13-9-2018

Basis for this course ICD10 – DSM-IV(R)

Manual of Civil Aviation Medicine ICAO document 8984:

Doc 8984 • based on ICD10
• Also uses DSM-IV

If applicable both will be mentioned.

What do we expect of pilots/aircrew? Basis for Notechs

Notechs: non technical skills

Flight-crew human factors handbook
Is a system used to assess the non-technical (social and CAP 737
cognitive) skills of crew members in the aviation Civil aviation authority
industry.

Cognitive skills Social skills

• Situational awareness (SA) • Leadership

• Awareness of aircraft systems • Use of authority and assertiveness
• Awareness of external environment • Providing and maintaining standards
• Awareness of Time • Planning and co-ordination
• Workload management
• Decision making • Teamwork
• Problem recognition and diagnosis • Team building & maintaining
• Option generation • Considering others
• Risk assessment and option selection • Supporting others
• Outcome review • Conflict solving
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Course materials Articles psychological tests

This presentation as PDF 5. Mini Mental State Exam

6. Psychology of the Cockpit The Pros and Cons of the
1. Manual of Civil Aviation Medicine DOC 8984 MMPI in Pre-Employment Screening
2. Flight-crew human factors handbook CAP737 7. MMPI-2 Personnel Interpretative report aviation
3. Manual on Prevention of Problematic use of 8. MSE Psychiatric Interviewing
substances DOC 9654
4. Specification for Psychological or Psychiatric Reports
CAA

The brain Brainstem

• Heartrate
• Breathing
• Temperature regulation

Limbic system Cerebellum

• Stress response
• Memory formation and storage • Fine motor movement
• Regulating emotion • Automatic movements
• Processing smells
• Arousal
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Cerebellum Occipital lobe

Assessment perspective: • Visual processing

• Loss of fine motor movement • Visual memory
• Loss of balance while walking
• Dizziness
• Slurred speech

Occipital lobe Temporal lobe

Assessment perspective: • Auditive processing

• Visual recognition • Auditive memory
• Visual memory • Language comprehension (Wernicke’s area)

Temporal lobe Parietal lobe

Assessment perspective: • Somatosensory perception

• Language comprehension (Wernicke’s area) • Visuospatial processing
• Verbal memory • Spatial attention
• Spatial mapping
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Parietal lobe Frontal lobe

• Decision making
Assessment perspective: • Planning
• Spatial orientation • Problem solving
• Spatial memory • Thinking
• Voluntary motor control
• Language Production
• Comprehension
• Etc.

Frontal lobe Memory

Assessment perspective:
• Selective attention • Long-Term Memory (LTM).
• Divided attention • Short-term Memory (STM) (working memory)
• Memory retrieval • Procedural memory
• Planning • Sensory Memory
• Problem solving
• Language production (Broca’s area)
• Personality change
• loss of social inhibitions
• Impulse control

Predisposition to psychiatric illness First signs in childhood

• Nature • Dissocial behavior

• Nurture • Poor academic achievement
• Life events • Difficulty in finding regular employment
• Use of addictive substances
No one is immune to the development of psychiatric • Anxieties
symptoms when exposed to severe stressors. • Mood disorders
• Attachment failures

Often, but not always!

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Mood disorders Depressive mood disorder

• Depressed mood
• Depressive mood disorders • Reduced energy
• Depression leads to subtle incapacitation • Impaired concentration and memory
• Depression is by nature recurring (50%) • Loss of interest in surroundings
• Response to treatment may be very good • Slowed cerebration
• Difficulty in making decisions
• Alteration of appetite and sleep
DSM-IV: Major depressive disorder • Guilt feelings
• Low self-esteem

Prevalence in pilot population Exceptions

Survey: 1848 pilots globally Recommendation:

An applicant with depression, being treated with antidepressant
medication, should be assessed as unfit unless the medical assessor,
having access to the details of the case concerned, considers the
applicant’s condition as unlikely to interfere with the safe exercise of
Depression threshold: 12.6% the applicant’s license and rating privileges.
(233)
Thoughts of suicide/self-harm: 4.1 %
(75) • Of medication for at least 6 months
• SSRI’s in carefully selected and monitored cases

