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PubMed2001

Possible artifacts in memory assessment with the Wechsler Memory Scale-III.

The Wechsler Memory Scale-III has a number of subtests on which scores can be influenced by random answering, malingering, and response sets as well as valid variance from memory functioning. Clinicians, researchers, and forensic psychologists need to take these possibly confounding sources into account when interpreting findings. Chance performance guidelines are presented along with some brief examples from clinical assessment.

Adult↗
PubMed1985

Thermographic imaging of cutaneous sensory segment in patients with peripheral nerve injury. Skin-temperature stability between sides of the body.

Sensory examination based on the patient's subjective assessment of symptoms may raise difficult questions about whether the individual's expressed complaint is based on organic nerve damage, psychogenic factors, or even malingering. A prototype computerized telethermograph has allowed clinical quantification of peripheral nerve injury. The system makes possible mapping and imaging of the damaged area, as well as skin temperature measurements. In normal persons, the skin temperature difference between sides of the body was only 0.24 degree +/- 0.073 degree C. In contrast, in patients with peripheral nerve injury, the temperature of the skin innervated by the damaged nerve deviated an average of 1.55 degrees C (p less than 0.001). The new technique requires further refinement, but it appears that use of this method may be cost-effective in helping to resolve medicolegal conflicts concerning peripheral nerve injury.

Adolescent↗
PubMed2000

Are all brain functions computable?

BACKGROUND: Whether the human brain is nothing but an advanced computer is a matter of inconclusive debate. This paper contributes to that debate. METHOD: Critical reasoning based on evidence provided by the history of a woman who complained of amnesia after each of two separate acts of attempted suicide. FINDINGS: A life-threatening tendency (suicidal impulses) may be countered by a functional imperfection (selective amnesia) or a feigned malfunction (malingering). INTERPRETATION: Some aspects of brain function may depend on operations that no hitherto invented computer can duplicate.

Adult↗
PubMed2006

Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy.

BACKGROUND: The evaluation of acute appendicitis (AA), the most common cause of acute abdomen, in conscripts is important, specifically when it seems that the probability of malingering for secondary gains (such as exemption) is high, and surgeons may lose some cases of AA through this assumption. METHODS: In this analytic cross-sectional study, 455 male conscripts with suspected AA were compared with 142 male individuals between 14 and 26 years of age who had already been selected for appendectomy. RESULTS: The mean age (+/-SE) was 20.4+/-0.08 years. There were no statistically significant differences between the case and control groups in terms of age, rates of different symptoms and signs, quality and duration of pain, vital signs, and laboratory findings. CONCLUSIONS: There was no significant difference between conscripts and others in terms of the presentation of AA and its accurate diagnosis. Therefore, it is recommended that military physicians approach conscripts with suspected AA like other patients.

Abdominal Pain↗
PubMed1999

[Diagnosis and treatment of postoperative nerve damage. Chronic neuropathic pain].

Neuropathic pain is caused by lesions in the peripheral and/or central nervous system. Patients with pain due to nerve damage after operations are often misinterpreted and met with suspicion of malingering. Neuropathic pain typically presents with a characteristic set of sensory disorders independent of the cause. The sensory dysfunction may manifest itself as hypo- and/or hyperesthesia to one or more modalities, increased pain to painful stimuli (hyperalgesia) and/or pain to non-painful stimuli (allodynia). Conventional analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs and opioids are often ineffective. Instead, antidepressants and anticonvulsants may be tried. The pain condition is unknown to most physicians. This may result in mistreated patients having undergone several unnecessary and ineffective investigations and treatments.

Aged↗
PubMed1999

What is reflex sympathetic dystrophy?

In the literature there is no unanimity with respect to the diagnosis of reflex sympathetic dystrophy (RSD). Frequently, the diagnosis is established on mere clinical grounds. In our opinion, however, bone scintigraphy is of major importance for the diagnosis. Using this examination, true RSD can be clearly differentiated from other conditions which are incorrectly diagnosed and treated as RSD. If the bone scan is not suggestive of RSD, the clinical picture, radiological examination and vascular scan may lead to the correct diagnosis. This may be a pseudodystrophy, in which a hypovascularization is found right from the start, while in true RSD there is initially a hypervascularization. Other conditions which may be confused with RSD are causalgia, neurotic compulsive postures, hysterical conversion, malingering and even self-mutilation. In the spontaneous course of RSD three phases can be distinguished. Stage I is the warm or hypertrophic phase, stage II the cold or atrophic phase. Per definition the third phase corresponds to stabilization or, in rare instances, to healing. By means of the vascular scan the correct stage can be determined, and the results of treatment evaluated. Finally it should be noted that in children the condition is completely different from true RSD, as it concerns a pseudodystrophy or disuse-related dystrophy. This condition may also be seen in adults and adolescents, usually females. The bone scan is always negative. In this way bone scintigraphy constitutes the means to answer the question as to what RSD is and what it is not. An algorithm for the differential diagnosis is presented.

