-
Journal of Clinical and Experimental... Mar 2024
Topics: Humans; Reproducibility of Results; Neuropsychological Tests; Malingering
PubMed: 38654620
DOI: 10.1080/13803395.2024.2346022 -
Journal of the International... Mar 2020Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with... (Comparative Study)
Comparative Study
OBJECTIVE
Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with validity test performance and may thus lead to an incorrect (i.e., false-positive) classification of the patient's scores as non-credible. The study aimed at examining the false-positive rate of three validity tests in patients with cognitive impairment and apathy.
METHODS
A cross-sectional, comparative study was performed in 56 patients with dementia, 41 patients with mild cognitive impairment, and 41 patients with Parkinson's disease. Two PVTs - the Test of Memory Malingering (TOMM) and the Dot Counting Test (DCT) - and one SVT - the Structured Inventory of Malingered Symptomatology (SIMS) - were administered. Apathy was measured with the Apathy Evaluation Scale, and severity of cognitive impairment with the Mini Mental State Examination.
RESULTS
The failure rate was 13.7% for the TOMM, 23.8% for the DCT, and 12.5% for the SIMS. Of the patients with data on all three tests (n = 105), 13.5% failed one test, 2.9% failed two tests, and none failed all three. Failing the PVTs was associated with cognitive impairment, but not with apathy. Failing the SVT was related to apathy, but not to cognitive impairment.
CONCLUSIONS
In patients with cognitive impairment or apathy, failing one validity test is not uncommon. Validity tests are differentially sensitive to cognitive impairment and apathy. However, the rule that at least two validity tests should be failed to identify non-credibility seemed to ensure a high percentage of correct classification of credibility.
Topics: Aged; Aged, 80 and over; Apathy; Cognitive Dysfunction; Cross-Sectional Studies; Dementia; Female; Humans; Male; Malingering; Memory Disorders; Middle Aged; Neuropsychological Tests; Parkinson Disease; Reproducibility of Results; Sensitivity and Specificity
PubMed: 31658930
DOI: 10.1017/S1355617719001139 -
Behavioral Sciences & the Law 2024Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if...
Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness-related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.
Topics: Humans; Somatoform Disorders; Malingering; Forensic Psychiatry; Nervous System Diseases; Factitious Disorders; Disability Evaluation
PubMed: 38450761
DOI: 10.1002/bsl.2651 -
Behavioral Sciences & the Law 2024Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such...
Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such determinations may modify or even override other clinical findings. As a result, practitioners must be alert to their own misassumptions that may unintentionally bias their conclusions about response styles. Detection strategies for malingering-based on unlikely or markedly amplified presentations-are highlighted in this article. Given page constraints, assessment methods for feigning are succinctly presented with their applications to administrative, civil, and criminal referrals.
Topics: Humans; Malingering; Reproducibility of Results; Criminals; Deception
PubMed: 38047870
DOI: 10.1002/bsl.2636 -
NeuroRehabilitation 2015In clinical neuropsychological practice, assessment of response validity (e.g., effort, over-reporting, under-reporting) is an essential component of the assessment... (Review)
Review
BACKGROUND
In clinical neuropsychological practice, assessment of response validity (e.g., effort, over-reporting, under-reporting) is an essential component of the assessment process. By contrast, other health care professionals, including those in neurorehabilitation settings, often omit assessment of this topic from their evaluations or only rely on subjective impressions.
OBJECTIVE
To provide the first comprehensive review of response validity assessment in the neurorehabilitation literature, including why the topic is often avoided, what methods are commonly used, and how to decrease false positives.
METHODS
A literature review and documentation of personal experience and perspectives was used to review this topic.
RESULTS
There is a well-established literature on the necessity and utility of assessing response validity, particularly in patients who have external incentives to embellish their presentation or to under-report symptoms. There are many reasons why non-neuropsychologists typically avoid assessment of this topic. This poses a significant problem, particularly when patients exaggerate or malinger, because it can lead to misdiagnosis and it risks increasing the cost of healthcare by performing unnecessary tests and treatments, unfair distribution of disability/compensation resources, and a reduced access to these and other health resources by patients who genuinely need them.
CONCLUSIONS
There is a significant need for non-neuropsychologists to develop and incorporate symptom and performance validity assessments in clinical evaluations, including those in neurorehabilitation settings.
Topics: Bias; Humans; Malingering; Neurocognitive Disorders; Neurologic Examination
PubMed: 26409488
DOI: 10.3233/NRE-151228 -
Medical History Apr 2023The fear of the malingering soldier or veteran has existed in Australia since its first nationwide military venture in South Africa. The establishment of the...
