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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 -
Case Reports in Psychiatry 2021Malingering involves the intentional production of physical or psychological behaviors due to motivation from external incentives, posing unique challenges to...
Malingering involves the intentional production of physical or psychological behaviors due to motivation from external incentives, posing unique challenges to healthcare. Although malingering as an entity has been well studied, the current literature does not explore the intentional production of catatonia-like behavior or how to differentiate malingering from catatonia. Here, we describe a 45-year-old female who was admitted to an acute psychiatric hospital with a complex presentation of catatonia-like signs that was ultimately thought to be volitional behavior, resulting in a diagnosis of malingering. We highlight the important factors considered in her presentation, the differences between her behaviors and true catatonia, and other important differential diagnoses to consider. Although a diagnosis of malingering is difficult to make, we underscore the importance of reaching this conclusion in order to avoid unnecessary and potentially harmful medical interventions. We stress the importance of shifting focus from medical management to more appropriate patient goals such as providing social services and treatment of other underlying psychiatric illnesses.
PubMed: 34881069
DOI: 10.1155/2021/1860757 -
European Journal of Psychotraumatology 2021Individuals with dissociative identity disorder (DID) have complex symptoms consistent with severe traumatic reactions. Clinicians and forensic assessors are challenged...
The utility of the Structured Inventory of Malingered Symptomatology for distinguishing individuals with Dissociative Identity Disorder (DID) from DID simulators and healthy controls.
BACKGROUND
Individuals with dissociative identity disorder (DID) have complex symptoms consistent with severe traumatic reactions. Clinicians and forensic assessors are challenged by distinguishing symptom exaggeration and feigning from genuine symptoms among these individuals. This task may be aided by administering validity measures.
OBJECTIVE
This study aimed to document how individuals with DID score on the Structured Inventory of Malingered Symptomatology (SIMS). The second objective was to compare coached DID simulators and healthy controls to DID patients on the SIMS's total score and subscales. The third objective was to examine the utility rates of the SIMS in distinguishing simulated DID from clinically diagnosed DID.
METHOD
We compared SIMS data gathered from participants from two Dutch sites, one Swiss site and one U.S. site. Sixty-three DID patients were compared to 77 coached DID simulators and 64 healthy controls on the SIMS. A multivariate analysis compared the groups on the SIMS total scores and subscales, and post-hoc Games Howell tests and univariate ANOVAs examined differences between the groups. Utility statistics assessed the accuracy of the SIMS in distinguishing clinical from simulated DID.
RESULTS
DID simulators scored significantly higher than DID individuals and healthy controls on every SIMS subscale as well as the total score. The majority (85.7%) of the individuals with DID scored above the cut-off, which is typically interpreted as indicative of possible symptom exaggeration. DID individuals scored higher than the healthy controls on every subscale except Low Intelligence, even after controlling for dissociation. The subscales and items most frequently endorsed by the DID group are consistent with symptoms associated with complex trauma exposure and dissociative reactions. The SIMS total score had a sensitivity of 96% but an unacceptably low specificity of 14%.
CONCLUSIONS
The findings indicate that the instrument is not accurate in assessing potential symptom exaggeration or feigning in DID.
Topics: Adult; Dissociative Identity Disorder; Female; Humans; Male; Malingering; Middle Aged; Neuropsychological Tests; Young Adult
PubMed: 34868478
DOI: 10.1080/20008198.2021.1984048 -
Psychological Injury and Law 2022In 2013, a special issue of the Spanish journal published a review on symptom and performance validity assessment in European countries (Merten et al. in , 24(3),... (Review)
Review
In 2013, a special issue of the Spanish journal published a review on symptom and performance validity assessment in European countries (Merten et al. in , 24(3), 129-138, 2013). At that time, developments were judged to be in their infancy in many countries, with major publication activities stemming from only four countries: Spain, The Netherlands, Great Britain, and Germany. As an introduction to a special issue of , this is an updated report of developments during the last 10 years. In that period of time, research activities have reached a level where it is difficult to follow all developments; some validity measures were newly developed, others were adapted for European languages, and validity assessment has found a much stronger place in real-world evaluation contexts. Next to an update from the four nations mentioned above, reports are now given from Austria, Italy, and Switzerland, too.
PubMed: 34849185
DOI: 10.1007/s12207-021-09436-8 -
PloS One 2021The U.S. government forcibly separated more than 5,000 children from their parents between 2017 and 2018 through its "Zero Tolerance" policy. It is unknown how many of...
