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Frontiers of Neurology and Neuroscience 2018This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering.... (Review)
Review
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist's consultation. The first challenge is to detect them, and recent studies have confirmed the importance of "positive" clinical bedside signs based on incoherence and discordance, such as the Hoover's sign for the diagnosis of conversion disorder. Functional neuroimaging has allowed a better understanding of the pathophysiology, and highlighted abnormal cerebral activation patterns in conversion disorder in relation to motor, emotional, and limbic networks, different from feigners. This supports the theory evoked by Charcot of a "psychodynamic lesion," which is also reflected by the new term introduced in the DSM-5: functional neurological disorder. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Topics: Conversion Disorder; Factitious Disorders; Humans; Malingering; Medically Unexplained Symptoms
PubMed: 29151092
DOI: 10.1159/000475699 -
Nature Reviews. Neurology Apr 2023Functional neurological disorder (FND) is one of the commonest reasons that people seek help from a neurologist and is for many people a lifelong cause of disability and... (Review)
Review
Functional neurological disorder (FND) is one of the commonest reasons that people seek help from a neurologist and is for many people a lifelong cause of disability and impaired quality of life. Although the evidence base regarding FND pathophysiology, treatment and service development has grown substantially in recent years, a persistent ambivalence remains amongst health professionals and others as to the veracity of symptom reporting in those with FND and whether the symptoms are not, in the end, just the same as feigned symptoms or malingering. Here, we provide our perspective on the range of evidence available, which in our view provides a clear separation between FND and feigning and malingering. We hope this will provide a further important step forward in the clinical and academic approach to people with FND, leading to improved attitudes, knowledge, treatments, care pathways and outcomes.
Topics: Humans; Malingering; Quality of Life; Conversion Disorder; Disabled Persons
PubMed: 36797425
DOI: 10.1038/s41582-022-00765-z -
General Hospital Psychiatry May 2017Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these...
OBJECTIVE
Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these patients and keep further harm, iatrogenic or otherwise, from being inflicted.
METHOD
Once an indication has been identified, the therapeutic discharge can be carried out in a stepwise fashion, resulting in a safe discharge. We outlined how to prepare for, and execute, the therapeutic discharge, along with preemptive consideration of complications that may arise.
RESULTS
Consequences for the patient, physicians, and larger healthcare system are considered.
CONCLUSION
The therapeutic discharge is a safe and effective procedure for patients with deception syndromes in acute care settings. Carrying it out is a necessary element of psychiatric residency and psychosomatic medicine fellowship training.
Topics: Adult; Deception; Factitious Disorders; Humans; Malingering; Patient Discharge; Psychosomatic Medicine; Risk Assessment
PubMed: 28622821
DOI: 10.1016/j.genhosppsych.2017.03.010 -
Archives of Clinical Neuropsychology :... Aug 2020Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there...
OBJECTIVES
Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545-561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field.
METHOD
The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms.
RESULTS
The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment.
CONCLUSIONS
The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.
Topics: Cognition Disorders; Cognitive Dysfunction; Humans; Malingering; Neuropsychological Tests; Neuropsychology; Reproducibility of Results
PubMed: 32377667
DOI: 10.1093/arclin/acaa019 -
Current Topics in Behavioral... 2017This chapter reviews methylphenidate misuse, abuse, dependence, diversion, and malingering associated with its use as a prescription medication for... (Review)
Review
This chapter reviews methylphenidate misuse, abuse, dependence, diversion, and malingering associated with its use as a prescription medication for attention-deficit/hyperactivity disorder and the nonmedical use linked to its stimulant effects. Methylphenidate-induced regional elevations in brain dopamine appear to be integral to both efficacy in attention-deficit/hyperactivity disorder and potential for abuse, raising potential concerns for drug safety and prescription drug diversion costs associated with nonmedical use. Regardless, methylphenidate is an important treatment option, and detecting malingering for the purpose of illicit access to methylphenidate for subsequent misuse or diversion is a difficult challenge. Also discussed are the effects of methylphenidate in patients with comorbid substance use disorder and the potential linkage of methylphenidate use with subsequent substance abuse. The current data suggest that methylphenidate misuse and diversion are common health-care problems with a stimulant prescription drug diversion prevalence of approximately 5-10 % of high school students and 5-35 % of college students. The effectiveness and speed of action of methylphenidate are deemed desirable to enhance attention and focus performance for activities such as studying for exams, but methylphenidate is also misused recreationally. These data suggest a need for close screening and therapeutic monitoring of methylphenidate use in the treatment of attention-deficit/hyperactivity disorder.
