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Behavioral Sciences & the Law 2024Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such...
Forensic practitioners must shoulder special responsibilities when evaluating over-stated pathology (e.g., malingering) as well as simulated adjustment. Such determinations may modify or even override other clinical findings. As a result, practitioners must be alert to their own misassumptions that may unintentionally bias their conclusions about response styles. Detection strategies for malingering-based on unlikely or markedly amplified presentations-are highlighted in this article. Given page constraints, assessment methods for feigning are succinctly presented with their applications to administrative, civil, and criminal referrals.
Topics: Humans; Malingering; Reproducibility of Results; Criminals; Deception
PubMed: 38047870
DOI: 10.1002/bsl.2636 -
The Clinical Neuropsychologist Jul 2024To determine if similar levels of performance on the Overall Test Battery Mean (OTBM) occur at different forced choice test (FCT) value score failures. Second, to...
To determine if similar levels of performance on the Overall Test Battery Mean (OTBM) occur at different forced choice test (FCT) value score failures. Second, to determine the OTBM levels that are associated with failures at above chance on various performance validity (PVT) tests. OTBMs were computed from archival data obtained from four practices. We calculated each examinee's Estimated Premorbid Global Ability (EPGA) and OTBM. The sample size was 5,103 examinees with 282 (5.5%) of these scoring below chance at ≤ .20 on at least one FCT. The OTBM associated with a failure at ≤ .20 was equivalent to the OTBM that was associated with failing 6 or more PVTs at above-chance cutoffs. The mean OTBMs relative to increasingly strict FCT cutoffs were similar (T scores in the 30s). As expected, there was an inverse relationship between the number of PVTs failed and examinees' OTBMs. The data support the use of ≤ .20 as the probability level for testing the significance of below chance performance on FCTs. The OTBM can be used to index the influence of invalid performance on outcomes, especially when an examinee scores below chance.
Topics: Humans; Neuropsychological Tests; Male; Adult; Female; Middle Aged; Reproducibility of Results; Malingering; Choice Behavior; Psychometrics; Young Adult; Aged
PubMed: 38041021
DOI: 10.1080/13854046.2023.2284975 -
Journal of the International... May 2024Performance validity (PVTs) and symptom validity tests (SVTs) are necessary components of neuropsychological testing to identify suboptimal performances and response...
OBJECTIVE
Performance validity (PVTs) and symptom validity tests (SVTs) are necessary components of neuropsychological testing to identify suboptimal performances and response bias that may impact diagnosis and treatment. The current study examined the clinical and functional characteristics of veterans who failed PVTs and the relationship between PVT and SVT failures.
METHOD
Five hundred and sixteen post-9/11 veterans participated in clinical interviews, neuropsychological testing, and several validity measures.
RESULTS
Veterans who failed 2+ PVTs performed significantly worse than veterans who failed one PVT in verbal memory (Cohen's .60-.69), processing speed (Cohen's .68), working memory (Cohen's = .98), and visual memory (Cohen's .88-1.10). Individuals with 2+ PVT failures had greater posttraumatic stress (PTS; = 0.16; = .0002), and worse self-reported depression ( = 0.17; = .0001), anxiety ( = 0.15; = .0007), sleep ( = 0.10; = .0233), and functional outcomes ( = 0.15; = .0009) compared to veterans who passed PVTs. 7.8% veterans failed the SVT (Validity-10; ≥19 cutoff); Multiple PVT failures were significantly associated with Validity-10 failure at the ≥19 and ≥23 cutoffs ('s < .0012). The Validity-10 had moderate correspondence in predicting 2+ PVTs failures ( = 0.83; = 0.76, 0.91).
CONCLUSION
PVT failures are associated with psychiatric factors, but not traumatic brain injury (TBI). PVT failures predict SVT failure and vice versa. Standard care should include SVTs and PVTs in all clinical assessments, not just neuropsychological assessments, particularly in clinically complex populations.
Topics: Humans; Veterans; Brain Injuries, Traumatic; Neuropsychological Tests; Anxiety; Memory, Short-Term; Reproducibility of Results; Malingering
PubMed: 38014547
DOI: 10.1017/S1355617723000711 -
Journal of Clinical and Experimental... Feb 2024This study cross-validated multiple Trail Making Test (TMT) Parts A and B scores as non-memory-based embedded performance validity tests (PVTs) for detecting invalid...
OBJECTIVE
This study cross-validated multiple Trail Making Test (TMT) Parts A and B scores as non-memory-based embedded performance validity tests (PVTs) for detecting invalid neuropsychological performance among veterans with and without cognitive impairment.