Newer SSRI’s have significant lower side effects

Harvard T. H. Chan School of Public Health, 15-12-2016

Requirements for exception Bipolar disorder: (hypo)mania

• The applicant should be under the care of a medical • Grandiosity

practitioner experienced in the management of depression • Increased energy
• Demonstrate symptoms of depression being well • Euphoria
controlled, without evidence of psychomotor retardation • Reduced sleep
• Have no suicidal ideation or intent • Distractibility
• Have no history of psychotic symptoms • Poor judgement
• Have no features of arousal (e.g. irritability or anger)
• Have a normal sleep pattern Onset: early 20’s
• Have resolution of any significant precipitating factors of
the depression
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Exceptions Schizophrenia and delusional disorders

• Disorder of thinking
None!
• Disorder of perception
One period of (hypo)mania means disqualification • Auditory hallucinations
• Visual hallucinations
• Somatic hallucinations

• Delusions
• Persecutory
• Theme

Schizophrenia and delusional disorders Exceptions

• Affect • Brief psychotic disorder

• Drive • Less than a month
• Full return to premorbid level of functioning
• Interest
• Memory
• Secondary to severe external stressors
• Concentration
• Stability for at least 1 year without medication
Onset: early 20’s

Neurotic, stress related and somatoform disorders Disorders of personality and behaviour

(Temporarily) disqualifying: Personality disorders are deeply ingrained maladaptive

• Preoccupation with symptoms patterns of behaviour which are present during the
entire adult life of a person.
• Sense of anxiety
• Impaired cognition

DSM-IV:
DSM-IV:
• Personality disorders
• Anxiety disorders
• Impulse control disorders
• Somatoform disorders
• Dissociative disorders
• Adjustment disorders
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Personality disorders Borderline personality disorder

• Paranoid Personality Disorder A disorder characterized by an enduring pattern of

• Schizoid Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Personality Disorder Not Otherwise Specified
• Mental Retardation
unstable self-image and mood together with volatile
interpersonal relationships, self-damaging impulsivity,
recurrent suicidal threats or gestures and/or self-
mutilating behaviour.
• Unstable moods
• Impulsive behaviour
• Unstable personal relationships
• Loss of control of anger

Exceptions Organic mental disorders

Possible symptoms:
• Disorders of behaviour
• Habit • Delirium
• Gender
• Dementia
• Sexuality

But also:
Should be assessed on the basis of their ability to put
aside the disorder. • Anxiety
• Depression
• Behavioural changes

Organic mental disorders Dementia

Possible causes:
Important to rule out:
• External
• Alcohol • Reversable medical conditions
• Drugs
• Presence of depressive disorder
• Medication
• Injury
• Etc.
• Internal
• Tumours
• Endocrine disorders
• Degeneration
• Etc.
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Sleep disorders Drug use

• Harmfull use
• Primary insomnia Substance abuse is defined as the continued use of the substance
• Difficult to treat even at times when its use is harmful to health, excessive use of the
substance, problems related to the use of the substance, or legal
• Risk of self-medication problems related to its use.
• Dependance
• Transient (occasional) insomnia Excessive use of the substance, inability to curb the use of the
• Mostly due to situational concerns substance despite complications, increased tolerance to its effect and
• Should not last more than days the occurrence of withdrawal symptoms.

• Changes in circadian rhythm DSM-IV:

• Abuse
• Dependence
Insomnia affects up to 33 % of adult population

Alcohol abuse and dependence Exceptions

• Strict protocol
• Chronic
• Progressive • A period of sobriety, traditionally 3 years
• Difficult to diagnose
• Difficult to treat

Prevalence is about 7 % of population Western countries

Predisposition to psychiatric illness First signs in childhood

• Nature • Dissocial behavior

• Nurture • Poor academic achievement
• Life events • Difficulty in finding regular employment
• Use of addictive substances
No one is immune to the development of psychiatric • Anxieties
symptoms when exposed to severe stressors. • Mood disorders
• Attachment failures

Often, but not always!

