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NeuroRehabilitation 2015The assessment of any patient or examinee with neurological impairment, whether acquired or congenital, provides a key set of data points in the context of developing... (Review)
Review
BACKGROUND
The assessment of any patient or examinee with neurological impairment, whether acquired or congenital, provides a key set of data points in the context of developing accurate diagnostic impressions and implementing an appropriate neurorehabilitation program. As part of that assessment, the neurological physical exam is an extremely important component of the overall neurological assessment.
PURPOSE
In the aforementioned context, clinicians often are confounded by unusual, atypical or unexplainable physical exam findings that bring into question the organicity, veracity, and/or underlying cause of the observed clinical presentation. The purpose of this review is to provide readers with general directions and specific caveats regarding validity assessment in the context of the neurological physical exam.
CONCLUSIONS
It is of utmost importance for health care practitioners to be aware of assessment methodologies that may assist in determining the validity of the neurological physical exam and differentiating organic from non-organic/functional impairments. Maybe more importantly, the limitations of many commonly used strategies for assessment of non-organicity should be recognized and consider prior to labeling observed physical findings on neurological exam as non-organic or functional.
Topics: Humans; Malingering; Nervous System Diseases; Neurologic Examination
PubMed: 26409489
DOI: 10.3233/NRE-151229 -
Journal of Clinical and Experimental... Dec 2002Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based... (Comparative Study)
Comparative Study
Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in personal injury, (n = 6,371). disability (n = 3,688), criminal (n = 1,341), or medical (n = 22,131) matters. Base rates did not differ among geographic regions or practice settings, but were related to the proportion of plaintiff versus defense referrals. Reported rates would be 2-4% higher if variance due to referral source was controlled. Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).
Topics: Demography; Diagnosis, Differential; Disability Evaluation; Expert Testimony; Humans; Malingering; Neuropsychological Tests; Reproducibility of Results; Sick Role; Workers' Compensation
PubMed: 12650234
DOI: 10.1076/jcen.24.8.1094.8379 -
Journal of Anxiety Disorders 2007Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic... (Review)
Review
Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.
Topics: Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Malingering; Sensitivity and Specificity; Stress Disorders, Post-Traumatic
PubMed: 17141468
DOI: 10.1016/j.janxdis.2006.09.006 -
The Clinical Journal of Pain Dec 1999This is the first review of chronic pain (CP) malingering/disease simulation research. The purpose of this review was to determine the prevalence of malingering within... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This is the first review of chronic pain (CP) malingering/disease simulation research. The purpose of this review was to determine the prevalence of malingering within CP patients (CPPs), whether evidence exists that malingering can be detected within CPPs, and to suggest some avenues of research for this topic.
DESIGN
A computer and manual literature search produced 328 references related to malingering, disease simulation, dissimulation, symptom magnification syndrome, and submaximal effort. Of these, 68 related to one of these topics and to pain. The references were reviewed in detail, sorted into 12 topic areas, and placed into tabular form. These 12 topic areas addressed the following: existence of malingering within the CP setting; dissimulation, identification simulated (faked) facial expressions of pain; identification of malingering by questionnaire; identification of malingered sensory impairment; identification of malingered loss of hand grip strength; identification of submaximal effort by isometric strength testing; identification of submaximal or malingered effort by isokinetic strength testing; identification of submaximal or malingered effort by the method of coefficient of variation; self-deception; symptom magnification syndrome; and miscellaneous malingering identification studies. Each report, in each topic area, was rated for scientific quality according to guidelines developed by the Agency for Health Care, Policy and Research (AHCPR) for rating the level of evidence presented in the reviewed study. The AHCPR guidelines were then used to rate the strength and consistency of the research evidence in each topic area based on the type of evidence the reports represented. All review conclusions were based on the results of these ratings.
SETTING
Any medical setting reporting on either malingering or disease simulation, or dissimulation, or submaximal effort and pain.
PATIENTS
Normal volunteers, CPPs, or any group asked to produce a submaximal or malingered effort or a malingered test profile.
RESULTS
The reviewed studies indicated that malingering and dissimulation do occur within the CP setting. Malingering may be present in 1.25-10.4% of CPPs. However, because of poor study quality, these prevalence percentages are not reliable. The study evidence also indicated that malingering cannot be reliably identified by facial expression testing, questionnaire, sensory testing, or clinical examination. There was no acceptable scientific information on symptom magnification syndrome. Hand grip testing using the Jamar dynamometer and other types of isometric strength testing did not reliably discriminate between a submaximal/malingering effort and a maximal/best effort. However, isokinetic strength testing appeared to have potential for discriminating between maximal and submaximal effort and between best and malingered efforts. Repetitive testing with the coefficient of variation was not a reliable method for discriminating a real/best effort from a malingered effort.
