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General Hospital Psychiatry 2018The therapeutic discharge of patients assessed as misrepresenting suicidal ideation, though in the best interests of the patient, physician, and health care system, is... (Review)
Review
OBJECTIVE
The therapeutic discharge of patients assessed as misrepresenting suicidal ideation, though in the best interests of the patient, physician, and health care system, is an inherently risk-assuming action. The rationale and conduct of the therapeutic discharge has been written on previously. Here, we propose a method of documenting the therapeutic discharge in a way that is useful and teachable.
METHOD
After describing some other types of note-writing that can be needed in the care of deceptive patients, we describe an approach to each of the major sections of an initial consultation/encounter note as it applies to the therapeutic discharge.
RESULTS
Each note section is handled slightly differently than ordinarily. The history of present illness follows the sequence, rather than the re-organization of the information obtained. The past medical history requires and reflects a more granular chart review than is usually warranted. The mental status exam is less cross-sectional than usual. The assessment and plan incorporates several components that reflect a reasoning process specific to the therapeutic discharge.
CONCLUSION
While labor-intensive, the documentation approach advocated for and exemplified here reaffirms aspects of one's identity as a physician, ensures responsible execution of a risk-involving decision, and potentially simplifies subsequent patient encounters.
Topics: Documentation; Humans; Malingering; Mental Disorders; Patient Discharge; Suicidal Ideation
PubMed: 29309988
DOI: 10.1016/j.genhosppsych.2017.12.007 -
General Hospital Psychiatry 2023To characterize the socio-demographics and comorbid medical and psychiatric diagnoses of patients in the general hospital diagnosed with malingering. (Observational Study)
Observational Study
OBJECTIVE
To characterize the socio-demographics and comorbid medical and psychiatric diagnoses of patients in the general hospital diagnosed with malingering.
METHOD
We conducted a retrospective observational cohort study using data from the 2019 National Inpatient Sample, an all-payors database of acute care general hospital discharges in the United States, querying for patients aged 18 and older discharged with a diagnosis of "malingerer [conscious simulation]," ICD-10 code Z76.5.
RESULTS
45,645 hospitalizations (95% CI: 43,503 to 47,787) during the study year included a discharge diagnosis of malingering. 56.1% were for male patients, and the median age was 43 years (IQR 33 to 54). Black patients represented 26.8% of the patients with a discharge diagnosis of malingering, compared to 14.9% of all patients sampled. Zip codes in the lowest household income quartile comprised 39.9% of malingering diagnoses. The top categories of primary discharge diagnoses of hospitalizations included medical ("Diabetes mellitus without complications"), psychiatric ("Depressive disorders"), and substance use ("Alcohol-related disorders") disorders. "Sepsis, unspecified organism," was the most common primary diagnosis.
CONCLUSION
The striking overrepresentation of Black patients in hospitalizations with diagnosis of malingering raises concern about the roles of implicit and systemic biases in assigning this label. The disproportionate number of patients of low socioeconomic status is further suggestive of bias and disparity. Another potential contribution is that the lower health literacy in these populations results in a limited knowledge of traditional ways to meet one's needs and thus greater reliance on malingered behavior as an alternative means. Accurate description of these patients' socio-demographics and comorbid medical and psychiatric diagnoses with reliable data from large samples can lead to improved understanding of how the malingering label is applied and ultimately better patient care.
Topics: Adult; Humans; Male; Hospitalization; Hospitals, General; Inpatients; Malingering; Retrospective Studies; United States; Female; Middle Aged
PubMed: 38455076
DOI: 10.1016/j.genhosppsych.2023.10.005 -
Applied Neuropsychology. Adult Aug 2022The purpose of this study was to determine how malingered PTSD behavior affects the performance of a continuous performance task (CPT). An analog trauma group, two...
The purpose of this study was to determine how malingered PTSD behavior affects the performance of a continuous performance task (CPT). An analog trauma group, two malingering groups (with or without educational intervention), and a control group were organized according to simulation design. During the CPT, the numbers of errors and response time indicators along with post-error slowing (PES) and recovery (PER) process were measured. Results are as follows: First, the analog trauma group showed deficits of response inhibition and a higher level of PES compared to the control group. Second, malingered PTSD caused a significant number of errors, inconsistent performance, and no PES. Third, there was a significantly more impaired and inconsistent performance in the low level of knowledge of disability. Finally, a discriminant accuracy of more than 90% appeared in the discriminant analysis of all group comparison conditions. Taken together, the results of this study show that post-error behavior indicators are affected by malingered PTSD, and differences according to the degree of knowledge of PTSD can also be confirmed. These results are expected to be used as basic data for the development of tasks for the detection of malingerers in clinical scenes in the future.
