-
Frontiers in Psychology 2024Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need...
OBJECTIVE
Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need to explore differences in neuropsychological assessment outcomes with different levels of cooperation.
METHODS
A total of 420 participants with severe traumatic brain injury were classified into malingering group, partial cooperation group, and complete cooperation group according to the Binomial forced-choice digit memory test. The Wechsler Adult Intelligence Scale, event-related potential component, and Symptom Checklist 90 were applied subsequently to assess the psychological status of participants.
RESULTS
Participants in the malingering group presented lower scores in the binomial forced-choice digit memory test and the Wechsler Adult Intelligence Scale, lower P3 amplitude, and simultaneously higher scores in the Symptom Checklist 90 than the other two groups. The actual intelligence quotient of participants with malingering tendencies ranged mostly between normal and marginal damage, and they often reported elevated whole scale scores in the Symptom Checklist 90. The Cooperation Index (defined as the ratio of positive symptom distress index to global severity index, CI) was proposed and validated to function as an embedded validity indicator of the Symptom Checklist 90, and the area under the receiver operating characteristic (ROC) curve was 0.938. When valued at 1.28, CI has the highest classification ability in differentiating malingering from non-malingering. Combined with the CI and P3 amplitude, the area under the ROC curve for malingering diagnosis further reached 0.952.
CONCLUSION
Any non-optimal effort in a forensic context will lead to unexpected deviation in psychology evaluation results. CI is a potential candidate to act as an embedded validity indicator of the Symptom Checklist 90. The combination of CI and P3 amplitude can help to identify malingering in participants after severe traumatic brain injury.
PubMed: 38390415
DOI: 10.3389/fpsyg.2024.1320636 -
Sleep Medicine Clinics Mar 2024Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in... (Review)
Review
Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.
Topics: Humans; Parasomnias; Sexual Behavior; Sleep
PubMed: 38368065
DOI: 10.1016/j.jsmc.2023.10.010 -
Prenatal Diagnosis Mar 2024A 36 years old woman in her first pregnancy was referred at 24w3d for a dedicated neurosonographic examination due to a suspected short corpus callosum (CC). The...
A 36 years old woman in her first pregnancy was referred at 24w3d for a dedicated neurosonographic examination due to a suspected short corpus callosum (CC). The examination depicted a dysgenetic CC with asymmetric thickness at the level of the body in coronal views, very thin in the midline and thicker in both sides, suggesting bilateral formation of Probst bundles. The BPD, HC, and transverse cerebellar diameters were in the normal low range without associated growth restriction. Associated anomalies were not detected in the brain or other organs. Following genetic consultation and a normal CMA, trio exome sequencing was performed and a de novo missense pathogenic mutation c.2353 C > T in the DHX30 gene was detected. This variant has been previously reported in children and adults, mostly with a severe phenotype including neurodevelopmental disorder with variable motor and language impairment, but also mild phenotypes have been reported. MRI describes delayed myelination, ventriculomegaly, and cortical and cerebellar atrophy as imaging features in affected patients. This is the first prenatal report of a DHX30-associated neurodevelopmental disorder in which the fetus presents with isolated callosal dysgenesis, stressing the importance of exome sequencing in fetuses with this condition, as far as it is phenotypic presentation of numerous syndromes with different outcomes.
Topics: Adult; Female; Humans; Pregnancy; Agenesis of Corpus Callosum; Brain; Corpus Callosum; Fetus; Hydrocephalus; Magnetic Resonance Imaging; RNA Helicases
PubMed: 38366977
DOI: 10.1002/pd.6536 -
Journal of Clinical and Experimental... Feb 2024To adjust the decision criterion for the Word Memory Test (WMT, Green, 2003) to minimize the frequency of false positives.
OBJECTIVE
To adjust the decision criterion for the Word Memory Test (WMT, Green, 2003) to minimize the frequency of false positives.
METHOD
Archival data were combined into a database ( = 3,210) to examine the best cut score for the WMT. We compared results based on the original scoring rules and those based on adjusted scoring rules using a criterion based on 16 performance validity tests (PVTs) exclusive of the WMT. Cutoffs based on peer-reviewed publications and test manuals were used. The resulting PVT composite was considered the best estimate of validity status. We focused on a specificity of .90 with a false-positive rate of less than .10 across multiple samples.
