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Documenta Ophthalmologica. Advances in... Jun 2024Accurate objective assessment of visual acuity is crucial, particularly in cases of suspected malingering, or when the patient's inability to cooperate makes standard...
PURPOSE
Accurate objective assessment of visual acuity is crucial, particularly in cases of suspected malingering, or when the patient's inability to cooperate makes standard psychophysical acuity tests unreliable. The P300 component of the event-related potentials offers a potential solution and even allows for the use of standard optotypes like the Landolt C. However, low-vision patients with large eccentric visual field defects often struggle to locate the Landolt C gap quickly enough for a P300 to be reliably produced.
METHODS
Addressing this challenge, we introduce a novel optotype (the "FreiBurger") with a critical detail that extends through the optotype's center. Two experiments, with 16 and 12 participants, respectively, were conducted. In the first, psychophysical acuity estimates were obtained with both the FreiBurger and the Landolt C. In the second, we tested the performance of the FreiBurger, relative to the Landolt C, in eliciting a P300 with undegraded vision, simulated low vision, and in a simulated combination of low vision and visual field constriction.
RESULTS
Comparable psychophysical acuity values (average difference 0.03 logMAR) were obtained for both optotypes. In the P300 recordings, both optotypes produced similar P300 responses under conditions of undegraded vision and low vision. However, with the combination of low vision and constricted visual field, the P300 could only be reliably obtained with the FreiBurger, while the amplitude was drastically reduced with the Landolt C (9.1 µV vs. 2.2 µV; p < 0.0005).
CONCLUSION
The new optotype extends the applicability of P300-based acuity estimation to the frequently encountered combination of low vision and constricted visual field, where Landolt C optotypes fail. Although impairments were simulated in the present study, we assume that the advantages of the new optotype will also manifest in patients with such impairments. We furthermore expect the advantages to apply to time-sensitive psychophysical examinations as well.
PubMed: 38916779
DOI: 10.1007/s10633-024-09982-x -
Cureus May 2024Malingering is characterized by the deliberate fabrication and/or exaggeration of symptoms for secondary gain, posing a diagnostic challenge in healthcare settings. In...
Malingering is characterized by the deliberate fabrication and/or exaggeration of symptoms for secondary gain, posing a diagnostic challenge in healthcare settings. In this report, we present a 15-year-old male with a history of psychiatric disorders who attempted suicide to avoid legal sentencing, subsequently developing a stutter following an altercation with another patient. Despite initial concern for a concussion, further evaluation revealed malingering as the underlying motive. This case highlights the importance of identifying malingering in adolescents, which calls for a careful approach and thorough assessment for it to be distinguished from an authentic illness. Early identification of malingering optimizes resource allocation and ensures appropriate care for patients who have genuine medical needs.
PubMed: 38854334
DOI: 10.7759/cureus.60039 -
Forensic Assessments of Racial-Ethnic Differences in Genuine and Malingered Psychotic Presentations.The Journal of the American Academy of... Jun 2024Competent forensic practice has required continued training and professional practice in differentiating between genuine and malingered presentations, especially within...
Competent forensic practice has required continued training and professional practice in differentiating between genuine and malingered presentations, especially within the spectrum of psychotic disorders. Historically, practitioners valued racial, ethnic, and cultural differences but often considered them as peripheral matters. In contemporary forensic practice, however, language and culture play preponderant roles. This commentary is focused on core features of malingering via a cultural lens. Three core, race-informed principles, such as biases against the African American Language, are highlighted and discussed. Related subjects for forensic practice include relevant clinical constructs such as malingering bias and "imposed etics," specifically, the imposition of mainstream values and discounting of cultural differences.
Topics: Humans; Psychotic Disorders; Malingering; Forensic Psychiatry; Racism; Black or African American; Ethnicity
PubMed: 38824426
DOI: 10.29158/JAAPL.240007-24 -
Topics in Cognitive Science May 2024The existence or questionability of "repressed memories" can be discussed as being a matter of definition. It seems, however, far-fetched to consider all "lost" memories...
The existence or questionability of "repressed memories" can be discussed as being a matter of definition. It seems, however, far-fetched to consider all "lost" memories as caused by encoding problems, brain damage, forgetfulness, failure to disclose events, and so on. We argue that dissociative amnesia (DA) (or "psychogenic amnesia," or "functional amnesia," or, as we favor to call it, "mnestic block syndrome") is caused by psychic alterations, but ultimately they can be traced to changes in the physiology of the brain, as we are of the opinion that all memory processes-positive or negative-alter brain functions, sometimes more permanently, sometimes transiently. We have proven this idea using functional imaging techniques, in particular fluoro-deoxy-d-glucose positron emission tomography. Having investigated dozens of patients with severe and long-lasting DA conditions, we believe it to be disrespectful to many (but not to all) of the affected patients to question their disease condition, which can be proven to be not caused by feigning, malingering, or direct brain damage.
