Background: There is a lack of data on the frequency and neuropsychological correlates of tinnitus in distinct clinical populations such as persons injured in high impact motor vehicle accidents (MVAs). Method: Tinnitus severity and frequency were analyzed statistically in de-identified data of 106 post-MVA patients (mean age=39.5, SD=13.1; 31 males and 75 females). Correlations of tinnitus to the patients’ scores on the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Brief Pain Inventory, Insomnia Severity Index, PTSD measure (PCL-5), and to ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire were evaluated. The patients were interviewed an average of 53.6weeks (SD=39.9) after their MVA; all continued to suffer from post-MVA symptoms requiring therapy. Results: Tinnitus was reported by 70 of the 106 post-MVA patients (66%). Slightly less than a half of the 70 rated their tinnitus as “frequent” or “persistent” and slightly more than a half as “occasional.” With respect to Rivermead and SNPSS items, the severity and frequency of tinnitus correlated significantly (at p<.01, 2-tailed) with oversensitivity to light, restlessness, word finding difficulty, hand tremor, stutter, and instances of reduced muscular control over hand or arm (rs ranging from .28 to .37). Tinnitus severity correlated also with tingling in the limbs (r=.31), and with impaired balance (r=.28). Tinnitus frequency correlated also with difficulty articulating words (r=.28). Tinnitus also significantly correlated with ratings of pain and of insomnia (rs ranging from .26 to .32), but not with variables such as PTSD, depression, or anxiety. Discussion and Conclusions: Tinnitus is correlated with some aspects of whiplash trauma and the post-concussion syndrome. However, the size of these relationships is rather weak.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD). Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers. Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview. Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.

Background: The 20 items of PTSD Checklist for DSM-5 (PCL-5) can be rank ordered from highest to the lowest, based on item mean scores in a particular clinical group. Thus, they can provide an overview of the relative importance of each of the symptoms represented by these 20 items, i.e., a clinical profile for the particular type of patients. This study compared such ranking of PCL-5 items by US veterans with those of patients injured in high impact motor vehicle accidents (MVAs). Method: De-identified PCL-5 data were available for 80 post-MVA patients (mean age 38.9 years, SD=12.8) and for 468 US veterans (mean age 55.4 years, SD=13.8). The US veterans’ data are those published by Bovin et al. in 2016. Results and Discussion: The overall rank order of PCL-5 items was significantly similar in the two groups (Spearman’s rho=.83), perhaps due to certain similarities of the two groups (potential threat to life or of severe physical injury). Both groups rated the Item 20 (sleep difficulties) as the most prominent, and they rated Item 16 (taking too many risks) and then Item 8 (trouble remembering details of the stressful event) as least prominent. The largest clinically interesting difference in the item rank was on Item 12 (loss of interest in previously enjoyed activities) which was more prominent in the MVA patients, presumably due to their persistent post-accident pain (all but one MVA patient reported pain, and in 82.5% the pain was rated as more than mild). Conclusions: In both groups, the ratings of sleep difficulties were the most prominent and ratings of taking excessive risks and of not remembering details of stressful evens were least prominent. The overall rank order of the 20 items was significantly similar in the two groups.

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST) is used widely for the assessment of malingering of medical symptoms. Its validity has allegedly been supported by meta-analytic study of M-FAST in 2019 by Detullio et al. Credibility of Detullio’s results is damaged by an inclusion of data based on analog validation and also on dubious convergent validation procedures that falsify estimates of M-FAST’s validity. Method: In the present study, the meta-analysis was calculated on 3 types of M-FAST data: (1) 5 samples of scores of healthy persons instructed to respond honestly, (2) 5 samples of scores of medical patients, and (3) 10 samples of scores of healthy persons instructed to feign mental illness (so called “instructed malingerers”). Results: In an ANOVA (F(2,815)=398.50, p<.0001), significantly lowest MFAST scores were those of healthy controls (mean=1.59, SD=2.80), the next significantly higher scores were those of legitimate patients (mean=4.85, SD=4.22), and the instructed malingerers had significantly highest scores (mean=12.34, SD=5.71). Discussion: The significant difference between healthy controls and patients shows that inferences from analog validations of the M-FAST are inherently false. Furthermore, data of legitimate patients with severe psychiatric illness suggested that they may face the risk of about 50% to be falsely classified as malingerers by the M-FAST. Moreover, almost all validations of the M-FAST were done only with “instructed malingerers” (healthy volunteers instructed to feign symptoms). This overestimates the test’s capacity to detect real-life malingerers. Montes and Guyton documented that “instructed malingerers” warned to avoid detection score much lower than the unwarned ones (effect size: Cohen’s d=3.05). MFAST’s capacity for detection of real-life malingerers may be extremely low, in particular those more genuinely motivated to evade detection, well prepared, better educated, and systematically feigning only a few specific symptoms such as depression, pain, and insomnia. Conclusion: The M-FAST should no longer be used.

