-
Emergency Medicine Clinics of North... Feb 2024Individual rights can be limited in the context of psychiatric emergencies. The emergency physician should be familiar with state laws pertaining to involuntary holds.... (Review)
Review
Individual rights can be limited in the context of psychiatric emergencies. The emergency physician should be familiar with state laws pertaining to involuntary holds. Physicians are equipped to perform a medical screening examination, address mental health concerns, and lead efforts to de-escalate agitation. The physician should conduct a thorough assessment and distinguish between malingering and mental health decompensation, when appropriate.
Topics: Humans; Emergencies; Physicians; Anxiety; Mental Disorders
PubMed: 37977750
DOI: 10.1016/j.emc.2023.06.019 -
Neuropsychology Review Sep 2023The thoughtful commentaries in this volume of Drs. Bush, Jewsbury, and Faust add to the impact of the two reviews in this volume of statistical and methodological issues... (Review)
Review
The thoughtful commentaries in this volume of Drs. Bush, Jewsbury, and Faust add to the impact of the two reviews in this volume of statistical and methodological issues in the forensic neuropsychological determination of malingering based on performance and symptom validity tests (PVTs and SVTs). In his commentary, Dr. Bush raises, among others, the important question of whether such malingering determinations can still be considered as meeting the legal Daubert standard which is the basis for neuropsychological expert testimony. Dr. Jewsbury focuses mostly on statistical issues and agrees with two key points of the statistical review: Positive likelihood chaining is not a mathematically tenable method to combine findings of multiple PVTs and SVTs, and the Simple Bayes method is not applicable to malingering determinations. Dr. Faust adds important narrative texture to the implications for forensic neuropsychological practice and points to a need for research into factors other than malingering that may explain PVT and SVT failures. These commentaries put into even sharper focus the serious questions raised in the reviews about the scientific basis of present practices in the forensic neuropsychological determination of malingering.
PubMed: 37594691
DOI: 10.1007/s11065-023-09606-2 -
Neuropsychology Review Sep 2023Neuropsychologists' conclusions and courtroom testimony on malingering can have profound impact. Intensive and ingenious research has advanced our capacities to identify... (Review)
Review
Neuropsychologists' conclusions and courtroom testimony on malingering can have profound impact. Intensive and ingenious research has advanced our capacities to identify both insufficient and sufficient effort and thus make worthy contributions to just conflict resolution. Nevertheless, given multiple converging factors, such as misleadingly high accuracy rates in many studies, practitioners may well develop inflated confidence in methods for evaluating effort/malingering. Considerable research shows that overconfidence often increases diagnostic and predictive error and may lead to fixed conclusions when caution is better advised. Leonhard's work thus performs an important service by alerting us to methodological considerations and shortcomings that can generate misimpressions about the efficacy of effort/malingering assessment. The present commentary covers various additional complicating factors in malingering assessment, including other factors that also inflate confidence; subtle and perhaps underappreciated methodological flaws that are inversely related to positive study outcomes (i.e., the worse the flaws the better methods appear to be); oversimplified classifications schemes for studying and evaluating effort that overlook, for example, common mixed presentations (e.g., malingering and genuinely injured); and the need to expand research across a greater range and severity of neuropsychological conditions and diverse groups. More generally, although endorsing various points that Leonhard raises, a number of questions and concerns are presented, such as methods for calculating the impact of case exclusions in studies. Ultimately, although Leonhard's conclusions may be more negative than is justified, it seems fair to categorize methods for assessing malingering/effort as advancing, but not yet advanced, with much more needed to be done to approach that latter status.
PubMed: 37594693
DOI: 10.1007/s11065-023-09605-3 -
Behavioral Sciences & the Law 2023In a recent paper, Acklin discussed a case of possible amnesia for a murder in terms of neurobiology, psychoanalysis, and personality assessment. Acklin accepted the... (Review)
Review
In a recent paper, Acklin discussed a case of possible amnesia for a murder in terms of neurobiology, psychoanalysis, and personality assessment. Acklin accepted the defendant's claim of amnesia for the crime as genuine. The considerable literature that takes a skeptical view of crime-related amnesia was not cited, and the possibility of feigning or malingering was "ruled out" with a single sentence that does not withstand scrutiny. A review of the literature on feigned amnesia suggests that it may not be possible to rule out malingering even if the best available tools are used: There has been minimal investigation of most validity tests and estimates of base rates of feigned amnesia for a crime vary widely and make estimates of Negative Predictor Power highly unreliable. Although one cannot know from the information presented if Acklin's defendant legitimately experienced amnesia, feigning could not be ruled out using an interview and the test data cited by Acklin. I call for a moratorium on publication of further articles on crime specific amnesia that do not conscientiously examine other potential explanations and do not use current best practices for assessing negative response bias.