Adolescent↗
PubMed2000

Advances in the clinical assessment of dissociation: the SCID-D-R.

A comprehensive assessment of dissociative symptoms is recommended for effective treatment of trauma survivors. The author reviews the systematic detection of dissociative symptoms and disorders using the Structured Clinical Interview for DSM-IV Dissociative Disorders--Revised (SCID-D-R) in adolescents and adults (Steinberg, 1994b). Numerous investigations have reported good-to-excellent reliability and validity of the SCID-D-R, both in the United States and abroad. Clinical applications, including the SCID-D-R's utility for psychological and forensic evaluations, treatment planning, differential diagnosis, and evaluation of malingering, are reviewed.

Adult↗
PubMed1975

Factitious lymphedema of the hand.

Twenty-two patients with factitious lymphedema of the hand were reviewed. Thirteen were female, with a median age of sixteen years at the onset of symptoms. Of the nine males, the median age at onset of symptoms was thirty-two years. The dominant hand was affected more frequently than the non-dominant hand. Edema was usually caused by a tourniquet, irritation of the skin, or blows to the back of the hand. Neurosis, psychosis, or suicidal tendency was diagnosed in twelve of these patients. Characteristically, the edema was not particularly painful; it frequently ended proximally in a circumferential discolored constriction ring; and it occasionally displayed characteristic lymphangiographic findings of normal or dilated lymphatic channels with increased collateral circulation and multiple blowouts. Although ten of the patients received Workmen's Compensation benefits, the course and psychiatric diagnosis indicated that malingering for secondary financial gain was not a primary goal. Hospitalization is usually required to confirm the diagnosis. Psychotherapy is indicated once the diagnosis is made.

Adolescent↗
PubMed2001

Posttraumatic stress disorder and depression in soldiers with combat experiences.

AIM: To compare psychological, medical, and trauma-related variables in veterans with combat-related post-traumatic stress disorder (CR-PTSD) comorbid with depression and veterans with CR-PTSD only. METHOD: Out of 402 Croatian veterans recruited during expert evaluation for war-related compensation claims, 346 met the criteria for CR-PTSD: 97 for CR-PTSD only and 249 for PTSD comorbid with other diagnoses (77 comorbid with depression). To reach diagnosis, psychiatrists used clinical interview based on DSM-IV criteria, interview with family and friends, previous medical documentation, and Hamilton Rating Scales for Depression and Anxiety. An independent psychologist used a structured psychological interview, Mississippi CR-PTSD scale, Watson's PTSD criteria, Minnesota Multiphasic Personality Inventory-version 201, and trauma questionnaire based on the Harvard Questionnaire. RESULTS: Out of 402 soldiers, 13.9% did not meet the criteria for PTSD or other psychiatric diagnosis, 61.9% met the criteria for comorbid diagnoses, and 24.2% for PTSD only. The PTSD group with depression did not differ from PTSD-only group in combat experience, number of traumatic events, age, length of employment, sick leave, education, or marital status (chi-square test, p = 0.121-0.672). The two groups differed in pre-trauma factors, such as mental disturbances before combat experiences (p = 0.003), positive family history of psychiatric illness (p = 0.008), primary major depression (p = 0.012), and the number of hospital admissions (p = 0.002). CONCLUSION: Different assessment methods in expert examination of combat-experienced soldiers with PTSD for compensation-related purposes are needed to establish the final diagnosis and avoid possibility of factitious disorder or malingering. Combat ability assessment should include assessment of previous psychiatric disturbances of soldiers and their families.

Adult↗
PubMed2001

Digital rectal examination for trauma: does every patient need one?