Background: Recent extensive content analyses demonstrated that the items of the Structured Inventory of Malingered Symptomatology (SIMS) have no capacity to differentiate malingerers from legitimate medical patients: all items list or assess legitimate medical symptoms. We examined which SIMS items are the most frequently endorsed by injured motorists. Method: De-identified archival data of 23 survivors (mean age=38.0, SD=12.8) of high impact motor vehicle accidents (MVAs) contained their SIMS scores, their responses to the Brief Pain Inventory, Morin’s Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, and to the Post-MVA Neurological Symptoms scale. Results: All SIMS items which were endorsed by more than 43% of the patients in the directions scored by the SIMS as indicative of “malingering” were selected. Twenty-five items met this criterion. On a closer examination, all these 25 items are legitimate psychological and neuropsychological symptoms typically experienced by injured motorists, such as depression, impaired sleep, and postconcussive symptoms (memory and concentration problems, impaired balance) and whiplash symptoms (numbness in the limbs, instances of reduced muscular control over some of the limbs). Discussion and Conclusions: The 25 endorsed items are consistent with the polytraumatic symptom profile of injured patients. In a travesty of psychological assessment, these symptoms are scored in the SIMS as denoting “malingering”.

Background: Survivors of high impact car accidents, when traveling in cars as passengers, may exhibit the phantom brake reaction. The reaction consists of involuntarily pressing the foot on the floor of the car in a reflexive attempt "to brake", even though there is no brake pedal in front of the passenger seat. This study examines the incidence and correlates of this special phenomenon. Method: De-identified data of 114 survivors (37 men, 77 women; mean age 38.6, SD=12.4) of high impact motor vehicle accidents (MVAs) were available, with their responses to the Brief Pain Inventory, Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), PTSD Checklist for DSM-5 (PCL-5), ratings of depression and of generalized anxiety, and 3 questionnaire measures of driving anxiety, i.e., Whetstone’s, Steiner’s, and the Driving Anxiety Questionnaire (DAQ). One item of the DAQ assesses the phantom brake phenomenon on a 4-point scale (0=No, 1=Mild, 2=Moderate, 3=Severe): this is the key variable in the present study. Results: Mild to severe forms of the phantom brake reaction were reported by 92.1% of the post-MVA patients. Significant correlations (p<0.05, 2-tailed) were found of the intensity of phantom brake reaction to the intensity of post-MVA pain (rs from 0.20 to 0.33), insomnia (r=0.40), the Rivermead post-concussion scale (r=.29), other post-concussive and whiplash symptoms as measured by the SNPSS (r=0.19), depression (r=0.30), generalized anxiety (r=0.32), and to DAQ (r=0.47) and Whetstone’s (r=0.50) measures of driving anxiety. No significant relationships were found of the phantom brake reaction to age and gender. Discussion and Conclusion: The phantom brake reaction was reported by almost all post-MVA patients and can be considered as a part of their post-MVA polytraumatic symptom pattern.

