMPI-2Other Important Validity Scales

• The Cannot Say (?) scale determined by the
  number items left unanswered 30 or more items
  unansweredinvalid
• VRIN (Variable Response Inconsistency Scale)
  detects inconsistent responding
• TRIN (True Response Inconsistency Scale) detects
  indiscriminant responding

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MMPI-2Clinical Scales

• Scale 1 (Hs, Hypochondriasis)
• Scale 2 (D, Depression)
• Scale 3 (Hy, Hysteria)
• Scale 4 (Pd, Psychopathic Deviate)
• Scale 5 (Mf, Masculinity-Femininity)

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MMPI-2Clinical Scales

• Scale 6 (Pa, Paranoia)
• Scale 7 (Pt, Psychasthenia)
• Scale 8 (Sc, Schizophrenia)
• Scale 9 (Ma, Hypomania)
• Scale 0 (Si, Social Introversion)

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MMPI-2Interpretation

• Determine validity of the profile first
• Note scores above T65
• Interpret highest elevations first, moderate
  interpretations on only slightly elevated scales

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The MCMI-III

• The Millon Clinical Multiaxial Inventory-III
• Commonly called the Millon or MCMI
• Standardized, self-report questionnaire that
  assesses a wide range of information related to a
  clients personality, emotional adjustment, and
  attitude toward test taking. It uniquely focuses
  on personality disorders.
• Based on Millons theory of personality and the
  DSM-IV
• Originally developed in 1977 This revision
  1994/1997

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MCMI-IIIThe Basics

• 175 items
• 28 scales
• 20-30 minutes to complete
• For 18 yrs and older
• Only appropriate for those seeking or receiving
  more than a moderate level of mental health
  treatment
• 8th grade reading level

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MCMI-IIIPsychometric Properties

• Overall, well constructed psychometric instrument
• Reliability
• Internal Consistency Most Scales above .80
• Test Retest 5-14 day interval Median .91
• Validity
• Correlated with other measures from .59 to .70
• Normative Sample
• 1,079 Clinical patients who had come from a
  diversity of backgrounds and treatment settings

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MCMI-IIIScaling and Scoring

• Initial item pool theoretically developed
  (Millons theory of personality and DSM-IV
  criteria) and utilized empirical methods to
  determine final item pool and scale structures
• Scores are reported in Base Rates (BR)
• BR gt 85-characteristics definitely present
• BR gt 75-some features present
• BR pf 35-,median score of nonpsychiatric groups
• BR of 60-median for psychiatric populations

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MCMI-IIILimitations and Group Issues

• Scale overlap and some mixed results with
  diagnostic accuracy when compared to clinicians
  interview and MMPI
• Criteria for scales vary on whether more related
  to Millons theory or DSM criteria
• State and Trait issue
• Frequent revisions make it difficult for research
  to catch up
• Overdiagnoses and Overpathologizes despite the
  group involved

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MCMI-IIIScales

• 5 categories of scales
• Modifying Indices
• Clinical Personality Patterns
• Severe Personality Pathology
• Clinical Syndromes
• Severe Syndromes

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MCMI-IIIModifying Indices

• Disclosure
• Debasement
• Desirability
• Validity

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MCMI-IIISevere Personality Pathology Scales

• Schizotypal
• Borderline
• Paranoid

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MCMI-III Clinical Personality Pattern Scales

• Schizoid
• Avoidant
• Depressive
• Dependent
• Histrionic

• Narcissistic
• Antisocial
• Aggressive
• Compulsive
• Passive Aggressive
• Self-Defeating

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MCMI-IIISevere Syndrome Scales

• Thought Disorder
• Major Depression
• Delusional Disorder

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MCMI-IIIClinical Syndrome Scales

• Anxiety
• Somatoform
• Bipolar Manic
• Dysthymia

• Alcohol Dependence
• Drug Dependence
• PTSD

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MCMI-IIISteps of Interpretation

• 1. Check validity through the Modifying Indices
• 2. Interpret the Personality Scales first
• 3. Interpret Clinical Syndrome Scales
• 4. Review noteworthy items

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MMSE

• Mini-Mental Status Examination
• Used to assess cognitive mental status as an
  initial evaluation tool or evaluation of
  treatment
• assesses orientation, attention, immediate and
  short-term recall, language, and the ability to
  follow simple verbal and written commands

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MMSE
Domains on the Folstein version

• Orientation to time
• Orientation to Place
• Immediate Recall
• Attention
• Delayed Recall

• Naming
• Repetition
• 3 Stage Command
• Reading
• Copying
• Writing