Review

Authors: Veronica Giorgione, Karina Krajden Haratz, Shlomi Constantini...

Fetal cerebral ventriculomegaly is a relatively common finding, observed during approximately 1% of obstetric ultrasounds. In the second and third trimester, mild (≥10 mm) and severe ventriculomegaly (≥15 mm) are defined according to the measurement of distal lateral ventricles that is included in the routine sonographic examination of central nervous system. A detailed neurosonography and anatomy ultrasound should be performed to detect other associated anomalies in the central nervous system and in other systems, respectively. Fetal MRI might be useful when neurosonography is unavailable or suboptimal. The risk of chromosomal and non-chromosomal genetic disorders associated with ventriculomegaly is high, therefore invasive genetic testing, including microarray, is recommended. Screening for prenatal infections, in particular cytomegalovirus and toxoplasmosis, should also be carried out at diagnosis. The prognosis is determined by the severity of ventriculomegaly and/or by the presence of co-existing abnormalities. Fetal ventriculoamniotic shunting in progressive isolated severe ventriculomegaly is an experimental procedure. After delivery, ventricular-peritoneal shunting or ventriculostomy are the two available options to treat hydrocephalus in specific conditions with similar long-term outcomes. A multidisciplinary fetal neurology team, including perinatologists, geneticists, pediatric neurologists, neuroradiologists and neurosurgeons, can provide parents with the most thorough prenatal counseling. This review outlines the latest evidence on diagnosis and management of pregnancies complicated by fetal cerebral ventriculomegaly.

Topics: Pregnancy; Child; Female; Humans; Prospective Studies; Hydrocephalus; Ultrasonography, Prenatal; Nervous System Malformations; Parents; Cerebral Ventricles; Prenatal Diagnosis

PubMed: 36371614
DOI: 10.1002/pd.6266

Authors: Laura Kathryn House, Andrea Furr Lewis

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

PubMed: 30571908
DOI: 10.15441/ceem.17.291

Authors: Elisabeth M S Sherman, Daniel J Slick, Grant L Iverson...

OBJECTIVES

Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545-561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field.

METHOD

The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms.

RESULTS

The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment.

CONCLUSIONS

The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.

Topics: Cognition Disorders; Cognitive Dysfunction; Humans; Malingering; Neuropsychological Tests; Neuropsychology; Reproducibility of Results

PubMed: 32377667
DOI: 10.1093/arclin/acaa019

Review

Authors: Vedat Şar, Martin J Dorahy, Christa Krüger...

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.

PubMed: 28496375
DOI: 10.2147/PRBM.S113743

Review

Authors: M S Bhatia

Pseudoseizures are paroxysmal alterations in behavior that resemble seizures but are without any organic cause. They are recognized by various terms. Pseudoseizures are found in about one fourth of all patients seen with hysteria and 20% of those referred to epilepsy clinic. Pseudoseizures are often difficult to differentiate because there are client based or clinician based factors leading to misdiagnosis. Detailed history, observation, psychological testing and laboratory investigations are used for correct diagnosis. Pseudoseizures are not only to be differentiated from various forms of epilepsy but also from disorders like malingering, somatization disorder, hyperventilation, migraine, syncope etc. Management consists of making the patient and relatives aware about the causation and diagnosis. Psychotherapy (supportive and psycho-dynamic), behavior therapy (biofeedback, relaxation), drugs (anxiolytic and anti-depressants), hypnosis and placebo are used for treatment. The correct recognition is helpful in avoiding physical tests and the unnecessary use of antiepileptic drugs.

Topics: Adolescent; Child; Diagnosis, Differential; Humans; Seizures; Somatoform Disorders

PubMed: 15297682
DOI: No ID Found

Authors: Mateo Boberg, Julie Nordgaard

This is a case report of a woman with a long history of schizophrenia. She suddenly "confessed" that she had been feigning symptoms all along. Taken at face value, this statement caused a delay in antipsychotic treatment followed by a serious deterioration of the patient's mental state. It became clear over time that several components of the patient's experience of lying were delusional in nature. The diagnosis of schizophrenia was once again validated and antipsychotic treatment resumed. Doctors are advised to be very careful when basing clinical decisions upon suspicion of malingering.

Topics: Female; Humans; Antipsychotic Agents; Malingering; Schizophrenia; Psychiatry

PubMed: 36999298
DOI: No ID Found

Authors: L J Salomon, Z Alfirevic, V Berghella...

Topics: Female; Gestational Age; Humans; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal

PubMed: 35592929
DOI: 10.1002/uog.24888

Authors: Renzo C Lanfranco, Juan Carlos Martínez-Aguayo, Marcelo Arancibia...

Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID's cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities' consistency and adaptation styles, aiding in malingering assessments in future studies.

Topics: Humans; Dissociative Identity Disorder; Malingering; Personality

PubMed: 38704614
DOI: 10.1080/13554794.2024.2348218