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PubMed2004

An examination of the ECST-R as a screen for feigned incompetency to stand trial.

Psychological assessments of competency-to-stand-trial (CST) referrals must consider whether the defendants' impairment is genuine or feigned. This study addressed feigning on the Evaluation of Competency to Stand Trial--Revised (ECST-R), a standardized interview designed for assessing dimensions of CST and screening for feigned CST. In particular, this study examined the effectiveness of the ECST-R's Atypical Presentation (ATP) scales as screens for feigned incompetency. It examined ATP scales for (a) jail detainees (n=96) in simulation and control conditions and (b) inpatient competency cases (n=56) in clinical comparison and probable malingering groups. Comparisons of ATP scales yielded very large effect sizes for feigners when compared with jail controls (mean d=2.50) and genuine inpatient competency cases (mean d=1.83). Several cut scores were established with very few false negatives and robust sensitivity estimates. In summary, the ECST-R ATP scales appear to be homogenous scales with established clinical use as feigning screens in CST evaluations.

Crime↗
PubMed1999

Headaches and face pains as a manifestation of Munchausen syndrome.

Virtually every psychological or physical symptom may be feigned in order to assume a sick role; the term Munchausen syndrome is applied when the physical features are predominant. Complaints of headache as a manifestation of this condition are rare. We report such a case and review the literature of similar cases. A 34-year-old man consulted several headache specialists in different cities. Many different diagnoses were made, consistent with the various histories the patient related. It seems most unlikely that any one individual could experience 14 distinct headache disorders. Dozens of medications were prescribed, and a dozen or more were taken by the patient daily. People with Munchausen syndrome consciously feign physical symptoms and signs because of the apparently senseless need to assume a sick role. This condition is distinguished from malingering in which the symptoms are consciously feigned for personal gain and from somatoform disorder in which development of symptoms for psychological purposes is unconscious. Primary headache disorders, once thought to have a psychological basis, are now recognized as biological disorders. Though psychogenic mechanisms have been largely discredited, rarely, as illustrated by the present case, psychological mechanisms are predominant.

Adult↗
PubMed2001

Forensic issues in pain: review of current practice.

Forensic activity in pain practice is reviewed with reference to the differing roles of the pain clinician and the independent expert. Ethical guidelines and recommendations for assessment, documentation, record review, and court testimony are discussed. Specific issues include the assessment of disability and impairment, malingering, and application of the Daubert standard in forensic pain practice. Examples of case law are reviewed for civil liability and CRPS, malpractice with opioid prescribing, and practice issues in a correctional setting.

Journal Article↗
PubMed1997

Neuropsychological Outcome, Post Concussion Symptoms, and Forensic Considerations in Mild Closed Head Trauma.

Controversy regarding the long-term outcome of mild head trauma (MHT) is discussed. Variable results are related to potential methodological problems such as failure to consider issues of sensitivity, specificity, base-rates of symptoms in non-injured populations, and failure to match control to MHT subjects on demographic and motivational factors. Meta-analytic data from well-conducted studies show good long-term neuropsychological recovery for most persons who have sustained MHT. Symptom base-rate data show poor specificity for several so-called "post-concussion" symptoms, which occur frequently in non-brain damaged populations. Persistence of "post-concussive" complaints is considered as a function of somatization, which is potentially amenable to effective cognitive behavioral treatment. Forensic aspects of MHT are discussed, with particular reference to appropriate methods of clinical and scientific inference, and evaluation for malingering.

Journal Article↗
PubMed2001

[Nonorganic disorders in ophthalmology: overview of diagnosis and therapy].

BACKGROUND: Nonorganic diseases may be psychogenic (somatoform diseases) or due to malingering. Both occur frequently in the ophthalmologic practice. METHODS: This article reviews the different diagnostic and therapeutic procedures in nonorganic ocular diseases. RESULTS: After presenting the general symptoms, the origins of psychogenic diseases are discussed. Then, the specific tests used in ophthalmology to diagnose nonorganic diseases and the organic eye diseases most frequently confused with nonorganic diseases will be reported. At the end, we will discuss the treatment and the prognosis of psychogenic diseases. CONCLUSION: An early diagnosis of nonorganic diseases is important, since a delayed diagnosis may worsen their prognosis.

