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RehabMeasures Instrument

Iowa Scales of Personality Change

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Purpose

30 characteristics are assessed in the ISPC, the participant is asked to rate both the extent to which the behavior is present and degree of change from baseline.

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Instrument Details

Acronym ISPC

Area of Assessment

Personality

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Parkinson's Disease & Movement Disorders

Key Descriptions

  • Ratings are gathered from family members with regular contact with the patient.
  • Guidelines are provided using behavioral examples for each scale.
  • Twenty six “clinical scales” assess:
    1) Disturbances in behavioral control
    2) Goal directed behavior
    3) Decision making
    4) Emotional expression
    5) Interpersonal relations
    6) Insight
  • Four control scales assess possible biases made by raters, these include:
    1) Type A behavior
    2) Vanity
    3) Frugality
    4) Manipulativeness
  • Current level and extent of change for each characteristics is assessed on all dimensions.
  • Versions for female and male patients are identical except for the use of sex-appropriate pronouns.

Number of Items

30

Time to Administer

30-60 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

ICF Domain

Body Function

Measurement Domain

Cognition

Considerations

The ISPC may be particularly sensitive to assessing  acquired sociopathy in patients with ventromedial prefrontal damage.

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Parkinson's Disease

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Test/Retest Reliability

Parkinson's: (Houeto et al, 2001; = 16; patients successfully treated by bilateral subthalamic stimulation, assessed by the patients spouse before and 6 months after surgery)

Changes in IRSPC scores in patients treated by continuous bilateral STN stimulation:

 

Test-Retest

 >10*

Test-Retest

<10*

 

Mean (SD)

Mean (SD)

Dimension

n = 8

n = 8

Irritability

-0.8 (2.0)

1.7 (1.4)

Lack of initiative

-2.8 (2.0)

2.6 (1.7)

Perseveration

-3.4 (1.8)

1.8 (1.3)

Depression

-2.9 (1.8)

1.3 (2.0)

Impulsivity

-0.5 (0.9)

1.2 (1.6)

Obsessiveness

0.5 (2.3)

-0.1 (1.8)

Lability/moodiness

0.0 (1.8)

1.1 (1.0)

Lack of persistence

-3.1 (2.0)

2.5 (1.5)

Lack of stamina

-2.4 (0.7)

1.0 (3.7)

Lack of planning

-2.0 (2.1)

2.4 (1.9)

Inflexibility

-1.1 (1.5)

1.4 (1.2)

Poor judgment

-1.0 (1.5)

1.3 (1.2)

Anxiety

-0.9 (1.0)

0.8 (3.0)

Insensitivity

-0.4 (1.1)

1.4 (0.9)

Social inappropriateness

-0.4 (1.1)

0.6 (1.4)

Dependency

-2.0 (2.1)

1.0 (1.9)

Impatience

-1.2 (2.1)

1.3 (1.0)

Type A behaviour

-0.9 (2.0)

-0.6 (1.4)

Blunted affect/unemotional

-0.6 (1.2)

0.6 (2.1)

Social withdrawal

-2.4 (2.4)

0.9 (2.0)

Aggression

-0.2 (0.7)

1.4 (1.6)

Indecisiveness

-0.7 (1.2)

1.6 (1.8)

Vanity

0.2 (0.7)

0.1 (1.1)

Suspiciousness

-0.1 (0.8)

1.2 (1.9)

Apathy

-1.9 (1.6)

2.0 (1.5)

Frugality

-0.1 (0.3)

-0.8 (2.6)

Inappropriate affect/emotion

-0.3 (0.7)

1.1 (1.6)

Manipulativeness

0.3 (0.7)

0.4 (0.5)

Vulnerability to pressure

-1.0 (1.1)

2.3 (1.6)

Lack of insight

-0.4 (1.1)

0.6 (1.4)

Total

-32.6 (16.8)

33.5 (14.1)

*Mean (SD)
BOLD = p < 0.05

Brain Injury

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Normative Data

No studies have been published assessing IRSPC norms with control subjects (Malloy and Grace 2005)

 

Bilateral Ventromedial Prefrontal Damage: (Barrash et al, 2000; n = 57; mean ages for the three groups ranged from 54 to 59 years; informants (close others) knew the patient, on average, more than 30 years)

 

IRSPC Ratings of Severity and Change:

 

 

 

 

 

 

 

Level Ratings

 

 

Change Ratings

 

 

Scale

PF–BVM

PF–NBVM

NPF

PF–BVM

PF–NBVM

NPF

Lack of insight

6.4 (1.0)

2.9 (1.5)

2.9 (1.6***)

2.4 (0.5)

0.3 (1.2)

0.1 (0.8***)

Lack of initiative

6.6 (0.8)

3.4 (1.7)

3.2 (1.4***)

2.6 (0.5)

1.0 (1.1)

0.5 (0.9***)

Irritability

6.1 (0.9)

