NEUROBEHAVIORAL TOXICOLOGICAL ANALYSIS OF A RAMPAGE KILLER
Raymond Singer, Ph.D.
Independent Practice
Santa Fe, New Mexico
and
New York, New York
www.neurotox.com
ray.singer@gmail.com
and
Jack Dwayne Thrasher, Ph.D.
Independent Practice
Citrus Grove, California
Published until April 15, 2012 at: http://neurotox.blogspot.com/
Abstract
In September 2008, a 28-year-old man went on a shooting rampage that left six people dead and four others wounded. Upon arraignment, he told the judge that God told him to kill. The evaluation was conducted to determine if exposure to various neurotoxic agents impacted the defendant's sanity.
Methods: Review of records (criminal, educational, historical, medical, toxicological), diagnostic neuro-psychological interview, family members interview, police reports, and administration of neuropsychological/ behavioral tests.
Results: The defendant had a history of exposure to multiple neurotoxic substances. He lived in a new formaldehyde emitting mobile home from birth to age 14 with psychomotor symptoms. In 2001-2007, he worked as a union painter with resulting headaches and other symptoms. By 2003, there were reports of hallucinations. From 2006-2008, he lived in an extremely moldy trailer. Sampling of the trailer in 2009 found numerous ERMI moldiness index samples were at Level 4, showing the greatest likelihood of having a mold problem; mold and mycotoxin samples found 30.5 ppb trichothecenes; 57 ng/sample LSD from ergotomines in the ceiling, 86 ng on bed pillow; 28.9 ppb ochratoxin A on mattress cover; 14 ppb ochratoxin A in the defendant's urine. In April 2008, he had overdosed dermal exposure to pyrethroids for treating probably hallucinated lice.
Neuropsychological testing post-offense (April, 2009) found IQ at the 42%tile; Working Memory, 1%tile; Processing Speed 27%tile; Visual Immediate Memory 7%tile; Booklet Category Test 11%tile; Trailmaking 1%tile; and other findings. Borderline Personality Disorder was identified by the NEO-3. Multiple tests for malingering, including the TOMM, were negative.
Conclusion: Significant mental illness was found, with neuropsychological results consistent with adult-onset neurotoxicity, including mycotoxicosis. The defendant was found not guilty by reason of insanity on some counts, guilty on other counts, spared the death penalty, committed to a mental hospital until cured, and then to prison for life.
The subject was at heightened risk of neurotoxicity from significant exposure to formaldehyde, solvents, products of repeated indoor water intrusion - including mold and mycotoxins (including lysergic acid diethylamide (LSD) resulting from mold in the defendant’s residence) - and pesticides. The additive or synergistic effects of these exposures rendered him delusional, with significant impairment of cognitive, emotional and executive function. Neuropsychological testing was consistent with these impairments.
The defendant suffered from an undiagnosed mental disorder as a child, involving social and cognitive dysfunction. He had significant formaldehyde exposure as a fetus and child. He had a difficult upbringing in his home, was functioning somewhat successfully given his circumstances until exposed to a series of toxic chemicals as a painter, at which time his mental health deteriorated - from the solvent neurotoxicity insult- which permanently sent him into a downward spiral of deteriorating mental health.
As his mental health deteriorated, during 2006-2008, the defendant lived in a very moldy trailer, with environmental LSD exposure from the mycotoxins produced by mold. In his delusional state, he acquired and probably overdosed with pesticides for lice and bedbugs, which would exacerbate his pre-existing mental illness, and result in an acute delusional and confusional state.
The defendant may be viewed as having an underlying thought disorder, such as schizophrenia, which was exacerbated by neurotoxicity from various sources, resulting in delusional psychosis at the time of the shooting.
Mold exposure in the trailer
The extensive moldy condition of the residence was caused by repeated indoor water intrusion. Per environmental inspection, the shingles on roof were faulty, allowing rain to pour in. Among numerous surfaces, the ceiling was extensively moldy. The unit had been moldy since being purchased, with sick previous occupants. See color photographs.
Mold exposure lab reports
Environmental Relative Moldiness Index (ERMI) Report: 3/20/2009. ERMI interpretation: the ERMI takes into account both the quantity of each mold species and the diversity of species present. It measures the long term mold burden. ERMI Level 2 are less likely to have a mold problem; ERMI Level 3 are more likely to have a mold problem; ERMI Level 4 have the greatest likelihood of having a mold problem.
