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The Clinical Neuropsychologist Apr 2024The present study aims to evaluate the classification accuracy and resistance to coaching of the Inventory of Problems-29 (IOP-29) and the IOP-Memory (IOP-M) with a...
Classification accuracy and resistance to coaching of the Spanish version of the Inventory of Problems-29 and the Inventory of Problems-Memory: A simulation study with mTBI patients.
The present study aims to evaluate the classification accuracy and resistance to coaching of the Inventory of Problems-29 (IOP-29) and the IOP-Memory (IOP-M) with a Spanish sample of patients diagnosed with mild traumatic brain injury (mTBI) and healthy participants instructed to feign. Using a simulation design, 37 outpatients with mTBI (clinical control group) and 213 non-clinical instructed feigners under several coaching conditions completed the Spanish versions of the IOP-29, IOP-M, Structured Inventory of Malingered Symptomatology, and Rivermead Post Concussion Symptoms Questionnaire. The IOP-29 discriminated well between clinical patients and instructed feigners, with an excellent classification accuracy for the recommended cutoff score (FDS ≥ .50; sensitivity = 87.10% for coached group and 89.09% for uncoached; specificity = 95.12%). The IOP-M also showed an excellent classification accuracy (cutoff ≤ 29; sensitivity = 87.27% for coached group and 93.55% for uncoached; specificity = 97.56%). Both instruments proved to be resistant to symptom information coaching and performance warnings. The results confirm that both of the IOP measures offer a similarly valid but different perspective compared to SIMS when assessing the credibility of symptoms of mTBI. The encouraging findings indicate that both tests are a valuable addition to the symptom validity practices of forensic professionals. Additional research in multiple contexts and with diverse conditions is warranted.
Topics: Humans; Brain Concussion; Neuropsychological Tests; Sensitivity and Specificity; Mentoring; Malingering; Reproducibility of Results
PubMed: 37615421
DOI: 10.1080/13854046.2023.2249171 -
Neuropsychology Review Sep 2023Forensic neuropsychological examinations with determination of malingering have tremendous social, legal, and economic consequences. Thousands of studies have been... (Review)
Review
Forensic neuropsychological examinations with determination of malingering have tremendous social, legal, and economic consequences. Thousands of studies have been published aimed at developing and validating methods to diagnose malingering in forensic settings, based largely on approximately 50 validity tests, including embedded and stand-alone performance validity tests. This is the first part of a two-part review. Part I explores three statistical issues related to the validation of validity tests as predictors of malingering, including (a) the need to report a complete set of classification accuracy statistics, (b) how to detect and handle collinearity among validity tests, and (c) how to assess the classification accuracy of algorithms for aggregating information from multiple validity tests. In the Part II companion paper, three closely related research methodological issues will be examined. Statistical issues are explored through conceptual analysis, statistical simulations, and through reanalysis of findings from prior validation studies. Findings suggest extant neuropsychological validity tests are collinear and contribute redundant information to the prediction of malingering among forensic examinees. Findings further suggest that existing diagnostic algorithms may miss diagnostic accuracy targets under most realistic conditions. The review makes several recommendations to address these concerns, including (a) reporting of full confusion table statistics with 95% confidence intervals in diagnostic trials, (b) the use of logistic regression, and (c) adoption of the consensus model on the "transparent reporting of multivariate prediction models for individual prognosis or diagnosis" (TRIPOD) in the malingering literature.
PubMed: 37612531
DOI: 10.1007/s11065-023-09601-7 -
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 -
Journal of Occupational Rehabilitation Mar 2024Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries...
PURPOSE
Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries requiring time off work. Safely returning to work post-injury is critical, yet little is known about current return-to-work (RTW) practices in police services. This study examines RTW practices and experiences in police services from the perspective of RTW personnel and workers with physical and/or psychological health conditions.
METHODS
We used a purposive sampling approach to recruit sworn and civilian members from several police services in Ontario, Canada. The recruited members had experienced RTW either as a person in a RTW support role or as a worker with a work-related injury/illness. We conducted and transcribed interviews for analysis and used qualitative research methods to identify themes in the data.