METHOD
Data were collected from a demographically and diagnostically diverse mixed clinical sample of 100 veterans undergoing outpatient neuropsychological evaluation at a Southwestern VA Medical Center. As part of a larger battery of neuropsychological tests, all veterans completed TMT A and B and four independent criterion PVTs, which were used to classify veterans into valid ( = 75) and invalid ( = 25) groups. Among the valid group 47% ( = 35) were cognitively impaired.
RESULTS
Among the overall sample, all embedded PVTs derived from TMT A and B raw and demographically corrected T-scores significantly differed between validity groups (ηp = .21-.31) with significant areas under the curve (AUCs) of .72-.78 and 32-48% sensitivity (≥91% specificity) at optimal cut-scores. When subdivided by cognitive impairment status (i.e., valid-unimpaired vs. invalid; valid-impaired vs. invalid), all TMT scores yielded significant AUCs of .80-.88 and 56%-72% sensitivity (≥90% specificity) at optimal cut-scores. Among veterans with cognitive impairment, neither TMT A or B raw scores were able to significantly differentiate the invalid from the valid-cognitively impaired group; however, demographically corrected T-scores were able to significantly differentiate groups but had poor classification accuracy (AUCs = .66-.68) and reduced sensitivity of 28%-44% (≥91% specificity).
CONCLUSIONS
Embedded PVTs derived from TMT Parts A and B raw and T-scores were able to accurately differentiate valid from invalid neuropsychological performance among veterans without cognitive impairment; however, the demographically corrected T-scores generally were more robust and consistent with prior studies compared to raw scores. By contrast, TMT embedded PVTs had poor accuracy and low sensitivity among veterans with cognitive impairment, suggesting limited utility as PVTs among populations with cognitive dysfunction.
Topics: Humans; Veterans; Male; Cognitive Dysfunction; Female; Middle Aged; Trail Making Test; Aged; Reproducibility of Results; Adult; Sensitivity and Specificity; Malingering; Psychometrics; Neuropsychological Tests
PubMed: 38007610
DOI: 10.1080/13803395.2023.2287784 -
Fa Yi Xue Za Zhi Oct 2023Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important... (Review)
Review
Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important application value in assisting auxiliary diagnosis and disease monitoring of mental disorders. In recent years, the development of artificial intelligence and big data technology has made the automatic recognition of micro-expressions possible, which will make micro-expression analysis more convenient and more widely used. This paper reviews the development of facial micro-expression analysis and its application in forensic psychiatry, to look into further application prospects and development direction.
Topics: Humans; Forensic Psychiatry; Artificial Intelligence; Mental Disorders; Facial Expression; Emotions
PubMed: 38006270
DOI: 10.12116/j.issn.1004-5619.2022.120104 -
Emergency Medicine Clinics of North... Feb 2024Individual rights can be limited in the context of psychiatric emergencies. The emergency physician should be familiar with state laws pertaining to involuntary holds.... (Review)
Review
Individual rights can be limited in the context of psychiatric emergencies. The emergency physician should be familiar with state laws pertaining to involuntary holds. Physicians are equipped to perform a medical screening examination, address mental health concerns, and lead efforts to de-escalate agitation. The physician should conduct a thorough assessment and distinguish between malingering and mental health decompensation, when appropriate.
Topics: Humans; Emergencies; Physicians; Anxiety; Mental Disorders
PubMed: 37977750
DOI: 10.1016/j.emc.2023.06.019 -
Emergency Medicine Clinics of North... Feb 2024Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in... (Review)
Review
Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in the emergency department is unknown because of the difficulty of identifying whether patients are fabricating their symptoms. Malingering is considered a diagnosis of exclusion; a differential diagnosis framework is described to guide emergency physicians. Several case studies are presented and analyzed from a medical ethics perspective. Practical recommendations include use of the NEAL (neutral, empathetic, and avoid labeling) strategy when caring for patients suspected of malingering.
Topics: Humans; Malingering; Diagnosis, Differential
PubMed: 37977749
DOI: 10.1016/j.emc.2023.06.018 -
Archives of Clinical Neuropsychology :... Nov 2023This study investigated performance validity in the understudied Romanian clinical population by exploring classification accuracies of the Dot Counting Test (DCT) and...
OBJECTIVE
This study investigated performance validity in the understudied Romanian clinical population by exploring classification accuracies of the Dot Counting Test (DCT) and the first Romanian performance validity test (PVT) (Memory of Objects and Digits and Evaluation of Memory Malingering/MODEMM) in a heterogeneous clinical sample.