The digital rectal examination is widely accepted as an essential component in the initial assessment of trauma. However, no data have been published that justify its routine use in all seriously injured patients. The objective of this study was to determine what if any impact on subsequent treatment and management decisions the initial digital rectal examination had on injured patients arriving at our emergency department (ED). We conducted a prospective observational study of all injured patients arriving at a Level II trauma center over a period of 6 months. A digital rectal examination was performed on all patients during the secondary survey phase of their initial evaluation shortly after arrival to the ED. The results of the rectal examination were noted for each patient with particular attention placed on the presence or absence of gross blood, Hemoccult result, prostatic examination, rectal vault integrity, and rectal sphincter tone. In addition the patient's hemodynamic parameters while in the ED and the injuries that were sustained were noted, as was their final disposition. Four hundred twenty-three patients were admitted to the ED after sustaining serious injuries. The mean Injury Severity Score was 9.96. The prostatic examination was normal in more than 99 per cent of patients; no high-riding or nonpalpable prostate glands were noted. Twenty-two patients (5.2%) were Hemoccult positive, but in none of these cases did the presence of occult blood in the stool lead to a change in the initial management or diagnostic approach. Three patients (0.7%) with penetrating injuries to the perineal/pelvic area had gross blood on digital rectal examination that prompted operative exploration to rule out a lower gastrointestinal injury. All three had rectal injuries confirmed at surgery. Rectal sphincter tone was normal in 406 (96%) patients, weak in 17 (4%), and absent in none. The only patient in whom the sphincter tone influenced management was an individual complaining of complete paralysis after a blunt mechanism of injury. He had normal rectal sphincter tone and admitted to malingering shortly thereafter. Overall the rectal examination influenced therapeutic decision making in five cases (1.2%). The digital rectal examination is unlikely to affect initial management when applied indiscriminately to all seriously injured patients during the secondary survey. Patients in whom the rectal examination may have a higher probability of influencing management are those with penetrating injuries in proximity to the lower gastrointestinal tract, questionable spinal cord damage, and severe pelvic fractures with potential urethral disruption or open fractures in continuity with the rectal vault. The Hemoccult test does not add useful information and should be discontinued as part of the secondary survey of injured patients.

Adult↗
PubMedDate not supplied

[Differential diagnosis of post-concussive syndrome].

INTRODUCTION: Posconcussional syndrome is characterized by a heterogeneous group of somatic, cognitive and psychosocial symptoms, which occur in patients with head trauma, generally of mild severity. It is the neuropsychiatric postraumatic disorder more prevalent in the field of forensic medicine. DEVELOPMENT: Classical authors (Lishamn and Barraquer, for example) focused on controversial aspects of this syndrome, such as conceptual problems and etiology (organic versus functional). The objective of this report is to review the posconcussional literature in search of relevant aspects in forensic neuropsychology: conceptual aspects, epidemiology, etiology, clinical features, methodology for assessment, and its differential diagnosis with other postraumatic disorders, such as postraumatic stress disorder, adjustment disorder, anxiety disorder, mood disorders (major depressive disorder), substancerelated disorders, dementia due to head trauma, amnesic disorder, somatoform disorders, factitious disorder, malingering, chronic pain and chronic whiplash syndrome.

Cognition Disorders↗
PubMed2001

["Medical expert assessment in psychosomatic and psychotherapy medicine--social justice questions" guideline].

Guidelines on the medico-legal assessment of patients in the field of psychosomatics and psychotherapy prepared by the "German Society für Psychotherapeutic Medicine" is presented. These guidelines are based on published evidence and on expert consensus among psychotherapists, psychiatrists, judges and social security experts. They give a systematic overview on aspects relevant to the assessment of persons suffering from somatoform disorders, psychological factors in organic diseases and posttraumatic, anxiety, depressive, personality and eating disorders. These aspects are disability, severity, assessment of malingering, of disability and causality.

Disability Evaluation↗
PubMed1996

[André Léri and the evolution of the concept of the commotion and of emotion during the Great War].

Under wing of Babinski and Pierre Marie at "La Salpétrière Hospital", André Léri (1875-1930) became a member of the Académie de Neurologie since 1904, then, Associated Professor in 1910. Between the 14-18 War, he was entrusted to run the head of medical military Districts and jumped at the chance to go deeply into war nevrosis. He sharpened exognosis diagnosis to set apart a lot of mental disorders which were before confused under the name of "brain concussion"; he listed hysteria, neurasthenia, psychosis, nevrosis and psycho-nevrosis, emotional syndromes, and clearly defined malingering.

Emotions↗
PubMed1995

[Nervous disorders and pithiatism in French soldiers during the Great War].

Nervous disorders due to war are known since antiquity. From 1915 young physicians wrote theses about this problem in military psychiatry. The question of hysteria breed many difficulties. Physicians of the time make a remarkable nosographical work during the sessions of the neurologic and of the psychiatric French societies, so as in their feature articles. Babinsky's term of "pithiatisme" comes back into medical vocabulary of WW I. The "torpillage" (a kind of electrical treatment), impels sharp controversies, but reveals to be a precious mean against malingering. Prs and Drs P. Marie, J. Déjerine, A. Léri, A. Souques, H. Claude, J. Froment, Cl. Vincent, H. Meige, G. Roussy, J. Lhermitte, G. Ballet and Babinski, mentioned their applied treatment, from psychotherapy to electricity, going by injections of bromide serum or isolation. Hysterical disorders were very important by number during this "drôle de guerre". They finally admit that they are bound to emotion.

