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Epilepsy & Behavior : E&B Mar 2022The aim of the study was to examine the neuropsychological performance and effort in patients with a confirmed PNES diagnosis. The second aim of the study was to...
PURPOSE
The aim of the study was to examine the neuropsychological performance and effort in patients with a confirmed PNES diagnosis. The second aim of the study was to investigate the relationship between validity indicators from the cognitive battery with validity and clinical scales from a personality scale.
METHOD
Patients with PNES (N = 250; F:M 186:64; mean age 38.32 (13.23)) were assessed utilizing the RBANS (Czech Research version) to evaluate cognitive performance and to obtain the Effort Index. The MMPI-2 was used to evaluate personality and psychopathology.
RESULTS
Global cognitive performance was 0.92 SD below average (according to the Gaussian distribution) in patients with PNES. The lowest scores in the sample were in the Attention domain (-1.7SD). Insufficient effort was detected in 10% of patients. Education correlated negatively with the Effort index (rs = -0.25, p = 0.01). A mild significant correlation in Scale 7 (rs = 0.21, p = 0.01) and Scale 8 (rs = 0.24, p = 0.01), and a significant correlation between Effort Index and Back F Scale (rs = 0.23, p = 0.01) were noted.
CONCLUSIONS
Assessment of cognitive performance and effort is an essential part of the comprehensive evaluation of patients with PNES during their hospitalization at Epilepsy centers. Many aspects of the neuropsychological assessment can offer useful indications for reaching a differential diagnosis, including clinical history, behavioral observations, cognitive and symptom validity testing, and structured psychological inventories.
Topics: Adult; Czech Republic; Electroencephalography; Epilepsy; Humans; Neuropsychological Tests; Psychogenic Nonepileptic Seizures; Seizures
PubMed: 35131734
DOI: 10.1016/j.yebeh.2022.108584 -
Improving renal phenotype and evolving extra-renal features of 17q12 deletion encompassing the gene.Translational Pediatrics Dec 2021deletion/intragenic mutations are the most commonly identified genetic cause of congenital anomalies of the kidney and urinary tract (CAKUT) suggested by fetal...
BACKGROUND
deletion/intragenic mutations are the most commonly identified genetic cause of congenital anomalies of the kidney and urinary tract (CAKUT) suggested by fetal ultrasound findings such as: parenchymal hyperechogenicity, overt cystic changes or gross morphological urinary system (UT) abnormalities. The postnatal evolution of these 17q12 deletions encompassing the gene-associated findings has not been assessed in depth.
METHODS
In this observational study, we present postnatal follow-up findings in 5 of 6 cases (one pregnancy was terminated on parental request) of fetal-onset cystic/hyperechogenic kidneys eventually diagnosed with 17q12 microdeletion encompassing the gene between 2009 and 2017.
RESULTS
Complete normalization of kidney parenchymal abnormalities and of depressed neonatal renal function was observed in 4/5 and 5/5 patients within 2-4.9 years and 1.5-8 months, respectively. All 5 patients had preserved normal renal function at 3-11 years of follow-up. The evolving later-onset renal features included: hypomagnesemia, hyperuricemia, urinary tract infection (UTI), and bilateral grade 3-4 vesicoureteral reflux and bladder diverticula in 3, 3, 2, and 1 patient, respectively. gene deletion-associated extra-renal manifestations with delayed presentation were global developmental delay/autistic spectrum disorder (ASD), rolandic-type seizures, overweight, and borderline fasting hyperglycemia observed in 1-2 patients each. Family history was positive for small-size or asymptomatic cystic kidneys with normal function, diabetes mellitus, seizures, and mental/psychiatric problems in 3/6 cases.
CONCLUSIONS
Fetal-onset deletion-associated kidneys' parenchymal abnormalities confirmed postnatally with initially depressed renal function might undergo complete resolution within several years and few months, respectively. However, later-onset urinary tract, metabolic, and neurodevelopmental features of this mutation might appear over years. Therefore, genetic molecular evaluation/diagnosis and continuous follow-up for evolving features are mandatory in affected children.
