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NeuroRehabilitation 2015Forensic neuropsychiatric assessment requires thorough consideration of malingering and response bias. Neuropsychiatric evaluations are complicated due to the multiple... (Review)
Review
BACKGROUND
Forensic neuropsychiatric assessment requires thorough consideration of malingering and response bias. Neuropsychiatric evaluations are complicated due to the multiple domains in which symptoms and impairment present. Moreover, symptom exaggeration in these evaluations can also present along various symptom domains (e.g., psychological, neurocognitive, somatic). Consequently, steps must be taken to ensure adequate coverage of response bias across all three domains of function.
PURPOSE
The following article reviews the conceptualization of malingering in neuropsychiatric settings, as well as various approaches and measures that can be helpful in the assessment of malingering and response bias.
CONCLUSIONS
Forensic neuropsychiatric assessment requires thorough consideration of malingering and response bias. These evaluations are complicated due to the multiple domains in which symptoms and impairment present. Performance and symptom validity measures should be routinely included in these evaluations. Collaboration between psychiatry and psychology can provide the optimal multi-method approach needed for thorough neuropsychiatric assessment in forensic cases. We illustrate our points with two case studies from forensic traumatic brain injury neuropsychiatric evaluations.
Topics: Humans; Malingering; Mental Disorders; Neuropsychological Tests
PubMed: 26409491
DOI: 10.3233/NRE-151231 -
Handbook of Clinical Neurology 2016Interest in malingering has grown in recent years, and is reflected in the exponential increase in academic publications since 1990. Although malingering is more... (Review)
Review
Interest in malingering has grown in recent years, and is reflected in the exponential increase in academic publications since 1990. Although malingering is more commonly detected in medicolegal practice, it is not an all-or-nothing presentation and moreover can vary in the extent of presentation. As a nonmedical disorder, the challenge for clinical practice remains that malingering by definition is intentional and deliberate. As such, clinical skills alone are often insufficient to detect it and we describe psychometric tests such as symptom validity tests and relevant nonmedical investigations. Finally, we describe those areas of neurologic practice where symptom exaggeration and deception are more likely to occur, e.g., postconcussional syndrome, psychogenic nonepileptic seizures, motor weakness and movement disorders, and chronic pain. Factitious disorders are rare in clinical practice and their detection depends largely on the level of clinical suspicion supported by the systematic collection of relevant information from a variety of sources. In this chapter we challenge the accepted DSM-5 definition of factitious disorder and suggest that the traditional glossaries have neglected the extent to which a person's reported symptoms can be considered a product of intentional choice or selective psychopathology largely beyond the subject's voluntary control, or more likely, both. We present evidence to suggest that neurologists preferentially diagnose factitious presentations in healthcare workers as "hysterical," possibly to avoid the stigma of simulated illness.
Topics: Conversion Disorder; Factitious Disorders; Humans; Malingering; Nervous System Diseases
PubMed: 27719868
DOI: 10.1016/B978-0-12-801772-2.00042-4 -
The Journal of the American Academy of... Jun 2021Sexsomnia is a non-rapid eye movement parasomnic behavior characterized by sexual activity during sleep. Recognized in the most recent editions of the Diagnostic and...
Sexsomnia is a non-rapid eye movement parasomnic behavior characterized by sexual activity during sleep. Recognized in the most recent editions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Sleep Disorders, sexsomnia is likely to arise with increasing frequency in court as a potential explanation for sexual offending. The forensic psychiatrist has a unique role in the evaluation and management of sexsomnia. The psychosexual evaluation may elucidate the presence or absence of paraphilias and paraphilic disorders and identify any overlap between the alleged sexsomnic behavior and paraphilic interest. In addition, forensic psychiatrists may assess for malingered sexsomnia, provide an opinion regarding criminal responsibility, or evaluate the risk for committing future sexual offenses. Forensic psychiatrists should therefore understand basic information regarding the disorder, as well as how to conduct a psychosexual evaluation effectively in cases of alleged sexsomnia. This article describes the various considerations involved in the forensic evaluation of sexsomnia.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Forensic Psychiatry; Humans; International Classification of Diseases; Malingering; Paraphilic Disorders; Parasomnias; Sex Offenses; Sexual Behavior
PubMed: 33579735
DOI: 10.29158/JAAPL.200077-20 -
International Journal of Law and... 2016The paper outlines the difference between the so-called normal (common) lying and pathological lying. Pathological lying is an intriguing topic, still lacking any strong... (Review)
Review
The paper outlines the difference between the so-called normal (common) lying and pathological lying. Pathological lying is an intriguing topic, still lacking any strong professional consensus, clear etiology, treatment options and prognoses. The paper explores some possible psychological mechanisms of pathological lying, reviews biological factors in pathological lying, and considers forensic significance of normal and pathological lying. The relationship between pathological lying and mental disorders is also discussed. The authors suggest that lying should be considered as a heterogenic and multidimensional behavioral pattern. The paper highlights how important it is to assess the patient's control over lying, the function of lying, insight into and awareness of lying, as well as the effect of lying on everyday functioning.