Diagnosis, Differential↗
PubMed2001

[Functional reduction of vision symptomatic of a conversion reaction in paediatric population].

BACKGROUND: First case reports of psychogenic visual disorders date back into the 19th century. Nowadays we speak of functional visual disorders of somatoform origin, a conversion reaction in which neurotic conflicts are solved on somatic level. This is the initial kind of reduction of agitation specially in children. In contrary to malingering and aggravation conversion symptoms are unconscious actions. Besides the problems of numerous specific tests for differential diagnosis between organic and functional disturbances strategies for further management are necessary. PATIENTS AND METHODS: 26 patients at the age of 8 - 17 years with isolated reduction of vision due to conversion reaction were analyzed referring to sex, age, wether one or both eyes were affected, the duration of symptoms, the possible reasons for the conversion reaction and the further management. RESULTS: 75 % of our patients were females, the average was 12 years old, in 50 % we found a bilateral involvement. The main reasons for the conversion reaction were in 30 % interfamiliar problems, in 25 % school problems, 2 cases (4 %) occurred after mild head trauma and in 41 % no reason was found. Treatment consisted in discussions and suggestive therapy - "eyeglasses" and/or "eyedrops" parents were not primarily informed the diagnosis. One to three months later the tests were repeated. 90 % were without symptoms, 10 % needed psychotherapy. CONCLUSION: Apart from comprehensive neuroophthalmologic and orthoptic examination it is important to observe the patient for possible doctor shopping, symptom shift and the rare development of depression.

Adolescent↗
PubMed2006

Psychogenic gait disorders.

Psychogenic disorders of posture and gait are common and are the major manifestation in 8 to 10% of patients with psychogenic movement disorders. The colorful history of these disorders is reviewed. Anxiety and depression are the commonest psychological accompaniments of functional gait disorder in contemporary practice. The particular case of the cautious gait and its flip side, "fear of falling," are considered in more detail. Common presentations for somatoform disorders and malingering are also described. It is often possible to make this diagnosis based on recognition features and gait observation. Incongruous neurologic signs are commonly found, and several features are so typical as to be nearly diagnostic. Caveats and pitfalls in diagnosis based on observational features are noted. In particular, the cautious gait is often the presenting feature of an older patient with an organic balance impairment. An approach to the patient with psychogenic gait disorder is described. Although the nature of the problem is often quickly apparent in such patients, the optimal management is a challenge. Dramatic cures still occur, and some patients respond quickly to psychological management and rehabilitation therapies, but persistence for more than 6 to 12 months is frequently associated with an unfavorable prognosis and long-term disability. The outcome studies are reviewed.

Anxiety↗
PubMed2006

Psychogenic movement disorders.

All varieties of movement disorders may be mimicked by a psychogenic disorder, most commonly tremor, dystonia, and myoclonus. Approximately 3% of patients seen in specialty clinics have a psychogenic movement disorder (PMD). The diagnosis of a PMD depends on not just ruling out an organic movement disorder, but moreover, recognizing features from the history and examination that are inconsistent or incongruous with an organic movement disorder. Most PMDs represent a conversion disorder, sometimes as part of a somatoform disorder; less common diagnoses include a factitious disorder or malingering. Co-morbid psychiatric illness is prevalent in patients with PMD including depression, anxiety, and personality disorders. Many PMDs remain chronic, but a multidisciplinary approach centering on psychiatric intervention can be successful. A shorter duration of symptoms and a co-existent treatable psychiatric disorder portend a better prognosis, whereas compensation and pending litigation are associated with a poorer prognosis.

Female↗
PubMed2002

Documenting the prominence of forensic neuropsychology at national meetings and in relevant professional journals from 1990 to 2000.

