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PubMed2007

[Negative response bias and the validity of personality profiles in neuropsychiatric assessment].

Although symptom validity tests have become available to German test users during the last few years, there is very little research into measures of negative response bias in personality assessment. The present study investigates the effects of negative response bias as measured by the Word Memory Test (WMT) and the Structured Inventory of Malingered Symptomatology (SIMS) on self-report personality scales. A retrospective analysis was performed on data from 93 patients who had undergone neuropsychiatric assessment in the context of independent medical examination. Complete data sets were available for the WMT, the SIMS, and the Freiburg Personality Inventory-Revised (FPI-R). Significant differences were found for a number of personality scales, depending on WMT and SIMS classification. The FPI-R validity scale (Openness) was linked to neither WMT nor SIMS, whereas the results in the latter two instruments showed a significant overlap of classification results (phi=0.44). A principal axis analysis yielded corresponding results. It is concluded that self-report personality measures may be considerably distorted by negative response bias. FPI-R Openness scale scores do not allow any interpretation in terms of negative response bias. More effort should be directed in German-speaking countries towards the development and validation of appropriate validity scales.

Adult↗
PubMed2006

[Problems involved in expert opinions on acceleration injuries of the cervical spine].

Reasons for problems in stating an expert opinion on acceleration injuries of the cervical spine are numerous. The presence of unexpected or the absence of expected symptoms, the lack of objective proof for alterations or the presence of complaints that are difficult to prove, the discrepancy between recognizable force of the impact versus the resulting damage to the injured as well as the chance of being completely incapable of rendering proof that unquestionably a potentially damage-causing event is--beyond any reasonable doubt--the origin of an observed alteration in an injured individual are some of the problems a medical expert has to face when dealing with the analysis of injuries of the cervical spine. Unsatisfactory documentation in the patient's records, discussions about the reliability of diagnostic means or the interpretation of their results, difficult to procure evidence of accident-specific biomechanics and their direct or indirect impact on the body or neck of the injured person as well as distinguishing cervical sprain from mild brain damage, post-traumatic distress syndrome, cognitive disorder, psychiatric disease, aggravation, or malingering makes it hard for an expert to state an expert opinion.

Acceleration↗
PubMed1999

Information from false statements concerning visual acuity and visual field in cases of psychogenic visual impairment.

BACKGROUND: If visual acuity (VA) and/or visual field (VF) is claimed to be worse than in reality, it can be difficult to estimate the actual VA/VF. This paper describes a method of proving malingering and of estimating the actual VA by statistical evaluation of the subjective responses to discrete visual stimuli. METHODS: VA is measured by using a Landolt or Snellen optotype with four possible directions. There are n (> or = 16) questions at each acuity level. Each direction of the optotype occurs with the same frequency. The sequence is not predictable. In testing the VF, the stimulus is presented in an unpredictable sequence but with the same frequency at each of four distinct locations outside the claimed field at the horizontal and the vertical meridian. The field is divided into four quadrants defined by the 45 degrees-225 degrees and 135 degrees-315 degrees meridians. The candidate is requested to search for the light. The target quadrant of the first eye movement is recorded. At each VA level, the distribution function of the binomial formula allows estimation of the probability Pc of < or = kc and > or = kc correct answers to n questions by mere accident. Regarding the VF, the direction of the first saccade at each stimulus presentation can be processed accordingly. RESULTS: If n = 32 and kc = 0,1,2, the chance P that this pattern is merely accidental is about 0.0001, 0.001, 0.007. Values of P < or = 0.01 strongly suggest that the answers were voluntarily wrong. Preference for the opposite direction can also point to psychogenic influence: If ko = 15,16,17,18, P is about 0.006, 0.002, 0.0006, 0.0002. CONCLUSION: Systematically false statements can yield valuable information about the actual visual functions.

Adult↗
PubMed2005

Forensic applications of the Miller Forensic Assessment of Symptoms Test (MFAST): screening for feigned disorders in competency to stand trial evaluations.

Forensic evaluations must systematically assess malingering and related response styles. In the criminal forensic domain, competency to stand trial evaluations are the most common referrals. Effective screens for feigned incompetency would be valuable assets for forensic evaluations. This study evaluates the effectiveness of the Miller Forensic Assessment of Symptoms Test (MFAST) as a screen for feigned incompetency. Using a simulation design, the MFAST was tested on jail and competency-restoration samples. Most notably, recommended MFAST cut score (> or =6) was useful for the identification of feigning cases in competency evaluations. Recommendations for forensic practice, including the advantages and disadvantages of systematic screens, are discussed.