METHODS
We evaluated 54 outpatients (26 females; MAge = 62.02; SDAge = 12.3; MEducation = 2.41, SDEducation = 2.82) with the Test of Memory Malingering 1 (TOMM-1), Rey Fifteen Items Test (Rey-15) (free recall and recognition trials), DCT, MODEMM, and MMSE/MoCA as part of their neuropsychological assessment. Accuracy parameters and base failure rates were computed for the DCT and MODEMM indicators against the TOMM-1 and Rey-15. Two patient groups were constructed according to psychometrically defined credible/noncredible performance (i.e., pass/fail both TOMM-1 and Rey-15).
RESULTS
Similar to other cultures, a cutoff of ≥18 on the DCT E score produced the best combination between sensitivity (0.50-0.57) and specificity (≥0.90). MODEMM indicators based on recognition accuracy, inconsistencies, and inclusion false positives generated 0.75-0.86 sensitivities at ≥0.90 specificities. Multivariable models of MODEMM indicators reached perfect sensitivities at ≥0.90 specificities against two PVTs. Patients who failed the TOMM-1 and Rey-15 were significantly more likely to fail the DCT and MODEMM than patients who passed both PVTs.
CONCLUSIONS
Our results offer proof of concept for the DCT's cross-cultural validity and the applicability of the MODEMM on Romanian clinical examinees, further recommending the use of heterogeneous validity indicators in clinical assessments.
PubMed: 37961918
DOI: 10.1093/arclin/acad085 -
Prenatal Diagnosis Nov 2023To study the early second trimester development of brain hemispheres, lateral ventricles, choroid plexus, and ganglionic eminence/basal ganglia complex (GEBG).
OBJECTIVE
To study the early second trimester development of brain hemispheres, lateral ventricles, choroid plexus, and ganglionic eminence/basal ganglia complex (GEBG).
METHODS
A retrospective analysis of TVUS 3D volumes of 14-18 gestational weeks (GW) fetuses. Hemispheres were analyzed for wall thickness, choroid plexus extension, GEBG height and length, lamination pattern (intermediate zone and the subplate border, IZ-SP), ventricle height, width, and angle. Measurements were correlated with GW and assessed for symmetry and impact of probe resolution.
RESULTS
We included 84 fetuses (168 hemispheres). The CP location is variable at 14-16 GW, becoming consistently and symmetrically posterior at 18 GW. Hemispheric thickness, GEBG height and length grow significantly with fetal age, whereas ventricle height, width, and angle regress. The detection rate of the IZ-SP line at 14, 15, 16, 17, and 18 weeks was 0%, 24%, 78.26%, 100%, and 100%, respectively. The ratio between the upper and lower segments of the cerebral lamination grows with GW. For all brain structures, the asymmetry between sides was significant only for ventricular height. The transducer type did not have a significant effect on any outcome except for ventricle height.
CONCLUSION
These normal features of the parasagittal view should aid clinicians in fetal brain assessment during the early weeks of the second trimester.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Brain; Cerebral Ventricles; Gestational Age; Fetus; Ultrasonography, Prenatal
PubMed: 37946665
DOI: 10.1002/pd.6456 -
The Clinical Neuropsychologist Jul 2024Symptom validity tests (SVTs) and performance validity tests (PVTs) are important tools in sociomedical assessments, especially in the psychosomatic context where...
Symptom validity tests (SVTs) and performance validity tests (PVTs) are important tools in sociomedical assessments, especially in the psychosomatic context where diagnoses mainly depend on clinical observation and self-report measures. This study examined the relationship between reaction times (RTs) and scores on the Structured Inventory of Malingered Symptomatology (SIMS). It was proposed that slower RTs and larger standard deviations of reaction times (RTSDs) would be observed in participants who scored above the SIMS cut-off (>16). Direct surface electromyography (EMG) was used to capture RTs during a computer-based RT test in 152 inpatients from a psychosomatic rehabilitation clinic in Germany. Correlation analyses and Mann-Whitney U were used to examine the relationship between RTs and SIMS scores and to assess the potential impact of covariates such as demographics, medical history, and vocational challenges on RTs. Therefore, dichotomized groups based on each potential covariate were compared. Significantly longer RTs and larger RTSDs were found in participants who scored above the SIMS cut-off. Current treatment with psychopharmacological medication, diagnosis of depression, and age had no significant influence on the RT measures. However, work-related problems had a significant impact on RTSDs. There was a significant relationship between longer and more inconsistent RTs and indicators of exaggerated or feigned symptom report on the SIMS in psychosomatic rehabilitation inpatients. Findings from this study provide a basis for future research developing a new RT-based PVT.
Topics: Humans; Male; Female; Adult; Psychophysiologic Disorders; Middle Aged; Reaction Time; Malingering; Electromyography; Young Adult; Aged
PubMed: 37917133
DOI: 10.1080/13854046.2023.2276480