4.4 (1.4)

3.7 (1.5***)

2.1 (0.4)

1.4 (1.0)

0.6 (0.9***)

Social inappropriateness

5.9 (1.5)

2.8 (1.1)

2.3 (1.4***)

2.4 (0.8)

0.4 (0.9)

0.2 (0.7***)

Poor judgment

6.3 (0.9)

3.6 (1.5)

3.2 (1.3***)

2.0 (1.4)

0.7 (0.8)

0.3 (0.7**)

Lack of persistence

5.4 (1.8)

3.4 (0.9)

2.6 (1.3***)

2.0 (1.1)

0.8 (0.9)

0.2 (0.7***)

Indecisiveness

6.0 (1.5)

3.0 (1.0)

3.6 (1.3***)

2.0 (1.0)

0.4 (0.9)

0.6 (0.9)

Lability

6.1 (1.2)

3.7 (1.5)

3.4 (1.4***)

2.3 (0.8)

0.9 (0.7)

0.6 (0.8***)

Blunted emotional experience

4.9 (1.5)

2.7 (1.5)

2.8 (1.1*)

1.6 (1.1)

–0.3 (0.7)

–0.3 (0.6***)

Apathy

4.9 (1.2)

3.6 (1.1)

3.3 (0.9*)

1.6 (1.0)

0.9 (0.9)

0.5 (0.8)

Inappropriate affect

5.1 (1.3)

2.9 (1.0)

2.8 (1.6**)

2.3 (0.8)

0.3 (0.6)

0.4 (0.7***)

Lack of planning

5.0 (2.3)

4.1 (1.3)

3.6 (1.3)

1.6 (1.4)

0.9 (1.1)

0.4 (0.9)

Poor frustration tolerance

5.0 (1.0)

4.5 (1.1)

3.4 (1.5**)

2.1 (0.9)

1.6 (0.8)

0.7 (1.0***)

Inflexibility

5.9 (1.2)

4.1 (1.3)

3.6 (1.5**)

2.0 (1.1)

0.7 (1.2)

0.4 (0.8*)

Behavioral rigidity

5.6 (2.1)

3.3 (1.3)

3.6 (1.4)

1.4 (1.5)

0.6 (0.9)

0.5 (0.7)

Low emotional expressivity

4.0 (1.7)

2.7 (1.4)

3.3 (1.6)

1.3 (1.6)

–0.3 (0.8)

–0.2 (0.8)

Insensitivity

5.3 (1.9)

3.7 (1.5)

2.9 (1.5)

1.4 (1.0)

0.1 (1.1)

0.2 (0.8*)

Excitability

 3.6 (1.9)

3.7 (1.3)

3.3 (1.3)

0.6 (1.3)

0.6 (1.3)

0.6 (0.9)

Anxiety

5.0 (2.0)

5.0 (2.0)

3.5 (1.5)

1.6 (1.5)

1.0 (0.9)

0.6 (0.7)

Impulsivity

3.9 (1.9)

3.5 (1.1)

2.8 (1.4)

1.1 (1.6)

0.6 (0.9)

0.2 (0.7)

Self-absorption

4.7 (1.9)

3.5 (1.3)

3.2 (1.2)

1.0 (1.1)

0.4 (0.9)

0.3 (0.6)

Obsessiveness

4.1 (2.2)

3.8 (1.3)

3.7 (1.4)

0.9 (1.9)

0.1 (1.0)

0.4 (0.7)

Social withdrawal

4.0 (2.4)

3.1 (1.3)

3.1 (1.4)

0.7 (1.4)

0.4 (0.7)

0.3 (0.8)

Disorganization

3.4 (2.4)

3.9 (1.0)

3.2 (1.5)

1.0 (1.7)

1.3 (1.0)

0.3 (0.9)

Manipulativeness

3.6 (2.2)

2.5 (1.0)

2.5 (1.3)

0.9 (1.2)

0.1 (0.7)

0.0 (0.3)

Dependency

3.7 (1.8)

2.9 (1.1)

3.4 (1.5)

1.0 (1.4)

0.9 (0.6)

0.6 (0.9)

Depression

3.9 (1.2)

3.5 (0.8)

3.4 (1.2)

1.3 (1.1)

0.8 (1.1)

0.6 (0.8)

Type A behavior

2.0 (1.7)

3.1 (1.7)

2.7 (1.3)

0.0 (1.4)

0.0 (1.2)

–0.3 (0.7)

Delusional thinking

2.9 (1.7)

1.9 (0.9)

2.2 (1.2)

0.9 (0.9)

0.3 (0.5)

0.1 (0.5)

Frugality

3.4 (2.8)

2.9 (1.1)

3.3 (1.1)

1.0 (1.3)

–0.1 (0.8)

0.3 (0.7)

PF–BVM = participants with prefrontal lesions with bilateral involvement of the ventromedial region

