Clinically isolated syndromes (CIS), such as optic neuritis, brainstem or spinal cord syndromes are frequently the first clinical presentations of multiple sclerosis. However, not all CIS patients develop multiple sclerosis and in those who do, disability is highly variable. In previous follow-up studies, brain lesions on T2-weighted MRI are associated with increased risk of multiple sclerosis and to an extent disability. We evaluated the longitudinal relationships between the MRI lesions and clinical course over a period of 20 years. CIS patients were recruited between 1984 and 1987 and previously followed up after 1, 5, 10 and 14 years. Of the 140 subjects who were initially recruited with a CIS for a baseline MRI study, we followed up 107 patients after a mean of 20.2 years (range 18-27.7). Multiple sclerosis was diagnosed as clinically definite on clinical grounds only and disability determined using the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) score. Clinically definite multiple sclerosis developed in 67 out of 107 (63%) overall: 60 out of 73 (82%) with abnormal and 7 out of 34 (21%) with normal baseline MRI. Multiple sclerosis was still relapsing-remitting in 39 (58%)--including 26 (39%) with a 'benign' course (EDSS < or = 3)--whilst 28 (42%) had developed secondary progression. T2 lesion volume at all time-points correlated moderately with 20-year EDSS (r(s) values 0.48 to 0.67; P < 0.001) and MSFC z-score [r(s) values (-0.50) to (-0.61); P < 0.001]. In those developing multiple sclerosis, a concurrent correlation of change in T2 lesion volume with change in EDSS was most evident in years 0-5 (r(s) = 0.69, P < 0.001). The estimated rate of lesion growth over 20 years was 0.80 cm3/year in those who retained a relapsing remitting multiple sclerosis course, and 2.89 cm3/year in those who developed secondary progressive multiple sclerosis, a difference of 2.09 cm3/year (95% CI: 0.77, 2.96; P < 0.001). This study extends previous follow-up of CIS patients and sheds new light on how the lesions evolve according to the natural history. Baseline MRI findings are predictive for development of clinically definite multiple sclerosis. Lesion volume and its change at earlier time points are correlated with disability after 20 years. Lesion volume increases for at least 20 years in relapse-onset multiple sclerosis and the rate of lesion growth is three times higher in those who develop secondary progressive than in those who remain relapsing remitting multiple sclerosis.

This paper describes the rationale, development, and validation of the Psychological Screening Inventory (PSI), a 10-20-minute instrument designed to maximize the advantages of the inventory technique. It is intended as a brief screening device for use in mental health related settings where time and psychological skills may be at a premium. The five scales are: (a) Alienation, assessing similarity to psychiatric patients; (6) Social Nonconformity, assessing similarity to incarcerated prisoners; (c) Discomfort, assessing the major personality factor of anxiety or perceived maladjustment; (rf) Expression, assessing the factor of extraversion or undercontrol; and (e) Defensiveness, assessing test-taking attitude. Norms were established on a national sample of SOO men and SOO women. Validity data include mean profiles of cross-validation groups, hit-and-miss discriminations, intercorrelations with other inventories, factor analyses of correlations with the MMPI for college students, mean MMPI profiles of extreme scorers on certain PSI scales, and relationships with intelligence.Lt n s 2£riisr^u;°sr£ ^rf^f £ (eg -Art s< 19 r 66; JT*

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This paper reviews the state of current knowledge on child molestation, as distinguished from child rape. The traditional view that deviant sexual behavior is based in a character disorder is contrasted with the functional view, which makes no assumptions about etiology. Descriptive characteristics of child molesters are presented; in particular, preference molesters or pedophiles, who prefer children, are distinguished from situational molesters, whose basic preference is for adult partners, but who choose children as a function of circumstances. Structured assessment devices are needed for making this distinction and also for assessing molesters' potential for violence. From a clinical perspective, the family-systems approach is widely considered to be the treatment of choice for incestuous families. For eliminating the deviant behavior and impulses of offenders themselves, the empirical treatment literature shows that behavioral methods using covert sensitization have considerable promise, at least for situational molesters.

The internal and external validity of scores on the two-scale Balanced Inventory of Desirable Responding (BIDR) and its recent revision, the Paulhus Deception Scales (PDS), developed to measure two facets of social desirability, were studied with three groups of forensic clients and two groups of college undergraduates (total N ¼ 519). The two scales were statistically significantly related in all groups and for both versions of the inventory. A two-factor congeneric, orthogonal measurement model was rejected for all groups. However, a two-factor model that allowed cross-loadings among the items and correlation between the factors provided adequate fit. Concurrent validity data showed scores on both the Impression Management and Self-Deceptive Enhancement (SDE) scales to be satisfactory measures of their respective constructs and also of general social desirability, for both forensic clients and undergraduates. An exception was found in lower validity correlates for scores on the SDE scale in the PDS form.

Sustained weight loss after GBP was related to a rather wide range of pre-surgery variables, each of which made a small contribution, but composite variables grounded in the general literature provided more effective prediction. It is cautioned that continued success after > or =2 years could be dependent on yet other variables, with a possible contribution from some post-surgery factors.

Item factor analyses were conducted on the 5 scales of the Psychological Screening Inventory separately for 400 normal males and 400 normal females, who were representative of the U.S. adult population with respect to age and diverse in education and geographic location. Between 3 and 6 factors were identified for each scale, and each was tentatively named according to item content. Clinical use of these factor-based item clusters as individual scales should await criterion-related research.

This study examined the utility of the traditional MMPI validity indicators in successfully identifying subjects who were known to have engaged in defensive denial in a real-life situation involving very serious personal consequences. Ninety indicted sex offenders were divided into no-denial, part-denial, and full-denial groups on the basis of formal police reports. The Minnesota Multiphasic Personality Inventory (MMPI) was administered independently. Part-and fulldenial subjects were similar enough to be combined into a single denial group, which was best discriminated from the no-denial group by an L + K -F raw score index. Group membership was predicted with 83% accuracy by a discriminant function involving just the validity scales, rising to 89% when the MMPI clinical scales were included in the pool of predictors. These figures would be expected to decline on cross-validation.