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Mood disorders Depressive mood disorder

• Depressed mood
• Depressive mood disorders • Reduced energy
• Depression leads to subtle incapacitation • Impaired concentration and memory
• Depression is by nature recurring (50%) • Loss of interest in surroundings
• Response to treatment may be very good • Slowed cerebration
• Difficulty in making decisions
• Alteration of appetite and sleep
DSM-IV: Major depressive disorder • Guilt feelings
• Low self-esteem

Prevalence in pilot population Exceptions

Survey: 1848 pilots globally Recommendation:

An applicant with depression, being treated with antidepressant
medication, should be assessed as unfit unless the medical assessor,
having access to the details of the case concerned, considers the
applicant’s condition as unlikely to interfere with the safe exercise of
Depression threshold: 12.6% the applicant’s license and rating privileges.
(233)
Thoughts of suicide/self-harm: 4.1 %
(75) • Of medication for at least 6 months
• SSRI’s in carefully selected and monitored cases

Newer SSRI’s have significant lower side effects

Harvard T. H. Chan School of Public Health, 15-12-2016

Requirements for exception Bipolar disorder: (hypo)mania

• The applicant should be under the care of a medical • Grandiosity

practitioner experienced in the management of depression • Increased energy
• Demonstrate symptoms of depression being well • Euphoria
controlled, without evidence of psychomotor retardation • Reduced sleep
• Have no suicidal ideation or intent • Distractibility
• Have no history of psychotic symptoms • Poor judgement
• Have no features of arousal (e.g. irritability or anger)
• Have a normal sleep pattern Onset: early 20’s
• Have resolution of any significant precipitating factors of
the depression
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Exceptions Schizophrenia and delusional disorders

• Disorder of thinking
None!
• Disorder of perception
One period of (hypo)mania means disqualification • Auditory hallucinations
• Visual hallucinations
• Somatic hallucinations

• Delusions
• Persecutory
• Theme

Schizophrenia and delusional disorders Exceptions

• Affect • Brief psychotic disorder

• Drive • Less than a month
• Full return to premorbid level of functioning
• Interest
• Memory
• Secondary to severe external stressors
• Concentration
• Stability for at least 1 year without medication
Onset: early 20’s

Neurotic, stress related and somatoform disorders Disorders of personality and behaviour

(Temporarily) disqualifying: Personality disorders are deeply ingrained maladaptive

• Preoccupation with symptoms patterns of behaviour which are present during the
entire adult life of a person.
• Sense of anxiety
• Impaired cognition

DSM-IV:
DSM-IV:
• Personality disorders
• Anxiety disorders
• Impulse control disorders
• Somatoform disorders
• Dissociative disorders
• Adjustment disorders
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Personality disorders Borderline personality disorder

• Paranoid Personality Disorder A disorder characterized by an enduring pattern of

• Schizoid Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Personality Disorder Not Otherwise Specified
• Mental Retardation
unstable self-image and mood together with volatile
interpersonal relationships, self-damaging impulsivity,
recurrent suicidal threats or gestures and/or self-
mutilating behaviour.
• Unstable moods
• Impulsive behaviour
• Unstable personal relationships
• Loss of control of anger

Exceptions Organic mental disorders

Possible symptoms:
• Disorders of behaviour
• Habit • Delirium
• Gender
• Dementia
• Sexuality

But also:
Should be assessed on the basis of their ability to put
aside the disorder. • Anxiety
• Depression
• Behavioural changes

Organic mental disorders Dementia

Possible causes:
Important to rule out:
• External
• Alcohol • Reversable medical conditions
• Drugs
• Presence of depressive disorder
• Medication
• Injury
• Etc.
• Internal
• Tumours
• Endocrine disorders
• Degeneration
• Etc.
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Sleep disorders Drug use

• Harmfull use
• Primary insomnia Substance abuse is defined as the continued use of the substance
• Difficult to treat even at times when its use is harmful to health, excessive use of the
substance, problems related to the use of the substance, or legal
• Risk of self-medication problems related to its use.
• Dependance
• Transient (occasional) insomnia Excessive use of the substance, inability to curb the use of the
• Mostly due to situational concerns substance despite complications, increased tolerance to its effect and
• Should not last more than days the occurrence of withdrawal symptoms.

