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Behavioral Sciences & the Law Apr 2024With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In...
With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.
PubMed: 38583136
DOI: 10.1002/bsl.2656 -
Archives of Clinical Neuropsychology :... Apr 2024The use of performance validity tests (PVTs) in a neuropsychological assessment to determine indications of invalid performance has been a common practice for over a...
INTRODUCTION
The use of performance validity tests (PVTs) in a neuropsychological assessment to determine indications of invalid performance has been a common practice for over a decade. Most PVTs are memory-based; therefore, the Groningen Effort Test (GET), a non-memory-based PVT, has been developed.
OBJECTIVES
This study aimed to validate the GET in patients with suspected chronic solvent-induced encephalopathy (CSE) using the criterion standard of 2PVTs. A second goal was to determine diagnostic accuracy for GET.
METHOD
Sixty patients with suspected CSE referred for NPA were included. The GET was compared to the criterion standard of 2PVTs based on the Test of Memory Malingering and the Amsterdam Short Term Memory Test.
RESULTS
The frequency of invalid performance using the GET was significantly higher compared to the criterion of 2PVTs (51.7% vs. 20.0% respectively; p < 0.001). For the GET index, the sensitivity was 75% and the specificity was 54%, with a Youden's Index of 27.
CONCLUSION
The GET showed significantly more invalid performance compared to the 2PVTs criterion suggesting a high number of false positives. The general accepted minimum norm of specificity for PVTs of >90% was not met. Therefore, the GET is of limited use in clinical practice with suspected CSE patients.
PubMed: 38572600
DOI: 10.1093/arclin/acae025 -
Clinical Child Psychology and Psychiatry Jul 2024Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be... (Review)
Review
Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features. However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as "functional" solely because other conditions can be excluded.
Topics: Humans; Adolescent; Diagnostic Errors; Male; Diagnosis, Differential; Conversion Disorder; Nervous System Diseases
PubMed: 38515429
DOI: 10.1177/13591045241240805 -
Journal of Clinical and Experimental... Mar 2024The Response Bias Scale (RBS) is the central measure of cognitive over-reporting in the MMPI-family of instruments. Relative to other clinical populations, the research...
The Response Bias Scale (RBS) is the central measure of cognitive over-reporting in the MMPI-family of instruments. Relative to other clinical populations, the research evaluating the detection of over-reporting is more limited in Veteran and Active-Duty personnel, which has produced some psychometric variability across studies. Some have suggested that the original scale construction methods resulted in items which negatively impact classification accuracy and in response crafted an abbreviated version of the RBS (RBS-19; Ratcliffe et al., 2022; Spencer et al., 2022). In addition, the most recent edition of the MMPI is based on new normative data, which impacts the ability to use existing literature to determine effective cut-scores for the RBS (despite all items having been retained across MMPI versions). To date, no published research exists for the MMPI-3 RBS. The current study examined the utility of the RBS and the RBS-19 in a sample of Active-Duty personnel ( = 186) referred for neuropsychological evaluation. Using performance validity tests as the study criterion, we found that the RBS-19 was generally equitably to RBS in classification. Correlations with other MMPI-2-RF over- and under-reporting symptom validity tests were slightly stronger for RBS-19. Implications and directions for research and practice with RBS/RBS-19 are discussed, along with implications for neuropsychological assessment and response validity theory.
Topics: Humans; Male; Female; Adult; MMPI; Psychometrics; Military Personnel; Reproducibility of Results; Middle Aged; Young Adult; Malingering; Bias; Neuropsychological Tests
PubMed: 38493366
DOI: 10.1080/13803395.2024.2330727 -
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 -
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 -
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 -
Journal of Clinical and Experimental... Feb 2024Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious...
OBJECTIVE
Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious control. This study examined pupillary dilation patterns during a performance validity test (PVT) among adults with true and feigned impairment of traumatic brain injury (TBI).
PARTICIPANTS AND METHODS
Participants were 214 adults in three groups: adults with bona fide moderate to severe TBI (TBI; = 51), healthy comparisons instructed to perform their best (HC; = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; = 91). The Recognition Memory Test (RMT) was administered in the context of a comprehensive neuropsychological battery. Three pupillary indices were evaluated. Two pure pupil dilation (PD) indices assessed a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillary-behavioral index was also evaluated. Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer).
RESULTS
All three indices differed significantly among the groups, with medium-to-large effect sizes. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI; adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, subgroup analyses indicated that DRI differed significantly for simulators who scored in the invalid range on the RMT ( = 45) versus adults with genuine TBI who scored invalidly ( = 15).
CONCLUSIONS
The findings support continued research on the application of pupillometry to performance validity assessment: Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.
Topics: Humans; Male; Female; Adult; Recognition, Psychology; Malingering; Brain Injuries, Traumatic; Cognitive Dysfunction; Middle Aged; Pupil; Neuropsychological Tests; Young Adult; Memory and Learning Tests
PubMed: 38402625
DOI: 10.1080/13803395.2024.2312624