Insulation Ceiling: ERMI Level 2
Bedroom Closet: ERMI Level 4
Pillowcase: ERMI Level 4
Mattress Cover: ERMI Level 4
Kitchen Ceiling: ERMI Level 4
Ceiling over Sink: ERMI Level 3
Mycotoxin Testing Note: All Mycotoxins are reported in parts per billion (ppb) TRICOTHECENES AFLATOXINS OCHRATOXIN A
Ceiling Insulation over Bed 30.463 3.5 2.8
Ceiling Tile Above Kitchen Sink 0 0 9.1
Kitchen Ceiling 0 0 4.9
Plastic and Insulation Bedroom closet 0.901 2.1 9.8
Pillow cover 0 1.4 9.8
Mattress Cover 0 0 28.9
Urine (defendant) Not Present Not Present 14
Trailer Testing
15-Mar-09 FUNGAL CULTURES
Received in lab 17 Mar 09
Refer to COC forms
Living Room R0309031 Penicillium sp.
Scopulariopsis sp.
Aspergillus sp
Bedroom Closet R0309032 Scopulariopsis sp.
Rhizopus sp
Penicillium sp.
Aspergillus sp
Bedroom R0309033 Scopulariopsis sp.
Penicillium sp.
Aspergillus sp
Front Seat - Van R0309034 Penicillium sp.
Aspergillus sp
Kitchen Baby High Chair R0309034 Scopulariopsis sp.
Penicillium sp.
Rhizopus sp.
Aspergillus sp
Van Rear Seat R0309035 Penicillium sp.
Aspergillus sp
Cladasporium sp.
Ergotamines: After acidic extractions of the samples, the specimens were found to contain lysergic acid (LSD) in the samples taken from the ceiling over the bed (57 ng/sample) and the pillow from the bed (86 ng/sample)
Neurobehavioral test results
Age: 28
Gender: Male
Race: White
Height: 6' 00"
Weight: 170
Education: Per parents: dropped out of school as a sophomore at age 15. Educational record review: high school transcript: In 9th and 10th grade, the subject received quite a number of A's, including in subjects such as science, art, physical education, health, occupational education, science, and biology. His grades included A's in Library Science.
Marital status: Never married
Children: 0
Occupation: Mechanic, painter
Premorbid IQ Estimates: Based on a demographic formula which considers current vocabulary scores, education, and occupation, expected pre-morbid IQ would be approximately:
Score Percentile SEe
Full Scale 112 75 8.64
Cognitive Testing Standard: Scores significantly below the standard are considered abnormal for the subject and deficit.
Scaled Score Cutoff
IQ Percent equiv. Scaled/Percentile
112 75 12 8/25
Wechsler Adult Intelligence Scale, Third Edition: WAIS-III:
Age - Adjusted
Scaled Scores Percentile
Verbal Subscales
Vocabulary 13 84
Similarities 10 50
Arithmetic 7 16
Digit Span 4 2
Information 14 91
Comprehension 9 37
Letter-Number
Sequencing 3 1
Performance Subscales
Picture Completion 11 63
Digit Symbol - Coding 8 25
Block Design 10 50
Matrix Reasoning 11 63
Picture Arrangement 9 37
Symbol Search 9 37
Object Assembly 9 37
Score Percentile Confidence Interval - 95%
Verbal IQ: 96 39 91 – 101
Performance IQ: 98 45 91 – 105
Full Scale IQ: 97 42 93 – 101
Index Scores:
Verbal Comprehension 112 79 106 – 117
Perceptual Organization 103 58 96 – 110
Working Memory 67 1 62 – 76
Processing Speed 91 27 83 – 101
Discrepancy Comparisons: Statistical significance 0.05 level
Frequency of Difference in Standardization
Difference Sample
Verbal Comprehension - Working Memory 45 0.5
Verbal Comprehension – Processing Speed 21 17
Interpretation: A decline in cognitive functioning was detected, particularly affecting Working Memory, at the 1st percentile and Processing speed at the 27th percentile. This was further reflected in the contrast between the Verbal Comprehension Index and the Working Memory Index, as well as the Verbal Comprehension Index and the Processing Speed Index, with a statistically very infrequent spread between the two indexes. This finding suggests that there has been a decline affecting working memory and processing speed, consistent with patients with diagnosed neurotoxicity.
Further analysis shows that attentional skills have been compromised, with Digit Span at the 2nd percentile, Letter Number Sequencing at the 1st percentile, and Digit Symbol -- Coding at the 25th percentile.
These findings are consistently with patients with diagnosed neurotoxicity.
