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PubMedDate not supplied

Does posturography differentiate malingerers from vertiginous patients?

Voluntary, simulated vertigo and acute vertigo due to vestibular neuritis were examined by means of static posturography in 81 tests to evaluate the extent to which intentional malingering can be detected. Thirty healthy, normal subjects were first instructed to stand as still as possible on a static force platform and then to simulate dizziness. The true cases consisted of 21 patients with vestibular neuritis. The parameters analyzed included body sway velocity (BSV), body sway area of ellipse (BSE), and the Romberg quotient. Both the simulated and pathological posturographic BSV and BSE values differed from normal values under all test conditions, but they did not differ from each other, whereas the simulated values could be differentiated from the pathological ones with the Romberg quotient based on BSV. Five staff members of our audiological department were able to differentiate between the simulations and pathological cases quite well, with a median sensitivity of 0.77 and a specificity of 0.71 in a blinded test. A posturographic measurement, even performed once, can be useful to some extent for detecting simulation, but more investigation and development of the analysis system is required to obtain more specific results. For the present, the results obtained by trained observation of the subject in the test situation are at least as reliable as those obtained through the analysis of statistical measurements.

Adult↗
PubMedDate not supplied

Misdiagnosed HIV infection in pregnant women: implications for clinical care.

Out of nearly 900 women in a research study of human immunodeficiency virus infection in pregnancy, 8 were subsequently found not to be infected. Misdiagnoses could have resulted from (a) laboratory errors or specimen mixups; (b) failure to follow the testing algorithm recommended by the Centers for Disease Control and Prevention to confirm results; (c) women perceiving they were infected by high-risk behavior in the absence of testing, despite the receipt of negative test results, or based on screening results only; or (d) factitious disorder, HIV Munchausen syndrome, or malingering. Because of the potentially devastating impact of an HIV diagnosis and the toxicity of HIV therapies, health care providers should obtain independent confirmation of the diagnosis before initiating treatment or followup for HIV based on patient report or provider referral. Quality test interpretation and counseling must be ensured. Therapeutic interventions may be indicated for persons intentionally and falsely presenting themselves as HIV-infected.

Adult↗
PubMedDate not supplied

[Neuropsychological findings in a case of simulation].

The case of a malingerer is reported with special emphasis on the neuropsychological findings. The diagnosis of malingering is a challenge to medicine, and neuropsychology can come to be an efficient instrument, once greater experience is achieved, and the results can be systematized and generalized. Nevertheless, it must be kept in mind that the manifestations are specially subject to sociocultural, geographic and temporal factors.

Adult↗
PubMed1977

Psychological factors in pediatric optometry.

There are many special considerations and unique approaches applicable in the optometric care of children. In pursuing diagnostic procedures, the behavioral adjustment and responsiveness of the child during the examination proceedings may be optimally managed through an appropriate atmosphere and demeanor. Malingering and other interrelationships of behavioral anomalies and visual disorders may be understood and analyzed in relevant contexts. In pursuing procedures in treatment, approaches in prescribing lenses may be associated with resistance on the part of the child or parent, and may relate to personality characteristics and changes. The application of thoughtful techniques may facilitate maximal progress in a therapy program of visual training. Furthermore, complex psychological problems may coexist with visual disorders in learning disabilities, where broad aspects of development are of concern. Finally, the effective care of routine cases or of learning disabled children requires careful communication and counseling with parents.

Child↗
PubMed1993

Multiple personality disorder: scientific and medicolegal issues.

Despite the intense study it has received since its inclusion in DSM-III, multiple personality disorder (MPD) largely remains an unvalidated construct. Definitional problems remain (there is not even agreement in the field as to whether a diagnosis of MPD truly means the existence of more than one personality), while the vagueness and liberality of existing criteria give the clinician little guidance in diagnosis. In forensic settings, diagnosis of MPD is even more problematic, since there is substantial evidence that the disorder cannot currently be phenomenologically distinguished from malingering. It also remains to be demonstrated that evaluators can determine whether alter personalities, if they exist, are truly unaware of each other, lack control over other alters' behavior, or are unable to know right from wrong.

Dissociative Identity Disorder↗
PubMed1993

Psychologic assessment of patients with industrial hand injuries.