Background: Steiner’s Automobile Anxiety Inventory (AAI) is a 23 item questionnaire which provides a quantitative measure of vehicular anxiety (amaxophobia), common in survivors of motor vehicle accidents (MVAs). The present study examines criterion and convergent validity of the AAI. Method: De-identified data from a sample of 50 patients (mean age=39.1, SD=12.1; 17 men, 33 women) injured in high impact MVAs included the scores on Steiner’s AAI, as well as the pain ratings on the Brief Pain Inventory (BPI), scores on the Insomnia Severity Index (ISI), the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whetstone Vehicle Anxiety Questionnaire, and on Driving Anxiety Questionnaire (DAQ). The patients’ scores were compared to de-identified AAI data of 22 normal controls (mean age=45.9, SD=21.3; 10 men, 12 women). Results: Mean score of the patients on Steiner’s AAI (mean=15.0, SD=2.5) was significantly higher than the one of normal controls (mean=3.2, SD=3.8) in a t-test (t=15.6, df=70, p<.001). The underlying correlation is very high (r=.88): this indicates an excellent criterion validity. Satisfactory convergent validity is suggested by significant correlations (p<.001) of Steiner’s AAI scores to the Whetstone Vehicle Anxiety Questionnaire (r=.58) and Driving Anxiety Questionnaire (r=.52). The AAI correlated at p<.001 with post-accident neuropsychological impairments as measured by Rivermead (r=.89) and SNPSS (r=.72). Internal consistency of the AAI is satisfactory (Cronbach alpha=.95). Discussion and Conclusion: The results indicate satisfactory criterion and convergent validity of the Automobile Anxiety Inventory.

Despite the devastating impact of COVID-19 on all domains of health, very few studies focus on epigenetics-based approaches to target both the viral-host immune responses and central nervous system involvement in COVID-19. Hospitalized COVID-19 patients experience a wide array of neurological symptoms ranging from convulsions to strokelike syndrome and anosmia. None of the pipeline antiviral drugs has been shown to penetrate the blood-brain barrier to exert neurotrophic actions to counteract the COVID-19 damage to the brain. We have identified curcumin extracted from Turmeric (Curcuma longa) exhibiting dual properties: to disrupt viral attachment and hijacking host-viral immune response and to target epigenetics pathway regulating oxidative stress and inflammation responses underlying COVID-19 syndrome. We recruit nanotechnology to formulate liposome-based curcumin: Lipocurc, and completed Phase I study showing very favorable safety and efficacy in Parkinson disease model. We propose to translate the findings to COVID-19 syndrome and exploit the antidepressant and cognitive enhancing properties to accelerate recovery from COVID-19 through navigating brain pathways regulating mood, behavioral control, and cognition within the context of acute and postacute COVID-19 syndrome.

Background:The symptom of double vision, known in ophthalmology as diplopia, is observed with various neurological conditions such as in multiple sclerosis, Parkinson's disease, and the post-concussion syndrome. Our study examines the correlates of diplopia in survivors of high impact motor vehicle accidents (MVAs).Method: Data on diplopia were available for 65 patients injured in MVAs (mean age of 38.1 years, SD=13.1;24 men, 41 women).All patients were assessed using the Rivermead Post-Concussion Symptoms Questionnaire, Immediate Concussion Symptoms scale, the Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, as well as selected items from the Brief Pain Inventory (ratings of worst, least, and of average pain) and from the Whiplash Disability Questionnaire (ratings of depression, anger, and anxiety).Results: Diplopia was reported by 27.7% of the patients.Ratings of diplopia correlated at a significant level (p<.05, 2-tailed) with the total Rivermead post-concussive score (r=.46) after the item "double vision" was removed from the Rivermead's total score, and also with the total score on the PMNS scale (r=.35).Diplopia also correlated significantly with Rivermead's post-concussive symptoms of blurred vision, oversensitivity to bright lights (photosensitivity), restlessness, dizziness, nausea, and problems with slow speed of thinking (the rs ranged from .30 to .57).With respect to individual items of the PMNS scale, diplopia correlated significantly to impaired balance, hand tremor, reduced control over hand or arm, and to some loss of bladder control (the rs ranged from .30 to .41).Discussion and Conclusions: Diplopia was reported by 27.7% of survivors of high impact MVAs and was correlated with various other post-concussive symptoms, especially blurred vision, photosensitivity, and impaired balance.