Wechsler Memory Scale, Third Edition (WMS-III):
Primary Subtests Age Scaled Score Percentile
Logical Memory I - Recall 8 25
Faces I - Recognition 9 37
Verbal Paired Assoc. I - Recall 9 37
Family Pictures I - Recall 2 <1
Letter-Number Sequencing 3 1
Spatial Span 10 50
Logical Memory II - Recall 9 37
Faces II - Recognition 12 75
Verbal Paired Assoc. II - Recall 13 84
Family Pictures II - Recall 2 <1
Auditory Recognition - Delayed 10 50
Auditory Process Subtests
Logical Memory I
1st Recall Total 9 37
Learning Slope 8 25
Verbal Paired Assoc. I
1st Recall Total 8 25
Learning Slope 12 75
Logical Memory II
Percent Retention 10 50
Verbal Paired Assoc. II
Percent Retention 12 75
Confidence
Primary Index Scores Index Score Percentile Interval (95%)
Auditory Immediate 92 30 85 – 100
Visual Immediate 71 3 66 – 86
Immediate Memory 78 7 72 – 88
Auditory Delayed 105 63 95 – 114
Visual Delayed 81 10 74 – 94
Auditory Recog. Delayed 100 50 89 – 111
General Memory 93 32 86 – 102
Working Memory 81 10 74 – 93
Interpretation: Memory deficits primarily affecting Visual (Immediate and Delayed) and Working Memory. Memory deficits are consistent with patients with diagnosed neurotoxicity.
Benton Visual Retention Test (Administration B, Form C). Comparison IQ = 112
Expected for IQ Observed Difference
Number correct 8 - 1 = 7 3 4
Number errors 2 + 2 = 4 16 12
Interpretation:
Number correct score: Suggested acquired impairment of cognitive functioning.
Number of errors score: Strong indication of acquired impairment of cognitive functioning
The Booklet Categories Test (CT):
Subtest Raw Score
I Errors 0
II Errors 0
III Errors 35
IV Errors 2
V Errors 9
VI Errors 9
VII Errors 5
T-score Percentile
Total Errors 60 38 11
Interpretation: Impaired abstraction or concept formation ability, flexibility in the face of complex and novel problem-solving, and capacity to learn from experience, indicative of brain damage.
Comprehensive Trail-Making Test (CTMT):
Trail # Raw Score T-Score Percentile
1 26 56 72
2 29 52 57
3 41 41 18
4 26 50 50
5 106 22 <1
Interpretation: Deficit on the critical trail #5.
Controlled Oral Word Association Test evaluates verbal fluency, the ability to find and use words.
Raw Score Correction Total Percentile
30 3 33 27
Interpretation: Borderline or possible deficit
Embedded Figures Test evaluates the ability to detect visual figure-ground relationships (the use of the eyes to make sense out of what the eye sees).
Number detected out of 40 objects: 37
Interpretation: Within normal limits
Frontal Systems Behavior Scale (FRSBE)
In this case, before illness refers to the time before solvent exposure
Self Rating
T-score T-score
Before Illness % After Illness %
Apathy 55 69 88 >99
Disinhibition 56 73 80 >99
Executive Dysfunction 44 30 80 >99
Total 55 69 89 >99
Interpretation: Elevated symptoms of frontal lobe damage.
Grooved Pegboard Test: Dominant Hand: Left.
Dominant Non-dominant
Time for completion: 75 s 74 s
Percentile: 22 47
Interpretation: Within normal limits
Neitz Test of Color Vision screens for color vision defects. Number correct of 9 items: 9 Interpretation: Within normal limits
Neurotoxicity Screening Survey:
Factor Results
Score Classification
Memory and Concentration...... 76 Elevated
Autonomic Nervous System...... 62 Elevated
Vision........................ 17 Elevated
Hearing....................... 10 Elevated
Balance....................... 2 Borderline elevated
Smell-Taste.................. 9 Elevated
Peripheral Numbness........... 20 Elevated
Sensory-Motor................. 52 Elevated
Chemical Sensitivity......... 6 Elevated
Emotionality.................. 62 Elevated
Distortion I..................
Overall Neurotoxicity Indicator 316
Interpretation: Results are consistent with patients with diagnosed neurotoxicity.
Selective Reminding Test:
Words continuously remembered, summed over trials (CLTR): 36
Expected: 90
Percentile rank for gender, age and education: 7%
Interpretation: Deficit
Stroop Color and Word Test
Raw Age/Ed
Score Predicted Residual T-Score Percentile
Word reading: 92 99 -7 45 31
Color naming: 58 76 -18 35 7
Color/Word: 41 40 1 51 54
Interpretation: Generally within normal limits
Visual Search and Attention Test:
Left Right Total
Score 72 69 141
Percentile 16 15 15
Interpretation: Deficit Deficit Deficit
EMOTIONAL FUNCTION
Beck Anxiety Inventory measures emotional anxiety. Score: 33
Interpretation: Severe anxiety
Beck Depression Inventory measures emotional depression. Score: 28
Interpretation: Moderate depression
Profile of Mood States
Raw Score T Score %
Tension 22 52 58
Depression** 24 48 42
Anger/Hostility 5 41 18
Vigor 2 38 12
Fatigue 20 59 82
Confusion/Bewilderment 12 48 42
Interpretation: Mood within normal limits at time of testing. Low level of vigorous mood.