RESULTS
Five overarching themes emerged. Two pointed to the context and culture of police services and included matters related to RTW processes, injury/illness complexity, the hierarchical nature of police organizations, and a culture of stoicism and stigma. The remaining three themes pointed to the RTW processes of accommodation, communication and trust-building. They included issues related to recovery from injury/illness, meaningful accommodation, timely and clear communication, malingering and trust.
CONCLUSIONS
Our findings point to potential areas for improving RTW practices in police services: greater flexibility, more clarity, stricter confidentiality and reduced stigma. More research is needed on RTW practices for managing psychological injuries to help inform policy and practice.
Topics: Humans; Ontario; Return to Work; Police; Qualitative Research; Policy
PubMed: 37735312
DOI: 10.1007/s10926-023-10135-1 -
Assessment Mar 2024Our study compared the impact of administering Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs) in in-person versus remote formats and assessed...
Our study compared the impact of administering Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs) in in-person versus remote formats and assessed different approaches to combining validity test results. Using the MMPI-2-RF, IOP-29, IOP-M, and FIT, we assessed 164 adults, with half instructed to feign mild traumatic brain injury (mTBI) and half to respond honestly. Within each subgroup, half completed the tests in person, and the other half completed them online via videoconferencing. Results from 2 ×2 analyses of variance showed no significant effects of administration format on SVT and PVT scores. When comparing feigners to controls, the MMPI-2-RF RBS exhibited the largest effect size (d = 3.05) among all examined measures. Accordingly, we conducted a series of two-step hierarchical logistic regression models by entering the MMPI-2-RF RBS first, followed by each other SVT and PVT individually. We found that the IOP-29 and IOP-M were the only measures that yielded incremental validity beyond the effects of the MMPI-2-RF RBS in predicting group membership. Taken together, these findings suggest that administering these SVTs and PVTs in-person or remotely yields similar results, and the combination of MMPI and IOP indexes might be particularly effective in identifying feigned mTBI.
PubMed: 38468147
DOI: 10.1177/10731911241235465 -
Journal of Forensic and Legal Medicine Apr 2024As Forensic Psychology continues to expand as an independent field, professionals regularly resort to psychological assessment tools to assess people involved within the... (Review)
Review
As Forensic Psychology continues to expand as an independent field, professionals regularly resort to psychological assessment tools to assess people involved within the justice system. The Personality Assessment Inventory (PAI) is a 344-item, self-report inventory that aims to provide meaningful information for diagnosis and clinical decision-making, specifically relating to psychopathology, personality, and psychosocial environment. Its applicability in forensic settings has been increasingly recognized on account of its benefits in comparison to other self-report inventories (e.g., MMPI-2, MCMI-III), since it includes scales that are relevant to forensic settings (e.g., violence risk levels, psychopathy, substance abuse), and the existence of profile distortion indicators is useful when dealing with highly defensive and/or malingering populations. The goal of this paper is to conduct a thorough review of the PAI's utility in forensic settings, by focusing on the relevant forensic constructs assessed by the PAI (e.g., personality disorders, psychosis, substance abuse, aggression, recidivism risk, and response distortion), as well as its application to offender and inmate populations, intimate partner violence contexts, family law cases, and forensic professionals. Overall, the PAI continues to gather international recognition and its relevance and usefulness in forensic settings is generally accepted and acknowledged.
Topics: Humans; Personality Assessment; Substance-Related Disorders; Recidivism; Forensic Psychology; Correctional Facilities; Prisoners; Forensic Psychiatry; Personality Inventory; Mental Disorders; Aggression; Personality Disorders
PubMed: 38461694
DOI: 10.1016/j.jflm.2024.102661 -
Journal of Clinical and Experimental... Mar 2024
Topics: Humans; Reproducibility of Results; Neuropsychological Tests; Malingering
PubMed: 38654620
DOI: 10.1080/13803395.2024.2346022 -
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 -
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