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Archives of Clinical Neuropsychology :... Aug 2022Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional...
BACKGROUND
Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional neurological disorder. Although FCD is understood as different from exaggerated or feigned cognitive complaints, previous accounts have provided little practical advice on how FCD can be separated from factitious or malingered cognitive complaints. Also, the distinction of FCD from other medical or mental health disorders that impact on cognition is an area of ongoing study and debate. Diagnostic precision is important to prevent iatrogenesis and for the development of needed treatment protocols.
METHOD
We summarize the current literature and present seven anonymized case vignettes to characterize the challenges in this area and develop proposals for solutions.
RESULTS/CONCLUSIONS
Recognizing the limitations of categorical diagnostic systems, we position FCD as distinct from feigning and cognitive symptoms of psychiatric disorders, although with overlapping features. We set out typical clinical features and neuropsychological profiles for each category of cognitive disorder and a statistical method to analyze performance validity tests/effort tests to assist in determining feigned or invalid responding.
Topics: Cognition; Cognition Disorders; Diagnosis, Differential; Humans; Malingering; Neuropsychological Tests
PubMed: 35484819
DOI: 10.1093/arclin/acac020 -
Archives of Clinical Neuropsychology :... Aug 2022The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion.
METHODS
Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8 weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared.
RESULTS
Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07).
CONCLUSIONS
Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.
Topics: Adult; Brain Concussion; Cognition; Cognition Disorders; Female; Humans; Male; Memory Disorders; Neuropsychological Tests; Post-Concussion Syndrome
PubMed: 35443277
DOI: 10.1093/arclin/acac021 -
Prenatal Diagnosis Sep 2022Variants in CCND2 gene are known to cause syndromic macrocephaly. Recently inverse growth proximal variants were described in five individuals with microcephaly. CCND2...
Variants in CCND2 gene are known to cause syndromic macrocephaly. Recently inverse growth proximal variants were described in five individuals with microcephaly. CCND2 loss of function distal variants can cause fetal microcephaly.
Topics: Cyclin D2; Female; Fetus; Head; Humans; Microcephaly; Nervous System Malformations; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Ultrasonography, Prenatal
PubMed: 35437818
DOI: 10.1002/pd.6148 -
Archives of Clinical Neuropsychology :... Aug 2022Individuals with early-onset dysexecutive Alzheimer's disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom...
OBJECTIVE
Individuals with early-onset dysexecutive Alzheimer's disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom misinterpretation and misdiagnosis.
METHOD
The aim of this retrospective study is to evaluate rates of failure on a common PVT, the test of memory malingering (TOMM), in a sample of clinical patients with biomarker-confirmed early-onset dAD who completed neuropsychological testing.
RESULTS
We identified seventeen patients with an average age of symptom onset at 52.25 years old. Nearly fifty percent of patients performed below recommended cut-offs on Trials 1 and 2 of the TOMM. Four of six patients who completed outside neuropsychological testing were misdiagnosed with alternative etiologies to explain their symptomatology, with two of these patients' performances deemed unreliable based on the TOMM.
CONCLUSIONS
Low scores on the TOMM should be interpreted in light of contextual and optimally biological information and do not necessarily rule out a neurodegenerative etiology.
Topics: Alzheimer Disease; Diagnostic Errors; Humans; Malingering; Memory Disorders; Memory and Learning Tests; Middle Aged; Neuropsychological Tests; Reproducibility of Results; Retrospective Studies
PubMed: 35435228
DOI: 10.1093/arclin/acac016 -
Frontiers in Psychology 2022Feigning (i.e., grossly exaggerating or fabricating) symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests (SVTs) have...
Feigning (i.e., grossly exaggerating or fabricating) symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests (SVTs) have been developed to help clinicians differentiate feigned from genuine symptom presentations. While a deviant SVT score is an indicator of a feigned symptom presentation, a non-deviant score provides support for the hypothesis that the symptom presentation is valid. Ideally, non-deviant SVT scores should temper suspicion of feigning even in cases where the patient fits the DSM's stereotypical yet faulty profile of the "antisocial" feigner. Across three studies, we tested whether non-deviant SVT scores, indeed, have this corrective effect. We gave psychology students (Study 1, = 55) and clinical experts (Study 2, = 42; Study 3, = 93) a case alluding to the DSM profile of feigning. In successive steps, they received information about the case, among which non-deviant SVT outcomes. After each step, participants rated how strongly they suspected feigning and how confident they were about their judgment. Both students and experts showed suspicion rates around the midpoint of the scale (i.e., 50) and did not respond to non-deviant SVT outcomes with lowered suspicion rates. In Study 4, we educated participants (i.e., psychology students, = 92) about the shortcomings of the DSM's antisocial typology of feigning and the importance of the negative predictive power of SVTs, after which they processed the case information. Judgments remained roughly similar to those in Studies 1-3. Taken together, our findings suggest that students and experts alike have difficulties understanding that non-deviant scores on SVTs reduce the probability of feigning as a correct differential diagnosis.
PubMed: 35369141
DOI: 10.3389/fpsyg.2022.789762 -
Military Psychology : the Official... 2022This study evaluated the Personality Assessment Inventory's (PAI) symptom validity-based over-reporting scales with concurrently administered performance validity...