Topics: Awareness; Deception; Delusions; Diagnosis, Differential; Humans; Malingering; Mental Disorders; Motivation; Personality Disorders
PubMed: 27048622
DOI: 10.1016/j.ijlp.2016.02.036 -
Assessment Mar 2017Psychological assessments are highly dependent on the forthrightness and sincere efforts of examinees. In particular, evaluations in forensic settings must consider...
Psychological assessments are highly dependent on the forthrightness and sincere efforts of examinees. In particular, evaluations in forensic settings must consider whether feigning or other response styles are utilized to intentionally distort the clinical presentation. The current study examines the effectiveness of the Inventory of Legal Knowledge (ILK) at detecting feigned incompetency within a sample of jail detainees. As an ancillary goal, several scales of the Standardized Assessment of Miranda Abilities were included in the same within-subjects simulation design. Results of the total ILK score raised concerns regarding the mischaracterization of genuine offenders as "suggestive of feigning." Pending cross-validation, however, a Revised ILK proved highly effective, using a floor effect detection strategy. Although intended for Miranda-specific abilities, several detection strategies on the Standardized Assessment of Miranda Abilities appeared to be very promising within a broadened context of feigned incompetency.
Topics: Adult; Deception; Expert Testimony; Female; Forensic Psychiatry; Humans; Insanity Defense; Male; Malingering; Mental Competency; Middle Aged; Personality Assessment; Prisoners; Psychometrics; Vocabulary; Wechsler Scales
PubMed: 26384736
DOI: 10.1177/1073191115605613 -
The Journal of the American Academy of... Mar 2021The Inventory of Legal Knowledge (ILK) is a feigning measure of growing usage, familiarity, and controversy in research and practice. A comprehensive review of a smaller... (Review)
Review
The Inventory of Legal Knowledge (ILK) is a feigning measure of growing usage, familiarity, and controversy in research and practice. A comprehensive review of a smaller literature base yields recurring themes in the ILK literature. There were mentions of feigned lack of legal knowledge tending to associate with feigned psychopathology, concerns about false positives at or around the ILK cutoff score, and potential complications when the ILK is administered to individuals with very low intellectual functioning. Possible underestimation of both false positives and false negatives suggests there may be a need for a revised edition of the measure, further item discrimination, and a meta-analysis of extant research studies with similar designs. An ILK-2 with required user training, as well as a lower cutoff score, an indeterminate range, and weighting of scores in association with criminal history may increase the measure's validity, robustness, and utility in larger assessments of malingering.
Topics: Forensic Psychiatry; Humans; Malingering; Mental Competency; Psychometrics; Reproducibility of Results; United States
PubMed: 33234539
DOI: 10.29158/JAAPL.200042-20 -
Irish Journal of Psychological Medicine Sep 2018To review existing literature about university students with Attention Deficit Hyperactivity Disorder (ADHD). (Review)
Review
OBJECTIVES
To review existing literature about university students with Attention Deficit Hyperactivity Disorder (ADHD).
METHODS
A framework for scoping studies and content analysis were used to source and review selected publications from PubMed, ScienceDirect, Google Scholar and relevant bibliographies.
RESULTS
Seventy-four publications were reviewed and key findings were categorised under six core themes that represent the issues germane to university students with ADHD. These themes are: academic, social and psychological functioning, giftedness, new media technologies, treatment, substance misuse and the non-medical use of prescription stimulants, and malingering.
