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Journal of the Academy of... 2023We present the case of a young woman with an extensive medical history that most notably includes over 60 emergency-room visits for unfounded respiratory distress that... (Review)
Review
We present the case of a young woman with an extensive medical history that most notably includes over 60 emergency-room visits for unfounded respiratory distress that often prompted intubations. Each presentation displays elements of deceitfulness or inappropriate demands that align with factitious disorder imposed on self. Top experts in the Consultation-Liaison field provide guidance for this commonly encountered clinical case based on their experience and review of available literature. Key teaching topics include a review of risk factors for development of deceptive syndromes, distinguishing factitious disorder from malingering and conversion disorder, and the role of a consulting psychiatrist in such cases. Patients with factitious disorder often show signs of pathologic lying, obstinance, and erratic behavior. Such attributes frequently arouse negative countertransference in providers, causing frustration and dread with continuing care, rendering psychiatric involvement. We address the unique challenges in managing factitious disorder and how to effectively collaborate with an interdisciplinary inpatient team with these cases.
Topics: Female; Humans; Factitious Disorders; Malingering; Conversion Disorder; Dissociative Disorders; Risk Factors
PubMed: 37499871
DOI: 10.1016/j.jaclp.2023.07.001 -
International Journal of Legal Medicine Jul 2021The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims....
The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%.
Topics: Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Discriminant Analysis; Female; Germany; Humans; Linear Models; Male; Malingering; Middle Aged; Reproducibility of Results; Self Report; Sensitivity and Specificity; Surveys and Questionnaires; Symptom Assessment; Whiplash Injuries
PubMed: 33774707
DOI: 10.1007/s00414-021-02572-5 -
The Journal of Law, Medicine & Ethics :... 2021This Introduction frames the context of the interdisciplinary working group that examined the role of malingering in health and social policy in 2019-2020. The Symposium...
This Introduction frames the context of the interdisciplinary working group that examined the role of malingering in health and social policy in 2019-2020. The Symposium Issue here is the result of the group's time, energy, and analysis.
Topics: Humans; Malingering; Public Policy
PubMed: 34665087
DOI: 10.1017/jme.2021.52 -
European Journal of Neurology Apr 2023Performance validity tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid...
BACKGROUND AND PURPOSE
Performance validity tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid reflection of an individual's abilities. Data on functional motor disorder (FMD) are currently poor and conflicting. We aimed to examine the rate of failure on three different PVTs of nonlitigant, non-compensation-seeking FMD patients, and we compared their performance to that of healthy controls and controls asked to simulate malingering (healthy simulators).
METHODS
We enrolled 29 nonlitigant, non-compensation-seeking patients with a clinical diagnosis of FMD, 29 healthy controls, and 29 healthy simulators. Three PVTs, the Coin in the Hand Test (CIH), the Rey 15-Item Test (REY), and the Finger Tapping Test (FTT), were employed.
RESULTS
Functional motor disorder patients showed low rates of failure on the CIH and REY (7% and 10%, respectively) and slightly higher rates on the FTT (15%, n = 26), which implies a motor task. Their performance was statistically comparable to that of healthy controls but statistically different from that of healthy simulators (p < 0.001). Ninety-three percent of FMD patients, 7% of healthy simulators, and 100% of healthy controls passed at least two of the three tests.
CONCLUSIONS
Performance validity test performance of nonlitigant, non-compensation-seeking patients with FMD ranged from 7% to 15%. Patients' performance was comparable to that of controls and significantly differed from that of simulators. This simple battery of three PVTs could be of practical utility and routinely used in clinical practice.
Topics: Humans; Reproducibility of Results; Neuropsychological Tests; Malingering
PubMed: 36692870
DOI: 10.1111/ene.15703 -
International Journal of Law and... 2016With the population aging, the legal and mental health systems need to be prepared for cases that involve older adults beyond the customary matters of guardianship and...
With the population aging, the legal and mental health systems need to be prepared for cases that involve older adults beyond the customary matters of guardianship and competency. Assessing older adults with the current tests raises concerns because these measures may not be adequately normed for this age group. Malingering, factitious disorders, and somatoform disorders are discussed due to health-related issues of normal aging. These topics complicate the assessment procedure and need consideration because they may affect the claimant's performance or symptom presentation. Although claims of posttraumatic stress disorder (PTSD) are common in civil litigation cases, it can be additionally complex in older adults. The evaluator needs to weigh not only factors related to the normal biological process of aging but also those that are attendant with the litigation.
Topics: Age Factors; Aged; Aging; Factitious Disorders; Geriatric Assessment; Humans; Jurisprudence; Malingering; Psychiatric Status Rating Scales; Psychological Tests; Somatoform Disorders; Stress Disorders, Post-Traumatic
PubMed: 27810112
DOI: 10.1016/j.ijlp.2016.10.010 -
General Hospital Psychiatry 2021
Topics: Comorbidity; Emergency Service, Hospital; Humans; Malingering; Mental Disorders
PubMed: 34373126
DOI: 10.1016/j.genhosppsych.2021.08.002 -
Behavioral Sciences & the Law Jan 2019Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering...
Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Building on Rogers' central motivations for malingering, the current article provides four explanatory models for FPPs; three of these parallel malingering (pathogenic, criminological, and adaptational) but differ in their central features. In addition, the nurturance model stresses how patients with FPPs attempt to use their relationship with treating professionals to fulfill their unmet psychological needs. Relying on these models, practical guidelines are recommended for evaluating FPPs in a forensic context.
