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PubMed1990

MMPI subtle-obvious scales and malingering: clinical versus simulated scores.

Subtle-obvious scale discrepancies on the Minnesota Multiphasic Personality Inventory were compared for pathology simulators and clinical groups to test the hypothesis that subtle-obvious scores help differentiate simulators. Total obvious minus subtle T score discrepancy greater than 100 discriminated the student malingerers and produced few false positives among clinical populations such as psychiatric inpatients and outpatients. The hypothesis that these clinical patients score high on these indices of malingering as a baserate or as a cry for help was rejected. These data suggest that there are differences between simulators and clinical patients, which are detectable by use of subtle-obvious scores, and that this procedure bears further exploration.

Adult↗
PubMed1999

The detection of malingering.

A 60-item paper-and-pencil inventory showed a 98% "hit-rate" in distinguishing between honest and simulated malingering protocols produced by 29 nonclinical subjects who took the inventory in both the honest and faked conditions. When instructed to take the Wildman Symptom Cheklist "as if applying for some kind of disability compensation," subjects endorsed a significantly higher number of the self-statements which appear clinically unbelievable. Independent replication is now required.

Adult↗
PubMed2000

Are brain-damaged patients inappropriately labeled as malingering using the 21-item Test and the WMS-R Logical Memory Forced Choice Recognition Test.

This study examined the false positive hit rate of the 21-item Test and the WMS-R Logical Memory Forced Choice Recognition Test and compared the relationship between the measures in classifying biased responding/malingering. Of 40 patients referred for comprehensive neuropsychological evaluation, 18 were classified as brain-damaged based on independent neurological or neuroradiological examination. The remaining 22 patients could not be so classified on neurological or neuroradiological evidence and thus served as a medical control group. Findings indicated the brain-damaged group performed more poorly than did the control group across measures, and both groups, on the average, performed markedly better than that required to suggest biased responding. Also, taking both tests together, no individual patient was classified as malingering.

Brain Injuries↗
PubMed1979

Malingering: a dangerous diagnosis.

Karl Kast, a migrant with a bad back, was examined by four Brisbane orthopaedic surgeons who all independently agreed that there was no physical basis for his complaint. After brooding over this for months, he resolved to kill these doctors and shot three (killing two) before taking his own life. This tragedy and its background are summarized, and a second instance is recorded where a surgeon could have been killed by another accident litigant. There is more to emotional disturbance after injury than a mere quest for compensation. Doctors who hold this simple belief may be at risk if they do not carefully handle the rare cases of severe and dangerous mental illness which masquerade as malingering.

Australia↗
PubMed2000

A collaborative approach to managing student malingering.

The authors present a case study of a successful collaborative effort to reduce student malingering in a school-based health center and to address the academic and social problems related to overuse of center services. School-based health centers have been identified as important sources of support for teenagers who have emotional and psychological problems, and, in this case, the overuse of a school-based health center is linked to such challenges for a substantial subset of students. It demonstrates that it is possible to identify, based on their status as frequent center users, students with potentially serious academic, family, or personal problems who are at risk for academic failure. The case involves multiple professionals, from a variety of disciplines, who dealt successfully with the problems associated with overuse of center services.

Adolescent↗
PubMed2003

Detecting malingered performance on the Wechsler Adult Intelligence Scale. Validation of Mittenberg's approach in traumatic brain injury.

This study assesses the effectiveness of the Wechsler Adult Intelligence Scale (WAIS) performance validity markers devised by Mittenberg et al. [Prof. Psychol.: Res. Pract. 26 (1995) 491] in the detection of malingered neurocognitive dysfunction (MND). Subjects were 65 traumatic brain injury (TBI) patients referred for neuropsychological evaluation. Twenty-eight met the Slick et al. [Clin. Neuropsychol. 13 (1999) 545] criteria for at least probable MND. The control group was comprised of 37 patients without external incentive and who thus did not meet the Slick et al. criteria. All subjects completed the Wechsler Adult Intelligence Scale-Revised (WAIS-R or WAIS-III). The discriminant function score (DFS) and the vocabulary-digit span (VDS) difference score were calculated and sensitivity, specificity, and predictive power were examined for several cut-offs for each marker individually and the two combined. Classification accuracy for the DFS was acceptable and better than for VDS. The use of the two markers in combination resulted in no incremental increase in classification accuracy. Issues related to the clinical application of these techniques are discussed.

Adult↗
PubMed1992

Improvements in the M test as a screening measure for malingering.

Recent studies of the M have failed to confirm its effectiveness as a screening measure for malingering. The present study involved a further analysis of 99 cases reported by Gillis et al. and the construction of Rule-Out and Rule-In scales. Both scales evidence excellent internal reliability, and their combined use was effective in accurately screening greater than 80 percent of potential malingerers.

Disability Evaluation↗
PubMedDate not supplied

[Malingering in the clinical setting].

This article presents an overview of advances in the clinical and neuropsychological assessment of malingering, issues in diagnostic differential, neuropsychological and psychodynamic test methods, and special issues presented by medical - legal context, and other factors which may affect presentations. Cautions and recommendations for practice are presented.

Diagnosis, Differential↗
PubMed1990

[Low back pain malingering].

As in the case of other painful conditions, patients with low back pain may exhibit symptoms of malingering and of decreased function. This may occur at a conscious or a subconscious level. Certain signs in the case history and the clinical examination are typical of malingerers. Local treatment of symptoms may cause an exaggeration of the patients decreased function. Treatment should focus on possible underlying psycho-social problems. Sick leave should be avoided if possible during the treatment period.

