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PubMed2002

[On the problems of diagnosis of PTSD and its legal management].

Since DSM-III in 1980 and DSM-IV in 1994 were enacted, "traumatic stress" meant mainly severe bio-psycho-social stress which cause some trauma, not only psychological but physiological and social stress to the person. However, PTSD was defined as to cause some psychological stress, with criterion of A to D. The concept of PTSD are used only to psychological trauma and stress and not include physiological trauma and stress. When psychological trauma caused some psychological stress, it become a legal problem of compensation.... However, the degree of psychological trauma and stress are sometimes difficult to evaluate objectively. To prevent Malingering or Factitious Disorder, it needs to establish a strict diagnostic criteria of psychological trauma and stress, in PTSD. In particular, the definition of Trauma, which is not limited to psychological trauma should be evaluated objectively, i.e. it should be more, scientifically defined, and measured by some evaluations.

Compensation and Redress↗
PubMed1954

The value of electromyography in neurology.

By detection of muscular fibrillation, a sign of motor nerve impairment, through electromyography, diseases of the motor nervous system can be distinguished from muscular disorders, malingering, and psychoneurotic states. The site of lesion can be determined and the degree of impairment and progress of recovery can be estimated. The method has been used successfully in amyotrophic lateral sclerosis, poliomyelitis, peripheral neuritis and neuronitis, and root compression syndrome, as also for indirect evidence in muscular dystrophy and other myopathic conditions.

Amyotrophic Lateral Sclerosis↗
PubMed1992

Mentally disordered offenders. Patterns in the relationship between mental disorder and crime.

Five patterns among mentally disordered offenders are distinguished by the relationship between mental disorder, on the one hand, and criminality, on the other. Pattern 1 offenders are those for whom crime is a response to psychotic symptoms, most often delusions or hallucinations. Pattern 2 offenders commit crimes motivated by compulsive desires, such as sex offenses by paraphiles and offenses regarded as evidence of disorders of impulse control. Pattern 3 offenders are those with personality disorder for whom the crime is merely one example of a maladaptive pattern of voluntary and knowing behavior. Pattern 4 offenders have coincidental mental illness that is unrelated to the crime. Pattern 5 offenders are those who become mentally disordered or feign mental disorder as a result of their crimes, such as those who dissociate upon seeing what they have done, those who become depressed in prison, those who become psychotic on death row, and those who malinger mental illness. Although these categories do not determine whether offenders are responsible for their behavior, some unknown proportion of Pattern 1 offenders do meet legal criteria for insanity, depending on the facts of each case and the applicable legal standards. It is arguable whether or not Pattern 2 offenders ever meet legal criteria of insanity. Offenders evidencing only Patterns 3, 4, or 5 are not candidates for an insanity defense.

Adult↗
PubMed1992

Approaches to forensic assessment of false claims of sexual misconduct by therapists.

The author offers systematic approaches to evaluation of claims of therapist-patient sexual misconduct, together with their rationales. False accusations should be considered in all such cases in order to maintain the balanced forensic perspective and to probe for malingering, as in all evaluations. Practical techniques are offered and the underlying reasoning described.

Ethics, Professional↗
PubMed1959

Analysis of absenteeism in industry.

There are many nonmedical factors that contribute to employee absenteeism in industry. An employee's total life situation or total environment may be a causative factor in excessive "sick absenteeism." In many instances the cure for "abnormal" sickness absenteeism is within the province of supervisory personnel, who should look upon abuse of sick leave benefits among employees as morale problems and as evidence of possible maladjustment to the demands of the job or the industry. There are, however, many problems in mental and physical health affecting absence rates in which preventive psychiatry and medicine can make greater contributions. Even truancy and malingering may sometimes be conditions requiring professional medical care. The role of a private physician in determining and certifying the true state of a patient's health is a most important one economically to industry and the community. The total problem of absenteeism for sickness, as it exists in industry today, points up the need for the most effective cooperation and communication possible between industrial and private physicians. Since no more than 25 per cent of the total work force is employed in industries having in-plant medical programs, the burden of responsibility for the control of absenteeism for sickness rests mainly with private practitioners.

Absenteeism↗
PubMed2002

A validity index for the MMPI-2.

There have been numerous methods developed for the detection of valid profiles on the Minnesota Multiphasic Personality Inventory (MMPI)-2. The current study examined a method of combining seven different validity scales of the MMPI-2 into a common weighted method in assessing malingering in chronic pain patients. The weighted method was able to correctly classify 100% of nonlitigants, using a cutoff score of > or =5. The findings of this study suggest that chronic pain patients in litigation produce a different profile on the MMPI-2 validity scales than do nonlitigants. In a group of knowledgeable actors (malingerers), 86% was correctly classified. The overall finding showed 100% specificity and 86% sensitivity. The findings support the need for multiple validity scales to be examined in determining a valid profile. The weighted validity scales method was robust enough to account for "emotional distress" and still identify invalid MMPI-2 performance.

Journal Article↗
PubMed2001

A re-examination of the rate of vocational dysfunction among patients with anosmia and mild to moderate closed head injury.