The benefits and rationale for including a psychologic assessment of a patient with an industrial hand injury are discussed. Issues of compliance and malingering in patients are addressed. The role of pre-existing conditions in understanding an injured patient's current emotional state is explored and contrasted with posttraumatic stress disorders. Recent trends in psychologic assessment techniques are highlighted.

Accidents, Occupational↗
PubMed1996

[Voluntary changes of visual evoked potentials in cases with hysteria and/or simulation].

We report a 25-year-old woman with gradual loss of visual acuteness, during puerperium and blindness in fifteen days. Two months latter she remain steady. Visual evoked potentials using monocular checkerboard pattern-reversal, were abnormal. Clinical suspicion of voluntary alteration of VEP was considered. A second VEP exploration with binocular stimulation and maneuvers of distraction were carried out. Normal VEP were recorded. Deliberate alteration of the visual evoked potential should be considered in patients suspicious of hysteria or malingering.

Adult↗
PubMedDate not supplied

[The set-related behavior of patients with vibration-induced disease].

Data are submitted on patients with vibration disease, showing a disposition to malingering in this particular patient population, which fact necessitates its recognition in settling questions related to expert evaluation of the work fitness. Recommendations are offered on approaches to avoiding expert errors.

Adult↗
PubMed1998

Unrecognized Tourette syndrome in adult patients referred for psychogenic tremor.

BACKGROUND: The diagnosis of Tourette syndrome may be overlooked in patients with severe psychopathologic disorder but mild motor manifestations of Tourette syndrome. OBJECTIVE: To describe 4 patients with long-lasting general psychopathologic disorder and previously unrecognized mild motor and phonic tics exacerbated during adulthood by the onset of tremor; all of the patients had been referred for the evaluation of psychogenic tremor. SUBJECTS: Four adult patients, with previous psychiatric diagnoses of depression (2 cases), generalized anxiety disorder (3 cases), malingering (1 case), and conversion disorder (3 cases). METHODS: Single case studies. RESULTS: Clinical interviews disclosed that the 4 patients had positive family histories of Tourette syndrome, and all had mild motor and phonic tics that had started before the age of 18 years. On neurologic examination, 2 patients had bilateral postural tremor of the hands that varied in frequency, rhythmicity, and amplitude, and the other 2 had resting tremor mimicking parkinsonism. All 4 patients described involuntary somatic sensations of the affected limbs, which they attempted to alleviate by executing movements. No consistent positive placebo response was observed, but in all patients tremoric movements improved with haloperidol. CONCLUSIONS: These cases illustrate an unusual movement disorder (tremor as a "tic equivalent") in adults with Tourette syndrome and emphasize that cases of the syndrome with mild tics often go unrecognized, precluding adequate treatment.

Adult↗
PubMed1988

Reflex sympathetic dystrophy syndrome in children and adolescents. Report of 18 cases and review of the literature.

Reflex sympathetic dystrophy syndrome is a well-recognized disorder in adults, but it is rarely diagnosed in the pediatric age group. This report summarizes our experience with this condition from 1975 to 1985. We diagnosed, treated, and followed up this condition in 18 children and adolescents. The condition usually followed trauma. The most prominent feature in all patients was a constant limb pain with episodes of paroxysmal exacerbation. The pain was associated with two or more of the following: edema, hyperhidrosis or anhidrosis, cyanosis or erythema, and, in severe cases, dystrophic skin changes and muscle atrophy. Roentgenograms were normal. Bone scans were helpful to exclude other possible causes of bone and joint pain. Reflex sympathetic dystrophy syndrome in children probably often goes unrecognized, sometimes being confused with psychiatric conditions such as conversion reaction and malingering. Reflex sympathetic dystrophy syndrome should always be considered in the differential diagnosis of unexplained persistent limb pain in children: early recognition and proper management may result in the prevention of potentially crippling sequelae.

Adolescent↗
PubMed1999

Challenging a flexible neuropsychological battery under Kelly/Frye: a case study.

The ability of the flexible neuropsychological battery approach to withstand a challenge under California's evidentiary standard, Kelly/Frye, was tested in an actual trial. Despite repeating many criticisms offered by the literature (e.g., no malingering measures, unknown accuracy rates, ignoring statistical limitations, not using age norms), the battery was allowed in "for the weight of the evidence," rather than being excluded as unreliable.