CONCLUSION
In Ireland and the United Kingdom (UK) young people with ADHD are unlikely to enrol into further education, and of those who do go to university, few will graduate at the same time as their non-ADHD peers. ADHD is associated with poor educational outcomes and it may be a hidden disability within institutions of higher education (e.g. universities). Surprisingly, in this topic area, there is a paucity of research in Ireland and the UK. Most studies originate from North America were research activity in the field has been ongoing since the 1990s. These studies however, tend to use relatively small samples of college (university) students recruited at a single institution. It is difficult to generalise the findings of these studies to student populations in North America, let alone in Ireland and the UK. At the very least, these North American studies provide insights into key areas of concern. This topic area straddles education and psychiatry. This means an inter-disciplinary approach is required to examine, better understand and address the impact of ADHD on the educational outcomes of university students. The philosophies of difference, equity and self-realisation can offer a conceptual framework for conducting further research and/or developing services to deliver more personalised learning support for university students with ADHD.
Topics: Attention Deficit Disorder with Hyperactivity; Educational Status; Humans; Ireland; Malingering; Students; Substance-Related Disorders; Universities
PubMed: 30124182
DOI: 10.1017/ipm.2017.20 -
Applied Neuropsychology. Adult 2016Over the last 20-25 years, considerable research has been devoted to the development of the science involved with detecting invalid symptom presentations and... (Review)
Review
Over the last 20-25 years, considerable research has been devoted to the development of the science involved with detecting invalid symptom presentations and performances in psychological and neuropsychological examinations. Early work on these concepts drove the construction and validation of several measures of symptom and performance validity leading to the eventual utilization of these measures to establish base rates across various populations. More recent works have sought to demonstrate correlations between select domains and researchers have further labored to investigate the real world costs of invalid response styles. In this article, a hierarchical model is developed to explain and classify the manifestations and consequences of invalid responding. The primary goals of this work are (a) to outline a model characterizing the pervasive implications of select styles of invalid responding and (b) to provide a heuristic for the development of research on secondary and tertiary consequences of such response styles across health care evaluations.
Topics: Cognition Disorders; Humans; Malingering; Models, Theoretical; Psychological Tests; Reproducibility of Results
PubMed: 27219126
DOI: 10.1080/23279095.2016.1178646 -
Neuro-Chirurgie May 2021The neuropsychological assessment is a cornerstone in the care management of concussion or mild traumatic injury.
INTRODUCTION
The neuropsychological assessment is a cornerstone in the care management of concussion or mild traumatic injury.
OBJECTIVE
To present the different stages of an exhaustive neuropsychological assessment exploring cognitive and behavioral domains.
METHOD
Description of the value of the main tests available for behavioral and cognitive assessment. The choice of tests is based on the clinical experience and expertise of the authors.
RESULTS
Questionnaires are mainly used to explore the behavioral sequelae (depression, anxiety or fatigue) and the impact of these potential difficulties in daily life. Four cognitive abilities could be impaired by concussion: attention, memory, visuospatial functions and executive functions. These abilities could be explored with "paper and pencil" tests or with computerized test batteries. While cognitive sequelae in the context of a moderate or a severe traumatic brain injury are consolidated, in the context of concussion, neuropsychological sequelae tend to resolve in a short time. As a consequence, several neuropsychological assessments could be conducting in a short period involving some methodological considerations. Moreover, as concussion could be reported in a Whiplash injury from a car crash with forensic consequences, it is crucial to propose tests to be sure that the weak performance obtained into the neuropsychological assessment is not explained by poor effort and/or malingering.
DISCUSSION/CONCLUSION
This article revises these aspects of a neuropsychological assessment in the specific context of concussion.
Topics: Activities of Daily Living; Anxiety; Behavior; Brain Concussion; Cognition; Depression; Fatigue; Female; Humans; Male; Malingering; Neurologic Examination; Neuropsychological Tests; Surveys and Questionnaires; Whiplash Injuries
PubMed: 33049285
DOI: 10.1016/j.neuchi.2020.06.134 -
JEMS : a Journal of Emergency Medical... Aug 2014
Topics: Emergency Medical Services; Humans; Malingering; Medical History Taking; Prisoners; Wit and Humor as Topic
PubMed: 25204121
DOI: No ID Found