WELL-BEING MEASURES
Alcohol Use Disorders Identification Test (AUDIT). Score: 8
Interpretation: Low-medium likelihood of alcohol problems.
Fatigue Severity Scale: Score: 46/9 = 5.1
Interpretation: Consistent with medically ill patients
Quick Environmental Exposure and Sensitivity Inventory, Version 1 (QEESI) identifies health problems respondent may experience in response to various environmental exposures.
Score Interpretation
Chemical Intolerance 26 Medium
Other Intolerance 12 Medium
Symptom Severity 53 High
Masking Index 6 High
Life Impact 49 High
Interpretation: Somewhat suggestive of multiple chemical intolerance.
PERSONALITY TESTING
Revised Neo Personality Inventory: Interpretive report: Summary
Moderately high on the factor Neuroticism, with moderately high levels of negative emotion and the occasional episodes of psychological distress. Such scorers are rather low in self-esteem and somewhat insecure.
Low in Conscientiousness, with a fairly low need for achievement and a tendency not to organize his time well. Raters describe such people as relatively unreliable and careless.
Average range in Agreeableness, Openness, and Extroversion.
Axis II disorders: Personality disorders: Profile agreement between this respondent and the average profile for Borderline Personality Disorder is higher than 90% of subjects in the normative sample, suggesting that the patient may have Borderline features or a Borderline Personality Disorder. No other Axis II disorders were suggested or ruled out.
The respondent can be characterized as: A Gloomy Pessimist, Maladaptive (using primitive and ineffective psychological defenses; lacking insight; cannot verbalize his feelings; may be considered alexithymic (literally "without words for emotions", to describe a state of deficiency in understanding, processing, or describing emotions), Temperamental, and Under - controlled.
DISTORTION AND MALINGERING TESTS
Amnesia Questionnaire assesses the subject's possible mis-reporting memory symptoms. Number correct of 13/13
Interpretation: Non-malingering
Dot Counting Test detects suspect test-taking efforts in adults.
Comparison Group: Mild Dementia
Mean Ungrouped Time 5.5
Mean Grouped Time 2.2
Number of errors 0
Signs of suspect effort
Does mean Grouped time exceed mean Ungrouped time by 1 sec? No
Are there counting errors on Card 6 and/or Card 12? No
E-Score (# of errors plus mean time, ungrouped and group) 7.7
E-Score Cutoff 22
Under test development conditions:
Sensitivity (the test's ability to detect suspect effort) 62%
Specificity (the test's ability to detect normal effort) 94%
Under base rate assumption of 15% population suspect effort:
Positive Predictive Accuracy (the test's ability to detect suspect effort) 64%
Negative Predictive Accuracy(the test's ability to detect normal effort) 93%
Interpretation: Normal effort; non-malingering
Endorsement of Rare Symptoms. The Neurotoxicity Screening Survey presents 14 symptoms that are rare. If a number of these symptoms are endorsed, the question of distortion is highlighted.
Number endorsed: Distortion I: 3; Distortion II: 4
Interpretation: Although distortion or confusion was possible, the total distortion number was not elevated when compared with normal controls.
Memorization of "16" Items: Number correct: 16/16
Interpretation: Non-malingering
Miller Forensic Assessment of Symptoms Test (M-FAST) Total score cutoff = 6. Total Interview Time: 1:45
% Negative % Positive
Raw Score Prediction Prediction
Reported vs. Observed 1
Extreme Symptomatology 1
Rare Combinations 0
Unusual Hallucinations 0
Unusual Symptom Course 0
Negative Image 0
Suggestibility 1
Total 3 99% 57%
Interpretation: Non-malingering
Portland Digit Recognition Test
Percent correct responses (5 sec delay): 3/3
Percent correct responses (15 sec delay): 3/3
Percent correct responses (30 sec delay): 1/1
Interpretation: Non-malingering
Three Word Memory Test
Number correct: 9/9
Interpretation: Non-malingering
Test of Memory Malingering (TOMM): Decision rules: 1) Scoring lower than chance on any trial indicates the possibility of malingering: Scores below 18 are unlikely to occur by chance; 2) any score lower than 45 on Trial 2 or the Retention Trial indicates the possibility of malingering.
Raw Score
Trial 1 31
Trial 2 45
Retention 48
Interpretation: Non-malingering.
Twenty-one Item Memory Test assesses the probability of malingering based on a forced choice comparison. If the subject does not remember correctly nine of the 21 items on the forced choice test, the subject may be malingering.
Number of words correctly recalled:
Free recall: 9
Forced choice: 19
Interpretation: Non-malingering
Recognition testing: Recognition is an easier task than recall.
Recognition test Results Classification
Logical Memory II 26/30 good or better effort
Verbal Paired Associates II 24/24 word pairs excellent effort
Word Lists II (min. 18) 20/24 good or better effort
Visual Reproduction II NA NA
Auditory recognition - Delayed (min. 43) 44 good or better effort
Raymond Singer, Ph.D.