Brain Injury, Chronic↗
PubMed1986

The detection of faking on the Millon Clinical Multiaxial Inventory (MCMI).

This study investigated the effects of a variety of faking strategies on the Weight Factor correction scores (designed to detect malingering) of the Millon Clinical Multiaxial Inventory, a relatively new personality questionnaire. Subjects (both psychiatric patients [N = 95] and general medical/surgical controls [N = 90]) were asked to take the MCMI according to one of the following instructional sets: traditional faking-good; traditional faking-bad; role faking-positive; role faking-negative; role faking-neutral; and honest. The results indicated that neutral social role faking resulted in no significant differences in weight factor correction from subjects in the honest condition and that directionally role faked profiles did not differ in correction from those in the traditional "best" and "worst" conditions. Finally, only the Weight Factor corrections in the protocols from the fake bad conditions (whether in traditional "worst" or negative social role conditions) differed significantly from those in the honest conditions for both subject groups. Implications for the practicing clinician are discussed.

Adult↗
PubMed1992

Syncope and seizures of psychogenic origin: identification with head-upright tilt table testing.

Psychogenic seizures and psychogenic syncope are common disorders but are difficult to identify. Head-upright tilt table testing has emerged as a promising means of evaluating vasovagally mediated syncope and convulsive syncope. Of a total of 42 patients evaluated by head-up tilt for recurrent syncope and 10 evaluated for recurrent idiopathic seizures, a total of 5 patients experienced syncope and 3 had tonic-clonic seizure activity unaccompanied by any significant changes in blood pressure, heart rate, transcranial Doppler cerebral blood flow velocity, and electroencephalographic monitoring. Psychiatric evaluation revealed that seven patients suffered from conversion reactions and one from probable malingering. We conclude that patients who pass out or convulse during head-upright tilt without any change in physiologic parameters can be presumed psychogenic in origin and may be referred for psychiatric evaluation without further expensive diagnostic studies.

Adolescent↗
PubMed2008

The Assessment of Depression Inventory (ADI): an appraisal of validity in an outpatient sample.

In this study we examined the validity of the Assessment of Depression Inventory (ADI) using outpatient participants. The ADI Depression scale (Dep) was compared to three other measures used to assess depression: Beck Depression Inventory-II (BDI-II), Zung Self-Rating Depression Scale (ZSDS), and Personality Assessment Inventory (PAI). Correlations between the ADI and these three measures were significant. An analysis of the discriminant ability of the ADI Dep scale resulted in sensitivities, specificities, positive predictive power, negative predictive power, hit rate, and area under the curve (92.3%) that were supportive of the scale's effectiveness. The ADI Feigning scale (Fg) was compared to the six PAI validity scales. The Fg scale correlated significantly with the PAI Negative Impression Management (NIM) and Positive Impression Management (PIM) scales, and the Malingering (MAL) and Defensive (DEF) indexes. Directionality was as would be predicted. The ADI did not correlate with the two PAI validity scales derived by discriminant analysis function.

Ambulatory Care↗
PubMed1996

Clinical consequences of the EI/MCS "diagnosis": two paths.

There are two distinct paths down which patients "diagnosed" with environmental illness/multiple chemical sensitivities (EI/MCS) can travel. Along the first path, beliefs about low-level, multiple chemical sensitivities as the cause of physical and psychological symptoms are instilled and reinforced by a host of factors including toxicogenic speculation, iatrogenic influence mediated by unsubstantiated diagnostic and treatment practices, patient support/advocacy networks, and social contagion. Intrapsychic factors also reinforce this path through the motivational mechanism of factitious malingering, or unconscious primary and secondary gain, mediated through psychological defenses, particularly projection of cause of illness onto the physical environment. The second path involves restructuring distorted beliefs about chemical sensitivities. Explanations of the placebo effect, the physiology of the stress response, and the symptoms of anxiety and panic facilitate the direction of EI/MCS patients onto this path. A decision model is presented to discriminate among toxicogenic and psychogenic explanations of the EI/MCS phenomenon, based on appraisal of reaction and physiologic and cognitive responses during provocation chamber challenges under double-blind, placebo-controlled conditions. These studies have been helpful therapeutically for some patients in selecting the path that leads to wellness. This paper suggests how various therapeutic techniques can be employed with difficult patients. Often, supportive psychotherapy establishes a therapeutic alliance which facilitates cognitive therapy to restructure distorted beliefs. In the process of finding alternative explanations to chemical sensitivities, the etiology of symptoms is related to stressful life events, including childhood experiences which may have disrupted normal personality development and coping capacity. Furthermore, biological and physiological sequelae stemming from early, chronic trauma have been identified which could explain many of the multisystem complaints. The incidence of childhood abuse reported by EI/MCS patients is strikingly high, and it is recollection of trauma that many EI/MCS patients avoid by displacing the psychologic and physiologic adults sequelae onto the physical environment. The reenactment of these experiences may be necessary in the therapy of some affected individuals. Despite the significant therapeutic effort expanded, some patients who are imprisoned by a closed belief system about the harmful effects of chemical sensitivities are resigned to travel down the path which ultimately leads to despair and depression, social isolation, and even death.

