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The Medico-legal Journal 2011
Review
Topics: Deception; Forensic Psychiatry; Humans; Interview, Psychological; Malingering
PubMed: 21908492
DOI: 10.1258/mlj.2011.011023 -
The Journal of the American Academy of... Jun 2022The military mental health clinic is a medico-legal setting that provides servicemembers with treatment, administrative, and forensic services. Clinicians must be...
The military mental health clinic is a medico-legal setting that provides servicemembers with treatment, administrative, and forensic services. Clinicians must be vigilant for malingering in this setting but flexible enough to recognize genuine symptoms. This task is often complicated by servicemembers' delayed report of symptoms. Three explanatory models are proposed that distinguish delayed report from malingering: genuine delayed report of symptoms, acute distress malingering, and disability malingering. These explanatory models improve clinician objectivity and offer a systematic understanding of these different presentations.
Topics: Disabled Persons; Humans; Malingering; Military Personnel
PubMed: 35470255
DOI: 10.29158/JAAPL.210068-21 -
The Clinical Neuropsychologist 2012This paper proposes that malingered symptoms may become internalized due to the self-deceptive power of cognitive dissonance. Studies demonstrating how other-deception... (Review)
Review
This paper proposes that malingered symptoms may become internalized due to the self-deceptive power of cognitive dissonance. Studies demonstrating how other-deception may turn into self-deception are briefly discussed, as are clinical notions about the overlap between malingering and medically unexplained symptoms. In our view this literature showcases the relevance of cognitive dissonance for research on malingering. A cognitive dissonance perspective may help to clarify how ambiguous sensations may escalate into subjectively compelling symptoms. This perspective suggests that malingered symptom reports are more than just a complication during psychological evaluation. It may generate new research avenues and may clarify practically relevant issues.
Topics: Cognitive Dissonance; Humans; Malingering
PubMed: 22928617
DOI: 10.1080/13854046.2012.710252 -
Fortschritte Der Neurologie-Psychiatrie Mar 2002Current problems and neuropsychological assessment strategies of malingering detection (assessment of negative response bias or non-optimal test behaviour) are reviewed.... (Review)
Review
Current problems and neuropsychological assessment strategies of malingering detection (assessment of negative response bias or non-optimal test behaviour) are reviewed. First, the paper discusses major conceptual problems inherent in the definition of malingering, factitious disorders, and somatoform disorders. Traditional and modern test approaches and diagnostic procedures are reviewed. Two case vignettes illustrate the application of particular strategies for malingering assessment. In German speaking countries, malingering research has not yet aroused profound interest comparable to that in English speaking countries. Diagnostic standards and instruments still have to be refined.
Topics: Humans; Malingering; Neuropsychological Tests
PubMed: 11880945
DOI: 10.1055/s-2002-20531 -
NeuroRehabilitation 2002The past decade has seen numerous advancements in the assessment of malingered brain injury, though the current diagnostic system offers only guidelines in which... (Review)
Review
The past decade has seen numerous advancements in the assessment of malingered brain injury, though the current diagnostic system offers only guidelines in which malingering should be suspected. This article presents an overview of advances in the clinical and neuropsychological assessment of malingering, issues in diagnostic differential, neuropsychological test methods, and special issues presented by the medical-legal context, and other factors which may affect presentations. Cautions and recommendations for practice are presented.
Topics: Brain Injuries; Diagnosis, Differential; Female; Forecasting; Humans; Injury Severity Score; Male; Malingering; Neuropsychological Tests; Risk Assessment; Sensitivity and Specificity
PubMed: 12082236
DOI: No ID Found -
Pain Practice : the Official Journal of... Jun 2007
Topics: Disability Evaluation; Humans; Malingering; Neuropsychological Tests; Psychological Tests; Reproducibility of Results
PubMed: 17559478
DOI: 10.1111/j.1533-2500.2007.00116.x -
Brain Injury 2013Effort indicators are used to determine if neuropsychological test results are valid measures of a patient's cognitive abilities. The use of multiple effort measures is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Effort indicators are used to determine if neuropsychological test results are valid measures of a patient's cognitive abilities. The use of multiple effort measures is often advocated, but the false positive rate for multiple indicators depends on the number of measures used and the correlation among indicators. This study presents a meta-analysis of correlations among effort measures. False positive rates for multiple correlated indicators are then estimated using Monte Carlo simulations.