PubMed: 38728576
DOI: 10.1111/tops.12734 -
Journal of Clinical and Experimental... Mar 2024Overreporting is a common problem that complicates psychological evaluations. A challenge facing the effective detection of overreporting is that many of the identified...
Overreporting is a common problem that complicates psychological evaluations. A challenge facing the effective detection of overreporting is that many of the identified strategies (e.g., symptom severity approaches; see Rogers & Bender, 2020) are not incorporated into broadband measures of personality and psychopathology (e.g., Minnesota Multiphasic Personality Inventory family of instruments). While recent efforts have worked to incorporate some of these newer strategies, no such work has been conducted on the MMPI-3. For instance, recent symptom severity approaches have been used to identify patterns of multivariate base rate "skyline" elevations on the BASC, and similar strategies have been adopted into the PAI to measure psychopathology (Multi-Feigning Index; Gaines et al., 2013) and cognitive symptoms (Cognitive Bias Scale of Scales; Boress et al., 2022b). This study used data from a simulation study ( = 318) and an Active-Duty (AD) clinical sample ( = 290) to develop and cross-validate such a scale on the MMPI-2-RF and MMPI-3. Results suggest that the MMPI SOS (Scale of Scales) scores perform equitably to existing measures of overreporting on the MMPI-2-RF and MMPI-3 and incrementally predict a PVT-classified "known-group" of Active Duty service members. Effects were generally large in magnitude. Classification accuracy achieved desired specificity (.90) and approximated expected sensitivity (.30). Implications of these findings are discussed, which emphasize how alternative overreporting detection strategies may be useful to consider for the MMPI. These alternative strategies have room for expansion and refinement.
Topics: Humans; MMPI; Female; Male; Adult; Middle Aged; Psychometrics; Malingering; Reproducibility of Results; Young Adult
PubMed: 38726688
DOI: 10.1080/13803395.2024.2320453 -
Neurocase Oct 2023Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from...
Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID's cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities' consistency and adaptation styles, aiding in malingering assessments in future studies.
Topics: Humans; Dissociative Identity Disorder; Malingering; Male; Personality; Adult; Female
PubMed: 38704614
DOI: 10.1080/13554794.2024.2348218 -
International Journal of Molecular... Apr 2024Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic... (Review)
Review
Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder.
Topics: Humans; Neuroimaging; Conversion Disorder; Nervous System Diseases; Brain
PubMed: 38674056
DOI: 10.3390/ijms25084470 -
La Revue de Medecine Interne Apr 2024Factitious disorder imposed on self (FDIS) is a mental disorder characterized by conscious manipulative behavior from patients with no clearly identifiable external...
Factitious disorder imposed on self (FDIS) is a mental disorder characterized by conscious manipulative behavior from patients with no clearly identifiable external objective. It affects subjects with a wide range of characteristics, only some of whom fit the stereotypical profile of the young female working in the health sector. It can take the form of a variety of symptoms or clinical signs, and is likely to involve all specialties. Munchausen syndrome is a particular form of FDIS, more prevalent in men and marked by its severity. Psychiatric comorbidities are common in patients with FDIS. Death is rare but possible, either as a result of the disease itself, complications of examinations or treatments, or suicide. The diagnostic approach must seek to identify positive arguments in favor of the disorder. Diagnosis by elimination remains possible when no other hypothesis can explain a clinical picture suggestive of FDIS. The prognosis is often poor, at least in the short and medium term. Avoiding unnecessary prescriptions is essential to prevent iatrogenesis. The management of FDIS is poorly codified. In all cases, the practitioner must adopt a non-aggressive, empathetic attitude.
PubMed: 38658265
DOI: 10.1016/j.revmed.2024.04.001 -
Journal of Clinical and Experimental... Mar 2024
Topics: Humans; Reproducibility of Results; Neuropsychological Tests; Malingering
PubMed: 38654620
DOI: 10.1080/13803395.2024.2346022 -
Applied Neuropsychology. Adult Apr 2024The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory...
The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of or similar is likely sufficient to help the patient.
PubMed: 38615907
DOI: 10.1080/23279095.2024.2341801