Adult↗
PubMed2006

Symptom overreporting and recovered memories of childhood sexual abuse.

The authenticity of recovered memories is a much debated issue. Surprisingly, no study has systematically looked at symptom overreporting in people claiming recovered memories of childhood sexual abuse (CSA). In a first sample we administered the Structured Inventory of Malingered Symptomatology (SIMS) to individuals who said they had recovered CSA memories (n=66), individuals who said their CSA had always been accessible (continuous CSA memory group; n=119), and controls who said they had no CSA experiences (n=83). In a second sample individuals reporting recovered (n=45) or continuous (n=45) CSA memories completed the Morel Emotional Numbing Test (MENT). Our aim was to compare these groups with regard to their tendency to overreport symptoms. The results indicate that people with recovered memories do not score higher on the SIMS and the MENT than other CSA survivors suggesting that symptom overreporting is not typical for people reporting recovered memories.

Adult↗
PubMed1985

Pain and deception: use of verbal pain measurement as a diagnostic aid in differentiating between clinical and simulated low-back pain.

The pain reports of 553 patients with low back pain and 347 healthy subjects faking low back pain were compared to determine if pain language can be employed as diagnostic aids in differentiating between clinical groups and groups attempting to feign a clinical condition. The best set of discriminating words correctly identified 90% of the subjects using 18 to 54 words in pain description, and 83% using 4 to 17 words in their pain report. The same pain words were used to categorize 366 new pain cases and 202 new fake cases. Cross-validation shrinkage was 8 and 7% respectively. Effectiveness in discriminating between pain and simulation was increased using selective cut-off scores. Patients in active treatment for back pain whose choice of pain words resemble those of the simulators reported 21% more clinical pain in a follow-up validation study suggesting that an accurate representation of malingering may have been achieved using a simulation research design.

Adult↗
PubMedDate not supplied

Detecting simulated amnesia for autobiographical and recently learned information using the P300 event-related potential.

To investigate whether the P300 (P3) event-related potential (ERP) can be used as an index of the intactness of recognition memory in subjects trying to simulate amnesia, two groups of subjects (n = 12 and n = 15) were instructed to simulate amnesia and one group of control subjects (n = 14) did not simulate amnesia while taking three recognition tests, during which ERPs were recorded. The three tests consisted of three different types of memory items: (1) the subject's birthday (birth), (2) the experimenter's name (name), (3) a word list of 14 nouns (words). The memory item was presented in a random series with other, similar in type, non-memory items. In group tests, memory items evoked larger amplitude P3s than non-memory items (p < 0.001). Within-subjects tests were used to determine whether the P3 amplitude in response to memory items was larger than the P3 amplitude in response to non-memory items for each individual. There was no difference between the sensitivity of the best within-subjects tests for amnesia simulators (birth = 0.9, name = 0.85, words = 0.53) versus non-simulators (birth = 1.0, name = 0.81, words = 0.5) averaged across the three test types. This suggests that P3 used as an index of the intactness of recognition memory may be useful in cases of suspected malingering.

Adult↗
PubMed1990

Incongruence between self-reported symptoms and objective evidence of respiratory disease among construction workers.

In clinical settings, self-reported symptoms and objective evidence of disease may be poorly correlated. In the present study, symptoms and objective evidence of pulmonary disease were compared in a community sample of construction workers with occupational exposure to asbestos. Symptoms of dyspnea and cough were assessed by a standardized questionnaire. The clinical examination included a chest X-ray, pulmonary function testing (PFT), and a physical examination. Both symptoms and objective clinical findings were strongly related to years in these trades. However, less than 1% of workers reported symptoms in the absence of any clinical evidence of disease. A similar low percentage of workers denied any symptoms yet produced clear evidence of pulmonary disease on clinical examination. Results were interpreted in terms of the variety of factors which have been associated with patients' readiness, and conversely, reluctance to report symptoms. The comparatively low frequency of incongruence between symptoms and objective clinical findings in this study suggests over emphasis of malingering by other authors. Health care might be improved if more attention is given by clinicians and researchers to patients who fail to report symptoms in the presence of disease.

Adult↗
PubMed2004

A comparison of WMT, CARB, and TOMM failure rates in non-head injury disability claimants.

Two-alternative forced-choice procedures have been the most widely employed for detecting incomplete effort and exaggeration of cognitive impairment. However, it cannot be assumed that different symptom validity tests (SVTs) are of equal sensitivity. In this study, 519 claimants referred for disability or personal injury related assessments were administered three SVTs, one based on digit recognition (Computerized Assessment of Response Bias, CARB), one using pictorial stimuli (Test of Memory Malingering, TOMM) and one employing verbal recognition memory (Word Memory Test, WMT). More than twice as many people failed the WMT than TOMM. CARB failure rates were intermediate between those on the other two tests. Thus, tests of recognition memory using digits, pictorial stimuli or verbal stimuli, all of which are objectively extremely easy tasks, resulted in widely different failure rates. This suggests that, while these tests may be highly specific, they vary substantially in their sensitivity to response bias.

