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General Hospital Psychiatry 2023Patients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the...
OBJECTIVE
Patients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the scientific literature lacks robust data on FDIS. The present study aimed to estimate the annual mean of in-hospital FDIS codings in France, describe the sociodemographic characteristics of subjects with FDIS, assess healthcare utilisation and medical nomadism, and describe the pathologies most frequently associated with FDIS.
METHOD
Subjects with at least one coding of FDIS in French health insurance databases between January 1, 2009, and December 31, 2017 were included. Subjects younger than 18 years of age at the time of first coding were excluded from the study. Sociodemographic data of subjects and diagnoses associated with the first coding of FDIS were collected. Healthcare utilisation and medical nomadism were analysed descriptively from one year before to one year after the first FDIS coding.
RESULTS
2232 subjects were included, representing an average of 248 new in-hospital FDIS codings per year. The subjects included were 58.2% female. The mean age at diagnosis was 48.5 years. In the year following the first coding of FDIS, 1268 subjects (56.8%) were re-hospitalised at least once, including 159 (7.1%) with at least one new coding for FDIS. From one year before to one year after the first coding of FDIS, 66% of the subjects included had received at least one prescription for benzodiazepines, 58.3% for antidepressants, and 42.6% for antipsychotics.
CONCLUSIONS
Our findings bring new data working towards a better understanding of FDIS. The consumption of psychotropic drugs is particularly frequent in patients with FDIS.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Factitious Disorders; Antipsychotic Agents; Psychotropic Drugs; Insurance, Health
PubMed: 37862960
DOI: 10.1016/j.genhosppsych.2023.10.007 -
Clinical & Experimental Optometry May 2024
Topics: Humans; Diagnosis, Differential; Child; Malingering; Male; Adolescent; Female
PubMed: 37797945
DOI: 10.1080/08164622.2023.2244984 -
Journal of Clinical and Experimental... Mar 2024The extent to which performance validity (PVT) and symptom validity (SVT) tests measure separate constructs is unclear. Prior research using the Minnesota Multiphasic...
INTRODUCTION
The extent to which performance validity (PVT) and symptom validity (SVT) tests measure separate constructs is unclear. Prior research using the Minnesota Multiphasic Personality Inventory (MMPI-2 & RF) suggested that PVTs and SVTs are separate but related constructs. However, the relationship between Personality Assessment Inventory (PAI) SVTs and PVTs has not been explored. This study aimed to replicate previous MMPI research using the PAI, exploring the relationship between PVTs and overreporting SVTs across three subsamples, neurodevelopmental (attention deficit-hyperactivity disorder (ADHD)/learning disorder), psychiatric, and mild traumatic brain injury (mTBI).
METHODS
Participants included 561 consecutive referrals who completed the Test of Memory Malingering (TOMM) and the PAI. Three subgroups were created based on referral question. The relationship between PAI SVTs and the PVT was evaluated through multiple regression analysis.
RESULTS
The results demonstrated the relationship between PAI symptom overreporting SVTs, including Negative Impression Management (NIM), Malingering Index (MAL), and Cognitive Bias Scale (CBS), and PVTs varied by referral subgroup. Specifically, overreporting on CBS but not NIM and MAL significantly predicted poorer PVT performance in the full sample and the mTBI sample. In contrast, none of the overreporting SVTs significantly predicted PVT performance in the ADHD/learning disorder sample but conversely, all SVTs predicted PVT performance in the psychiatric sample.
CONCLUSIONS
The results partially replicated prior research comparing SVTs and PVTs and suggested that constructs measured by SVTs and PVTs vary depending upon population. The results support the necessity of both PVTs and SVTs in clinical neuropsychological practice.
Topics: Humans; Female; Male; Malingering; Adult; Middle Aged; Attention Deficit Disorder with Hyperactivity; Young Adult; Neuropsychological Tests; Reproducibility of Results; MMPI; Referral and Consultation; Brain Concussion; Learning Disabilities; Adolescent
PubMed: 37791494
DOI: 10.1080/13803395.2023.2261633 -
The Journal of Head Trauma...To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with...
OBJECTIVE
To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with persistent symptoms after mild traumatic brain injury (mTBI).