Topics: Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Humans; Malingering; Methylphenidate; Prescription Drug Diversion; Substance-Related Disorders
PubMed: 26695166
DOI: 10.1007/7854_2015_426 -
Der Nervenarzt May 2017Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons.... (Review)
Review
Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants.
Topics: Diagnosis, Differential; Dissociative Disorders; Evidence-Based Medicine; Factitious Disorders; Humans; Malingering; Self-Injurious Behavior; Somatoform Disorders; Treatment Outcome
PubMed: 28451707
DOI: 10.1007/s00115-017-0337-8 -
The Israel Medical Association Journal... Nov 2021
Topics: Disability Evaluation; Gait; Gait Analysis; Humans; Malingering; Walking
PubMed: 34811997
DOI: No ID Found -
Asian Journal of Psychiatry Apr 2020Since time immemorial, humans have tried to feign physical and mental illnesses for various reasons. This led to the development of the concept of illness deception or... (Review)
Review
Since time immemorial, humans have tried to feign physical and mental illnesses for various reasons. This led to the development of the concept of illness deception or malingering when one tries to assume a sick role and feigns signs and symptoms to gain external incentives. The conceptual framework of malingering has undergone several changes and there is sufficient evidence to demonstrate that malingering exists. However, the diagnosis of malingering has not yet been established in the mainstream psychiatric nosological systems and still it is present in the appendices as an additional area requiring attention. This is due to the poor construct validity of the diagnosis, problems in defining malingering, problems in assessment by psychological tests and clinical assessment methodology, no well-established guidelines to detect malingering and issues related to labelling/reporting malingering. Because of several controversies in multiple domains of assessment and ethical-social issues, malingering as a distinct entity is grossly neglected. In the upcoming arena of law suits and consumer benefits suits, it is extremely important to have a better understanding of the conceptual issues related to malingering and the controversies related to it. In this review, a brief overview of evolution of concepts and controversies related to malingering is described.
Topics: Humans; Malingering; Models, Psychological
PubMed: 32088586
DOI: 10.1016/j.ajp.2020.101952 -
Practical Neurology Apr 2019Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation,... (Review)
Review
Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate. Neurological disorders where difficulty in determining the degree of willed exaggeration is most likely include functional weakness and movement disorders, post-concussional syndrome (or mild traumatic brain injury), psychogenic non-epileptic attacks and complex regional pain syndrome type 1 (especially when there is an associated functional movement disorder). Symptom amplification or even fabrication are more likely if the patient might gain benefit of some sort, not necessarily financial. Techniques to detect deception in medicolegal settings include covert surveillance and review of social media accounts. We also briefly describe specialised psychological tests designed to elicit effort from the patient.
Topics: Animals; Behavior; Cognition; Factitious Disorders; Female; Humans; Malingering; Middle Aged; Movement Disorders; Nervous System Diseases; Young Adult
PubMed: 30425128
DOI: 10.1136/practneurol-2018-001950 -
Ugeskrift For Laeger Mar 2023This is a case report of a woman with a long history of schizophrenia. She suddenly "confessed" that she had been feigning symptoms all along. Taken at face value, this...
This is a case report of a woman with a long history of schizophrenia. She suddenly "confessed" that she had been feigning symptoms all along. Taken at face value, this statement caused a delay in antipsychotic treatment followed by a serious deterioration of the patient's mental state. It became clear over time that several components of the patient's experience of lying were delusional in nature. The diagnosis of schizophrenia was once again validated and antipsychotic treatment resumed. Doctors are advised to be very careful when basing clinical decisions upon suspicion of malingering.
Topics: Female; Humans; Antipsychotic Agents; Malingering; Schizophrenia; Psychiatry
PubMed: 36999298
DOI: No ID Found