This study evaluated the Personality Assessment Inventory's (PAI) symptom validity-based over-reporting scales with concurrently administered performance validity testing in a sample of active-duty military personnel seen within a neuropsychology clinic. We utilize two measures of performance validity to identify problematic performance validity (pass all/fail any) in 468 participants. Scale means, sensitivity, specificity, predictive value, and risk ratios were contrasted across symptom validity-based over-reporting scales. Results indicate that the Negative Impression Management (NIM), Malingering Index (MAL), and Multiscale Feigning Index (MFI) scales are the best at classifying failed performance validity testing with medium to large effects ( = .61-.73). In general, these scales demonstrated high specificity and low sensitivity. Roger's Discriminant Function (RDF) had negligible group differences and poor classification. The Feigned Adult ADHD index (FAA) performed inconsistently. This study provides support for the use of several PAI over-reporting scales at detecting probable patterns of performance-based invalid responses within a military sample. Military clinicians using NIM, MAL, or MFI are confident that those who elevate these scales at recommended cut scores are likely to fail concurrent performance validity testing. Use of the Feigned Adult FAA and RDF scales is discouraged due to their poor or mixed performance.
PubMed: 38536284
DOI: 10.1080/08995605.2021.2013059 -
GMS Ophthalmology Cases 2022Non-organic visual loss can be hard to prove or explain to the parents of affected children at times. Here, we describe a simple yet effective approach that may help...
Non-organic visual loss can be hard to prove or explain to the parents of affected children at times. Here, we describe a simple yet effective approach that may help solve both issues by ensuring that the patient refrains from visual stimuli.
PubMed: 35291589
DOI: 10.3205/oc000192 -
Ultrasound in Obstetrics & Gynecology :... Jul 2022Prenatally detected central nervous system (CNS) anomalies present a diagnostic challenge. In this study, we compared the diagnostic yield of exome sequencing (ES) and...
OBJECTIVE
Prenatally detected central nervous system (CNS) anomalies present a diagnostic challenge. In this study, we compared the diagnostic yield of exome sequencing (ES) and chromosomal microarray analysis (CMA) in fetuses with a major CNS anomaly.
METHODS
This was a retrospective study of 114 cases referred for genetic evaluation following termination of pregnancy (TOP) due to a major CNS anomaly detected on prenatal ultrasound. All fetuses were first analyzed by CMA. All CMA-negative cases were offered ES. CMA-positive cases were reanalyzed using ES to assess its ability to detect copy-number variants (CNVs).
RESULTS
CMA identified a pathogenic or likely pathogenic (P/LP) CNV in 11/114 (10%) cases. Eighty-six CMA-negative cases were analyzed using ES, which detected P/LP sequence variants in 38/86 (44%). Among recurrent cases (i.e. cases with a previously affected pregnancy), the incidence of P/LP sequence variants was non-significantly higher compared with non-recurrent ones (12/19 (63%) vs 26/67 (39%); P = 0.06). Among the 38 cases with an ES diagnosis, 20 (53%) were inherited and carried a significant risk of recurrence. Reanalysis of 10 CMA-positive cases by ES demonstrated that the bioinformatics pipeline used for sequence variant analysis also detected all P/LP CNVs, as well as three previously known non-causative CNVs.
CONCLUSIONS
In our study, ES provided a high diagnostic yield (> 50%) in fetuses with severe CNS structural anomalies, which may have been partly due to the highly selected case series that included post-TOP cases from a specialist referral center. These data suggest that ES may be considered as a first-tier test for the prenatal diagnosis of major fetal CNS anomalies, detecting both P/LP sequence variants and CNVs. This is of particular importance given the time constraints of an ongoing pregnancy and the risk of recurrence in future pregnancies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Central Nervous System; Central Nervous System Diseases; Chromosome Aberrations; DNA Copy Number Variations; Exome; Female; Fetus; Humans; Microarray Analysis; Nervous System Malformations; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Exome Sequencing
PubMed: 35229910
DOI: 10.1002/uog.24885 -
Epilepsy & Behavior Reports 2022•Functional (psychogenic) symptoms exist in all specialties.•They are by definition not under voluntary control, unlike factitious disorders and malingering.•The... (Review)
Review
•Functional (psychogenic) symptoms exist in all specialties.•They are by definition not under voluntary control, unlike factitious disorders and malingering.•The diagnostic approach to functional symptoms varies among specialties.
PubMed: 35198949
DOI: 10.1016/j.ebr.2021.100506 -
Psychiatry, Psychology, and Law : An... 2023The study aimed to establish a normative data set for the Paulhus Deception Scales (PDS) and Structured Inventory of Malingered Symptomology (SIMS) in a community adult...
The study aimed to establish a normative data set for the Paulhus Deception Scales (PDS) and Structured Inventory of Malingered Symptomology (SIMS) in a community adult sample of high functioning autistic (HFA) people. Assessments were administered anonymously online. Seventy surveys were completed, with respondents contributing from 16 countries. The majority of subscales and total scores for the PDS and SIMS fell above cut-off for self-report response bias, suggesting that completion of these measures by HFA individuals may lead to conclusions of intentional response distortion, even when this is not the case. Significant relationships were found between high scores and education level, as well as psychological distress. The findings of the study raise concerns about the use of these measures with HFA people, particularly in 'high stakes' situations.
PubMed: 37346057
DOI: 10.1080/13218719.2021.2006097