RESULTS
Each examinee was administered the WMT, as well as on average 5.5 (SD = 2.5) other PVTs. Based on the original scoring rules of the WMT, 31.8% of examinees failed. Using a single failure on the criterion PVT (C-PVT), the base rate of failure was 45.9%. When requiring two or more failures on the C-PVT, the failure rate dropped to 22.8%. Applying a contingency analysis (i.e., X) to the two failures model on the C-PVT measure and using the original rules for the WMT resulted in only 65.3% agreement. However, using our adjusted rules for the WMT, which consisted of relying on only the IR and DR WMT subtest scores with a cutoff of 77.5%, agreement between the adjusted and the C-PVT criterion equaled 80.8%, for an improvement of 12.1% identified. The adjustmeny resulted in a 49.2% reduction in false positives while preserving a sensitivity of 53.6%. The specificity for the new rules was 88.8%, for a false positive rate of 11.2%.
CONCLUSIONS
Results supported lowering of the cut score for correct responding from 82.5% to 77.5% correct. We also recommend discontinuing the use of the Consistency subtest score in the determination of WMT failure.
Topics: Humans; Female; Male; Adult; False Positive Reactions; Middle Aged; Neuropsychological Tests; Young Adult; Aged; Malingering; Adolescent; Memory and Learning Tests; Reproducibility of Results; Sensitivity and Specificity
PubMed: 38362939
DOI: 10.1080/13803395.2024.2314736 -
Journal of Clinical and Experimental... Mar 2024There are very few symptom validity indices directly examining overreported posttraumatic stress disorder (PTSD) symptomatology, and, until recently, there were no...
INTRODUCTION
There are very few symptom validity indices directly examining overreported posttraumatic stress disorder (PTSD) symptomatology, and, until recently, there were no symptom validity indices embedded within the PTSD Checklist for the DSM-5 (PCL-5), which is one of the most commonly used PTSD measures. Given this, the current study sought to develop and cross-validate symptom validity indices for the PCL-5.
METHOD
Multiple criterion groups comprised of Veteran patients were utilized ( = 210). Patients were determined to be valid or invalid responders based on Personality Asessment Inventory symptom validity indices. Three PCL-5 symptom validity indices were then examined: the PCL-5 Symptom Severity scale (PSS), the PCL-5 Extreme Symptom scale (PES), and the PCL-5 Rare Items scale (PRI).
RESULTS
Area under the curve statistics ranged from .78 to .85. The PSS and PES both met classification accuracy statistic goals, with the PES achieving the highest sensitivity rate (.39) when maintaining specificity at .90 or above across all criterion groups. When an ad hoc analysis was performed, which included only patients with exceptionally strong evidence of invalidity, sensitivity rates increased to .60 for the PES while maintaining specificity at .90.
CONCLUSIONS
These findings provide preliminary support for new PTSD symptom validity indices embedded within one of the most frequently used PTSD measures.
Topics: Humans; Stress Disorders, Post-Traumatic; Male; Female; Middle Aged; Adult; Veterans; Malingering; Reproducibility of Results; Psychiatric Status Rating Scales; Aged; Psychometrics
PubMed: 38353609
DOI: 10.1080/13803395.2024.2314728 -
Journal of Clinical and Experimental... Feb 2024It is common to use normative adjustments based on race to maintain accuracy when interpreting cognitive test results during neuropsychological assessment. However,...
INTRODUCTION
It is common to use normative adjustments based on race to maintain accuracy when interpreting cognitive test results during neuropsychological assessment. However, embedded performance validity tests (PVTs) do not adjust for these racial differences and may result in elevated rates of false positives in African American/Black (AA) samples compared to European American/White (EA) samples.
METHODS
Veterans without Major Neurocognitive Disorder completed an outpatient neuropsychological assessment and were deemed to be performing in a valid manner (e.g., passing both the Test of Memory Malingering Trial 1 (TOMM1) and the Medical Symptom Validity Test (MSVT), ( = 531, EA = 473, AA = 58). Five embedded PVTs were administered to all patients: WAIS-III/IV Processing Speed Index (PSI), Brief Visuospatial Memory Test-Revised: Discrimination Index (BVMT-R), TMT-A (secs), California Verbal Learning Test-II (CVLT-II) Forced Choice, and WAIS-III/IV Digit Span Scaled Score. Individual PVT false positive rates, as well as the rate of failing two or more embedded PVTs, were calculated.