Topics: Humans; Amnesia; Crime; Malingering; Personality Assessment
PubMed: 37071040
DOI: 10.1002/bsl.2623 -
Fa Yi Xue Za Zhi Oct 2023Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important... (Review)
Review
Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important application value in assisting auxiliary diagnosis and disease monitoring of mental disorders. In recent years, the development of artificial intelligence and big data technology has made the automatic recognition of micro-expressions possible, which will make micro-expression analysis more convenient and more widely used. This paper reviews the development of facial micro-expression analysis and its application in forensic psychiatry, to look into further application prospects and development direction.
Topics: Humans; Forensic Psychiatry; Artificial Intelligence; Mental Disorders; Facial Expression; Emotions
PubMed: 38006270
DOI: 10.12116/j.issn.1004-5619.2022.120104 -
Topics in Cognitive Science May 2024The existence or questionability of "repressed memories" can be discussed as being a matter of definition. It seems, however, far-fetched to consider all "lost" memories...
The existence or questionability of "repressed memories" can be discussed as being a matter of definition. It seems, however, far-fetched to consider all "lost" memories as caused by encoding problems, brain damage, forgetfulness, failure to disclose events, and so on. We argue that dissociative amnesia (DA) (or "psychogenic amnesia," or "functional amnesia," or, as we favor to call it, "mnestic block syndrome") is caused by psychic alterations, but ultimately they can be traced to changes in the physiology of the brain, as we are of the opinion that all memory processes-positive or negative-alter brain functions, sometimes more permanently, sometimes transiently. We have proven this idea using functional imaging techniques, in particular fluoro-deoxy-d-glucose positron emission tomography. Having investigated dozens of patients with severe and long-lasting DA conditions, we believe it to be disrespectful to many (but not to all) of the affected patients to question their disease condition, which can be proven to be not caused by feigning, malingering, or direct brain damage.
PubMed: 38728576
DOI: 10.1111/tops.12734 -
Neuropsychology Review Sep 2023Forensic neuropsychological examinations to detect malingering in patients with neurocognitive, physical, and psychological dysfunction have tremendous social, legal,... (Review)
Review
Forensic neuropsychological examinations to detect malingering in patients with neurocognitive, physical, and psychological dysfunction have tremendous social, legal, and economic importance. Thousands of studies have been published to develop and validate methods to forensically detect malingering based largely on approximately 50 validity tests, including embedded and stand-alone performance and symptom validity tests. This is Part II of a two-part review of statistical and methodological issues in the forensic prediction of malingering based on validity tests. The Part I companion paper explored key statistical issues. Part II examines related methodological issues through conceptual analysis, statistical simulations, and reanalysis of findings from prior validity test validation studies. Methodological issues examined include the distinction between analog simulation and forensic studies, the effect of excluding too-close-to-call (TCTC) cases from analyses, the distinction between criterion-related and construct validation studies, and the application of the Revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) in all Test of Memory Malingering (TOMM) validation studies published within approximately the first 20 years following its initial publication to assess risk of bias. Findings include that analog studies are commonly confused for forensic validation studies, and that construct validation studies are routinely presented as if they were criterion-reference validation studies. After accounting for the exclusion of TCTC cases, actual classification accuracy was found to be well below claimed levels. QUADAS-2 results revealed that extant TOMM validation studies all had a high risk of bias, with not a single TOMM validation study with low risk of bias. Recommendations include adoption of well-established guidelines from the biomedical diagnostics literature for good quality criterion-referenced validation studies and examination of implications for malingering determination practices. Design of future studies may hinge on the availability of an incontrovertible reference standard of the malingering status of examinees.
PubMed: 37594690
DOI: 10.1007/s11065-023-09602-6 -
International Journal of Molecular... Apr 2024Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic... (Review)
Review
Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder.
Topics: Humans; Neuroimaging; Conversion Disorder; Nervous System Diseases; Brain
PubMed: 38674056
DOI: 10.3390/ijms25084470 -
Emergency Medicine Clinics of North... Feb 2024Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in... (Review)
Review
Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in the emergency department is unknown because of the difficulty of identifying whether patients are fabricating their symptoms. Malingering is considered a diagnosis of exclusion; a differential diagnosis framework is described to guide emergency physicians. Several case studies are presented and analyzed from a medical ethics perspective. Practical recommendations include use of the NEAL (neutral, empathetic, and avoid labeling) strategy when caring for patients suspected of malingering.
Topics: Humans; Malingering; Diagnosis, Differential
PubMed: 37977749
DOI: 10.1016/j.emc.2023.06.018