SETTING
Outpatient concussion clinics in British Columbia, Canada. Participants were assessed at intake (average 12.9 weeks postinjury) and again following 3 to 4 months of rehabilitation.
PARTICIPANTS
Adults who met the World Health Organization Neurotrauma Task Force definition of mTBI. Litigation status was known for 69 participants ( n = 21 reported litigation), and 62 participants completed a PVT ( n = 13 failed the Test of Memory Malingering) at clinic intake.
DESIGN
Secondary analysis of a clinical trial (ClinicalTrials.gov #NCT03972579).
MAIN MEASURES
Outcomes included number of completed sessions, homework adherence, symptoms (Rivermead Post Concussion Symptoms Questionnaire), disability ratings (World Health Organization Disability Assessment Schedule 2.0), and patient-rated global impression of change.
RESULTS
We did not observe substantial differences in session and homework adherence associated with litigation or PVT failure. Disability and postconcussion symptoms generally improved with treatment. Involvement in litigation was associated with a smaller improvement in outcomes, particularly disability ( B = 2.57, 95% confidence interval [CI] [0.25-4.89], P = .03) and patient-reported global impression of change (odds ratio [OR] = 4.19, 95% CI [1.40-12.57], P = .01). PVT failure was not associated with considerable differences in treatment outcomes. However, participants who failed the PVT had a higher rate of missing outcomes (31% vs 8%) and perceived somewhat less global improvement (OR = 3.47, 95% CI [0.86-14.04]; P = .08).
CONCLUSION
Adults with mTBI who are in litigation or who failed PVTs tend to adhere to and improve following treatment. However, involvement in litigation may be associated with attenuated improvements, and pretreatment PVT failure may predict lower engagement in the treatment process.
Topics: Humans; Male; Female; Adult; Brain Concussion; Middle Aged; Treatment Outcome; Disability Evaluation; British Columbia; Neuropsychological Tests; Post-Concussion Syndrome; Young Adult; Jurisprudence; Malingering
PubMed: 37773600
DOI: 10.1097/HTR.0000000000000903 -
Journal of Occupational Rehabilitation Mar 2024Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries...
PURPOSE
Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries requiring time off work. Safely returning to work post-injury is critical, yet little is known about current return-to-work (RTW) practices in police services. This study examines RTW practices and experiences in police services from the perspective of RTW personnel and workers with physical and/or psychological health conditions.
METHODS
We used a purposive sampling approach to recruit sworn and civilian members from several police services in Ontario, Canada. The recruited members had experienced RTW either as a person in a RTW support role or as a worker with a work-related injury/illness. We conducted and transcribed interviews for analysis and used qualitative research methods to identify themes in the data.
RESULTS
Five overarching themes emerged. Two pointed to the context and culture of police services and included matters related to RTW processes, injury/illness complexity, the hierarchical nature of police organizations, and a culture of stoicism and stigma. The remaining three themes pointed to the RTW processes of accommodation, communication and trust-building. They included issues related to recovery from injury/illness, meaningful accommodation, timely and clear communication, malingering and trust.
CONCLUSIONS
Our findings point to potential areas for improving RTW practices in police services: greater flexibility, more clarity, stricter confidentiality and reduced stigma. More research is needed on RTW practices for managing psychological injuries to help inform policy and practice.
Topics: Humans; Ontario; Return to Work; Police; Qualitative Research; Policy
PubMed: 37735312
DOI: 10.1007/s10926-023-10135-1 -
Research in Social & Administrative... Dec 2023Prevalence of Non-Medical Use of Prescription Stimulants (NMUPS) is estimated to be high among young adults enrolled in college. However, precise estimation of the...
BACKGROUND
Prevalence of Non-Medical Use of Prescription Stimulants (NMUPS) is estimated to be high among young adults enrolled in college. However, precise estimation of the prevalence of NMUPS is challenging owing to biases affecting self-report of sensitive and potentially illegal behaviors.
OBJECTIVE
This study aimed to estimate the prevalence and risk factors of NMUPS using the crosswise randomized response technique (CRRT) and compare findings to the traditionally-used direct self-report (DSR) method.