Topics: Criminology; Deception; Diagnosis, Differential; Factitious Disorders; Forensic Psychiatry; Humans; Malingering
PubMed: 30225846
DOI: 10.1002/bsl.2365 -
Psychological Assessment Dec 2017Invalid self-report and invalid performance occur with high base rates in attention deficit/hyperactivity disorder (ADHD; Harrison, 2006; Musso & Gouvier, 2014)....
The importance of assessing for validity of symptom report and performance in attention deficit/hyperactivity disorder (ADHD): Introduction to the special section on noncredible presentation in ADHD.
Invalid self-report and invalid performance occur with high base rates in attention deficit/hyperactivity disorder (ADHD; Harrison, 2006; Musso & Gouvier, 2014). Although much research has focused on the development and validation of symptom validity tests (SVTs) and performance validity tests (PVTs) for psychiatric and neurological presentations, less attention has been given to the use of SVTs and PVTs in ADHD evaluation. This introduction to the special section describes a series of studies examining the use of SVTs and PVTs in adult ADHD evaluation. We present the series of studies in the context of prior research on noncredible presentation and call for future research using improved research methods and with a focus on assessment issues specific to ADHD evaluation. (PsycINFO Database Record
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Diagnosis, Differential; Female; Humans; Male; Malingering; Neuropsychological Tests; Patient Simulation; Psychometrics; Reproducibility of Results; Self Report
PubMed: 29227123
DOI: 10.1037/pas0000535 -
Psychological Assessment Jun 2022The recently released Minnesota Multiphasic Personality Inventory-3 (MMPI-3) includes a revised set of Validity Scales on which there is currently limited validity and...
The recently released Minnesota Multiphasic Personality Inventory-3 (MMPI-3) includes a revised set of Validity Scales on which there is currently limited validity and clinical utility evidence for the detection of overreporting. The present study evaluated the MMPI-3 Validity Scales in the identification of such response bias. An analogue simulation design was used in which participants in an overreporting condition (163 undergraduate students) were instructed to feign mental health symptoms when responding to the MMPI-3 in the context of a compensation-seeking claim. Two comparison groups (657 undergraduate students and 223 community mental health patients) were instructed to respond to the MMPI-3 under standard instructions. The results indicated that those in the overreporting group generally had higher scores on MMPI-3 substantive scales than did genuine responding patients and students. In addition, results indicated that the criterion validity of the substantive scale scores was compromised in the context of overreporting. All MMPI-3 Validity Scales, particularly Fp ( = 1.29), F ( = 1.05), and RBS ( = 1.11), differentiated the overreporting group from patients with genuine psychopathology. Classification accuracies associated with the overreporting Validity Scale scores were evaluated and generally supported their utility in correctly classifying overreporters and patients. Overall, the findings generally support the validity and clinical utility of the MMPI-3 Validity Scales in the detection of overreporting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Humans; MMPI; Malingering; Mental Disorders; Psychopathology; Reproducibility of Results; Students
PubMed: 35201824
DOI: 10.1037/pas0001112 -
Documenta Ophthalmologica. Advances in... Jun 2015To investigate the efficacy of pattern visual evoked potentials (VEPs) in evaluating objective visual acuity (VA) and discriminating malingerers.
PURPOSE
To investigate the efficacy of pattern visual evoked potentials (VEPs) in evaluating objective visual acuity (VA) and discriminating malingerers.
METHODS
Two hundred and forty-nine eyes of 249 patients aged 20-65 years were included. There were 147 eyes with macular diseases (group 1) and 102 eyes with optic nerve diseases (group 2). Amplitudes and latencies were analyzed and correlated with best-corrected visual acuity by a regression analysis. We found the best-correlated mode of pattern VEP, determined the relations, and then calculated the pattern VEP-estimated VA (PVEP-VA) of all 249 eyes, another 30 malingering eyes, 13 eyes with macular diseases, and 17 eyes with optic nerve diseases, and used a receiver operating characteristic (ROC) curve to determine a cutoff for acceptable variance between PVEP-VA and subjective VA to discriminate malingerers.
RESULTS
The best correlation was between the amplitude of 50' checkerboard size (Amp50') and VA in every group. Significant correlation was between Amp50' and VA, where p < 0.0001 in group 1 and p = 0.020 in group 2. A logarithmic curve best fitted the correlation in the regression analysis, where y = 1.731 - 1.569x (R(2) = 0.611, p < 0.0001) in group 1 and y = 2.413 - 2.169x (R(2) = 0.531, p < 0.0001) in group 2 [x: log(Amp50'), y: PVEP-VA (logMAR)]. By using the relations and ROC curve, we determined a variance value of 0.4041 (logMAR) with 100% sensitivity and 94.0% specificity in group 1 and 0.3658 with 70.6% sensitivity and 50.5% specificity in group 2 to discriminate malingerers.
CONCLUSIONS
The pattern VEP amplitude of 50' checkerboard size was useful to assess VA and can be helpful in discriminating malingering from real disability.
Topics: Adult; Aged; Evoked Potentials, Visual; Female; Fluorescein Angiography; Humans; Male; Malingering; Middle Aged; Optic Nerve Diseases; ROC Curve; Retinal Diseases; Retrospective Studies; Visual Acuity; Visual Cortex; Visual Fields; Visual Pathways; Young Adult
PubMed: 25618450
DOI: 10.1007/s10633-015-9483-0