VA Portland Health Care System, Portland, OR, United States of America; Oregon Health & Science University, Portland, OR, United States of America.
Oregon Health & Science University, Portland, OR, United States of America.
Epilepsy Behav. 2020 Oct;111:107246. doi: 10.1016/j.yebeh.2020.107246. Epub 2020 Jul 7.
Identification of clinically meaningful subgroups among patients with psychogenic nonepileptic seizures (PNES) or epileptic seizures (ES) is of potential value for assessing prognosis and predicting therapeutic response. Invalid performance on validity tests has been associated with noncredible complaints and worse cognitive test scores, and may be one such classification criteria. We studied invalid performance in Veterans with PNES or ES, and the association of invalid performance with cognitive test scores and subjective complaints.
Patients were consecutive admissions to three veterans affairs (VA) epilepsy monitoring units. Evaluations included two validity tests: the Test of Memory Malingering (TOMM); and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) over-reporting validity scales. We compared the frequency of invalid performance on the TOMM or MMPI-2-RF in patients diagnosed with PNES vs. ES. We evaluated the association of invalid performance with scores on the Repeatable Battery for Assessment of Neuropsychological Status (RBANS), and four subjective symptom measures including the Beck Depression Inventory-II, and Quality of Life in Epilepsy-31.
Invalid TOMM performance was found in 25.3% of Veterans diagnosed with PNES and 10.8% of those with ES (p = .03). Invalid reporting on the MMPI-2-RF was found in 35.9% of the PNES group vs. 15.3% of the ES group (p = .01). Effects of valid vs. invalid reporting on external measures were similar for ES and PNES groups. Patients with invalid vs. valid TOMM performance had lower scores on the RBANS (p < .001). Patients with invalid performance had greater complaints on all subjective measures, with largest effect sizes for the MMPI-2-RF validity scales (p < .001).
In Veterans admitted for evaluation of poorly controlled seizures, invalid performance on validity tests was not uncommon. Cognitive test results and subjective reports from patients with invalid performance may not be credible. These observations have implications for the analysis of clinical trials, where primary and secondary outcomes often rely on self-report measures.
鉴定心因性非癫痫性发作（PNES）或癫痫发作（ES）患者中具有临床意义的亚组对于评估预后和预测治疗反应具有潜在价值。效度测试中的无效表现与不可信的投诉和较差的认知测试分数有关，可能是其中一种分类标准。我们研究了退伍军人中 PNES 或 ES 患者的无效表现，以及无效表现与认知测试分数和主观投诉的关系。
患者为连续入住三个退伍军人事务部（VA）癫痫监测单位。评估包括两项效度测试：记忆测谎测试（TOMM）和明尼苏达多项人格问卷-2 修订版（MMPI-2-RF）过度报告效度量表。我们比较了 PNES 与 ES 患者中 TOMM 或 MMPI-2-RF 无效表现的频率。我们评估了无效表现与重复性成套神经心理状态评估（RBANS）分数以及四项主观症状测量（包括贝克抑郁量表二项式和癫痫生活质量-31 项）之间的关系。
PNES 诊断患者中无效 TOMM 表现为 25.3%，ES 患者中为 10.8%（p=0.03）。PNES 组中 MMPI-2-RF 报告无效的比例为 35.9%，ES 组为 15.3%（p=0.01）。效度与无效报告对 ES 和 PNES 组外部测量的影响相似。与有效 TOMM 表现的患者相比，无效 TOMM 表现的患者 RBANS 分数较低（p<0.001）。无效表现患者在所有主观测量中抱怨更大，MMPI-2-RF 效度量表的效应量最大（p<0.001）。
在因控制不佳的癫痫发作而入院评估的退伍军人中，效度测试中的无效表现并不少见。认知测试结果和无效表现患者的主观报告可能不可信。这些观察结果对临床试验分析具有意义，其中主要和次要结局通常依赖于自我报告的测量。