The U.S. government forcibly separated more than 5,000 children from their parents between 2017 and 2018 through its "Zero Tolerance" policy. It is unknown how many of the children have since been reunited with their parents. As of August 1, 2021, however, at least 1,841 children are still separated from their parents. This study systematically examined narratives obtained as part of a medico-legal process by trained clinical experts who interviewed and evaluated parents and children who had been forcibly separated. The data analysis demonstrated that 1) parents and children shared similar pre-migration traumas and the event of forced family separation in the U.S.; 2) they reported signs and symptoms of trauma following reunification; 3) almost all individuals met criteria for DSM diagnoses, even after reunification; 4) evaluating clinicians consistently concluded that mental health treatment was indicated for both parents and children; and 5) signs of malingering were absent in all cases.
Topics: Adult; Child; Family Separation; Humans; Mexico; Middle Aged; Parents; Refugees; Wounds and Injuries; Young Adult
PubMed: 34818368
DOI: 10.1371/journal.pone.0259576 -
BMC Psychiatry Nov 2021Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed...
BACKGROUND
Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients.
METHODS
Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse.
RESULTS
49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self.
CONCLUSIONS
The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.
Topics: Adolescent; Adult; Factitious Disorders; Female; Hospitalization; Humans; Neurology; Research; Retrospective Studies
PubMed: 34814866
DOI: 10.1186/s12888-021-03582-8 -
The Israel Medical Association Journal... Nov 2021
Topics: Disability Evaluation; Gait; Gait Analysis; Humans; Malingering; Walking
PubMed: 34811997
DOI: No ID Found -
Heliyon Sep 2021Several general psychiatrists experience lack of confidence when they perform forensic psychiatric evaluations that may be due to limited or insufficient training. This...
OBJECTIVE
Several general psychiatrists experience lack of confidence when they perform forensic psychiatric evaluations that may be due to limited or insufficient training. This study aimed to determine whether structured forensic psychiatry educational modules are associated with general psychiatrists' self-confidence in conducting forensic psychiatric evaluations in Indonesia.
METHOD
A cross-sectional study was conducted with 246 general psychiatrists. A questionnaire was developed exclusively for this study by a group of experts based on relevant references and it was distributed online. Sample questions included: "How often do you perform forensic psychiatric evaluations?", "As a general psychiatrist, are you confident in conducting forensic psychiatric evaluations?", and "Do you experience any difficulties when conducting forensic psychiatric evaluations?" Data were analyzed through SPSS 20 for Windows; a p-value <0.05 indicated statistical significance.
RESULTS
Compared to general psychiatrists who did not study structured forensic psychiatry educational modules during their residency training, those exposed to such modules reported confidence in conducting forensic psychiatric evaluations in the following cases: insanity defense in cases of violence, insanity defense, fitness to stand trial, malingering, capacity to consent to treatment, risk of recidivism, guardianship, and parenting capacity. Furthermore, those with higher self-confidence were less likely to experience difficulties in conducting forensic psychiatric evaluations.
CONCLUSION
Structured forensic psychiatry educational modules during general psychiatry residency training played an important role in the development of psychiatrists' self-confidence.
PubMed: 34622054
DOI: 10.1016/j.heliyon.2021.e08045 -
Annals of Clinical and Translational... Oct 2021Data on fetal MRI in L1 syndrome are scarce with relevant implications for parental counseling and surgical planning. We identified two fetal MR imaging patterns in 10...
Data on fetal MRI in L1 syndrome are scarce with relevant implications for parental counseling and surgical planning. We identified two fetal MR imaging patterns in 10 fetuses harboring L1CAM mutations: the first, observed in 9 fetuses was characterized by callosal anomalies, diencephalosynapsis, and a distinct brainstem malformation with diencephalic-mesencephalic junction dysplasia and brainstem kinking. Cerebellar vermis hypoplasia, aqueductal stenosis, obstructive hydrocephalus, and pontine hypoplasia were variably associated. The second pattern observed in one fetus was characterized by callosal dysgenesis, reduced white matter, and pontine hypoplasia. The identification of these features should alert clinicians to offer a prenatal L1CAM testing.
Topics: Brain; Fetus; Humans; Magnetic Resonance Imaging; Male; Nervous System Malformations; Neural Cell Adhesion Molecule L1; Phenotype; Prenatal Diagnosis; Retrospective Studies
PubMed: 34510796
DOI: 10.1002/acn3.51448 -
Ultrasound in Obstetrics & Gynecology :... Sep 2021
Topics: Choroid Plexus; Cysts; Follow-Up Studies; Humans; Karyotyping; Trisomy
PubMed: 34468061
DOI: 10.1002/uog.23750