personality measure as part of assessment battery

[bmedclinic]

So I do a fair amount of testing in my practice, and in discussions with people, most people have a preference for certain assessments, but that preference seems to fit the clinician, not the patient or the reason for the assessment. For example, Dr X really loves the MCMI-IV for all her testing patients, seemingly regardless of the reason for testing, and so on. I'd much rather fit assessment Y with patient A because it's the best assessment I have access to for her possible diagnostic question.

So I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval? What about for an ADHD eval? What about others?

Note: I hope this is obvious, but for clarity's sake-- I'm always administering a full battery, but traditionally have given the MMPI-II /II-RF... but recently have come across some clinicians that prefer the MCMI-IV. It does not need to be limited to these two, either.

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[Justanothergrad]

There is a fair amount of literature on the RF with bariatric evals, most of it by Marek (Ben-Porath's student). I've been pretty impressed with the work he's done and have found the psychometrics o the RF far better than the 2 across the board, for those evals and others. That said, I'm not familiar enough with those evals to speak to what would be the most helpful.

As for ADHD evals, I'm not sure I would use personality assessment as part of the battery. It seems to be asking/answering a different question. If anything, I might include a FFM personality instrument (NEO or, my preference, the IPIP-based instruments) to get a sense of style of interacting with the world. I would probably focus on specific domains (N, C, A is my gut reaction) and include facet scores for those since those are going to tell the story about the day to day life of how that personal interacts with the world far better than the pathology-focused 2/RF/MCMI scales. That kind of info might be useful to provide meaningful, formative recommendations about areas they may need to change/consider adjusting to gain better control over their symptoms. I remember some folks developing a TRIN/VRIN proxy for one of the FFM instruments; I don't recall which one but I suspect it was the NEO. That may be of use if you took that route.

 

[barryggg]

I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval?[/quote[
how about none? The patient should get to decide what they want to do with their body.

 

[Therapist4Chnge]

how about none? The patient should get to decide what they want to do with their body.

That isn't the purpose of the evaluation.

Again...I'm doubting your credentials.

 

[barryggg]

That isn't the purpose of the evaluation.

Again...I'm doubting your credentials.

Yes, that is a big part of the purpose. You are giving recommendations to sway the person one way or another.

 

[erg923]

You are giving recommendations to sway the person one way or another.

Put a sock in it, son. You dont know what the purpose of this evaluation is (obviously), nor how they are/should be conducted.

 

[bmedclinic]

I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval?[/quote[
how about none? The patient should get to decide what they want to do with their body.

 

[barryggg]

Put a sock in it, son. You dont know what the purpose of this evaluation is (obviously), nor how they are/should be conducted.

There is nothing to know. There is no real purpose aside from offering pointless information.

 

[bmedclinic]

There is a fair amount of literature on the RF with bariatric evals, most of it by Marek (Ben-Porath's student). I've been pretty impressed with the work he's done and have found the psychometrics o the RF far better than the 2 across the board, for those evals and others. That said, I'm not familiar enough with those evals to speak to what would be the most helpful.

As for ADHD evals, I'm not sure I would use personality assessment as part of the battery. It seems to be asking/answering a different question.

Thanks for having a pertinent reply. My reason for doing this (and thus far, I've actually found this to be helpful a number of times) is to help rule out other (formerly) Axis I disorders. Whether or not the person meets the DSM V criteria for ADHD / flunks a CPT like you'd expect a patient with ADHD to, is only part of the picture. If there's something else going on, I want to have a tool (such as the aforementioned) to help me and also make sure I've not missed anything. From my perspective, its part of being thorough - one more piece of potentially understanding what's going on with the person.

That said, I'm always open to improving my practice, thus one reason why I started this thread...

 

[bmedclinic]

There is nothing to know. There is no real purpose aside from offering pointless information.

If that's the case, why are surgeons referring patients to me before doing a surgery?
Also, I seemed to have missed your qualifications. Mind filling me in on them?

 

[barryggg]

If that's the case, why are surgeons referring patients to me before doing a surgery?

Lawsuits.

 

[bmedclinic]

Lawsuits.

good call, I'll make sure to be mindful of that next time I'm, uh, persuading someone to get/not get a surgery...

Moving on from this brilliant insight, I'd love to hear others feedback /thoughts.