Numerous authors have opined that forensic activities have become more prominent within clinical neuropsychology. To investigate the merits of these claims, the entire contents of Archives of Clinical Neuropsychology (ACN), Journal of Clinical and Experimental Neuropsychology (JCEN), and The Clinical Neuropsychologist (TCN) from 1990 through 2000 were reviewed and cataloged. These three journals were selected because they are the highest-ranking clinical subscription journals according to surveys of neuropsychology practitioners. Prior to rating journal content, various categories of interest were delineated and practice ratings were obtained until the two raters reached 92% agreement. Each of the raters read the journal contents and recorded content ratings for half of the journal issues under review. Results of the 8323 ratings demonstrated increases across time in the absolute numbers of articles related to forensic neuropsychology, although variable and different for each journal. Published articles that were partially or substantially forensic in nature in the three journals combined increased from 4% in 1990 to 14% in 2000. An annual peak in absolute number (n=32;16%) of forensic journal articles occurred in 1997. The most common topic of 139 articles published in ACN, JCEN, and TCN from 1990 to 2000 was malingering, which appeared in 86% of the general forensic articles. Forensic presentations at annual NAN meetings ranged from 3.9 to 11.3% (M=8%) of the convention programs, whereas within Division 40's programs at the American Psychological Association meeting, the average percentage ranged from 2.3 to 11.7% (M=6%). Results pertaining to each journal and to specific forensic topics are presented and implications of these and other results are discussed.

Bibliometrics↗
PubMed2003

Sensitivity and specificity of memory dysfunction in schizophrenia: a comparison with major depression.

Fifty-three schizophrenic subjects were compared to 50 patients with major depression and 50 normal controls on measures of working memory, declarative memory and malingering. The schizophrenic group scored 1-2 SDs below controls on all measures, while depressive patients exposed only lesser deficits in working memory and free recall. The memory deficit of the schizophrenic subjects was disproportionately greater than their intellectual decline. Differences between clinical groups could not be explained by differences in IQ, clinical symptom load or demographic characteristics. This indicates that impaired memory is a particular sensitive symptom of schizophrenia and that the impairment is specific to the illness. Working memory failure was prominent in both clinical groups. The schizophrenic subjects displayed primarily an acquisition failure, while the depressed group showed retrieval difficulties.

Adult↗
PubMed2002

A review of objective measures of gustatory function.

Several studies of diagnostic tests of gustatory function have been reported. Results show that none of the subjective tests are satisfactory because they cannot detect psychogenic disease or malingering. Of the objective modalities that have been investigated, gustatory-evoked potential testing has been the most widely studied because it does not require expensive equipment and can be used in multicenter studies. The techniques developed to date for measuring gustatory-evoked potentials are not yet clinically useful for diagnosing taste disorders. Future directions for improving this method of evaluating gustatory function include improving stimulation methods and equipment, in order to obtain better stimulation-related potentials and better means of distinguishing between normal and abnormal gustatory-evoked potential patterns, and applying these new standards to the evaluation of data.

Electric Stimulation↗
PubMed1990

The Beck Depression Inventory: item order and the impact of response sets.

The lack of subtle content in the item groups of the Beck Depression Inventory (BDI) and the consistency in the ordering of the items from least to most pathological make this instrument unduly susceptible to either defensive or malingering response sets. Two experimental forms were developed for the BDI: a backwards version (a simple reversal of the order of items within each group) and a random-order version. These forms, together with the original item order, were given to college undergraduate women along with the Depression scale from the MMPI and the Burks-Martin Questionnaire covering recent life changes and current stressful situations. The random order BDI results in a significantly higher depression score than did either the original or backwards version. Correlations with the other instruments were comparable for all three forms. The random order of items within each set appears to break up a response set to endorse either the first or last item and is, therefore, recommended.

Adjustment Disorders↗
PubMed1982

Health care in jails: a unique challenge in medical practice.

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Adult↗
PubMed1990

Occupational neurotoxicology: some neuropsychological issues and challenges.