PubMed: 35070826
DOI: 10.21037/tp-21-386 -
Frontiers in Neurology 2021Dizziness is a frequent complaint after head trauma. Among patients who suffer a concussion (mild traumatic brain injury or mTBI), dizziness is second only to headache... (Review)
Review
Dizziness is a frequent complaint after head trauma. Among patients who suffer a concussion (mild traumatic brain injury or mTBI), dizziness is second only to headache in symptom frequency. The differential diagnosis of post-concussive dizziness (PCD) can be divided into non-vestibular, central vestibular and peripheral vestibular causes with growing recognition that patients frequently exhibit both central and peripheral findings on vestibular testing. Symptoms that traditionally have been ascribed to central vestibular dysfunction may be due to peripheral dysfunction. Further, our ability to test peripheral vestibular function has improved and has allowed us to identify peripheral disorders that in the past would have remained unnoticed. The importance of the identification of the peripheral component in PCD lies in our ability to remedy the peripheral vestibular component to a much greater extent than the central component. Unfortunately, many patients are not adequately evaluated for vestibular disorders until long after the onset of their symptoms. Among the diagnoses seen as causes for PCD are (1) Central vestibular disorders, (2) Benign Paroxysmal Positional Vertigo (BPPV), (3) Labyrinthine dehiscence/perilymph fistula syndrome, (4) labyrinthine concussion, (5) secondary endolymphatic hydrops, (6) Temporal bone fracture, and (7) Malingering (particularly when litigation is pending). These diagnoses are not mutually exclusive and PCD patients frequently exhibit a combination of these disorders. A review of the literature and a general approach to the patient with post-concussive dizziness will be detailed as well as a review of the above-mentioned diagnostic categories.
PubMed: 35058868
DOI: 10.3389/fneur.2021.718318 -
Healthcare (Basel, Switzerland) Dec 2021Although data and research on the topic are lacking, the phenomenon of feigned homicidality in short-term hospitalization appears to have increased in recent years....
Although data and research on the topic are lacking, the phenomenon of feigned homicidality in short-term hospitalization appears to have increased in recent years. Inpatient psychiatrists not only assess the seriousness of homicidal threats, but also whether such threats are authentic. However, specific literature and diagnostic manuals provide virtually no clinical guidance for this. The authors present two case examples of homicidality feigned for self-serving purposes that had little to do with hostility against the would-be victim. They recommend an approach to assessment that first takes any threat of homicide seriously, and involves an attempt to assess the seriousness of the threat and risk of harm. Secondly, if feigned homicidality is suspected, clinicians can methodically assess for this using criterion that have been applied to the assessment of malingering.
PubMed: 35052195
DOI: 10.3390/healthcare10010031 -
The Clinical Neuropsychologist Jan 2023Logistic regression (LR) is recognized as a promising method for making decisions about neuropsychological performance validity by integrating information across...
Logistic regression (LR) is recognized as a promising method for making decisions about neuropsychological performance validity by integrating information across multiple measures. However, this method has yet to be widely adopted in clinical practice, likely because several open questions remain about its utility relative to simpler methods, its effectiveness across different clinical contexts, and its feasibility at sample sizes common in the field. The current study addresses these questions by assessing classification performance of logistic regression and alternative methods across an array of simulated data sets. We simulated scores of valid and invalid performers on 6 tests designed to mimic the psychometric and distributional properties of real performance validity measures. Out-of-sample predictive performance of LR and a commonly used alternative ("vote counting") was assessed across different base rates, validity measure properties, and sample sizes. LR improved classification accuracy by 2%-12% across simulation conditions, primarily by improving sensitivity. False positives and negatives can be further reduced when LR predictions are interpreted as continuous, rather than binary. LR made robust predictions at sample sizes feasible for neuropsychology research ( = 307) and when as few as 2 tests with good psychometric properties were used. Although training and test data sets of at least several hundred individuals may be required to develop and evaluate LR models for use in clinical practice, LR promises to be an efficient and powerful tool for improving judgements about performance validity. We offer several recommendations for model development and LR interpretation in a clinical setting.