 

[barryggg]

good call, I'll make sure to be mindful of that next time I'm, uh, persuading someone to get/not get a surgery...

Moving on from this brilliant insight, I'd love to hear others feedback /thoughts.

http://www.medscape.com/features/slideshow/public/malpractice-report-2015

 

[barryggg]

http://www.obradovich.net/practice-...surgical-errors/gastric-bypass-complications/

FROM A LAW FIRM
Gastric Bypass Complications
Gastric bypass complications are an unfortunate byproduct of bariatric surgery. Bariatric surgery has grown in popularity in recent years. It is a procedure used to treat obesity and avoid the health problems obesity causes. For people who are morbidly obese and who have tried other weight loss methods and failed, they may view surgery as their only option. However bariatric surgery should not be recommended for everyone that is overweight. It should only be considered once more traditional weight loss options have failed. Additionally other health related criteria must be met. Candidates should undergo psychological assessment to determine suitablity. Nutrional counselling is also required to assist the patient in the significant dietary and lifestyle adjustments needed to make the surgery a success.

the ocurrence rate of gastric bypass complications is thought to be directly related to the amount of experience possessed by the surgeon performing the surgery. The fact that a complication has arisen does not mean that malpractice has occurred. If however the gastric bypass complications were caused by

to confirm the patient was a suitable candidate for the procedure
to counsel the patient on alternative weight loss methods
to have the patient use alternative beneficial weight loss methods
to inform the patient of the material risks of the surgery
a failure to fully pursue alternative treatments
performing the surgery properly
to recognize and act on complications
to follow-up with and properly monitor patient

then the criteria for medical malpractice may have been met.

-----------------------------------------------

So yes!

 

[barryggg]

Again...I'm doubting your credentials.

I'm a Masters level Educational Psychologist...but I've had some training in neuropsych.

Please refute the points I'm making.

Areas like this and child custody are money grabs, and have nothing to do with patient care. This service is utilized by Physicians because it decreases the chance by a HUGE margin if they will get sued/win a suit.

 

[Justanothergrad]

Ok, sure. I will. I'm waiting for soup to cook up so I have a few minutes to burn.

Referral for assessment decreases legal liability for other providers (duh, it involves other people as a best-practice of consultation... so it should do that.. just like consultation does with literally any field). That does /NOT/ make decreasing liability the primary purpose of assessment. Assessment is useful in the prediction of outcomes from surgery (C.f., Benoit et al., 2014; Malek et al., 2015; Marek et al., 2013) and in understanding the factors leading to that. If you want to know the risk factors, assessment offers an opportunity to get a picture of that. It also offers an opportunity to increase treatment planning to maximize positive outcomes (i.e., if someone is depressed going in, get them linked with psychiatric care since that will increase surgery outcomes). I'll give you some reading to brush up on really quickly to get a general sense of this. Most of it is about the RF but thats ok; it makes the point. As you can see, incremental outcome information is offered from personality assessment beyond just basic chart information (Marek et al., 2015) and is related directly to patient care. If we understand factors influencing outcomes, we can understand how to impact those same outcomes (i.e., adherence). Surgery evals aren't even my area and this is obvious/supported in the literature...Or let me guess, psychology doesn't do health stuff either?

For some night time reading:
https://www.ncbi.nlm.nih.gov/pubmed/23856990
https://www.ncbi.nlm.nih.gov/pubmed/25487292
http://psycnet.apa.org/journals/pas/27/1/114/

Your arguments are boring, inaccurate, and not reflective of the field. You need to read more and insist on being right less. Your training is clearly not sufficient for you to make the claims that you make (that doctoral programs do not offer incremental knowledge/ability, that assessment is easily trained, etc.).

 

[EmotRegulation]

So I do a fair amount of testing in my practice, and in discussions with people, most people have a preference for certain assessments, but that preference seems to fit the clinician, not the patient or the reason for the assessment. For example, Dr X really loves the MCMI-IV for all her testing patients, seemingly regardless of the reason for testing, and so on. I'd much rather fit assessment Y with patient A because it's the best assessment I have access to for her possible diagnostic question.

So I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval? What about for an ADHD eval? What about others?