PF–NBVM = prefrontal lesions without bilateral involvement of the ventromedial region

NPF = non-prefrontal lesions

Criterion Validity (Predictive/Concurrent)

Convergent validity:

Brain Injury: (Barrash et al., 2022; = 83, patients with ISPC ratings and available Minnesota Multiphasic Personality Inventory (MMPI) scores)

  • Adequate convergent validity between Emotional/Social dimension of the ISPC and Behavioral/externalizing dysfunction scale (BXD) of the MMPI (= 0.36, p < 0.001)
  • Adequate convergent validity between Dysexecutive dimension of ISPC and the Emotional/internalizing dysfunction (EID) and BXD scales of the MMPI (= 0.34 and 0.035, respectively, p < 0.001)
  • Adequate convergent validity between Distressed dimension of ISPC and the EID scale of the MMPI (= 0.38, p < 0.001)
  • Poor convergent validity between Emotional/Social dimension of ISPC and Thought Dysfunction (THD) scale of the MMPI (= 0.24, p < 0.05)
  • Poor convergent validity between Hypoemotional dimension of ISPC and EID scale of the MMPI (= 0.24, p < 0.05)
  • Poor convergent validity between Distressed dimension of ISPC and BXD scale of the MMPI (= 0.26, p < 0.05)

 

Brain Injury: (Barrash et al., 2022; = 182, male = 96 (52.7%); mean age = 48.1 (14.4) years; interval of 5.2 (6.0) years (range = 4-360 months) between lesion acquisition and collection of personality data. patients with ISPC ratings and available Minnesota Multiphasic Personality Inventory (MMPI) scores)

Significant correlations between neuropsychological scores and personality disturbances1

Neuropsychological score

Dysexecutive (r)

Distress (r)

FSIQ

-0.221**

-1.99*

VCI

-0.067

-0.144

POI

-0.183*

-0.143

WMS Gen Mem

-0.336

-0.206*

AVLT-DR

-0.286***

-0.173*

TMT-B (seconds)2

0;374***

0.124

BDI-II

0.294***

0.338***

FSIQ = WAIS IV Full Scale IQ; VCI = WAIS IV Verbal Comprehension Index; POI = WAIS IV Perceptual-Organizational Index; WMS Gen Mem = Wechsler Memory Scales III General Memory Index; AVLT-DR = Auditory Verbal Learning Test-Delayed Recall; TMT-B = Trailmaking Test- Trail B; BDI-II = Beck Depression Inventory-II.

1Emotional/social disturbance and hypoemotional disturbance were not associated with cognitive performance.

2For the Trail Making Test- Trail B (seconds to completion), positive correlations indicate worse cognitive performance was related to increased personality disturbance. For the Beck Depression Inventory, positive correlations indicate higher levels of depression are related to increased personality disturbance.

* = < 0.05, ** = < 0.01, *** = < 0.001

Construct Validity

Bilateral Ventromedial Prefrontal Damage: (Barrash et al, 2000)

The IRSPC was shown to discriminate between patients with Prefrontal lesions with bilateral involvement of the ventromedial region, Prefrontal lesions without bilateral involvement of the ventromedial region and non-prefrontal lesions (refer to the "IRSPC Ratings of Severity and Change" Table in the "normative data" section of this summary for details"

Content Validity

Ventromedial Prefrontal Damage: (Barrash, et al. 1997; n = 115) 

  • Factor analysis results suggest the IRSPC is composed of the following dimensions:
  • Emotional functioning
  • Behavioral control
  • Social and interpersonal behavior
  • Higher-order cognitive functions

Non-Specific Patient Population

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Interrater/Intrarater Reliability

Population Characteristics not Specified: (Barrash, et al 1997)

  • Adequate agreement; Weighted Kappa, means: LEVEL = 0.48; CHANGE = 0.52 (correcting for chance agreement)

Bibliography

Barrash, J., Anderson, S., et al. (1997). "The Iowa rating scales of personality change: reliability and validity." Journal of the International Neuropsychological Society 3: 27-28.

Barrash, J., Tranel, D., et al. (2001). "Acquired personality disturbances associated with bilateral damage to the ventromedial prefrontal region." Developmental Neuropsychology. Find it on PubMed

Barrash. J., Bruss, J., et al. (2022). "Lesions in different prefontal sectors are associated with different type of acquired personality disturbances. Cortex, 147, 169-184. https://doi.org/10.1016/j.cortex.2021.12.004.

Houeto, J., Mesnage, V., et al. (2002). "Behavioural disorders, Parkinson's disease and subthalamic stimulation." Journal of Neurology, Neurosurgery & Psychiatry 72(6): 701. Find it on PubMed

Malloy, P. and Grace, J. (2005). "A Review of Rating Scales for Measuring Behavior Change Due to Frontal Systems Damage." Cognitive and behavioral neurology 18(1): 18-27. Find it on PubMed