METHODS
This study utilized a cross-sectional, randomized experimental design to survey adult undergraduate students at a major southeastern university in the United States. Eligible respondents were randomly assigned to a DSR group or a CRRT group. Those in the DSR group were presented a direct question about NMUPS, but those in the CRRT group were asked to indicate whether their response to the NMUPS question was the 'same' or 'different' compared to a random non-sensitive question.
RESULTS
Prevalence of NMUPS was found to be 18.6% (95% CI:18.5%-18.7%) in the DSR group and 32.5% (95% CI:32.1%-32.9%; p = 0.003) in the CRRT group. Logistic regression analysis predicting NMUPS in the DSR group showed that it was significantly associated with positive expectancies (OR:3.50; 95% CI:2.44-5.02), negative expectancies (OR:0.49; 95% CI:0.35-0.68), perceived norms (OR:1.71; 95% CI:1.27-2.29), and religious beliefs (OR:0.69; 95% CI:0.52-0.92).
CONCLUSIONS
The setting and mechanism of the survey is likely closely related to the validity of prevalence estimation of sensitive behaviors. This study found that prevalence of sensitive behaviors such as NMUPS is significantly higher when respondents are provided increased anonymity.
PubMed: 37709643
DOI: 10.1016/j.sapharm.2023.08.005 -
Journal of Neurology Dec 2023To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic...
OBJECTIVE
To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms.
METHODS
Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated.
RESULTS
Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming.
CONCLUSION
Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Smartphone; Nystagmus, Pathologic; Nystagmus, Physiologic; Vestibular Function Tests
PubMed: 37653139
DOI: 10.1007/s00415-023-11965-y -
Psychological Assessment Oct 2023Current guidelines for conducting symptom validity assessments require that professionals administer multiple symptom validity tests (SVTs) and that the SVTs selected...
Current guidelines for conducting symptom validity assessments require that professionals administer multiple symptom validity tests (SVTs) and that the SVTs selected for their evaluations provide nonredundant information. However, not many SVTs are currently available, and most of them rely on the same, (in)frequency-based, feigning detection strategy. In this context, the Inventory of Problems (IOP-29) could be a valuable addition to the assessor's toolbox because of its brevity (29 items) and its different approach to assessing the credibility of presented symptoms. As its ecological validity has been poorly investigated, the present study used a criterion groups design to examine the classification accuracy of the IOP-29 in a data set of 174 court-ordered psychological evaluations focused on psychological injury. The validity scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form and the total score of the Structured Inventory of Malingered Symptoms were used as criterion variables. Overall, the results of this study confirm that the IOP-29 is an effective measure (1.70 ≤ ≤ 2.67) that provides valuable information when added to the multimethod assessment of symptom validity in civil forensic contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Follow-Up Studies; MMPI; Databases, Factual; Malingering; Psychological Trauma
PubMed: 37650794
DOI: 10.1037/pas0001273 -
Prenatal Diagnosis Sep 2023A Jewish couple of mixed origin was referred for genetic counseling following termination of pregnancy at 18 weeks of gestation due to severe ventriculomegaly with...
A Jewish couple of mixed origin was referred for genetic counseling following termination of pregnancy at 18 weeks of gestation due to severe ventriculomegaly with aqueduct stenosis. Trio exome sequencing revealed a loss-of-function heterozygous variant in the SMARCC1 gene inherited from an unaffected mother. The SMARCC1 gene is associated with embryonic neurodevelopmental processes. Recent studies have linked perturbations of the gene with autosomal dominant congenital hydrocephalus, albeit with reduced penetrance. However, these studies were not referenced in the SMARCC1 OMIM record (*601732) and the gene was not considered, at the time, an OMIM morbid gene. Following our case and appeal, SMARCC1 is now considered a susceptibility gene for hydrocephalus. This allowed us to reclassify the variant as likely pathogenic and empowered the couple to make informed reproductive choices.
Topics: Female; Humans; Pregnancy; Genetic Counseling; Heterozygote; Hydrocephalus; Penetrance; Transcription Factors
PubMed: 37639281
DOI: 10.1002/pd.6426