Note: I hope this is obvious, but for clarity's sake-- I'm always administering a full battery, but traditionally have given the MMPI-II /II-RF... but recently have come across some clinicians that prefer the MCMI-IV. It does not need to be limited to these two, either.

I don't do bariatric evals, but I do teach our grad personality assessment course and try to keep myself abreast of the basic literature. I'm definitely biased on this because of my on research area and grad training, but these formal clinical instruments (MCMI, PAI, MMPI) aren't really personality measures. The MCMI gets at PDs and the other two (PAI and MMPI) get at Axis I pathology. All of them are certainly influenced by personality traits (the MMPI-RF and 2 have revised Big Five scales) but I'd argue that personality and personality traits are not the same thing.

I like the MMPI-RF better than the MMPI-2, and I like the PAI more than the MMPI measures. I haven't used the MCMI-IV yet, but the MCMI-III over-pathologized. They claim the IV is better, but I dunno if that's actually true yet, we just got it at our clinic.

Basically, there's reason to give personality trait measures to get at normative intraindividual differences in style, but they won't be super helpful in predicting outcomes for any one patient, which is what we'd like to be able to use them for. I appreciate the clinical personality measures for the validity scales and for assessing symptoms of psychopathology, but dunno if I'd really call them "personality." Though that's a bigger comment than you actually asked for....

 

[erg923]

So I do a fair amount of testing in my practice, and in discussions with people, most people have a preference for certain assessments, but that preference seems to fit the clinician, not the patient or the reason for the assessment. For example, Dr X really loves the MCMI-IV for all her testing patients, seemingly regardless of the reason for testing, and so on. I'd much rather fit assessment Y with patient A because it's the best assessment I have access to for her possible diagnostic question.

So I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval? What about for an ADHD eval? What about others?

Note: I hope this is obvious, but for clarity's sake-- I'm always administering a full battery, but traditionally have given the MMPI-II /II-RF... but recently have come across some clinicians that prefer the MCMI-IV. It does not need to be limited to these two, either.

What do you mean "full batteries"? I would hope your battery is as short (or as lengthy) as it needs to be for the patient and the clinical question at hand. I frankly have always thought psychologists are little too in love with their "tests."

That said, I like PAI or mmpi-rf for bariatric. Generally speaking, that is the only "psychological test" I typically give for these evaluations unless there is a perceived need for more formal cognitive assessment. The Becks are used for pre-and post comparisons, but I consider that part of the clinical interview, as I do some other brief rating scales, mostly eating disorder screens, that I give to serve as comparison for what they reported during the interview.

I have sometime seen people giving the Shipley, rotter incomplete sentences, the million behavioral medicine inventory and various other normed rating scales, all of which I consider largely a waste of time and insurance company money. The MCMI-IV also seems like it would be similarly wasteful in the vast majority of cases to me.

 

[barryggg]

, all of which I consider largely a waste of time and insurance company money.

 

[LETSGONYR]

So I do a fair amount of testing in my practice, and in discussions with people, most people have a preference for certain assessments, but that preference seems to fit the clinician, not the patient or the reason for the assessment. For example, Dr X really loves the MCMI-IV for all her testing patients, seemingly regardless of the reason for testing, and so on. I'd much rather fit assessment Y with patient A because it's the best assessment I have access to for her possible diagnostic question.

So I submit to you, what do you think is the best personality assessment as part of a bariatric pre-surgical eval? What about for an ADHD eval? What about others?

Note: I hope this is obvious, but for clarity's sake-- I'm always administering a full battery, but traditionally have given the MMPI-II /II-RF... but recently have come across some clinicians that prefer the MCMI-IV. It does not need to be limited to these two, either.

Re: ADHD evals.

From the peds perspective, we tend to use behavioral scales, usually from informants (parents/guardians/teachers). The BASC and BRIEF are popular, as are others like the CBCL or SWAN. For adolescents, I get self-report, as well.

I usually don't feel the need to get a more extensive personality inventory (MMPI/PAI) unless there is a specific question about psychiatric comorbidities or a reason to suspect it would be helpful (e.g., questions of secondary gain).

Though... I will say, some of my choice in measures is governed by what is available at the practice where I work. For example, as an peds anxiety screener I prefer the MASC, but they have the RCMAS... so I use that.