Occupational neurotoxicology offers the opportunity for demonstration of neuropsychological capacity to detect otherwise non-demonstrable CNS compromise, and thereby the enhancement of human well-being. Simultaneously, neuropsychological applications in this field highlight some of the disciplines persisting problems, such as uncertainties over the differential sensitivities of tests, lack of a common functional taxonomy, limited employment of component-analysis procedures, insufficiencies of control over extraneous variance (including malingering and social expectancy effects), and knowledge limits regarding the everyday significance of findings. These problems are especially troublesome where effects are subtle, diffuse, or of insidious onset, and where physically demonstrable lesioning is uncommon. With neuroimaging advances, conditions so characterized may become increasingly the focus of neuropsychological efforts. The likelihood of increasing involvement with legal issues such as compensation makes awareness of these difficulties, and concerted efforts to resolve them, crucial.

Air Pollutants, Occupational↗
PubMed1991

Neuropsychological presentation of Ganser symptoms.

We describe a patient with memory complaints whose history of head injury, polysubstance abuse and positive neurological findings suggested the presence of dementia. Neuropsychological testing revealed inconsistent performance plus multiple verbal and visuospatial approximate answers leading to the diagnosis of a Ganser episode. This case illustrates the importance of neuropsychological assessment in diagnosing Ganser symptoms and in differentiating this disorder from organic conditions and malingering.

Factitious Disorders↗
PubMed1996

Victoria Symptom Validity Test: efficiency for detecting feigned memory impairment and relationship to neuropsychological tests and MMPI-2 validity scales.

Error scores and response times from a computer-administered, forced-choice recognition test of symptom validity were evaluated for efficiency in detecting feigned memory deficits. Participants included controls (n = 95), experimental malingerers (n = 43), compensation-seeking patients (n = 206), and patients not seeking financial compensation (n = 32). Adopting a three-level cut-score system that classified participant performance as malingered, questionable, or valid greatly improved sensitivity with relatively little impact on specificity. For error scores, convergent validity was found to be adequate and divergent validity was found to be excellent. Although response times showed promise for assisting in the detection of feigned impairment, divergent and convergent validity were weaker, suggesting somewhat less utility than error scores.

Adolescent↗
PubMed2003

The mediating effects of effort upon the relationship between head injury severity and cognitive functioning.

PRIMARY OBJECTIVE: Given that poor effort may have a profound impact upon the results of neuropsychological assessment, it is of critical importance that assessment of effort is incorporated into the interpretation of a patient's neuropsychological profile. The current study examines the relationship between head injury severity (as measured by length of post-traumatic amnesia) and level of cognitive functioning in patients passing or failing a test of effort (Test of Malingered Memory). RESEARCH DESIGN: A cross-sectional correlational design was employed in a consecutive cohort of 78 persons with ongoing compensation claims. METHODS AND PROCEDURES: Head injury severity was assessed by duration of post-traumatic amnesia. All participants received a clinical interview followed by neuropsychological assessment. MAIN OUTCOMES AND RESULTS: A systematic and interpretable negative correlation between head injury severity and intellectual and memory functioning was demonstrated in persons passing the test of effort. However, in persons failing the test of effort no such relationships were demonstrated. CONCLUSIONS: The implications for the interpretation of neuropsychological test data are discussed. It is strongly recommend that valid interpretation of neuropsychological assessment data should include consideration of at least one test of effort.

Adolescent↗
PubMed2004

Predictors of invalid neuropsychological test performance after traumatic brain injury.

OBJECTIVE: To investigate the usefulness of the Test of Memory Malingering (TOMM) and the California Verbal Learning Test-Second Edition (CVLT-II) in assessing invalid test performance after traumatic brain injury (TBI). DESIGN: Consecutive 3-year series of rehabilitation referrals (n = 132). METHODS AND PROCEDURES: Percentage of participants who failed validity criteria was determined. Hierarchical logistic regression analysis and odds ratios were used to identify predictors of invalid test performance. RESULTS: Twenty patients (15%) performed in the invalid range when held to a priori specified criteria for invalid test performance (i.e. TOMM <45/50 on Trial 2 or CVLT-II <15/16 on Forced-Choice recognition trial). Both psychiatric history and financial compensation seeking were associated with an almost 4-fold increase in likelihood of invalid responding. CONCLUSIONS: The TOMM and CVLT-II are sensitive to the potential impact of current financial compensation seeking and prior psychiatric history on neuropsychological test performance after TBI.

Adult↗