Background: In medical psychology, the Brief Pain Inventory (BPI) allows for a separate assessment of pain intensity (scales of worst, least, and average pain) and of daily functional limitations due to pain (impairments of mood, ability to walk, work, interpersonal relations, sleep, and enjoyment of life). The present study evaluates the convergent validity of BPI’s measure of such functional limitations by calculating its correlations to other relevant clinical measures of psychological impairments caused by motor vehicle accidents (MVAs). Method: De-identified archival data were available on 50 persons injured in MVAs (age 20 to 86 years, mean=42.1 years, SD=16.4; 23 males, 27 females). Their MVA occurred 11 to 280 weeks prior to psychological testing with the BPI (average time lapse 73.3 weeks, SD=53.8). All patients were still experiencing active post-MVA symptoms requiring medical attention and therapy. With respect to convergent validity, we examined Pearson correlations of the BPI to the Insomnia Severity Index (ISI), Rivermead Post-Concussion Symptoms Scale, Subjective Neuropsychological Symptoms Scale (SNPSS), and to measures of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results: Functional interference of pain with daily activities (sum of BPI Items 9B to 9G) correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.39), post-MVA subjective neuropsychological symptoms (r=0.45), insomnia scores (r=0.41), and ratings of depression (r=0.52), anger (r=0.46), and anxiety (r=0.44). When the sum of BPI ratings of worst, least, and average pain was added to the functional interference/limitations score, then this sum of 9 BPI items correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.36), post-MVA subjective neuropsychological symptoms (r=0.46), insomnia scores (r=0.37), and ratings of depression (r=0.53), anger (r=0.50), and anxiety (r=0.40). Discussion and Conclusion: The results lend support to convergent validity of the BPI when applied to persons injured in vehicular accidents.

Background: Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms. Method: De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.” Results and Discussion: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably, formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p>.05). Conclusion: The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Background: The Insomnia Severity Index (ISI) is widely used in clinical assessments of insomnia in patients injured in high impact motor vehicle accidents (MVAs). This study examines the criterion and convergent validity of ISI on this clinical population. Method: De-identified archival data were available on 112 post-MVA patients (37 men, 75 women, mean age 38.8 years, SD=13.1). They completed the ISI as well as the Brief Pain Inventory, the Rivermead Post-concussion Symptoms Questionnaire, the Subjective Neuropsychological Symptoms Scale (SNPSS), Items 10 to 12 of the Whiplash Disability Questionnaire (ratings of depression, anger, and of anxiety), Whetstone Vehicle Anxiety Questionnaire, Driving Anxiety Questionnaire (DAQ), Steiner’s Automobile Anxiety Inventory, and some of them also completed the PTSD Checklist for DSM-5 (PCL-5). The ISI responses were also available from a community sample of 21 controls (10 men, 11 women, mean age of 39.2 years, SD=18.5). Results: The mean ISI total score of post-MVA patients (23.6, SD=13.1) was significantly higher than the one of the controls (6.0, SD=5.4) and significant between groups differences in the same direction were also observed on all 7 individual ISI items: the magnitude of these underlying relationships ranged from Pearson point biserial r of 0.68 to 87. The ISI total score also significantly correlated with ratings of post-MVA pain, depression, generalized anxiety, scores on measures of the post-concussion and whiplash syndrome, PTSD, and on Whetstone’s and DAQ measures of post-MVA driving anxiety. Discussion and Conclusions: The results show an excellent level of criterion and convergent validity of ISI for clinical assessments of insomnia in post-MVA patients.

Background:The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is used widely in clinical assessments.Its 16 items describe subjective neuropsychological symptoms.This study evaluates the criterion validity, convergent validity, and internal consistency of the RPQ in a sample of survivors of high impact motor vehicle accidents (MVAs).Method: De-identified data on 65 post-MVA patients (mean age 38.1 years, SD=13.1;24 men, 41 women) were available.Their data include scores on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Subjective Neuropsychological Symptoms Scale (SNPSS), Insomnia Severity Index (ISI), Whetstone's and Steiner's measures of post-MVA driving anxiety, and the PCL-5 measure of PTSD.The data also included ratings of the worst pain, least pain, and of average pain (Items 3, 4, and 5 of the Brief Pain Inventory) and ratings of depression, anger, and of anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results:The patients' average RPQ score was 45.5 (SD=9.8)and that of the normal controls 8.3 (13.2): the effect size corresponds to point biserial coefficient of .84,thus indicating a very satisfactory criterion validity.The convergent validity is also satisfactory (r=.79 to the SNPSS).Cronbach alpha coefficient for the full 16 item RPQ was excellent (.97) and would not be improved by evaluating separately the first 3 RPQ items and the next 13 items. Discussion and Conclusions:We recommend that the RPQ be employed jointly with SNPSS in clinical assessments and research.The SNPSS includes important post-concussive symptoms missing in the RPQ as well as other subjective neuropsychological symptoms.