Sent from my SM-G930V using SDN mobile

 

[BuckeyeLove]

this might not be related outside of the fact that I saw it up top, but I would be wary of the MCMI-IV.

 

[barryggg]

this might not be related outside of the fact that I saw it up top, but I would be wary of the MCMI-IV.

All self-report measures are pure bs.

 

[erg923]

All self-report measures are pure bs.

Empirical keying is not BS though.

 

[psych.meout]

All self-report measures are pure bs.

Not this again.

 

[Therapist4Chnge]

All self-report measures are pure bs.

You don't know what you don't know….you have made that abundantly clear by your posts about assessments measures and utilization of them.

 

[barryggg]

You don't know what you don't know….you have made that abundantly clear by your posts about assessments measures and utilization of them.

You guys keep repeating this.

If someone was asked to self-report what kind of blood type they had..you'd laugh.

Not having answers to something is not an excuse for ****ty science. I'm sorry if you find this hurtful or annoying.

 

[smalltownpsych]

I also like the MMPI-2 RF and think that often the validity indicators are what are most useful. Regardless of which measure that is chosen, I find it important to correspond the test findings with actual behaviors and reported or collateral history. The best predictor of future behavior is past behavior and if the assessment results are consistent with that then the findings are all the more solid. I have seen too many reports where this key step wasn't done when I was reviewing assessments for potential admission to a treatment program and unfortunately this often led to a poor outcome.

 

[Justanothergrad]

You guys keep repeating this.

If someone was asked to self-report what kind of blood type they had..you'd laugh.

Not having answers to something is not an excuse for ****ty science. I'm sorry if you find this hurtful or annoying.

You keep bashing things and ignoring responses. I'm sorry if these facts are hurtful to you, but you are uninformed about psychology. Your knowledge of assessment is flagrantly ignorant. Please stop acting as if it is not.

 

[barryggg]

You keep bashing things and ignoring responses. I'm sorry if these facts are hurtful to you, but you are uninformed about psychology. Your knowledge of assessment is flagrantly ignorant. Please stop acting as if it is not.

I'm not ignoring things on purpose. If you have some post of yours you want answered, let me know which one. I have many of you responding to me, and I can't respond to everything you guys say (ie no time).

 

[Justanothergrad]

I'm not ignoring things on purpose. If you have some post of yours you want answered, let me know which one. I have many of you responding to me, and I can't respond to everything you guys say (ie no time).

You've done it numerous times anytime someone presents facts.

Start with the one in this thread right after you asked for a response to your invalid points on the role/impact of assessment on surgery evals.
https://forums.studentdoctor.net/th...-of-assessment-battery.1235879/#post-18465156

You keep making inaccurate claims about assessment; In what areas related to testing are you claiming competence?

 

[psych.meout]

You guys keep repeating this.

If someone was asked to self-report what kind of blood type they had..you'd laugh.

Not having answers to something is not an excuse for ****ty science. I'm sorry if you find this hurtful or annoying.

So, people are not aware of their own thoughts, feelings, sensations, and behaviors? There are no research techniques for validating inventories with criterion measures that match up with topics of interest (e.g. axis I psychopathology)?

It's almost like these topics are covered in depth during doctoral programs and in a shallow manner, at best, during masters programs, which is why assessment is one of the tasks that doctoral-level providers are uniquely qualified to perform.

 

[barryggg]

So, people are not aware of their own thoughts, feelings, sensations, and behaviors? There are no research techniques for validating inventories with criterion measures that match up with topics of interest (e.g. axis I psychopathology)?

It's almost like these topics are covered in depth during doctoral programs and in a shallow manner, at best, during masters programs, which is why assessment is one of the tasks that doctoral-level providers are uniquely qualified to perform.

I really have to explain to someone with a Phd all the issues with self-report measures? Really?

 

[Therapist4Chnge]

I really have to explain to someone with a Phd all the issues with self-report measures? Really?

I think I'd rather enjoy your "explanation" of these issues.

 

[barryggg]

I think I'd rather enjoy your "explanation" of these issues.