• Changes in circadian rhythm DSM-IV:

• Abuse
• Dependence
Insomnia affects up to 33 % of adult population

Alcohol abuse and dependence Exceptions

• Strict protocol
• Chronic
• Progressive • A period of sobriety, traditionally 3 years
• Difficult to diagnose
• Difficult to treat

Prevalence is about 7 % of population Western countries

Working environment Barometric pressure

• Information gathering mainly by vision • Most specific feature of the altitude climate
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Hypoxia Symptoms of hypoxia

Subjective symptoms Objective signs

• Hypoxic hypoxia I
Breathlessness (dyspnoea) Hyperpnoea or Hyperventilation
• Anaemic hypoxia Headache N Yawning
• Ischaemic hypoxia Dizziness (giddiness) C Tremor
Nausea Sweating
• Histotoxic hypoxia Feeling of warmth about face
R Pallor
Dimness of vision E Cyanosis
Blurring of vision A Drawn, anxious facies
Double vision (diplopia) S Tachycardia
Confusion I Bradycardia (dangerous)
Exhilaration Poor judgement
Sleepiness N Slurred speech
Faintness G Incoordination
Weakness Unconsciousness; convulsions
Stupor

Cabin pressurization Visual illusions

• Protective measures • Optical characteristics of windshields
• Rain on windshields
• Fog, haze, dust and their effects on depth perception
• Glide slope angle
• Width and length of runway
• Runway lighting systems
• Runway slope
• Terrain slope
• Landing at night over water or other unlit terrain
• Auto-kinetic illusion
• White-out, specifically in high-latitude areas

Semicircular canals Relationships

• The subjective impression of angle of bank during • Compartmentalization

instrument flying is false when the angular change is
introduced gradually and below the thresholds of
stimulation of the semicircular canals and
proprioceptors
• “Graveyard spiral”
• There's a little bin for everything from flying to
anniversary dates
(a smaller bin, easily closed evidently)
• Very effective in the air
• Very ineffective in a relationship
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Stress Long-term stress

• Death of a spouse or partner 100
• Divorce 73
• Long term stress
• Marital separation 65
• Short term stress (Flight, fight or freeze) • Death of a close family member 63
• Personal injury or illness 53
• Loss of job 47
• Retirement 45
• Pregnancy 40
• Sexual problems 40
• Son or daughter leaving home 29
• Change of residence 20
• Bank loan or credit card debt 17
• Vacation 13
• Minor law violation 11

Long-term stress Stress and performance

Performance
The cumulative points score gives an indication of life 100%
stress, but such schemes need to be treated with
caution because of wide individual variability.

Optimum
<60 Free of life stress
60-80 Normal life stress
Sub. Stress
80-100 High life stress
F, F en F
>100 Under serious life stress

0% Z,Z en ZZZ… Block

Task induced tension

Sleep Sleep and fatigue

• Waking up out of deep sleep (stage 3 or 4) takes some

time
• After waking up out of light sleep (stage 1) you can
perform almost instantly
• Napping: maximum of around 30 minutes

• Cycles typically last for about 90 minutes

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Circadian rhythm Accidents and circadian rhythm

• Biological clock
• On the average a person can compensate around 90
minutes per day

Symptoms and effects of fatigue Alcohol and fatigue

• tiredness
• slow reactions
• diminished motor skills
• diminished visual acuity
• reduced short term memory capacity

• channeled or tunneled concentration

• reduced awareness
• easy distraction
• poor instrument flying
• increased slips and mistakes
• abnormal mood swings

