Evalutaion of embedded malingering indices in a non-litigating, relief seeking sample: a partial cross-validation using control, clinical, and derived groups

Researchers have recently noted college students fail validity measures and base rate data are needed for students meeting Slick et al.’s criteria (1999) for malingering. The association between meeting Slick Criteria and subsequent recommendations (i.e., to receive external gain) is unknown as is the diagnostic utility of embedded validity indices in this population. The authors utilized archival data from: 1) a university psychological clinic (n = 986) and 2) a university student control sample (n = 182). Measures included the Wechsler Adult Intelligence Scale-III, Wechsler Memory Scale-III, and Personality Assessment Inventory. Empirically supported embedded validity indices were utilized to retrospectively identify suspected malingering patients. Group performance, according to level of symptom credibility and level of incentive seeking, was evaluated through a series of multivariate mean comparisons. Data are presented for frequency of falling in the noncredible range on all validity indices. Diagnostic statistics for each index are presented according to hypothetical base rates. Examination of receiving psychological recommendations to obtain external incentive (i.e., academic accommodations, medications, etc.) is reported according to incentive and credibility level. University patients explicitly seeking external gain, particularly those meeting criteria for malingering, demonstrated lower performance on the measures and received a higher rate of recommendations for academic accommodations and/or medications than patients not seeking external incentive. Nevertheless, a number of diagnostic statistics indicated some embedded validity indices lack specificity for malingering in university samples. The current study supports classifying patients according to level of incentive seeking when evaluating neurocognitive performance and feigned or exaggerated deficits

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

The Wender Utah Rating Scale: Adult ADHD diagnostic tool or personality index?

OBJECTIVE: The Wender Utah Rating Scale (WURS) is used to retroactively assess ADHD symptoms. This study sought to determine whether the WURS actually functions as an index of dysfunctional personality traits. METHOD: Five hundred twenty-two adult participants completed the WURS and at least one of the following measures: Wechsler Adult Intelligence Scale-III (WAIS-III), Trails Making Test (Forms A and B), Conners\u27 Continuous Performance Test, d2 Test of Attention, and the Personality Assessment Inventory (PAI). RESULTS: The WURS correlated significantly with all PAI clinical and treatment scales; however, of the neuropsychological measures, only the CPT significantly correlated with the WURS score. Multiple regression analyses revealed a significant model that included clinical and treatment scales from the PAI as well as working memory and processing speed indexes from the WAIS-III that accounted for 39% of the variance in WURS scores. CONCLUSION: Performance on the WURS was more related to dysfunctional personality traits than to actual attentional performance in this young adult sample. (J. of Att. Dis. 2009; 13(1) 87-94)

The use of clozapine among individuals with intellectual disability: a review

Clozapine has been approved in the United States since 1990 for refractory or treatment resistant schizophrenia in the general population. However, as with many other antipsychotic medications, it is being prescribed for reasons other than those indicated. Among individuals with intellectual disabilities, clozapine is increasingly being prescribed to treat behavioral problems, although the empirical evidence for such a practice is lacking. This review was undertaken as an attempt to summarize the available studies regarding the use of clozapine for behavioral purposes among individuals with intellectual disabilities. Findings of our review suggest that the effectiveness of clozapine in targeting challenging behaviors among individuals with intellectual disabilities is relatively inconclusive at present. We discuss reasons why these limitations exist and offer some solutions to help alleviate these limitations