Background: The PTSD Checklist for DSM-5 (PCL-5), is presently the most widely used psychological measure of PTSD along the criteria of DSM-5. We examined the criterion validity of PCL-5 separately for each of its 20 items by comparing scores of patients injured in high impact motor vehicle accidents (MVAs) to scores of persons in a control group. In addition, we evaluated criterion and convergent validity of the PCL-5 total scores. Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) included their scores on the PCL-5, Brief Pain Inventory (BPI), Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), ratings of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire), and three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA, but all still experienced active post-MVA symptoms requiring therapy. The PCL-5 scores were also available from 21 controls (mean age 43.0 years, SD=20.3). Results and Discussion: With respect to criterion validity of the PCL-5, the post-MVA patients differed significantly from the control group not only with respect to their total PCL-5 scores, but also on all 20 individual items of the PCL-5, and also on all 4 subscales of PCL-5 (Intrusion, Avoidance, Altered Cognitions/Mood, and Arousal). The PCL-5 total scores correlated significantly to all three measures of post-MVA driving anxiety, post-MVA pain and insomnia, post-MVA depression, anger, and generalized anxiety, and to post-MVA subjective neuropsychological symptoms in the post-concussion and whiplash spectrum. Conclusions: Both the criterion and convergent validity of the PCL-5 for the use on post-MVA patients are excellent.

Background: The incidence of NMS is rare. Relative frequencies of symptoms that are most valuable in making a diagnosis of NMS can be assessed statistically only if a large sample of suspected NMS cases is available. Similarly, the relationship of such NMS symptoms to temperature (a cardinal symptom of NMS) can be meaningfully evaluated only by studying large samples. Method: De-identified archival data on 212 suspected NMS cases were obtained from professionals across the USA and Canada or were extracted from studies published in medical journals. We recorded the symptoms frequencies. The patients’ temperature ranged from 37.20C to 43.00C, with the mean at 39.50 (SD=1.3). All cases were caused by older first-generation antipsychotics (FGAs). We evaluated the frequencies of symptoms reported in these cases. These included symptoms in the realm of mental status, rigidity, and autonomic symptoms. We calculated the frequency of abnormal blood pressure, respiration and heart rate, symptoms such as Dysarthria, Dysphagia, Rigidity, Focal Dystonia, Waxy Flexibility, Myoclonus, Masked Facies, Bradykinesia, Akinesia, Cogwheeling, Stupor, Coma, Obtundation, Mutism, Decrease in Consciousness, Disorientation, Diaphoresis, Sialorrhea, and Seizures. We also calculated their correlations with temperature elevations, the most spectacular symptom of this dangerous syndrome. Results: The highest symptom frequencies (those > 10%) were found for Rigidity (91.0% of patients), Autonomic Instability (66.5%), Diaphoresis (45.8%), Mutism (34.4%), Tremor (31.6%), Stupor (20.3%), Confusion (15.6%), Incontinence (15.6%), Sialorrhea (14.6%), Coma (13.2%), and Dysphagia (11.3%). Other symptoms were too rare within the sample of the 212 suspected NMS cases to calculate the statistical significances of their relationships to temperature. The only significant correlations found of temperature were to increased heart rate and to the severe cases of coma. Discussion and Conclusion: Besides the elevated temperature, the most frequently reported symptoms in this sample of suspected NMS caused by FGAs were Rigidity, Autonomic Instability, Diaphoresis, Mutism, and Tremor. Higher temperature was associated with tachycardia as well as profound impairment of consciousness or coma. Reviews and database studies of second generation antipsychotics (SGAs), also referred to as atypical antipsychotics, suggest a lower incidence of NMS and milder severity of symptoms such as hyperthermia and rigidity. It would be of clinical interest to generate similar de-identified files of archival data for suspected cases of NMS in patients treated with SGAs. Furthermore, a similar profile derived from archival data on milder or prodromal NMS cases could enhance our understanding of this syndrome from a spectrum perspective.