Independent Practice
Santa Fe, New Mexico
and
New York, New York
www.neurotox.com
ray.singer@gmail.com
and
Jack Dwayne Thrasher, Ph.D.
Independent Practice
Citrus Grove, California
Published until April 15, 2012 at: http://neurotox.blogspot.com/
Abstract
In September 2008, a 28-year-old man went on a shooting rampage that left six people dead and four others wounded. Upon arraignment, he told the judge that God told him to kill. The evaluation was conducted to determine if exposure to various neurotoxic agents impacted the defendant's sanity.
Methods: Review of records (criminal, educational, historical, medical, toxicological), diagnostic neuro-psychological interview, family members interview, police reports, and administration of neuropsychological/ behavioral tests.
Results: The defendant had a history of exposure to multiple neurotoxic substances. He lived in a new formaldehyde emitting mobile home from birth to age 14 with psychomotor symptoms. In 2001-2007, he worked as a union painter with resulting headaches and other symptoms. By 2003, there were reports of hallucinations. From 2006-2008, he lived in an extremely moldy trailer. Sampling of the trailer in 2009 found numerous ERMI moldiness index samples were at Level 4, showing the greatest likelihood of having a mold problem; mold and mycotoxin samples found 30.5 ppb trichothecenes; 57 ng/sample LSD from ergotomines in the ceiling, 86 ng on bed pillow; 28.9 ppb ochratoxin A on mattress cover; 14 ppb ochratoxin A in the defendant's urine. In April 2008, he had overdosed dermal exposure to pyrethroids for treating probably hallucinated lice.
Neuropsychological testing post-offense (April, 2009) found IQ at the 42%tile; Working Memory, 1%tile; Processing Speed 27%tile; Visual Immediate Memory 7%tile; Booklet Category Test 11%tile; Trailmaking 1%tile; and other findings. Borderline Personality Disorder was identified by the NEO-3. Multiple tests for malingering, including the TOMM, were negative.
Conclusion: Significant mental illness was found, with neuropsychological results consistent with adult-onset neurotoxicity, including mycotoxicosis. The defendant was found not guilty by reason of insanity on some counts, guilty on other counts, spared the death penalty, committed to a mental hospital until cured, and then to prison for life.
The subject was at heightened risk of neurotoxicity from significant exposure to formaldehyde, solvents, products of repeated indoor water intrusion - including mold and mycotoxins (including lysergic acid diethylamide (LSD) resulting from mold in the defendant’s residence) - and pesticides. The additive or synergistic effects of these exposures rendered him delusional, with significant impairment of cognitive, emotional and executive function. Neuropsychological testing was consistent with these impairments.
The defendant suffered from an undiagnosed mental disorder as a child, involving social and cognitive dysfunction. He had significant formaldehyde exposure as a fetus and child. He had a difficult upbringing in his home, was functioning somewhat successfully given his circumstances until exposed to a series of toxic chemicals as a painter, at which time his mental health deteriorated - from the solvent neurotoxicity insult- which permanently sent him into a downward spiral of deteriorating mental health.
As his mental health deteriorated, during 2006-2008, the defendant lived in a very moldy trailer, with environmental LSD exposure from the mycotoxins produced by mold. In his delusional state, he acquired and probably overdosed with pesticides for lice and bedbugs, which would exacerbate his pre-existing mental illness, and result in an acute delusional and confusional state.
The defendant may be viewed as having an underlying thought disorder, such as schizophrenia, which was exacerbated by neurotoxicity from various sources, resulting in delusional psychosis at the time of the shooting.
Mold exposure in the trailer
The extensive moldy condition of the residence was caused by repeated indoor water intrusion. Per environmental inspection, the shingles on roof were faulty, allowing rain to pour in. Among numerous surfaces, the ceiling was extensively moldy. The unit had been moldy since being purchased, with sick previous occupants. See color photographs.
Mold exposure lab reports
Environmental Relative Moldiness Index (ERMI) Report: 3/20/2009. ERMI interpretation: the ERMI takes into account both the quantity of each mold species and the diversity of species present. It measures the long term mold burden. ERMI Level 2 are less likely to have a mold problem; ERMI Level 3 are more likely to have a mold problem; ERMI Level 4 have the greatest likelihood of having a mold problem.