PubMed: 36027606
DOI: 10.1080/23279095.2022.2115370 -
Journal of Personality Assessment 2022Assessment of symptom feigning is paramount in forensic psychological and psychiatric assessment. The Structured Interview of Reported Symptoms, 2nd Edition (SIRS-2;... (Review)
Review
Assessment of symptom feigning is paramount in forensic psychological and psychiatric assessment. The Structured Interview of Reported Symptoms, 2nd Edition (SIRS-2; Rogers et al., 2010) is a revised edition to the original SIRS (Rogers et al., . Psychological Assessment Resources, Inc, 1992) and was developed to assess feigned psychiatric symptoms. The current paper reviews use of the SIRS-2 in forensic assessment, specifically addressing topics such as translations of the instrument, its use in assessing psychiatric and cognitive feigning, and its use in special populations. Empirical foundation and psychometric properties of the SIRS-2 is also covered. The SIRS-2 was revised in part to reduce false positive classifications of feigning. Research suggests that this goal was largely accomplished, albeit at the expense of reduced sensitivity. The paper also provides a review of federal and state appellate cases that mention the SIRS-2. Notably, most cases that cite the SIRS-2 do not actually center on the SIRS-2, and the test's admissibility has never been outrightly challenged. The paper concludes with a discussion of expert testimony concerning the SIRS-2.
Topics: Forensic Psychiatry; Humans; Interview, Psychological; Malingering; Mental Disorders; Mental Health; Psychometrics; Systemic Inflammatory Response Syndrome
PubMed: 34871131
DOI: 10.1080/00223891.2021.2006673 -
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 -
The Journal of the American Academy of... Jun 2022The military mental health clinic is a medico-legal setting that provides servicemembers with treatment, administrative, and forensic services. Clinicians must be...
The military mental health clinic is a medico-legal setting that provides servicemembers with treatment, administrative, and forensic services. Clinicians must be vigilant for malingering in this setting but flexible enough to recognize genuine symptoms. This task is often complicated by servicemembers' delayed report of symptoms. Three explanatory models are proposed that distinguish delayed report from malingering: genuine delayed report of symptoms, acute distress malingering, and disability malingering. These explanatory models improve clinician objectivity and offer a systematic understanding of these different presentations.
Topics: Disabled Persons; Humans; Malingering; Military Personnel
PubMed: 35470255
DOI: 10.29158/JAAPL.210068-21 -
Applied Neuropsychology. Adult 2022The objective of the current archival study was to investigate the ability of the Modified Somatic Perception Questionnaire (MSPQ) to discriminate between noncredible...
The objective of the current archival study was to investigate the ability of the Modified Somatic Perception Questionnaire (MSPQ) to discriminate between noncredible and credible neurocognitive dysfunction in a large mixed non-pain forensic sample comprised of personal injury litigants and disability claimants. Participants included 149 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, i.e., Credible Group (CG), or Noncredible Group (NCG) based upon their performance on stand-alone performance validity tests (PVT) including the Word Memory Test (WMT), and/or Test of Memory Malingering (TOMM), and Victoria Symptom Validity Test (VSVT). After excluding examinees with evidence of somatization participants in the NCG scored significantly higher on the MSPQ compared to participants in the CG. Scores on the MSPQ were not only related to cognitive performance validity but also amplified by the co-existence of somatization. There were no significant effects of gender, age, or race on MSPQ scores. We conclude that the MSPQ demonstrates external validity as a self-report measure of symptom validity that is sensitive to somatic and autonomic complaints in non-pain forensic samples. Future research is needed to develop MSPQ cutscores with external validity pertinent to other non-pain populations.
Topics: Adult; Cognition; Humans; Malingering; Memory and Learning Tests; Neuropsychological Tests; Perception; Reproducibility of Results; Surveys and Questionnaires
PubMed: 32692261
DOI: 10.1080/23279095.2020.1794868 -
Deception is different: Negative validity test findings do not provide "evidence" for "good effort".The Clinical Neuropsychologist Aug 2022The purpose of this paper is to determine whether negative validity test findings should be used in the Bayesian aggregate along with positive test findings for the...