Background: University students often report feeling intense stress, high anxiety, depressive feelings, low self-esteem, suicidal ideation, and substance abuse. This study presents a new questionnaire measure of student stress consisting of 30 items to investigate the symptoms of stress and potentially protective factors. Method: A total of 100 Canadian university students (mean age 20.2 years, SD=2.5, 33 males, 67 females) participated in an internet survey. They all completed our 30 item questionnaire dealing with the perceived stress of studying and exams, and with symptoms such as nightmares, depression, feelings of “being better off dead,” low self-esteem, and with potentially protective factors such as the extent of positive attitude to professors and pride in or contentment with the social status as a university student. Results: High proportions of students reported feeling, at least at times, better off dead (52%). About a half of them felt that most professors do not seem to like them (56%) and many reported nightmares about exams (53%). Lower perceived levels of student stress were associated with more positive feelings towards the professors (r=-.37) and with more pride in being a university student and the contentment with the related social status (r=-.25). The Cronbach alpha coefficient of internal consistency of our questionnaire was .87, i.e., satisfactory. Discussion: The high prevalence of nightmares about exams, feeling of “being better off dead,” or of not being liked by the professors is worrisome. Positive relations towards the professors or pride in or contentment about being a university student function as statistically significant but only weak and hence insufficient protective factors. Conclusions: More than 50% of students reported nightmares about exams, feeling of “being better off dead,” or of not being liked by the professors. Further research is needed to evaluate correlates of student stress to other protective factors than those explored in the present study.

Background: There is a need for scales for standardized assessments of subjective neuropsychological symptoms reported by diverse patient populations such as injured motorists, patients with multiple sclerosis, very severe anorexia, and neurotoxin exposure.This article introduces the Subjective Neuropsychological Symptoms Scale (SNPSS) and describes its validation on a sample of persons injured in high-speed motor vehicle accidents (MVAs).The SNPSS consists of post-concussion items not included in the Rivermead Post-Concussion Symptoms Questionnaire (that is, e.g., tinnitus, impaired balance, word finding difficulty), items to assess motor symptoms (e.g., hand tremor), and symptoms frequently observed in patients with spinal injury or deterioration (tingling, numbness, or reduced feeling in the limbs).Method: De-identified file data of 141 post-MVA patients (49 men, 92 women, average age 39.4 years, SD=13.0)included their responses to the SNPSS, the Rivermead Post-Concussion Symptoms Questionnaire, Insomnia Severity Index, the PCL-5 measure of PTSD according to DSM5,the ratings of worst, least, and average pain on the Brief Pain Inventory and ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire.The patients' responses to the SNPSS and the Rivermead were compared to those of a sample of 23 normal controls (11 men, 12 women, average age 45.0 years, SD=21.2).Results: Average SNPSS score of patients (20.3 points, SD=11.3) was significantly higher than of normal controls (average of 2.5 points, SD=4.8): the magnitude of this relationship (r=.51, p<.001) indicates satisfactory criterion validity of the SNPSS on post-MVA patients.With respect to convergent validity, the SNPSS correlated significantly (r=.79, p<.001) with the Rivermead scores.The SNPSS also correlated significantly with clinical variables often associated with neurological trauma in injured motorists: pain (r=.37), insomnia (r=.45), and PTSD (r=.56).Cronbach alpha coefficient of the SNPSS is very satisfactory (.90). Discussion and Conclusions: Criterion and convergent validity data of SNPSS on injured motorists in thisstudy are satisfactory.Validation data from populations other than injured motorists are much needed, e.g., survey data from patient groups with neurological disease such as multiple sclerosis or those accidentally exposed to neurotoxins.