Alcohol and fatigue During training

Alcohol intake versus hours awake: • Long days

• High demands
After about 16 hours of wakefulness performance on a • Intense
tracking task is comparable to 0.04 alcohol.
“check out of family life”
Legal limit in The Netherlands 0.05 (0.02)
Rwanda 0.08
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During downtime On reserve

• Information overload • Brief home time

• Decompress • “Crash pad”
• Fatigue • Random scheduling

On the Line Relief

• Mentally fatiguing • More control over schedule

• Responsibility • Pay increase
• Time zones (circadian rhythm) • Holidays and important date
• Random scheduling
• Commuting

Junior pilots fly nights and weekends

Common mental health problems EASA (FAA very similar)

“Mental illness is second to cardiovascular disease in

reasons for losing an aviation license.” Preventive measures such as:

• Depression • Carrying out a psychological assessment of the flight

• Stress/Burn-out crew before commencing line flying.
• Anxiety/panic attack • Enabling, facilitating and ensuring access to a flight
• Substance abuse/Self medication crew support programme.
• Performing systematic drug and alcohol (D&A) testing
of flight and cabin crew upon employment.
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Mini Mental State Exam

ICAO on psychological testing

• Psychological testing of aircrew members is rarely

of value as a screening tool.
• Personality inventory testing may be of value in the
hands of a psychiatric consultant when used as an
adjunct to a psychiatric evaluation.
• Neuropsychological tests can be of benefit to
determine the degree of cognitive, volitional and
behavioral effect caused by the illness/injury.
• Neuropsychological tests can be used to monitor
the progress of a neuropsychiatric disease process
and may be conducted at intervals for this purpose.

Personality and pathology tests Suicide by pilot

• MMPI Suicide by pilot cases: 19

• Original version
• Tended to over pathologize in pilot populations
Only taking own life: 10
• 567 items
Disgruntled former employees: 4
• MMPI-2
• Restructured version Marital problems: 4
• Better suitable for pilot populations
• 567 items

1999 Air Botswana ATR 42 crash 1999 Air Botswana ATR 42 crash

On 11 October 1999, Phatswe commandeered an
Aérospatiale ATR 42-320 from the Air Botswana section
of the terminal at Sir Seretse Khama airport and took
off.
For two hours he circled the airport, radioing the
control tower and announcing his intention to kill
himself.
The airport was evacuated as a precaution; passengers
later reported a good deal of panic in the terminal.
Officials in the tower attempted to convince him to
land; efforts were led by General Tebogo Masire.
Phatswe threatened to crash it into an Air Botswana
building, saying he had a grudge with the airline's
management.
He demanded to speak to Ian Khama, Botswana's then
vice-president, and was about to be put through to him
when the plane ran out of fuel.
Officials in the control tower told Phatswe that there
were people in the Air Botswana building, whereupon he
crashed the stolen plane into two other ATR-42s on the
tarmac.
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1999 Air Botswana ATR 42: motives Interview techniques

Phatswe had repeatedly threatened airport authorities,

telling them that he would kill himself, but never gave a • Unstructured
reason. • 1 start question
• Follow up question following interviewee
At the time of the incident he was on medical leave • Semi structured
from the airline, having failed a physical two months • Open questions
previously and been declared unfit to fly; consequently, • Fixed topics
he was not authorized to take the plane.
• Focused
• Closed questions
• Specific topic

Suggested questions for depression Suggested questions for anxiety/panic attack

• During the past three months, have you often been • In the past three months, have you had an episode of
bothered by feeling down, depressed or hopeless? feeling sudden anxiety, fearfulness, or uneasiness?
• During the past three months, have you often been • In the past three months, have you experienced
bothered by having little interest or pleasure in doing
things? sensations of shortness of breath, palpitations (racing
heart beat) or shaking while at rest without reasonable
• During the past three months, have you been bothered cause?
by having problems falling asleep, staying asleep, or
sleeping too much, that is unrelated to sleep • In the past year have you needed to seek urgent
disruption from night flying or trans meridian medical advice because of anxiety?
operations?
• In the past three months, has there been a marked
elevation in your mood lasting for more than one
week?