1. Honesty/Wanting to maintain a certain image
2. Understanding of questions
3. People interpret scales differently
4. Many people are actually not aware of who they are, what they like, what they feel..that's sort of why they are there a lot of the time.
5. Response bias
6. Mostly ordinal data
7. People different not just in terms of what's actually measured but other factors..so how can you be sure you're actually measuring what you claim? (ie just because you see a difference between patients and control..does not mean it's actually measuring ie anxiety)
8. Also, how do you accurately quantify what a large difference is?

 

[Justanothergrad]

You must have "forgotten" to respond to me again eh?

That's ok. Lets talk about what you want to talk about. You mentioned response bias in self-report instruments. Just so happens I focus on that area. Want to discuss it? Please, outline why self-report is invalid because of this... and while you're at it, let me know why response bias is only a problem for self-report instruments.

 

[barryggg]

Ok, sure. I will. I'm waiting for soup to cook up so I have a few minutes to burn.

Referral for assessment decreases legal liability for other providers (duh, it involves other people as a best-practice of consultation... so it should do that.. just like consultation does with literally any field). That does /NOT/ make decreasing liability the primary purpose of assessment. Assessment is useful in the prediction of outcomes from surgery (C.f., Benoit et al., 2014; Malek et al., 2015; Marek et al., 2013) and in understanding the factors leading to that. If you want to know the risk factors, assessment offers an opportunity to get a picture of that. It also offers an opportunity to increase treatment planning to maximize positive outcomes (i.e., if someone is depressed going in, get them linked with psychiatric care since that will increase surgery outcomes). I'll give you some reading to brush up on really quickly to get a general sense of this. Most of it is about the RF but thats ok; it makes the point. As you can see, incremental outcome information is offered from personality assessment beyond just basic chart information (Marek et al., 2015) and is related directly to patient care. If we understand factors influencing outcomes, we can understand how to impact those same outcomes (i.e., adherence). Surgery evals aren't even my area and this is obvious/supported in the literature...Or let me guess, psychology doesn't do health stuff either?

For some night time reading:
https://www.ncbi.nlm.nih.gov/pubmed/23856990
https://www.ncbi.nlm.nih.gov/pubmed/25487292
http://psycnet.apa.org/journals/pas/27/1/114/

Your arguments are boring, inaccurate, and not reflective of the field. You need to read more and insist on being right less. Your training is clearly not sufficient for you to make the claims that you make (that doctoral programs do not offer incremental knowledge/ability, that assessment is easily trained, etc.).

I have data that suggests otherwise.

https://www.ncbi.nlm.nih.gov/pubmed/24760310

 

[bmedclinic]

What do you mean "full batteries"? I would hope your battery is as short (or as lengthy) as it needs to be for the patient and the clinical question at hand. I frankly have always thought psychologists are little too in love with their "tests."

I think some years ago, I could be accused of being "too in love with my tests".
What I meant by a full battery for ADHD, for example would be this:

CPT (our practice uses the IVA)
MMPI- II-RF/ MCMI-IV (MMPI II RF is my pref traditionally, but I was wondering about replacing it with the MCMI-IV) hence this post.
BAARS / ASRS- I also have a relative fill out historical BAARS and close friend/ other relative for their current perspective.
WAIS-IV

so by full battery, all I meant was I wasnt just administering the CPT and the MMPI, really. Not articulated well on my part.

 

[psych.meout]

1. Honesty/Wanting to maintain a certain image

The degree to which social desirability and similar biases are problematic are dependent on the constructions of given measures. Some are more problematic than others in this regard, but, generally, the authors of the instruments do everything they can to protect construct validity while balancing the other psychometric needs.

2. Understanding of questions

And this comes down to the individual patient and is part of the reason why a comprehensive clinical interview is necessary. These interviews allow clinicians to gauge whether culture, socioeconomics, language, and/or other variables might influence test performance and factor them into their diagnostic interpretation.

3. People interpret scales differently

Which is why interpretative guides and training in assessment exist. This is also why masters-level training is not sufficient. If it were as simple as administering and scoring measures, you could train people at the bachelors level to do evaluations.

4. Many people are actually not aware of who they are, what they like, what they feel..that's sort of why they are there a lot of the time.

Which is why these instruments and the profession exist. People may not know who they are as comprehensive individuals, or to fully articulate all of their symptoms or issues, or to even realize that some experiences they are having may be pertinent to their mental health evaluation/treatment. This is why it takes someone with excellent training in assessment and measures that have been well-tested and constructed to proficiently evaluate patients.