RESULTS
Failure rates of two embedded PVTs (PSI, TMT-A), and the total number of PVTs failed, were higher in the AA sample. The PSI and TMT-A remained significantly impacted by race after accounting for age, education, sex, and presence of Mild Neurocognitive Disorder. There were PVT failure rates greater than 10% (and considered false positives) in both groups (AA: PSI, TMT-A, and BVMT-R, 12-24%; EA: BVMT-R, 17%). Failing 2 or more PVTs (AA = 9%, EA = 4%) was impacted by education and Mild Neurocognitive Disorder but not by race.
CONCLUSIONS
Individual (timed) PVTs showed higher false positive rates in the AA sample even after accounting for demographic factors and diagnosis of Mild Neurocognitive Disorder. Requiring failure on 2 or more embedded PVTs reduced false positive rates to acceptable levels across both groups (10% or less) and was not significantly influenced by race.
Topics: Humans; Male; Female; Neuropsychological Tests; Veterans; Middle Aged; Adult; Malingering; White People; False Positive Reactions; Black or African American; Aged
PubMed: 38353039
DOI: 10.1080/13803395.2024.2314737 -
Journal of Clinical and Experimental... Mar 2024Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and...
INTRODUCTION
Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and validation of the Denney Competency Related Test (D-CRT) to assess feigned incompetency of defendants in the criminal adjudicative setting. It was expected the D-CRT would prove effective at identifying feigned incompetence based on its two alternative, forced-choice and performance curve characteristics.
METHOD
Development and validation of the D-CRT occurred in described phases. Items were developed to measure competency based upon expert review. Item analysis and adjustments were completed with 304 young teenage volunteers to obtain a proper spread of item difficulty in preparation for eventual performance curve analysis (PCA). Test-retest reliability was assessed with 44 adult community volunteers. Validation included an analog simulation design with 101 jail detainees using MacArthur Competency Assessment Test-Criminal Adjudication and Word Memory Test as criterion measures. Effects of racial/ethnic demographic differences were examined in a separate study of 208 undergraduate volunteers. D-CRT specificity was identified with 46 elderly clinic referrals diagnosed with mild cognitive impairment and dementia.
RESULTS
Item development, adjustment, and repeat analysis resulted in item probabilities evenly spread from .28 to 1.0. Test-retest correlation was good (.83). Internal consistency of items was excellent (KR-20 > .91). D-CRT demonstrated convergent validity in regard to measuring competency related information and as well as malingering. The test successfully differentiated between jail inmates asked to perforfm their best and inmates asked to simulate incompetency (AUC = .945). There were no statistically significant differences found in performance across racial/ethnic backgrounds. D-CRT specificity remained excellent among elderly clinic referrals with significant cognitive compromise at the recommended total score cutoff.
CONCLUSIONS
D-CRT is an effective measure of feigned criminal incompetency in the context of potential cognitive deficiency, and PCA is assistive in the determination. Additional validation using knowns groups designs with various mental health-related conditions are needed.
Topics: Humans; Malingering; Male; Female; Mental Competency; Adult; Adolescent; Reproducibility of Results; Neuropsychological Tests; Young Adult; Middle Aged; Criminals; Psychometrics; Aged
PubMed: 38346168
DOI: 10.1080/13803395.2024.2314731 -
Journal of Clinical and Experimental... Feb 2024Many commonly employed performance validity tests (PVTs) are several decades old and vulnerable to compromise, leading to a need for novel instruments. Because...
INTRODUCTION
Many commonly employed performance validity tests (PVTs) are several decades old and vulnerable to compromise, leading to a need for novel instruments. Because implicit/non-declarative memory may be robust to brain damage, tasks that rely upon such memory may serve as an effective PVT. Using a simulation design, this experiment evaluated whether novel tasks that rely upon perceptual memory hold promise as PVTs.