Insulation Ceiling: ERMI Level 2
Bedroom Closet: ERMI Level 4
Pillowcase: ERMI Level 4
Mattress Cover: ERMI Level 4
Kitchen Ceiling: ERMI Level 4
Ceiling over Sink: ERMI Level 3
Mycotoxin Testing Note: All Mycotoxins are reported in parts per billion (ppb) TRICOTHECENES AFLATOXINS OCHRATOXIN A
Ceiling Insulation over Bed 30.463 3.5 2.8
Ceiling Tile Above Kitchen Sink 0 0 9.1
Kitchen Ceiling 0 0 4.9
Plastic and Insulation Bedroom closet 0.901 2.1 9.8
Pillow cover 0 1.4 9.8
Mattress Cover 0 0 28.9
Urine (defendant) Not Present Not Present 14
Trailer Testing
15-Mar-09 FUNGAL CULTURES
Received in lab 17 Mar 09
Refer to COC forms
Living Room R0309031 Penicillium sp.
Scopulariopsis sp.
Aspergillus sp
Bedroom Closet R0309032 Scopulariopsis sp.
Rhizopus sp
Penicillium sp.
Aspergillus sp
Bedroom R0309033 Scopulariopsis sp.
Penicillium sp.
Aspergillus sp
Front Seat - Van R0309034 Penicillium sp.
Aspergillus sp
Kitchen Baby High Chair R0309034 Scopulariopsis sp.
Penicillium sp.
Rhizopus sp.
Aspergillus sp
Van Rear Seat R0309035 Penicillium sp.
Aspergillus sp
Cladasporium sp.
Ergotamines: After acidic extractions of the samples, the specimens were found to contain lysergic acid (LSD) in the samples taken from the ceiling over the bed (57 ng/sample) and the pillow from the bed (86 ng/sample)
Neurobehavioral test results
Age: 28
Gender: Male
Race: White
Height: 6' 00"
Weight: 170
Education: Per parents: dropped out of school as a sophomore at age 15. Educational record review: high school transcript: In 9th and 10th grade, the subject received quite a number of A's, including in subjects such as science, art, physical education, health, occupational education, science, and biology. His grades included A's in Library Science.
Marital status: Never married
Children: 0
Occupation: Mechanic, painter
Premorbid IQ Estimates: Based on a demographic formula which considers current vocabulary scores, education, and occupation, expected pre-morbid IQ would be approximately:
Score Percentile SEe
Full Scale 112 75 8.64
Cognitive Testing Standard: Scores significantly below the standard are considered abnormal for the subject and deficit.
Scaled Score Cutoff
IQ Percent equiv. Scaled/Percentile
112 75 12 8/25
Wechsler Adult Intelligence Scale, Third Edition: WAIS-III:
Age - Adjusted
Scaled Scores Percentile
Verbal Subscales
Vocabulary 13 84
Similarities 10 50
Arithmetic 7 16
Digit Span 4 2
Information 14 91
Comprehension 9 37
Letter-Number
Sequencing 3 1
Performance Subscales
Picture Completion 11 63
Digit Symbol - Coding 8 25
Block Design 10 50
Matrix Reasoning 11 63
Picture Arrangement 9 37
Symbol Search 9 37
Object Assembly 9 37
Score Percentile Confidence Interval - 95%
Verbal IQ: 96 39 91 – 101
Performance IQ: 98 45 91 – 105
Full Scale IQ: 97 42 93 – 101
Index Scores:
Verbal Comprehension 112 79 106 – 117
Perceptual Organization 103 58 96 – 110
Working Memory 67 1 62 – 76
Processing Speed 91 27 83 – 101
Discrepancy Comparisons: Statistical significance 0.05 level
Frequency of Difference in Standardization
Difference Sample
Verbal Comprehension - Working Memory 45 0.5
Verbal Comprehension – Processing Speed 21 17
Interpretation: A decline in cognitive functioning was detected, particularly affecting Working Memory, at the 1st percentile and Processing speed at the 27th percentile. This was further reflected in the contrast between the Verbal Comprehension Index and the Working Memory Index, as well as the Verbal Comprehension Index and the Processing Speed Index, with a statistically very infrequent spread between the two indexes. This finding suggests that there has been a decline affecting working memory and processing speed, consistent with patients with diagnosed neurotoxicity.
Further analysis shows that attentional skills have been compromised, with Digit Span at the 2nd percentile, Letter Number Sequencing at the 1st percentile, and Digit Symbol -- Coding at the 25th percentile.
These findings are consistently with patients with diagnosed neurotoxicity.