5. Response bias

Again, this is why clinical interviews exist and instruments are not used without them. Any clinician worth their salt is also going to be using symptom and/or performance validity measures with their other assessment measures. Heck, some instruments have these measures built into them.

6. Mostly ordinal data

Why is that a bad thing? Why would other forms of data, say, ratio or interval, be superior? They may give you greater precision, but do they also offer greater accuracy in this situation? What form gets you to the kinds of data and answers you're looking for? What form is most comprehensible to patients? How do we balance parsimony and comprehensiveness? Is it impossible to consider that the people who constructed these measures might have thought about this issue before you and made conscious decisions to use ordinal scales?

7. People different not just in terms of what's actually measured but other factors..so how can you be sure you're actually measuring what you claim? (ie just because you see a difference between patients and control..does not mean it's actually measuring ie anxiety)

There is wealth of existing and ongoing research of how clinical populations differ from healthy controls. This is used to develop profiles of symptomatology, but also to compare other variables, like neuropsychological functioning. This branches off into cross-cultural clinical research, health research that includes other medical conditions and functioning, etc.

8. Also, how do you accurately quantify what a large difference is?

By calculating effect sizes, variances, and other statistical analyses and then comparing an individual patient's scoring to the normed population parameters?

 

[barryggg]

You must have "forgotten" to respond to me again eh?

That's ok. Lets talk about what you want to talk about. You mentioned response bias in self-report instruments. Just so happens I focus on that area. Want to discuss it? Please, outline why self-report is invalid because of this... and while you're at it, let me know why response bias is only a problem for self-report instruments.

1. I didn't say it was only relevant for self-report. But self-report has many more problems than let's say performance based measures. I'm an Educational Psychologist so...

2. In regards to response bias. I'll try to be brief. All the research compiled in this area has issues with a) generalizability (ie how does instructing someone to fake things actually generalize to situations where people have a motivation to lie? How are these things the same at all? b. Can't differences among groups be related to recognition of the person that they are under suspicion? how is that not possibly going to impact how they do the self-report? .c. Statistically speaking..response bias indicators moderate the relationship between substantive criterion and criterion . It was awhile back now..but I believe 75% of the studies a moderating effect was found.

But in my head, I always go back to the issue of self-awareness...it's really the key. Some kind of measure to test self-awareness would be great. If we could separate individuals who lacked self-awareness, and understand that their self-reporting was an inability to understand the truth about themselves (which is so common in many mental disorder), then the picture changes a lot..and maybe these self-report instruments become much better.

 

[barryggg]

I'm still waiting justanothergrad.

 

[WisNeuro]

Waiting for what? The study you cited only looks at people greenlit for surgery, vs those who were narrowly characterized as a sort of "ok, but with caution" group. It doesn't dispute the need for the pre-surgical eval, rather it tries to question the differentiation for greenlight vs caution, rather than something like greenlight vs red light. Also, this study has some major methodological flaws. I'd suggest reading the commentary.

 

[barryggg]

Waiting for what? The study you cited only looks at people greenlit for surgery, vs those who were narrowly characterized as a sort of "ok, but with caution" group. It doesn't dispute the need for the pre-surgical eval, rather it tries to question the differentiation for greenlight vs caution, rather than something like greenlight vs red light. Also, this study has some major methodological flaws. I'd suggest reading the commentary.

I'm talking about my reply after that..response bias. He wanted to discuss that specifically. Read his post for god's sake.

 

[erg923]

Read his post for god's sake.

blasphemy

 

[psych.meout]

I'm still waiting justanothergrad.

Is this your first message board?

 

[WisNeuro]

I'm an atheist, the sake of an imaginary being does not compel me to do anything. Neither do poor arguments devoid of nuance.

 

[deleted343839]

This thread needs a "last call" bell. Or a gong, maybe.

 

[WisNeuro]

How about a good-bye pirate?

 

[barryggg]

I'm an atheist, the sake of an imaginary being does not compel me to do anything. Neither do poor arguments devoid of nuance.

This conversation goes over your head. Get back to work, sales shark.

 

[WisNeuro]

Sick burn, brah.

 

[PsyDr]

Barryggg is my favorite troll.