Suggested questions concerning alcohol use Suggested questions concerning drug use

• Have you ever felt that you should cut down on your
drinking? • Have you used drugs other than those required for
• Have people annoyed you by criticizing your drinking? medical reasons?
• Have you ever felt guilty about your drinking? • Which non-prescription (over-the-counter) drugs have
• Have you ever needed a drink first thing in the you used? When did you last use this drug(s)?
morning?
• How many alcoholic drinks would you have in a typical
week?
• How many alcoholic drinks would you have on a typical
day when you are drinking?

LAM Mozambique Airlines Flight 470
The aircraft was cruising at FL380 (an altitude of about
38,000 feet (12,000 m)) in Botswanan airspace about
halfway between Maputo and Luanda when it began to
lose altitude abruptly.
The aircraft descended rapidly at a rate of about 100
feet (30 m) per second and was being tracked on radar.
The aircraft's track was lost from screens at 3,000 feet
(910 m) above sea level, after about six minutes of
losing altitude.
Shortly after, the aircraft crashed into Bwabwata
National Park and exploded.
LAM Mozambique Airlines Flight 470
49-year old Captain Fernandes had suffered a number of
blows of fate prior to the accident.
His son died in a suspected suicide in November 2012;
Fernandes stayed away from the funeral.
His daughter was in hospital for heart surgery at the
time of the crash, and his divorce proceedings were
unresolved for over a decade
German Wings: crew
The flight's pilot in command
• 34-year-old Captain Patrick Sondenheimer
• 10 years of flying experience (6,000 flight hours) A320
The co-pilot
• 27-year-old Andreas Lubitz
• 2 years of flying experience (630 flight hours) A320
13-9-2018
LAM Mozambique Airlines Flight 470
Santos Fernandes had a "clear intention" to crash the jet
and manually changed its autopilot settings.
The aircraft's intended altitude was reportedly changed
three times from 38,000 feet (11,582 m) to 592 feet
(180 m), the latter being below ground level, and the
speed was manually adjusted as well.
The cockpit voice recorder captured several alarms
going off during the descent, as well as repeated loud
bangs on the door from the co-pilot, who was locked
out of the cockpit
German Wings
Flight 9525
Scheduled international passenger flight from
Barcelona–El Prat Airport in Spain to Düsseldorf Airport
in Germany.
The flight was operated by Germanwings, a low-cost
carrier owned by the German airline Lufthansa.
On 24 March 2015, the aircraft, an Airbus A320-211,
crashed 100 kilometers (62 mi) north-west of Nice in the
French Alps.
All 144 passengers and six crew members were killed.
German Wings: Andreas Lubitz
• Born: 18 December 1987
• Started flying at Luftsportclub Westerwald, an aviation
sports club in Montabaur.
• Lubitz was accepted into a Lufthansa trainee program
after finishing high school in September 2008.
• He suspended his pilot training in November 2008 after
being hospitalized for a severe episode of depression.
What would you do now?
 13-9-2018

German Wings: Psychiatrist German Wings: Crash

• His psychiatrist determined that the depressive
episode was fully resolved.
• He returned to the Lufthansa Flight Training school in
August 2009.
• Lubitz moved to the United States in November 2010
to continue training at the Lufthansa Airline Training
Center in Goodyear, Arizona.
• From June 2011 to December 2013, he worked as a
flight attendant for Lufthansa while training to get his
commercial pilot's license
• Joining Germanwings as a first officer in June 2014
• Lubitz was initially courteous to Captain Sondenheimer
during the first part of the flight.
• became "curt" when the captain began the mid-flight
briefing on the planned landing.
• When the captain returned from (probably) using the
toilet and tried to enter the cockpit, Lubitz had locked
the door.
• He had set the autopilot to descend to 100 feet (30 m)
and accelerated the speed of the descending aircraft
several times thereafter.