METHODS
a literature search of published studies identified 22 independent samples in which 407 correlations among 31 effort measures were available in 3564 participants with normal effort. Participants were patients with neurological or psychiatric disorders and healthy volunteers.
RESULTS
Meta-analysis showed a mean correlation among effort indicators of 0.31. Monte Carlo simulation based on a 15% false positive rate for individual indicators showed that, when 10 effort indicators are used together, 38% of patients with valid performance will be incorrectly identified as malingering if two failures is the diagnostic standard. Failure on five of 10 measures is required for a false positive rate of 10% or less. If five effort indicators are interpreted, a false positive rate of 19% results when two test failures are assumed to characterize poor effort and failure on three measures is required to maintain 90% specificity.
CONCLUSIONS
False positive rates for effort tests increase significantly as the number of indicators that are administered is increased.
Topics: Data Interpretation, Statistical; Disability Evaluation; False Positive Reactions; Female; Humans; Male; Malingering; Monte Carlo Method; Neuropsychological Tests; Reproducibility of Results
PubMed: 23782260
DOI: 10.3109/02699052.2013.793400 -
Annals of Medicine Jun 1999Malingering is a diagnosis that is frequently avoided by physicians. When there is a claim of symptoms or diseases that either are exaggerated or do not exist, the... (Review)
Review
Malingering is a diagnosis that is frequently avoided by physicians. When there is a claim of symptoms or diseases that either are exaggerated or do not exist, the diagnosis of malingering should be entertained. Malingering is associated with a conscious intent to deceive in order to obtain a known gain. Psychoanalytical, criteria-based (DSM-IV) and 'adaptational' models have been advanced to explain malingering. The differential diagnosis of malingering includes factitious disorder, the somatoform disorders, the dissociative disorders, and specific medical conditions without somatoform disorder. Upon consideration of the differential diagnosis, confirmation of the suspicion of malingering is still required in order to make the diagnosis. Confirmation can be achieved by observation or by inferential methods. Observation can be employed with controlled environment observation or with covert, 'real-world' surveillance; inference may involve primary and/or secondary source information. It may be concluded that a greater attempt should be made to identify this diagnosis, as the cost of malingering to society is considerable.
Topics: Diagnosis, Differential; Dissociative Disorders; Factitious Disorders; Fraud; Humans; Lie Detection; Malingering; Physician's Role; Psychological Tests; Somatoform Disorders
PubMed: 10442671
DOI: 10.3109/07853899909115975 -
Clinical Pediatrics Apr 2005Six cases of factitious disease and malingering in pediatric patients referred to an infectious diseases practice in a tertiary care children's hospital are described,... (Review)
Review
Six cases of factitious disease and malingering in pediatric patients referred to an infectious diseases practice in a tertiary care children's hospital are described, and implications for general clinical practice are reviewed. All patients were girls aged 9-15 years. Two patients were malingering with the secondary gain of avoiding attendance at school. The other 4 patients presented with factitious illness without clear link to secondary gain, but rather for a psychological purpose. Three of the subjects admitted to self-induced or feigned illness. The 2 patients diagnosed with malingering did very well with early parental support, psychotherapy, and attention paid to school difficulties. The outcomes of the others with underlying psychological conflicts were less resolved. Factitious disorders and malingering occur in the pediatric population. A high index of suspicion is needed for prompt diagnosis and care.
Topics: Adolescent; Child; Counseling; Factitious Disorders; Female; Humans; Malingering; Self-Injurious Behavior
PubMed: 15821848
DOI: 10.1177/000992280504400307 -
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