The fear of the malingering soldier or veteran has existed in Australia since its first nationwide military venture in South Africa. The establishment of the Repatriation Department in 1917 saw the medical, military and political fields work collectively, to some extent, to support hundreds of thousands of men who returned from their military service wounded or ill. Over the next decades the medical profession occasionally criticised the Repatriation Department's alleged laxness towards soldier recipients of military pensions, particularly those with less visible war-related psychiatric conditions. In 1963 this reached a crescendo when a group of Australian doctors drew battle lines in the correspondence pages of the , accusing the Repatriation Department of directing a 'national scandal', and provoking responses by both the Minister for Repatriation and the Chairman of the War Pensions Assessment Appeal Tribunal. Although this controversy and its aftermath does allow for closer investigation of the inner workings of the Repatriation Department, the words of the doctors themselves about 'phony cronies', 'deadbeats' and 'drongoes' also reveal how the medical fear of the malingering soldier, and particularly the traumatised soldier-malingerer, lingered into the early 1960s and beyond. This paper will analyse the medical conceptualisation of the traumatised soldier in the 1960s in relation to historical conceptions of malingering, the increasingly tenuous position of psychiatry, as well as the socio-medical 'sick role', and will explore possible links with the current soldier and veteran suicide crisis in Australia.
Topics: Male; Humans; Malingering; Military Personnel; Australia; Mental Disorders; Fear
PubMed: 37525458
DOI: 10.1017/mdh.2023.19 -
Behavioral Sciences & the Law Sep 2017Diversion programs screen justice-involved individuals for the presence of psychiatric disorders, and after negotiations take place with attorneys and treatment...
Diversion programs screen justice-involved individuals for the presence of psychiatric disorders, and after negotiations take place with attorneys and treatment providers, these programs link participants with community-based treatment programs in lieu of incarceration. As the number of diversion programs, including mental health courts, continues to rapidly grow, so does the need for "diversion evaluations". Diversion evaluations are a type of forensic mental health assessment (FMHA) conducted to assist the courts in making decisions regarding diversion eligibility. As a result, they should follow the general principles of FMHA and the American Academy of Psychiatry and Law Practice Guideline for Forensic Assessment. Diversion evaluations also require application of specific areas of knowledge and experience, as court-based diversion is a unique, therapeutically focused context that is purposefully non-adversarial. The diversion evaluator is a role that combines objective decision-making with clinical consultation. The purpose of this article is to apply generally accepted forensic report standards to diversion evaluations, with a particular focus on the unique issues of diversion-specific forensic evaluations.
Topics: Criminal Law; Decision Making; Forensic Psychiatry; Humans; Male; Malingering; Mental Disorders; Mental Health; United States
PubMed: 29052262
DOI: 10.1002/bsl.2309 -
Archives of Clinical Neuropsychology :... Aug 2022Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional...
BACKGROUND
Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional neurological disorder. Although FCD is understood as different from exaggerated or feigned cognitive complaints, previous accounts have provided little practical advice on how FCD can be separated from factitious or malingered cognitive complaints. Also, the distinction of FCD from other medical or mental health disorders that impact on cognition is an area of ongoing study and debate. Diagnostic precision is important to prevent iatrogenesis and for the development of needed treatment protocols.
METHOD
We summarize the current literature and present seven anonymized case vignettes to characterize the challenges in this area and develop proposals for solutions.
RESULTS/CONCLUSIONS
Recognizing the limitations of categorical diagnostic systems, we position FCD as distinct from feigning and cognitive symptoms of psychiatric disorders, although with overlapping features. We set out typical clinical features and neuropsychological profiles for each category of cognitive disorder and a statistical method to analyze performance validity tests/effort tests to assist in determining feigned or invalid responding.
Topics: Cognition; Cognition Disorders; Diagnosis, Differential; Humans; Malingering; Neuropsychological Tests
PubMed: 35484819
DOI: 10.1093/arclin/acac020 -
Fortschritte Der Neurologie-Psychiatrie Jul 2018Psychiatric expertise is necessary for a variety of legal expert opinion orders. Psychiatric assessment requires high professional competence and basic knowledge in the... (Review)
Review
Psychiatric expertise is necessary for a variety of legal expert opinion orders. Psychiatric assessment requires high professional competence and basic knowledge in the relevant areas of law. General conditions for comprehensive psychiatric assessment procedures are outlined. The problem of aggravation and simulation is discussed.
Topics: Expert Testimony; Forensic Psychiatry; Humans; Malingering; Mental Disorders
PubMed: 30029280
DOI: 10.1055/s-0043-119801 -
Assessment Apr 2023This study examined the effectiveness of the negative distortion measures from the Personality Assessment Inventory (PAI) and Inventory of Problems-29 (IOP-29), by...
This study examined the effectiveness of the negative distortion measures from the Personality Assessment Inventory (PAI) and Inventory of Problems-29 (IOP-29), by investigating data from a community and a forensic sample, across three different symptom presentations (i.e., feigned depression, posttraumatic stress disorder [PTSD], and schizophrenia). The final sample consisted of 513 community-based individuals and 288 inmates (total = 801); all were administered the PAI and the IOP-29 in an honest or feigning conditions. Statistical analyses compared the average scores of each measure by symptom presentation and data source (i.e., community vs. forensic sample) and evaluated diagnostic efficiency statistics. Results suggest that the PAI Negative Impression Management scale and the IOP-29 are the most effective measures across all symptom presentations, whereas the PAI Malingering Index and Rogers Discriminant Function generated less optimal results, especially when considering feigned PTSD. Practical implications are discussed.
Topics: Humans; Discriminant Analysis; Malingering; Personality Assessment; Research Design; Stress Disorders, Post-Traumatic
PubMed: 34872384
DOI: 10.1177/10731911211061282