Child↗
PubMed1991

Forensic neuropsychology: the art of practicing a science that does not yet exist.

Despite its future promise, neuropsychological evidence generally lacks scientifically demonstrated value for resolving legal issues, and thus, if admitted into court, should be accorded little or no weight. In support of this contention, examples of problems and limits in forensic neuropsychology are described. These include contrasts between the clinical and forensic context; the base-rate problem; lack of standardized practices; problems assessing credibility or malingering; difficulties determining prior functioning, limits in the capacity to integrate complex data; and the lack of relation between judgmental accuracy and education, experience, or credentials. Some possible counterarguments are also addressed.

Activities of Daily Living↗
PubMed1996

A taxonomy of neurobehavioral functions applied to neuropsychological assessment after head injury.

Neuropsychological dysfunctions after traumatic brain injury are classified into a taxonomy to plan a comprehensive examination, and organize and report findings for diagnosis and treatment: consciousness, information processing, sensorimotor, neurophysiological, cerebral personality disorders, intelligence, memory, language, stress, psychodynamic, identity and weltanschauung, adaptation, complex adaptive functions, and development of children. Wide-range sampling enhances the detection of acute and late-developing dysfunctions, and diagnosis of complex syndromes. Historical, personality, and injury data are components of the assessment. Issues discussed include underestimation of brain injury, malingering, interaction of symptoms, symptom persistence, and noncerebral lesional contributors to impairment after mild head injury.

Brain Damage, Chronic↗
PubMed1999

Truths, errors, and lies around "reflex sympathetic dystrophy" and "complex regional pain syndrome".

The shifting paradigm of reflex sympathetic dystrophy-sympathetically maintained pains-complex regional pain syndrome is characterized by vestigial truths and understandable errors, but also unjustifiable lies. It is true that patients with organically based neuropathic pain harbor unquestionable and physiologically demonstrable evidence of nerve fiber dysfunction leading to a predictable clinical profile with stereotyped temporal evolution. In turn, patients with psychogenic pseudoneuropathy, sustained by conversion-somatization-malingering, not only lack physiological evidence of structural nerve fiber disease but display a characteristically atypical, half-subjective, psychophysical sensory-motor profile. The objective vasomotor signs may have any variety of neurogenic, vasogenic, and psychogenic origins. Neurological differential diagnosis of "neuropathic pain" versus pseudoneuropathy is straight forward provided that stringent requirements of neurological semeiology are not bypassed. Embarrassing conceptual errors explain the assumption that there exists a clinically relevant "sympathetically maintained pain" status. Errors include historical misinterpretation of vasomotor signs in symptomatic body parts, and misconstruing symptomatic relief after "diagnostic" sympathetic blocks, due to lack of consideration of the placebo effect which explains the outcome. It is a lie that sympatholysis may specifically cure patients with unqualified "reflex sympathetic dystrophy." This was already stated by the father of sympathectomy, René Leriche, more than half a century ago. As extrapolated from observations in animals with gross experimental nerve injury, adducing hypothetical, untestable, secondary central neuron sensitization to explain psychophysical sensory-motor complaints displayed by patients with blatantly absent nerve fiber injury, is not an error, but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies particularly when entrepreneurially inspired are condemnable and call for peer intervention.

Causalgia↗