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Psychological Injury and Law 2023Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little...
Symptom feigning and malingering should be evaluated in forensic contexts due to their important socio-economic consequences. Despite this, to date, there is little research in Spain that evaluates its prevalence. The aim of this study was to investigate this issue using the perception of the general population, students, and professionals of medicine and forensic psychology. Three adapted questionnaires were applied to a total of 1003 participants (61.5% women) from 5 different groups. Approximately two-thirds of participants reported knowing someone who feigned symptoms, and one-third disclosed feigning symptoms themselves in the past. Headache/migraine, neck pain, and anxious-depressive symptoms were the most commonly chosen. Experts in psychology and forensic medicine estimated a prevalence of 20 to 40% of non-credible symptom presentations in their work settings and reported not having sufficient means to assess the distorted presentation of symptoms with certainty. Professionals and laypersons alike acknowledge that non-credible symptom presentations (like feigning or malingering) are relevant in Spain and occur at a non-trivial rate, which compares with estimates in other parts of the world.
PubMed: 35911787
DOI: 10.1007/s12207-022-09458-w -
Cognitive and Behavioral Neurology :... Sep 2022Individuals with probable Alzheimer disease (AD) may perform below cutoffs on traditional, memory-based performance validity tests. Previous studies have found success...
BACKGROUND
Individuals with probable Alzheimer disease (AD) may perform below cutoffs on traditional, memory-based performance validity tests. Previous studies have found success using event-related potentials (ERPs) to detect feigned neurocognitive impairment in younger populations.
OBJECTIVE
To evaluate the utility of an auditory oddball task in conjunction with the P3b peak amplitude to distinguish probable AD from simulated dementia.
METHOD
Twenty individuals with probable AD and 20 older healthy controls (HC) underwent an ERP auditory oddball protocol and the Test of Memory Malingering (TOMM). The HC were asked to perform honestly for one condition and to simulate dementia for the other. The individuals with probable AD were asked to perform honestly. The P3b peak amplitude and button press accuracy were collected from each participant and were analyzed to determine their effectiveness in detecting performance validity.
RESULTS
The P3b peak amplitude remained stable regardless of behavioral condition in the HC group. When combined with the TOMM Trial 2 score, the P3b peak amplitude further improved the ability to correctly differentiate individuals with probable AD from HC simulating dementia with 100% sensitivity and 90% specificity.
CONCLUSION
The P3b peak amplitude was found to be an effective physiologic measure of cognitive impairment in individuals with probable AD compared with HC simulating dementia. When combined with the TOMM Trial 2 score, the P3b peak amplitude served as a promising performance validity measure for differentiating individuals with probable AD from HC simulating dementia.
Topics: Alzheimer Disease; Cognition; Cognitive Dysfunction; Evoked Potentials; Humans; Memory and Learning Tests; Neuropsychological Tests
PubMed: 35830243
DOI: 10.1097/WNN.0000000000000311 -
Cureus Jun 2022Factitious disorder (FD) is a psychiatric illness in which an individual assumes the role of a patient by manifesting physical or psychological symptoms without...
Factitious disorder (FD) is a psychiatric illness in which an individual assumes the role of a patient by manifesting physical or psychological symptoms without conscious or obvious reward. Here, we present the case of a 28-year-old female with a history of endotracheal intubations 19 times secondary to anaphylaxis. During the current hospital visit, she complained of cough, shortness of breath (SOB), arthralgia, wheezing, and rashes over the chest. Serum C1 esterase inhibitor and C4 levels have been negative on multiple occasions. A previous laryngoscopy showed a normal larynx, normal vocal cords, and no obstruction. Due to the patient's history of multiple invasive procedures, malingering was considered a possible differential diagnosis. The patient also has a past psychiatric history of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), adjustment disorder with anxious mood, and anxiety disorder. Her complicated psychiatric history coupled with her multiple endotracheal intubations associated with normal laboratory findings raise the suspicion of factitious disorder. This case is meant to demonstrate the complicated matter of helping a patient whose psychiatric illnesses have put her at risk of serious health complications for the sake of assuming a sick role.
PubMed: 35795523
DOI: 10.7759/cureus.25638 -
Frontiers in Psychology 2022Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety...
The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement.
Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen's = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.
PubMed: 35769761
DOI: 10.3389/fpsyg.2022.818724 -
Clinical and Experimental Rheumatology Jun 2022Cognitive dysfunction is one of the criteria for the diagnosis of fibromyalgia (FM) and is typically based on self-report questionnaires such as the Symptom Severity...
OBJECTIVES
Cognitive dysfunction is one of the criteria for the diagnosis of fibromyalgia (FM) and is typically based on self-report questionnaires such as the Symptom Severity Scale. However, recent studies have shown that there is no correlation between these subjective measures of cognitive dysfunction and more lengthy objective measures of cognitive functioning. This points to the need for a briefer valid evaluation tool for cognitive dysfunction in FM. The aim of this study is to examine whether the Montreal Cognitive Assessment (MoCA) test is a valid measure of cognitive assessment in FM patients, by comparing it to a comprehensive computerised cognitive assessment battery.
METHODS
Sixty-two FM patients (55 women, 7 men, mean age = 46.17 years, sd=12.56) were administered the MoCA and a computerised cognitive assessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ), the Widespread Pain Index (WPI), the Symptom Severity Scale (SSS), and the Beck Depression Inventory (BDI-2). Patient effort was controlled on the TOMM (Test of Memory Malingering).