CONCLUSIONS
Current data on the prevalence of malingering within CPPs is not consistent, and no conclusions can be drawn from these data. As yet, there is no reliable method for detecting malingering within CPPs, although isokinetic testing shows promise. Claims by professionals that such a determination can be made should be viewed with caution.
Topics: Chronic Disease; Disabled Persons; Humans; Malingering; Pain; Prevalence
PubMed: 10617254
DOI: 10.1097/00002508-199912000-00002 -
Psychological Reports Dec 1990The complex nature of malingering observed in the military is examined, and a practical approach to the handling of such behaviour in the clinical setting is outlined....
The complex nature of malingering observed in the military is examined, and a practical approach to the handling of such behaviour in the clinical setting is outlined. The complementary tasks of the mental health professional, the primary care physician, and other community agents are discussed.
Topics: Adult; Humans; Male; Malingering; Military Personnel; Personality Development; Physician-Patient Relations
PubMed: 2084760
DOI: 10.2466/pr0.1990.67.3f.1315 -
Occupational Health; a Journal For... Mar 1993
Topics: Humans; Malingering; Occupational Health Services; United Kingdom
PubMed: 8483555
DOI: No ID Found -
Assessment Jun 2010There are several strategies, or models, for combining the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indicators to detect malingered psychiatric... (Comparative Study)
Comparative Study
There are several strategies, or models, for combining the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indicators to detect malingered psychiatric symptoms. Some scholars have recommended that an elevated F (Infrequency) score should be followed by the inspection of Fp (Infrequency-Psychopathology), whereas a recent meta-analysis indicated that Fp and Ds (Gough's Dissimulation Scale) should be examined. For correctional settings, one model of malingering suggests that F, Fp, and F - K (Gough's Dissimulation Index) should be inspected for one or more elevated scores. Although a large body of research has examined malingering detection with the MMPI-2, this research has typically focused on the contributions of individual validity indicators to differentiate malingered from genuine psychiatric symptoms. Therefore, the current study compared these models of malingering detection on the MMPI-2. Inmate simulators were contrasted with inmates who were hospitalized for psychiatric treatment. Results from classification and logistic regression analyses supported the sequential use of F and Fp in malingering detection.
Topics: Adult; Analysis of Variance; Decision Making; Humans; Logistic Models; MMPI; Male; Malingering; Models, Psychological; Models, Statistical; Prisoners; Prisons; Psychometrics; Regression Analysis; United States
PubMed: 20124427
DOI: 10.1177/1073191109359382 -
The Psychiatric Clinics of North America Mar 1999The detection of malingered psychosis is sometimes quite difficult. The decision that an individual is malingering is made by assembling all of the clues from a thorough... (Review)
Review
The detection of malingered psychosis is sometimes quite difficult. The decision that an individual is malingering is made by assembling all of the clues from a thorough evaluation of a person's past and current functioning with corroboration from clinical records and other people. Identifying malingered psychosis will prevent unnecessary hospital admissions and is critical in forensic assessments. Indeed, clinicians bear considerable responsibility to assist society in differentiating true psychosis from malingered madness.
Topics: Delusions; Diagnosis, Differential; Female; Forensic Psychiatry; Hallucinations; Humans; Lie Detection; Male; Malingering; Psychotic Disorders
PubMed: 10083952
DOI: 10.1016/s0193-953x(05)70066-6 -
Psychosomatics 2004
Topics: Adult; Autistic Disorder; Female; Humans; Intellectual Disability; Malingering; Munchausen Syndrome by Proxy
PubMed: 15232055
DOI: 10.1176/appi.psy.45.4.365 -
Brain Injury May 1997In this investigation, neuropsychological testing was conducted with 69 college students that were instructed to malinger either multiple sclerosis (MS) or traumatic... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
In this investigation, neuropsychological testing was conducted with 69 college students that were instructed to malinger either multiple sclerosis (MS) or traumatic brain injury (TIB) or were non-malingering controls. The two malingering groups were divided into informed and non-informed groups. The informed groups received information concerning their respective condition, and the non-informed groups were asked simply to malinger. Generally, all malingering groups performed considerably below the levels of non-malingering controls on measures of attention, learning and memory, word fluency, abstract reasoning, visuoconstruction and manual dexterity. There appeared to be no difference in the manner in which subjects attempted to malinger MS as opposed to TBI. However, the severity of the portrayed deficit suggested by the test scores was disproportionate to the severity of the injury being requested. The pattern of deficit presented was quite global, with well below average performance demonstrated by all malingering groups across all domains.
Topics: Adolescent; Adult; Brain Damage, Chronic; Brain Injuries; Diagnosis, Differential; Female; Humans; Male; Malingering; Multiple Sclerosis; Neuropsychological Tests; Psychometrics; Psychomotor Performance; Students
PubMed: 9146840
DOI: 10.1080/026990597123502