Topics: Humans; Neuropsychological Tests; Logistic Models; Malingering; Neuropsychology; Psychometrics; Reproducibility of Results
PubMed: 35006042
DOI: 10.1080/13854046.2021.2023650 -
Prenatal Diagnosis Apr 2022To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging.
OBJECTIVES
To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging.
METHODS
Based on a retrospective international series of Aicardi syndrome cases from tertiary centers encountered over a 20-year period (2000-2020), we investigated the frequencies of the imaging features in order to characterize an imaging pattern highly suggestive of the diagnosis.
RESULTS
Among 20 cases included, arachnoid cysts associated with a distortion of the interhemispheric fissure were constantly encountered associated with complete or partial agenesis of the corpus callosum (19/20, 95%). This triad in the presence of other CNS disorganization, such as polymicrogyria (16/17, 94%), heterotopias (15/17, 88%), ventriculomegaly (14/20, 70%), cerebral asymmetry [14/20, 70%]) and less frequently extra-CNS anomaly (ocular anomalies [7/11, 64%], costal/vertebral segmentation defect [4/20, 20%]) represent a highly suggestive pattern of Aicardi syndrome in a female patient.
CONCLUSION
Despite absence of genetic test to confirm prenatal diagnosis of AS, this combination of CNS and extra-CNS fetal findings allows delineation of a characteristic imaging pattern of AS, especially when facing dysgenesis of the corpus callosum.
Topics: Agenesis of Corpus Callosum; Aicardi Syndrome; Corpus Callosum; Female; Humans; Magnetic Resonance Imaging; Nervous System Malformations; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34984691
DOI: 10.1002/pd.6085 -
PloS One 2021Diagnostic tests for hearing impairment not only determines the presence (or absence) of hearing loss, but also evaluates its degree and type, and provides physicians...
Diagnostic tests for hearing impairment not only determines the presence (or absence) of hearing loss, but also evaluates its degree and type, and provides physicians with essential data for future treatment and rehabilitation. Therefore, accurately measuring hearing loss conditions is very important for proper patient understanding and treatment. In current-day practice, to quantify the level of hearing loss, physicians exploit specialized test scores such as the pure-tone audiometry (PTA) thresholds and speech discrimination scores (SDS) as quantitative metrics in examining a patient's auditory function. However, given that these metrics can be easily affected by various human factors, which includes intentional (or accidental) patient intervention, there are needs to cross validate the accuracy of each metric. By understanding a "normal" relationship between the SDS and PTA, physicians can reveal the need for re-testing, additional testing in different dimensions, and also potential malingering cases. For this purpose, in this work, we propose a prediction model for estimating the SDS of a patient by using PTA thresholds via a Random Forest-based machine learning approach to overcome the limitations of the conventional statistical (or even manual) methods. For designing and evaluating the Random Forest-based prediction model, we collected a large-scale dataset from 12,697 subjects, and report a SDS level prediction accuracy of 95.05% and 96.64% for the left and right ears, respectively. We also present comparisons with other widely-used machine learning algorithms (e.g., Support Vector Machine, Multi-layer Perceptron) to show the effectiveness of our proposed Random Forest-based approach. Results obtained from this study provides implications and potential feasibility in providing a practically-applicable screening tool for identifying patient-intended malingering in hearing loss-related tests.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Audiometry, Pure-Tone; Auditory Threshold; Child; Child, Preschool; Computational Biology; Discrimination Learning; Female; Hearing; Hearing Loss; Humans; Infant; Infant, Newborn; Machine Learning; Male; Middle Aged; Models, Statistical; Neural Networks, Computer; Reproducibility of Results; Republic of Korea; Speech Perception; Speech Reception Threshold Test; Young Adult
PubMed: 34972151
DOI: 10.1371/journal.pone.0261433 -
Journal of Occupational Rehabilitation Sep 2022Purpose Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being...