Back Pain↗
PubMed1986

The myth of malingering: why individuals withdraw from work in the presence of illness.

Federal policy to provide income to workers disabled by chronic illness has been under attack. Data from the Social Security Administration Survey of Disability and Work reveal that anticipation of higher levels of disability income does not correlate with cessation of work; the nature of illness and the structure of work do. Policies predicated on the myth of malingering will hurt millions of the disabled chronically ill.

Adult↗
PubMed1977

A review of malingering and hysteria in clinical practice.

Hysteria and malingering, both commonly seen, especially in orthopaedic clinics, are reveiwed. Advances in psychology and psychiatry are often unknown or ignored by surgeons, who may thus mistreat or misdiagnose a multitude of conditions.

Diagnosis, Differential↗
PubMed1994

Malingering behavior in private medical practice.

Malingering behavior presents a tremendous and unfair burden on our nation's health care system. Physicians must be prepared to identify and diplomatically discourage such abuse whenever possible. Failure to do so could jeopardize the economy of the entire health care system and will prevent good care from reaching those in most need of it at affordable rates.

Humans↗
PubMed1996

The erroneous diagnosis of malingering in a military setting.

The paper describes difficulties in diagnosing individuals from different cultures, focusing specifically on cases of erroneous diagnosis of malingering among ultraorthodox Jewish inductees. During one year, 24 inductees diagnosed as malingerers by several army psychiatrists were re-examined by the authors and subsequently re-diagnosed as psychotic, suffering from a personality disorder, or mentally retarded. Factors underlying the misdiagnosis are discussed.

Adolescent↗
PubMed1996

When Munchausen becomes malingering: factitious disorders that penetrate the legal system.

Psychiatrists and other physicians are usually familiar with factitious disorders, but attorneys and judges usually are not. Cases involving factitious disorders may enter the civil legal system in a number of ways and cause incorrect judgements, financial costs, and inappropriate medical care if these disorders are not identified. Psychiatric consultants may play a key role in identifying these cases and educating legal personnel about factitious disorders. This article describes three cases in which persons with factitious disorders entered the civil litigation system. The role of the psychiatrist in these cases is discussed. Clues to the identification of factitious disorders are described. The article also discusses the differentiation of factitious disorders from malingering and other forms of abnormal illness behavior, such as conversion, hypochondriasis, and somatization disorders. The concepts of primary and secondary gain in relationship to illness behaviors are elaborated.

Adult↗
PubMed1997

The 48-Pictures Test: a two-alternative forced-choice recognition test for the detection of malingering.

We tested the validity of the 48-Pictures Test, a 2-alternative forced-choice recognition test, in detecting exaggerated memory impairments. This test maximizes subjective difficulty, through a large number of stimuli and shows minimal objective difficulty. We compared 17 suspected malingerers to 39 patients with memory impairments (6 amnesic, 15 frontal lobe dysfunctions, 18 other etiologies), and 17 normal adults instructed to simulate malingering on three memory tests: the 48-Pictures Test, the Rey Auditory Verbal Learning Test (RAVLT), and the Rey Complex Figure Test (RCFT). On the 48-Pictures Test, the clinical groups showed good recognition performance (amnesics: 85%; frontal dysfunction: 94%; other memory impairments: 97%), whereas the two simulator groups showed a poor performance (suspected malingerers: 62% correct; volunteer simulators 68% correct). The two other tests did not show a high degree of discrimination between the clinical groups and the simulator groups, except in 2 measures: the 2 simulator groups tended to show a performance decrement from the last recall trial to immediate recognition of the RAVLT and also performed better than the clinical groups on the immediate recall of the RCFT. A discriminant analysis with the latter 2 measures and the 48-Pictures Test correctly classified 96% of the participants. These results suggest that the 48-Pictures Test is a useful tool for the detection of possible simulated memory impairment and that when combined to the RAVLT recall-recognition difference score and to the immediate recall score on the RCFT can provide strong evidence of exaggerated memory impairment.

Adult↗
PubMed1998

Ethics, Malingering, and a lie-detector at the bedside.

A psychiatric consultation is presented in which the physician uses a cardiac monitor in the manner of a lie-detector. Ethical analysis of a clinician's duties in cases of suspected malingering addresses both the standard of informed consent necessary for such assessments and the potential forensic consequences of unanticipated clinical findings.

Duty to Warn↗
PubMed1994

Malingered and Defensive Response Styles on the MMPI-2: An Examination of Validity Scales

The MMPI and more recently the MMPI-2 have been held to be the clinical standard for assessing both fake-good and fake-bad response styles. In a contrasted-groups design, we compared simulators under fake-good (n = 67) and fake-bad (n = 58) instructions to controls (n = 90) and psychiatric patients (n = 95) under standard instructions. For fake-good profiles, we found that F-K < -12 had a hit rate of 80.6% and was partly supported by earlier research (Austin, 1992). For fake-bad profiles, F > 89 and F-K > 7 were the optimum cutting scores with hit rates of 86.2% and 87.0%, respectively. Unfortunately, previous research fails to confirm these cutting scores and leading proponents of the MMPI-2 substantially disagree on what methods to employ. Therefore, we recommend in cases of suspected malingering that the MMPI-2 be used only for screening purposes.

Journal Article↗