Adult↗
PubMed2004

Setting empirical cut-offs on psychometric indicators of negative response bias: a methodological commentary with recommendations.

Malingering in neuropsychological assessment has been the subject of intense research for more than a decade and the detection methods arising from this work are diverse and sophisticated. However, the empirical findings are often presented in ways that limit the clinical utility of these techniques and may threaten their admissibility into legal proceedings. The purpose of this paper is to outline an approach for setting cut-offs on techniques designed to identify the presence of negative response bias. The use of this approach will result in the explicit specification of the error rate(s) of a given technique which can easily be applied by clinicians in the course of their practice and be admissible in court.

Bias↗
PubMed2005

Effects of severe depression on TOMM performance among disability-seeking outpatients.

The purpose of this study is to examine the effects of severe depression on the Test of Memory Malingering (TOMM). The present study examined whether 20 participants with high levels of depression, as measured by the Beck Depression Inventory 2nd Edition (BDI-II) and with current diagnoses of Major Depressive Disorder, would perform significantly worse on the TOMM than a control group. The results showed that the depressed and control groups did not have significant mean group differences on TOMM performance. Of the 20 depressed participants, only 2 on Trial 2 and 1 on the Retention Trial scored below the cutoff of 45, while none of the control participants performed in this range. The potential ameliorating effects of medications on the performance of the depressed group are discussed. The results indicate that the TOMM can be used with even severely depressed participants with only slight caution.

Adult↗
PubMed2006

Deception strategies in children: examination of forced choice recognition and verbal learning and memory techniques.

Thirty-five children ages 6-12 years were asked to complete two alternate forms of the Hopkins Verbal Learning Test-Revised (HVLT-R), once with the instruction to feign cognitive impairment and once instructed to do their best. They were also asked to complete the Test of Memory Malingering (TOMM). Regardless of condition, children performed comparably to adult norms on the TOMM, obtaining a score of 45 or above on Trial 2. Regarding the HVLT-R, differences emerged only when children were initially told to "do their best," followed by a subsequent trial in which they were told feign impairment. Within this group of participants, children demonstrated significantly lower levels of learning across trials and fewer words recalled in comparison to when they were instructed to do their best. In contrast, no reliable differences on the HVLT-R were observed among children who were initially told to feign impairment and subsequently told to do their best. These results suggest that the elicitation of "feigned" impairment within this age group on the HVLT-R requires the initial provision of an opportunity for optimal performance.

Age Factors↗
PubMed2006

Potential for interpretation disparities of Halstead-Reitan neuropsychological battery performances in a litigating sample.

The performances of 110 litigants on seven variables from the Halstead-Reitan neuropsychological battery (HRNB) were used to compare Heaton, Miller, Taylor, and Grant's (2004) Deficit Scale (DS) and Reitan and Wolfson's (1993) Neuropsychological Deficit Scale (NDS). Additional comparisons were made for people who passed or failed the Test of Memory Malingering (TOMM) to determine effects of effort on scores generated by either scoring system. Wilcoxon signed-rank tests revealed that all seven comparisons were significantly different for the full sample (p< or =0.001). The NDS indicated greater levels of impairment compared to DS across all variables. These findings were also obtained when considering effort, though TOMM failure was related to non-significant differences for two variables. These findings suggest that the two scoring systems are not equivalent, with Heaton et al.'s DS resulting in consistently higher identification rates of normal brain functioning compared to those generated from Reitan and Wolfson's NDS system.

Adult↗
PubMed2006

Pseudo-PTSD.

Pseudo-posttraumatic stress disorder (pseudo-PTSD) refers to cases in which a patient's presentation is but a simulation of the actual clinical syndrome. The problem of pseudo-PTSD has been neglected by many clinicians and researchers, who often rely on the assumption that a patient's reported symptoms can be accepted as valid. The purpose of this article is to (a) consider the diverse causes of pseudo-PTSD, (b) emphasize the importance of the DSM-IV's guideline to rule out malingering, and (c) discuss the implications that pseudo-PTSD has for research and clinical practice.

Compensation and Redress↗
PubMed2005

Ethical challenges in the management of chronic nonmalignant pain: negotiating through the cloud of doubt.