France↗
PubMed2002

Dynamic footprints: adjuvant method for postoperative assessment of patients after calcaneal fractures.

BACKGROUND: Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal fractures. Assessing treatment results is often difficult due to discrepancy between objective parameters such as range of movement, and subjective results such as pain. OBJECTIVES: To test the reliability of footprint analysis as an adjuvant method of postoperative assessment of patients who sustained calcaneal fractures. METHODS: Dynamic and static footprint analysis was used as an adjuvant additional method to objectively assess operative results. This method is simple and is independent of the patient's initiatives. This modality was used in 22 patients followed-up 9-90 months postoperatively. RESULTS: We found a good correlation between footprint analysis and objective and subjective parameters of results expressed by American Orthopedic Foot and Ankle Society hind foot score. In certain cases, this method can be used to distinguish between uncorrelated parameter results, such as malingering, and workmens' compensation claims. CONCLUSION: We recommend the use of this simple, non-invasive objective test as an additional method to assess the results of ankle and foot surgery treatment.

Adolescent↗
PubMed1975

[New results on the genesis of traumatic Achilles tendon rupture].

As a result of the development of a new fixing mechanism, which permitted the test of peak value of tensile strength in Achilles tendons, the following facts were demonstrated: 1. The average value of static maximum of tensile strength is about 7, 5 kp/mm2, of the dynamic maximum is about 10, 1 kp/mm2. 2. The charge maximum decreases with progressive age. 3. The tensile strength depends on the minimal cross-section plane of the tendon. 4. The minimal cross section plane decreases with progressive age. 5. With the test of dynamic tensile strength it is possible to malinger a Achilles tendon rupture.

Achilles Tendon↗
PubMed2002

Evaluation and treatment of postconcussive symptoms.

Postconcussive symptoms such as headache, dizziness, irritability, and difficulties with memory and attention are reported frequently after traumatic brain injuries (TBI) of all severities. The etiology of these symptoms in individuals with mild TBI has been a subject of some controversy with theories ranging from neural damage to malingering. Furthermore, although the term postconcussive syndrome is commonly used clinically and in the scientific literature, it is not clear that postconcussive symptoms constitute a syndrome per se. Instead, it may be the case that the various symptoms that commonly co-occur after TBI are relatively independent consequences of a single neurological event. In other words, because the locations and severity of injury vary between individuals despite ostensibly similar injuries, it follows that there should be variations in symptom type and severity between individuals as well. This article reviews the sequelae and natural course of recovery from mild TBI, the evidence regarding both persistent postconcussive symptoms and the postconcussive syndrome, and outlines an approach to the assessment and treatment of individuals with these symptoms after TBI.

Brain Injuries↗
PubMed2003

The reliability of frequency-doubling technology (FDT) perimetry in a pediatric population.

PURPOSE: Frequency-doubling Technology IFDT) Perimetry was introduced as a rapid, easy method for detection of visual-field defects in adults. Its reliability, howev, has never been tested among pediatric patients. The purpose of this study was to determine if children could complete a screening program of FDT Perimetry reliably and to define the age range over which it might be most applicable. METHODS: Two hundred fifty-nine normal children (mean age, 10.7 years; range, 4 to 17 years) were asked to complete the FDT C-20-1 screening test as part of their general eye examination. The visual-field results were analyzed for reliability using the number of false-positive errors, fixation losses, and visual-field defects. For the purposes of this analysis, field results were considered unreliable with false-positives > or = 1 or fixation errors > or = 1. The visual-field test was also considered unreliable if > 2 sectors were flagged. RESULTS: Data from 254 children were included in the analysis. Five children were excluded because of suspected malingering or ocular health diagnosis that may have produced a visual-field defect. False-positives were less than one for all but the youngest age group 14 years old). Fixation errors decreed with increasing age and fell below one (became reliable) at approximately 9 years of age, and remained less than one through 17 year. Visual-field loss for purposes of this study when present in more than two sectors was considered unreliable in this normal population. CONCLUSIONS: Children ages 10 years of age and older can reliably complete the FDT C-20-1 screening field test using the strictest criteria, combining false-positives, fixation losses, and visual-field losses. These data are derived from normal subjects, who on complete eye examination, had no ocular disease or reason to suspect visual-field defects.

Adolescent↗