RESULTS
Moderate positive correlations were found between the MoCA and the computerised cognitive scores as follows: Global Cognitive Score (r=0.493**, p=0.00), Memory Index Score (r= 0.384**, p=0.002), Executive Function Index Score (r=0.461**, p=0.00), Attention Index Score (r=0.310*, p=0.016), Information Processing Speed Index Score (r=0.435**, p=0.001), and Motor Skills (r=0.406**, p=0.002).
CONCLUSIONS
The MoCA is an acceptable cognitive screening test for the cognitive evaluation of FM patients.
Topics: Cognitive Dysfunction; Female; Fibromyalgia; Humans; Male; Mental Status and Dementia Tests; Middle Aged; Neuropsychological Tests; Surveys and Questionnaires
PubMed: 35699063
DOI: 10.55563/clinexprheumatol/3yxu6p -
Iranian Journal of Medical Sciences May 2022A major problem with the University of Pennsylvania Smell Identification Test (UPSIT) is its poor sensitivity for malingering detection in a group of people familiar...
BACKGROUND
A major problem with the University of Pennsylvania Smell Identification Test (UPSIT) is its poor sensitivity for malingering detection in a group of people familiar with the test mechanism. This study aimed to evaluate the modification of UPSIT to detect anosmia malingering.
METHODS
This was a pilot experimental study conducted in 2019 in Tehran. The participants were 60 healthy subjects classified into two groups of 30 people. The first group was requested to deliberately feign a negative result on the Iranian version of UPSIT, Iran Smell Identification Test (ISIT) (malingering group). The second group consisted of participants, who did not scratch the odorant part of ISIT during the tests (anosmia group). ISIT was modified in two steps. At each step, one incorrect option was deleted from the available choices. The number of each group's answers, altered away from the correct choice, was then calculated and compared.
RESULTS
The coached malingering group participants were able to feign anosmia in the original ISIT exam. In the modified ISIT, the number of answers changed from correct to wrong during the second stage (from three available choices to two choices) was significantly higher in the anosmia group (P<0.001). In the ROC analysis, the area under the curve was 0.92 (P<0.001). The cut-off of 4.5 for this test showed 93% sensitivity, 82% specificity, and 90% PPV and NPV.
CONCLUSION
The ISIT is not capable of detecting malingering in the coached participants, yet by deleting the choices step-by-step, the sensitivity and specificity of the test increased.
Topics: Anosmia; Humans; Iran; Neuropsychological Tests; Olfaction Disorders; Smell
PubMed: 35634524
DOI: 10.30476/IJMS.2021.89049.1977 -
ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan.Ultrasound in Obstetrics & Gynecology :... Jun 2022
Topics: Female; Gestational Age; Humans; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal
PubMed: 35592929
DOI: 10.1002/uog.24888 -
European Archives of Psychiatry and... Mar 2023Malingering consists of the production of false physical or psychological symptoms motivated by external incentives that are normally reproduced in pathologies that are... (Comparative Study)
Comparative Study
Malingering consists of the production of false physical or psychological symptoms motivated by external incentives that are normally reproduced in pathologies that are not related to organic origin or there are no laboratory tests for their diagnosis, as is the case of mixed anxiety-depressive disorder and fibromyalgia syndrome. The objective of this research consisted of comparing the profile of simulative patients with fibromyalgia and mixed anxiety-depressive disorder to obtain a profile and facilitate its detection in initial interviews. The research was carried out with 78 patients (42 patients with fibromyalgia and 36 patients with mixed anxiety-depressive disorder) who were administered the professional's structured clinical judgment, the Beck Depression Inventory, the State-Trait Anxiety Questionnaire, and the Structured Symptom Simulation Inventory. The main obtained results show that the simulation classification proposed by the questionnaire is in the range of 66.67-80% with regard to coinciding with the judgment of experts, and people with suspicion of simulation of both groups of patients present similar characteristics. The simulators thus present incongruous responses in relation to the questionnaires, and high levels of trait anxiety, state, and depression predict the simulation of symptoms.
Topics: Humans; Affect; Anxiety; Depression; Fibromyalgia; Malingering; Surveys and Questionnaires
PubMed: 35587278
DOI: 10.1007/s00406-022-01422-8 -
Disability and Rehabilitation Jun 2023This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the...
PURPOSE
This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the concept of a as a heuristic device to explore this policy paradox inherent in the design of most social insurance systems.
MATERIALS AND METHODS
This is a conceptual paper drawing on examples from existing research.
RESULTS
We identify three manifestations of the disability trap: not overcoming disability; underperforming; and returning to work prematurely. The causes of these manifestations are identified as structural rather than based on malingering clients, while negative consequences are identified both on client and system levels.
CONCLUSION
We emphasize the need for systems built on trust and reasonable expectations, and the need for providing rehabilitation support independently of economic compensation. Universal basic income is introduced as a potential tool to ameliorate some of the consequences of the disability trap.Implications for rehabilitationCompensation systems focusing too prominently on early return to work may have counter-productive effects on rehabilitation.Overly suspicious assessment systems nurture a view of people as malingerers.Rehabilitation professionals need to be attentive to system-generated effects which may prevent overcoming work disability.
Topics: Humans; Disabled Persons; Rehabilitation, Vocational; Policy
PubMed: 35576235
DOI: 10.1080/09638288.2022.2074554 -
Psychiatry Journal 2022Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic... (Review)
Review
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list malingering in its diagnostic section and therefore does not identify it as a formal mental disorder, malingering and verified mental illness commonly coexist. Some subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings. The article discusses these three theoretical concepts with their possible clinical aspects, illustrating each phenomenon by clinical case with self-reported and/or observed psychotic symptoms. We summarized relevant findings and provided a review of clinical considerations that physicians can use to aid in the evaluation of psychotic symptoms in the context of those three concepts.
PubMed: 35495616
DOI: 10.1155/2022/3884317