More Diagnostic Testing: The MMPI, the MCMI, and MMSE PSY 614 Fall 2007 Instructor: Emily E. Bullock, Ph.D.

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)

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 individual’s 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

The MMPI-2 The 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

The MMPI Psychometric 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

MMPI-2 Scaling and Scoring Type of scaling used: original pool of questions developed theoretically; final question pool determined empirically Scoring Mean=50; Standard Deviation=10 Clinical significance = T score of 65 (92nd percentile) Interpretation norm referenced Code types used in interpretation-good psychometric qualities

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

MMPI-2 The 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

MMPI-2 Other Important Validity Scales The Cannot Say (?) scale: determined by the number items left unanswered; 30 or more items unanswered=invalid VRIN (Variable Response Inconsistency Scale): detects inconsistent responding TRIN (True Response Inconsistency Scale): detects indiscriminant responding

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

MMPI-2 Clinical Scales Scale 6: (Pa, Paranoia) Scale 7: (Pt, Psychasthenia) Scale 8: (Sc, Schizophrenia) Scale 9: (Ma, Hypomania) Scale 0: (Si, Social Introversion)

MMPI-2 Interpretation Determine validity of the profile first Note scores above T65 Interpret highest elevations first, moderate interpretations on only slightly elevated scales

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 client’s personality, emotional adjustment, and attitude toward test taking. It uniquely focuses on personality disorders. Based on Millon’s theory of personality and the DSM-IV Originally developed in 1977; This revision 1994/1997

MCMI-III The 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

MCMI-III Psychometric 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

MCMI-III Scaling and Scoring Initial item pool theoretically developed (Millon’s 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 > 85-characteristics definitely present BR > 75-some features present BR pf 35-,median score of nonpsychiatric groups BR of 60-median for psychiatric populations

MCMI-III Limitations and Group Issues Scale overlap and some mixed results with diagnostic accuracy when compared to clinician’s interview and MMPI Criteria for scales vary on whether more related to Millon’s 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

MCMI-III Scales 5 categories of scales Modifying Indices Clinical Personality Patterns Severe Personality Pathology Clinical Syndromes Severe Syndromes

MCMI-III Modifying Indices Disclosure Debasement Desirability Validity

MCMI-III Severe Personality Pathology Scales Schizotypal Borderline Paranoid

MCMI-III: Clinical Personality Pattern Scales Schizoid Avoidant Depressive Dependent Histrionic Narcissistic Antisocial Aggressive Compulsive Passive Aggressive Self-Defeating

MCMI-III Severe Syndrome Scales Thought Disorder Major Depression Delusional Disorder

MCMI-III Clinical Syndrome Scales Anxiety Somatoform Bipolar: Manic Dysthymia Alcohol Dependence Drug Dependence PTSD

MCMI-III Steps of Interpretation 1. Check validity through the Modifying Indices 2. Interpret the Personality Scales first 3. Interpret Clinical Syndrome Scales 4. Review noteworthy items

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

MMSE Domains on the Folstein version Orientation to time Naming Orientation to Place Immediate Recall Attention Delayed Recall Naming Repetition 3 Stage Command Reading Copying Writing