METHOD
Sixty healthy participants were provided instructions to simulate symptoms of mild traumatic brain injury (TBI), and they were compared to a group of 20 honest responding individuals. Simulator groups received varying levels of information concerning TBI symptoms, resulting in naïve, sophisticated, and test-coached groups. The Word Memory Test, Test of Memory Malingering, and California Verbal Learning Test-II Forced Choice Recognition Test were administered. To assess perceptual memory, selected images from the Gollin Incomplete Figures and Mooney Closure Test were presented as visual perception tasks. After brief delays, memory for the images was assessed.
RESULTS
No group differences emerged on the perception trials of the Gollin and Mooney figures, but simulators remembered fewer images than the honest responders. Simulator groups differed on the standard PVTs, but they performed equivalently on the Gollin and Mooney figures, implying robustness to coaching. Relying upon a criterion of 90% specificity, the Gollin and Mooney figures achieved at least 90% sensitivity, comparing favorably to the standard PVTs.
CONCLUSIONS
The Gollin and Mooney figures hold promise as novel PVTs. As perceptual memory tests, they may be relatively robust to brain damage, but future research involving clinical samples is necessary to substantiate this assertion.
Topics: Humans; Male; Female; Adult; Neuropsychological Tests; Malingering; Young Adult; Brain Concussion; Reproducibility of Results; Visual Perception; Memory; Middle Aged
PubMed: 38346160
DOI: 10.1080/13803395.2024.2314991 -
American Journal of Law & Medicine Jul 2023Multiple states have enacted statutes to govern procedures when a state seeks to execute a person who may be incompetent to understand why s/he is being so punished, an...
Multiple states have enacted statutes to govern procedures when a state seeks to execute a person who may be incompetent to understand why s/he is being so punished, an area of the law that has always been riddled with confusion. The Supreme Court, in , sought to clarify matters, ruling that a mentally ill defendant had a constitutional right to make a showing that his mental illness "obstruct[ed] a rational understanding of the State's reason for his execution."However, the first empirical studies of how has been interpreted in federal courts painted a dismal picture. Only a handful of defendants have ever been successful in federal courts in seeking to enforce the ruling, and the authors of this abstract have characterized the relief ostensibly offered by that case as nothing more than an "illusion" or a "mirage" in a federal context. The issues of believability of experts, allegations of malingering, and "synthetic competency" dominate these decisions.In this paper, we seek to expand this inquiry to determine (1) how defendants in state courts seeking to assert claims have fared, and (2) the extent to which state statutes have made any meaningful difference in the way such cases have been decided. We also investigate the significance of the fact that the caselaw in this area has totally ignored the teachings of the school of legal thought known as therapeutic jurisprudence and offer some conclusions and recommendations (based on therapeutic jurisprudence principles) that, if implemented, can (at least partially) ameliorate this situation.
Topics: Humans; United States; Supreme Court Decisions; Mental Disorders
PubMed: 38344794
DOI: 10.1017/amj.2023.28 -
Asian Journal of Psychiatry Mar 2024UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White... (Review)
Review
BACKGROUND
UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White British heritage. Considered at greater risk of mental health problems generally, these populations are likely to suffer more in combat and in transition to civilian life. Yet, there is little data on how they fare.
METHODS
A scoping review was conducted of peer-reviewed studies of psychological illnesses suffered by racial and ethnic minority soldiers from World War One to the present, together with research at the National Archives, Wellcome Trust Archives and the Imperial War Museum for unpublished studies.
RESULTS
British commanders and psychiatrists argued that 'martial races' were protected against post-traumatic illnesses because of an innate resilience related to a rural heritage. Consequently, low morale and breakdown were interpreted as malingering to avoid combat. Indian troops received lower levels of psychiatric care than provided for British soldiers delivered with limited cultural understanding. Inferior terms and conditions were offered to Indian soldiers with lesser opportunities for promotion. These practices, established in both World Wars, continued for Gurkha and Commonwealth soldiers recruited to meet manpower and diversity targets. Disproportionate complaints of discrimination may explain why ethnic minority status is a risk factor for mental illness.
CONCLUSION
Management patterns laid down during the Imperial era continue to influence current practice for ethnic minority service personnel. Yet, armed forces can play a positive role in fostering diversity and integration to provide protective factors against mental illness.
Topics: Humans; Mental Health; Ethnicity; Minority Groups; Policy; United Kingdom
PubMed: 38340530
DOI: 10.1016/j.ajp.2024.103957