German Wings: impulse or preplanned? Reliability on self-declaration

Web searches:
• "ways to commit suicide" • Altered mental abilities
• "cockpit doors and their security provisions" • Financial consequences
• Loss of license

Reliability on self-declaration CIRP

1200 professional pilots diagnosed with depression who Critical Incident Response Program
contacted their office:
60% intended to continue flying (without taking Approachability
recommended medication)
Guarantied confidentiality
15% intended to continue flying (taking recommended
medication) but without declaring such medication Colleagues
25% intended to declare their medication and cease
flying
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CIRP CIRP
CIRP coordinator Critical Incident Response Program

Notification Approachability
Checklist Guarantied confidentiality
Decision to contact Colleagues

ASG OVB
Anti skid group
• National team of pilots and cabin crew
Peer support group for pilots struggling with • Everyone can report (website)
alcohol/substance abuse. • Strictly confidential
• Strict rules

Safe zone Benchmark for succes

Law
• Obvious criminal behaviour • Pilot Driven
• Direct danger to flight safety • Independent
• Only certain professionals are exempt • Transparent
• Confidential
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Workflow MMPI versus MMPI-2

• Study had three major goals:

• Pilot and ground operations • These data allowed for an evaluation of the effects of the new norms for the traditional
• Safe zone validity and clinical scale scores of the MMPI-2 in an employment selection program.
• The effects that test defensiveness had on the MMPI-2 scores of a group of individuals,
• Peer support airline pilot applicants who were taking the test in a preemployment context, were
evaluated.
• Useful descriptive information was provided on the performance of airline pilot applicants
• Pilot physician/Medical examiner on MMPI-2 scales to give interpretive guidelines for using the MMPI-2 in psychological
screening.
• Unless disorder is clear refer to licensed
• A sample of 437 airline pilot applicants seeking employment as airline flight crew
psychiatrist/psychologist members was administered the MMPI-2:
• The study showed that the MMPI-2 norms were more appropriate for characterizing pilot
applicants than were the original MMPI norms, which tended to over pathologize test takers.
• psychiatrist/psychologist • The effects of defensiveness on MMPI-2 profiles were found to be pronounced. Assessment of
Airline Pilot Applicants With the MMPI-2.
• Interview/assessment
Available from:
https://www.researchgate.net/publication/15060140_Psychological_Assessment_of_Airli
ne_Pilot_Applicants_With_the_MMPI-2

MMPI-2 validity scales MMPI-2 scales

• Lie (15 items)
The Lie scale is intended to identify individuals who are deliberately
• Hypochondriasis (32 items)
trying to avoid answering the MMPI honestly and in a frank manner. 15
items. • Depression (57)
• F (60 items) • Hysteria (60)
The F scale is intended to detect unusual or atypical ways of
answering the test items, like if a person were to randomly fill out
• Psychopathic Deviate (50)
the test. 60 items. • Masculinity/Femininity (56)
• Back F (40 items) • Paranoia (40)
The Back F scale measures the same issues as the F scale, except only
during the last half of the test. The scale has 40 items. • Psychasthenia (48) (OCD)
• K (30 items) • Schizophrenia (78)
The K scale is designed to identify psychopathology in people who • Hypomania (46)
otherwise would have profiles within the normal range. The scale
contains 30 items. (self control) • Social introversion (69)

MMPI-2 RF Neuropsychology tests

• Intelligence
• Verbal IQ
• Demoralization • Performance IQ
• Somatic Complaints
• Language
• Low Positive Emotions • Reception
• Production
• Cynicism
• Antisocial Behavior • Attention
• Selective attention
• Ideas of Persecution • Divided attention
• Dysfunctional Negative Emotions • Sustained attention (Vigilance)

• Aberrant Experiences • Memory

• Hypomanic Activation • Verbal memory
• Visual memory
• Short-term memory
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Warning

• Correct norms used

• Validity
• Reliability

• Premorbid levels