The purpose of this paper is to determine whether negative validity test findings should be used in the Bayesian aggregate along with positive test findings for the determination of malingering as the condition of interest (COI). Evidence-based diagnostic methods for conditions in neuropsychology and medicine were reviewed for comparison with their use in cases of malingering. Logical and Bayesian analyses of these cases were applied. A case study showed that negative validity test findings did not indicate "good effort". Deception about illness is fundamentally different from other constructs/diseases in evidence-based medicine and neuropsychology. This is because deception involves a deliberate process that may involve coaching, claimant research, and/or focusing the deception on one aspect (e.g., slowness) as opposed to other neurocognitive problems (e.g., memory). Comparatively, other conditions in medicine and neuropsychology are unlikely to be manipulated by the patient. The assertion by Frederick (2015) and Black, Necrason, and Omasta (2016) that both positive and negative validity test findings must be used together in the aggregate does not stand up to this comparative scrutiny. The fundamental assumption by these authors that a negative test finding concerning malingering represents "good effort" is flawed; it simply represents lack of evidence of malingering, which cannot be construed as evidence of lack of malingering. We recommend that in forensic determination of malingering, negative validity test findings should not be used in a Bayesian aggregation. This conclusion is consistent with current practices in the field.
Topics: Bayes Theorem; Deception; Humans; Malingering; Neuropsychological Tests; Neuropsychology; Reproducibility of Results
PubMed: 33300435
DOI: 10.1080/13854046.2020.1840633 -
Psychological Assessment Nov 2017The cross-cultural validity of feigning instruments and cut-scores is a critical concern for forensic mental health clinicians. This systematic review evaluated feigning... (Review)
Review
The cross-cultural validity of feigning instruments and cut-scores is a critical concern for forensic mental health clinicians. This systematic review evaluated feigning classification accuracy and effect sizes across instruments and languages by summarizing 45 published peer-reviewed articles and unpublished doctoral dissertations conducted in Europe, Asia, and North America using linguistically, ethnically, and culturally diverse samples. The most common psychiatric symptom measures used with linguistically, ethnically, and culturally diverse samples included the Structured Inventory of Malingered Symptomatology, the Miller Forensic Assessment of Symptoms Test, and the Minnesota Multiphasic Personality Inventory (MMPI). The most frequently studied cognitive effort measures included the Word Recognition Test, the Test of Memory Malingering, and the Rey 15-item Memory test. The classification accuracy of these measures is compared and the implications of this research literature are discussed. (PsycINFO Database Record
Topics: Humans; Malingering; Neuropsychological Tests; Psychiatric Status Rating Scales
PubMed: 28080105
DOI: 10.1037/pas0000438 -
Applied Neuropsychology. Adult 2022This article contributes to the growing research on the validity of the recently developed, Inventory of Problems - 29 (IOP-29) in the discrimination of feigned from... (Review)
Review
This article contributes to the growing research on the validity of the recently developed, Inventory of Problems - 29 (IOP-29) in the discrimination of feigned from bona fide mental or cognitive disorders. Specifically, we first developed a Lithuanian version of the IOP-29 and tested its validity on a sample of 50 depressed patients and 50 healthy volunteers instructed to feign depression. Next, we reviewed all previously published IOP-29 studies reporting on depression-related presentations ( = 5), and compared our results against previously reported findings. Statistical analyses showed that the Lithuanian IOP-29 discriminated almost perfectly between genuine and experimentally feigned major depression, with Area Under the Curve (AUC) = .98 ( = .01) and Cohen's = 3.31. When compared to previously published IOP-29 literature on this same topic, these findings may be characterized as similar or perhaps slightly more encouraging. Indeed, across all international, empirical studies considered in this article, Cohen's ranged from 1.80 to 4.30, and AUC ranged from .89 to .99. Taken together, these findings contribute to supporting the strong validity and cross-cultural applicability of the IOP-29. They also provide additional support for its use in forensic evaluations.
Topics: Depression; Depressive Disorder, Major; Epidemiologic Studies; Humans; Lithuania; Malingering; Reproducibility of Results
PubMed: 32064927
DOI: 10.1080/23279095.2020.1725518