Wechsler Memory Scale, Third Edition (WMS-III):
Primary Subtests Age Scaled Score Percentile
Logical Memory I - Recall 8 25
Faces I - Recognition 9 37
Verbal Paired Assoc. I - Recall 9 37
Family Pictures I - Recall 2 <1
Letter-Number Sequencing 3 1
Spatial Span 10 50
Logical Memory II - Recall 9 37
Faces II - Recognition 12 75
Verbal Paired Assoc. II - Recall 13 84
Family Pictures II - Recall 2 <1
Auditory Recognition - Delayed 10 50
Auditory Process Subtests
Logical Memory I
1st Recall Total 9 37
Learning Slope 8 25
Verbal Paired Assoc. I
1st Recall Total 8 25
Learning Slope 12 75
Logical Memory II
Percent Retention 10 50
Verbal Paired Assoc. II
Percent Retention 12 75
Confidence
Primary Index Scores Index Score Percentile Interval (95%)
Auditory Immediate 92 30 85 – 100
Visual Immediate 71 3 66 – 86
Immediate Memory 78 7 72 – 88
Auditory Delayed 105 63 95 – 114
Visual Delayed 81 10 74 – 94
Auditory Recog. Delayed 100 50 89 – 111
General Memory 93 32 86 – 102
Working Memory 81 10 74 – 93
Interpretation: Memory deficits primarily affecting Visual (Immediate and Delayed) and Working Memory. Memory deficits are consistent with patients with diagnosed neurotoxicity.
Benton Visual Retention Test (Administration B, Form C). Comparison IQ = 112
Expected for IQ Observed Difference
Number correct 8 - 1 = 7 3 4
Number errors 2 + 2 = 4 16 12
Interpretation:
Number correct score: Suggested acquired impairment of cognitive functioning.
Number of errors score: Strong indication of acquired impairment of cognitive functioning
The Booklet Categories Test (CT):
Subtest Raw Score
I Errors 0
II Errors 0
III Errors 35
IV Errors 2
V Errors 9
VI Errors 9
VII Errors 5
T-score Percentile
Total Errors 60 38 11
Interpretation: Impaired abstraction or concept formation ability, flexibility in the face of complex and novel problem-solving, and capacity to learn from experience, indicative of brain damage.
Comprehensive Trail-Making Test (CTMT):
Trail # Raw Score T-Score Percentile
1 26 56 72
2 29 52 57
3 41 41 18
4 26 50 50
5 106 22 <1
Interpretation: Deficit on the critical trail #5.
Controlled Oral Word Association Test evaluates verbal fluency, the ability to find and use words.
Raw Score Correction Total Percentile
30 3 33 27
Interpretation: Borderline or possible deficit
Embedded Figures Test evaluates the ability to detect visual figure-ground relationships (the use of the eyes to make sense out of what the eye sees).
Number detected out of 40 objects: 37
Interpretation: Within normal limits
Frontal Systems Behavior Scale (FRSBE)
In this case, before illness refers to the time before solvent exposure
Self Rating
T-score T-score
Before Illness % After Illness %
Apathy 55 69 88 >99
Disinhibition 56 73 80 >99
Executive Dysfunction 44 30 80 >99
Total 55 69 89 >99
Interpretation: Elevated symptoms of frontal lobe damage.
Grooved Pegboard Test: Dominant Hand: Left.
Dominant Non-dominant
Time for completion: 75 s 74 s
Percentile: 22 47
Interpretation: Within normal limits
Neitz Test of Color Vision screens for color vision defects. Number correct of 9 items: 9 Interpretation: Within normal limits
Neurotoxicity Screening Survey:
Factor Results
Score Classification
Memory and Concentration...... 76 Elevated
Autonomic Nervous System...... 62 Elevated
Vision........................ 17 Elevated
Hearing....................... 10 Elevated
Balance....................... 2 Borderline elevated
Smell-Taste.................. 9 Elevated
Peripheral Numbness........... 20 Elevated
Sensory-Motor................. 52 Elevated
Chemical Sensitivity......... 6 Elevated
Emotionality.................. 62 Elevated
Distortion I..................
Overall Neurotoxicity Indicator 316
Interpretation: Results are consistent with patients with diagnosed neurotoxicity.
Selective Reminding Test:
Words continuously remembered, summed over trials (CLTR): 36
Expected: 90
Percentile rank for gender, age and education: 7%
Interpretation: Deficit
Stroop Color and Word Test
Raw Age/Ed
Score Predicted Residual T-Score Percentile
Word reading: 92 99 -7 45 31
Color naming: 58 76 -18 35 7
Color/Word: 41 40 1 51 54
Interpretation: Generally within normal limits
Visual Search and Attention Test:
Left Right Total
Score 72 69 141
Percentile 16 15 15
Interpretation: Deficit Deficit Deficit
EMOTIONAL FUNCTION
Beck Anxiety Inventory measures emotional anxiety. Score: 33
Interpretation: Severe anxiety
Beck Depression Inventory measures emotional depression. Score: 28
Interpretation: Moderate depression
Profile of Mood States
Raw Score T Score %
Tension 22 52 58
Depression** 24 48 42
Anger/Hostility 5 41 18
Vigor 2 38 12
Fatigue 20 59 82
Confusion/Bewilderment 12 48 42
Interpretation: Mood within normal limits at time of testing. Low level of vigorous mood.
WELL-BEING MEASURES
Alcohol Use Disorders Identification Test (AUDIT). Score: 8
Interpretation: Low-medium likelihood of alcohol problems.