Purpose Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being more connected with work and attempts to expose malingering among the sickness absent. The aim of this study was to explore how power and trust are expressed by clients and stakeholders within the Swedish sickness insurance system. Methods This was a longitudinal qualitative study based on semi structured interviews and case files from 31 clients on sick leave in Sweden. Data was analyzed using a thematic analysis. Results The main theme 'Acts of power and distrust' illustrates how stakeholders' express suspicions towards each other, and how clients need to demonstrate desire and efforts to return to work which other stakeholders verified. Conclusions The clients desire to prove themselves able to contribute to society was prominent in this study and power relations need to be acknowledged, in particular between client and the SIA. Further, to preserve citizens trust in the system, the system needs to demonstrate trust also in the clients.
Topics: Employment; Humans; Qualitative Research; Sick Leave; Social Security; Sweden; Trust
PubMed: 34935082
DOI: 10.1007/s10926-021-10017-4 -
Noro Psikiyatri Arsivi 2021We aimed to explore how physicians from different specialties approach the management of functional neurological symptom (conversion) and somatic symptom disorders in...
INTRODUCTION
We aimed to explore how physicians from different specialties approach the management of functional neurological symptom (conversion) and somatic symptom disorders in the emergency department compared with pulmonary embolism and how physicians' professional and personal characteristics influence their diagnostic preferences.
METHODS
Using a vignette methodology, and cross-sectional design, three emergency department case vignettes of possible functional neurological symptom, somatic symptom disorder, and pulmonary embolism were presented to physicians from internal medicine, emergency medicine, and psychiatry. A structured survey including questions on diagnosis and management of these cases, and physicians' professional and personal characteristics (childhood trauma, attachment style) was conducted.
RESULTS
Physicians from internal medicine and emergency medicine tended to consider functional neurological symptom disorder as 'malingering' while psychiatrists tended to diagnose the pulmonary embolism case as a psychiatric condition. Emergency medicine physicians preferred to manage functional neurological symptom disorder themselves, while other doctors endorsed recommending a psychiatric consultation. In the univariable model, being a physician from psychiatry, emergency medicine, or internal medicine; being a specialist, history of childhood sexual abuse, dismissive, and fearful attachment styles of doctors were significant predictors of diagnosing functional neurological symptom disorder as malingering. Being a psychiatrist stayed as the only significant predictor in the multivariable model.
CONCLUSION
Objectively-aberrant functional neurological symptoms and subjective somatic symptoms may be creating different reactions in physicians. In the emergency department, physicians' diagnostic and treatment preferences of conversion disorder may be influenced by lack of training in conversion disorder, rather than their personal characteristics.
PubMed: 34924784
DOI: 10.29399/npa.27599 -
Journal of Audiology & Otology Apr 2022To describe all possible facets of non-organic hearing disorders (NOHD) and emphasize the superiority of auditory steady-state response (ASSR) over previously employed...
BACKGROUND AND OBJECTIVES
To describe all possible facets of non-organic hearing disorders (NOHD) and emphasize the superiority of auditory steady-state response (ASSR) over previously employed hearing assessment tools.
SUBJECTS AND METHODS
A series of seven patients consisting of three males and four females with NOHD were assessed at Attikon University Hospital (age range: 17-59 years). Three patients had Munchausen syndrome, three intentionally feigned hearing loss, and one intentionally feigned normal hearing. The audiological evaluation consisted of tympanometry, pure-tone audiometry, and ASSR testing.
RESULTS
The hearing of all patients was accurately determined using ASSR. The results were confirmed by auditory brainstem responses (ABR) and otoacoustic emissions.
CONCLUSIONS
NOHD is a multi-faceted condition encompassing various etiologies. ASSR testing represents an objective and reliable method of hearing assessment, which can serve as a gold standard method for distinguishing NOHD from actual hearing loss. It can reliably indicate the hearing levels at the four main frequencies (500, 1,000, 2,000, and 4,000 Hz) by obtaining a valid estimated audiogram through statistical measures. Compared to ABR testing, ASSR thresholds are closer to the actual audiometric thresholds in the presence of hearing impairment and are superior when the corresponding pure-tone audiogram is widely ranging between the adjacent frequencies or when the obtained ABR curves are not easily distinguished. A non-confrontational approach should be adopted by ENT doctors towards cases of suspected NOHD as the use of ASSR could reliably assess hearing even when medical or medico-legal implications are involved.
PubMed: 34922420
DOI: 10.7874/jao.2021.00283