UNLABELLED: After successful cancer pain initiatives, efforts have been recently made to liberalize the use of opioids for the treatment of chronic nonmalignant pain. However, the goals for this treatment and its place among other available treatments are still unclear. Cancer pain treatment is aimed at patient comfort and is validated by objective disease severity. For chronic nonmalignant pain, however, comfort alone is not an adequate treatment goal, and pain is not usually proportional to objective disease severity. Therefore, confusion about treatment goals and doubts about the reality of nonmalignant pain entangle therapeutic efforts. We present a case history to demonstrate that this lack of proportionality fosters fears about malingering, exaggeration, and psychogenic pain among providers. Doubt concerning the reality of patients' unrelieved chronic nonmalignant pain has allowed concerns about addiction to dominate discussions of treatment. We propose alternate patient-centered principles to guide efforts to relieve chronic nonmalignant pain, including accept all patient pain reports as valid but negotiate treatment goals early in care, avoid harming patients, and incorporate chronic opioids as one part of the treatment plan if they improve the patient's overall health-related quality of life. Although an outright ban on opioid use in chronic nonmalignant pain is no longer ethically acceptable, ensuring that opioids provide overall benefit to patients requires significant time and skill. Patients with chronic nonmalignant pain should be assessed and treated for concurrent psychiatric disorders, but those with disorders are entitled to equivalent efforts at pain relief. The essential question is not whether chronic nonmalignant pain is real or proportional to objective disease severity, but how it should be managed so that the patient's overall quality of life is optimized. PERSPECTIVE: The management of chronic nonmalignant pain is moving from specialty settings into primary care. Primary care providers need an ethical framework within which to adopt the principles of palliative care to this population.

Chronic Disease↗
PubMed2007

MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance.

BACKGROUND: Idiopathic environmental intolerance (IEI) is a descriptor for nonspecific complaints that are attributed to environmental exposure. METHODS: The Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was administered to 50 female and 20 male personal injury litigants alleging IEI. RESULTS: The validity scales indicated no overreporting of psychopathology. Half of the cases had elevated scores on validity scales suggesting defensiveness, and a large number had elevations on Fake Bad Scale (FBS) suggesting overreporting of unauthenticated symptoms. The average T-score profile for females was defined by the two-point code type 3-1 (Hysteria-Hypochondriasis), and the average T-score profile for males was defined by the three-point code type 3-1-2 (Hysteria, Hypochondriasis-Depression). On the content scales, Health Concerns (HEA) scale was significantly elevated. CONCLUSION: Idiopathic environmental intolerance litigants (a) are more defensive about expressing psychopathology, (b) express distress through somatization, (c) use a self-serving misrepresentation of exaggerated health concerns, and (d) may exaggerate unauthenticated symptoms suggesting malingering.

Adult↗
PubMed2005

Reevaluating spells initially identified as cataplexy.

BACKGROUND AND PURPOSE: Cataplexy, transient episodes of bilateral muscle weakness with areflexia provoked by emotions, is a state highly specific to narcolepsy. Cataplexy is diagnosed based on clinical interview. Two screening tools have been developed recently but their usefulness has been limited because of length or current lack of psychometric data. Used effectively even these screening tests require the interpreting physician to have an understanding of the typical features of cataplexy. Most physicians encounter patients with cataplexy fairly infrequently, making it difficult to gain proficiency in detecting cataplexy based on clinical interview alone. Relatively little attention has been given to the differential diagnosis of cataplexy, which increases the likelihood of unnecessary sleep testing or false positive diagnosis. PATIENTS AND METHODS: This case series describes six cases where cataplexy was initially diagnosed. In all cases the weakness spells were eventually not attributed to cataplexy. The presentation and characteristics of these cases will be presented as a means to discuss the differential diagnosis of cataplexy. RESULTS: These cases represent a diverse set of medical disorders including bradycardia, migraine, delayed sleep phase syndrome, conversion disorder, malingering and a chronic psychotic disorder. CONCLUSIONS: A more in-depth understanding of the classic features of cataplexy should improve recognition of this fascinating state. Improved cataplexy recognition will enhance the appropriate usage of sleep tests and eventually increase the timeliness and accuracy of the diagnosis of narcolepsy with cataplexy.

Adolescent↗
PubMed1999

Disorders of smell and taste.

As with almost any aspect of medical practice, a thorough history and physical examination coupled with a good understanding of the anatomy and physiology of an organ system are the key factors in reaching a diagnosis. The information in this article is provided to assist the internist with the diagnosis of chemosensory disorders and the differentiation of malingering or other disease process as well as providing insight into the workup, prognosis, and treatment of patients with taste and smell disorders.

Diagnosis, Differential↗