Fatigue Severity Scale: Score: 46/9 = 5.1
Interpretation: Consistent with medically ill patients
Quick Environmental Exposure and Sensitivity Inventory, Version 1 (QEESI) identifies health problems respondent may experience in response to various environmental exposures.
Score Interpretation
Chemical Intolerance 26 Medium
Other Intolerance 12 Medium
Symptom Severity 53 High
Masking Index 6 High
Life Impact 49 High
Interpretation: Somewhat suggestive of multiple chemical intolerance.
PERSONALITY TESTING
Revised Neo Personality Inventory: Interpretive report: Summary
Moderately high on the factor Neuroticism, with moderately high levels of negative emotion and the occasional episodes of psychological distress. Such scorers are rather low in self-esteem and somewhat insecure.
Low in Conscientiousness, with a fairly low need for achievement and a tendency not to organize his time well. Raters describe such people as relatively unreliable and careless.
Average range in Agreeableness, Openness, and Extroversion.
Axis II disorders: Personality disorders: Profile agreement between this respondent and the average profile for Borderline Personality Disorder is higher than 90% of subjects in the normative sample, suggesting that the patient may have Borderline features or a Borderline Personality Disorder. No other Axis II disorders were suggested or ruled out.
The respondent can be characterized as: A Gloomy Pessimist, Maladaptive (using primitive and ineffective psychological defenses; lacking insight; cannot verbalize his feelings; may be considered alexithymic (literally "without words for emotions", to describe a state of deficiency in understanding, processing, or describing emotions), Temperamental, and Under - controlled.
DISTORTION AND MALINGERING TESTS
Amnesia Questionnaire assesses the subject's possible mis-reporting memory symptoms. Number correct of 13/13
Interpretation: Non-malingering
Dot Counting Test detects suspect test-taking efforts in adults.
Comparison Group: Mild Dementia
Mean Ungrouped Time 5.5
Mean Grouped Time 2.2
Number of errors 0
Signs of suspect effort
Does mean Grouped time exceed mean Ungrouped time by 1 sec? No
Are there counting errors on Card 6 and/or Card 12? No
E-Score (# of errors plus mean time, ungrouped and group) 7.7
E-Score Cutoff 22
Under test development conditions:
Sensitivity (the test's ability to detect suspect effort) 62%
Specificity (the test's ability to detect normal effort) 94%
Under base rate assumption of 15% population suspect effort:
Positive Predictive Accuracy (the test's ability to detect suspect effort) 64%
Negative Predictive Accuracy(the test's ability to detect normal effort) 93%
Interpretation: Normal effort; non-malingering
Endorsement of Rare Symptoms. The Neurotoxicity Screening Survey presents 14 symptoms that are rare. If a number of these symptoms are endorsed, the question of distortion is highlighted.
Number endorsed: Distortion I: 3; Distortion II: 4
Interpretation: Although distortion or confusion was possible, the total distortion number was not elevated when compared with normal controls.
Memorization of "16" Items: Number correct: 16/16
Interpretation: Non-malingering
Miller Forensic Assessment of Symptoms Test (M-FAST) Total score cutoff = 6. Total Interview Time: 1:45
% Negative % Positive
Raw Score Prediction Prediction
Reported vs. Observed 1
Extreme Symptomatology 1
Rare Combinations 0
Unusual Hallucinations 0
Unusual Symptom Course 0
Negative Image 0
Suggestibility 1
Total 3 99% 57%
Interpretation: Non-malingering
Portland Digit Recognition Test
Percent correct responses (5 sec delay): 3/3
Percent correct responses (15 sec delay): 3/3
Percent correct responses (30 sec delay): 1/1
Interpretation: Non-malingering
Three Word Memory Test
Number correct: 9/9
Interpretation: Non-malingering
Test of Memory Malingering (TOMM): Decision rules: 1) Scoring lower than chance on any trial indicates the possibility of malingering: Scores below 18 are unlikely to occur by chance; 2) any score lower than 45 on Trial 2 or the Retention Trial indicates the possibility of malingering.
Raw Score
Trial 1 31
Trial 2 45
Retention 48
Interpretation: Non-malingering.
Twenty-one Item Memory Test assesses the probability of malingering based on a forced choice comparison. If the subject does not remember correctly nine of the 21 items on the forced choice test, the subject may be malingering.
Number of words correctly recalled:
Free recall: 9
Forced choice: 19
Interpretation: Non-malingering
Recognition testing: Recognition is an easier task than recall.
Recognition test Results Classification
Logical Memory II 26/30 good or better effort
Verbal Paired Associates II 24/24 word pairs excellent effort
Word Lists II (min. 18) 20/24 good or better effort
Visual Reproduction II NA NA
Auditory recognition - Delayed (min. 43) 44 good or better effort
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