This study sought to verify two earlier reports that up to 93% of patients with closed head injury (CHI) and anosmia are vocationally dysfunctional due to executive impairments associated with orbitofrontal damage. Participants were 11 men and 4 women identified from a pool of 60 potential subjects referred for evaluation of trauma-related chemosensory dysfunction at the University of Pennsylvania Smell and Taste Center from 1988 to 1994. These 15 subjects met four criteria: (i) willingness to complete a brief semi-structured interview concerning their pre- and post-CHI work history; (ii) age <60 years; (iii) evidence of mild to moderate CHI; and (iv) scores on the University of Pennsylvania Smell Identification Test indicative of anosmia or severe microsmia and non-malingering. In contrast to the earlier reports, only 7% of the subjects were vocationally dysfunctional. This study calls into question previous reports suggesting that anosmia is a reliable predictor of post-CHI vocational outcome.

Journal Article↗
PubMed2001

Practices in forensic neuropsychology: perspectives of neuropsychologists and trial attorneys.

Members of the National Academy of Neuropsychology and the Association of Trial Lawyers of America were surveyed concerning current practices in forensic neuropsychology. The majority of neuropsychologists and attorneys reported that attorneys never observe neuropsychological testing. Attorneys reported receiving raw data in almost all of their brain injury cases, but neuropsychologists reported that they produce raw data in only a minority of their forensic cases. Similarly, fewer neuropsychologists than attorneys acknowledged that they are asked to provide information to assist the lawyer in preparing for the cross-examination of the opposition's expert or to prepare the plaintiff for the opposition's evaluation. Lawyers typically spend up to an hour preparing their clients for neuropsychological evaluations and commonly cover test content, detection of malingering, and brain injury symptoms. Other topics addressed include attorney influence on findings, fees and billing, board certification, use of technicians, and methods used to generate referrals or locate experts. Areas of agreement and divergence between the groups were identified and ethical issues raised by identified practices were examined.

Journal Article↗
PubMed2000

Performance curve classification of invalid responding on the Validity Indicator Profile.

The purpose of this article is to provide evidence for the validity of performance curve classification on the nonverbal subtest of the Validity Indicator Profile (VIP-NV). A four-fold classification scheme of performance on cognitive testing is proposed. This scheme combines effort and motivation to generate four response classifications: compliant, careless, irrelevant, and malingering. Data are presented across six studies from cognitive and personality testing for 737 male pretrial criminal defendants. Additionally, computer-generated VIP-NV performances were subjected to four levels of randomization to investigate VIP-NV carelessness indicators. The findings support the validity of the four-fold classification scheme and support the classification of response on the basis of motivation and effort.

Journal Article↗
PubMed1998

Performance of normal adults on the Luria-Nebraska Neuropsychological Battery, form I.

To examine three problems in the interpretation of the Luria-Nebraska Neuropsychological Battery (LNNB), the normal participants from four different studies were pooled to form a sample of 241 LNNB profiles. The first problem addressed was the LNNB's false positive rate. All five yes/no decision rules were applied simultaneously. Each individual rule had a 0% to 8% false positive rate: combining the rules in four different ways increased the false positive rate by 0% to 6%. When divided into over and under 65 years old groups, each rule applied to the younger group had a 0% to 5% false positive rate: combining them increased the rate to 6-8%. When applying the rules to the older group, each rule had a 0 to 27% false positive rate: combining all rules but the one with the highest error rate produced a false positive rate of 27%. The false positive rate for the entire sample was 12%. To solve the second problem of interpretation, making qualitative item analyses easier, the difficulty level (i.e., percentage of normals missing the item) for each item was calculated. The third problem was the LNNB's malingering formula's accuracy. The formula was applied to the sample: as expected, the normal profiles had an inaccuracy rate of 26%. The few mildly impaired profiles had a 6% inaccuracy rate. When applied to the entire sample of normals and using the appropriate interpretive guidelines, the formula had a false positive rate of 1%.

Journal Article↗
PubMed2003

Surgical support of Operation Sea Signal: adaptability of the 59th Air Transportable Hospital in Cuba.

OBJECTIVE: The attempted migration of approximately 50,000 Cubans in the summer of 1994 created a large patient population detained at Guantanamo Bay, Cuba. This study examined the roles and results of the 59th Air Transportable Hospital (ATH) in treating surgical problems within that population during Operation Sea Signal. METHODS: The surgical case log of the 59th ATH was used to identify all patients operated on at the 59th ATH during the interval of August 1994 to April 1995. These case records and the individual records of the three 59th ATH surgeons were used to determine the types of cases performed, complications, and outcomes. RESULTS: A total of 333 operations were performed at the 59th ATH in three types of surgery: (1) elective (267); (2) emergency for nonself-inflicted conditions (46); and (3) emergency for self-inflicted conditions (20). The total perioperative complication rate was 2.4% (8/333), and the wound infection rate for clean surgical cases was 0.87% (2/229). CONCLUSIONS: Elective surgery may be performed in a field environment with acceptable complication and wound infection rates. Humanitarian missions will be faced with considerable pathology from pre-existing conditions within the population cared for. The humanitarian mission may be complicated by political situations that may encourage malingering and self-injurious behavior within the population cared for. The latter events have not been previously encountered in humanitarian missions involving the U.S. military and must be considered by policy makers and mission planners in planning future humanitarian missions.

Cuba↗
PubMed2004

Pseudoseizures.

Pseudoseizures are paroxysmal alterations in behavior that resemble seizures but are without any organic cause. They are recognized by various terms. Pseudoseizures are found in about one fourth of all patients seen with hysteria and 20% of those referred to epilepsy clinic. Pseudoseizures are often difficult to differentiate because there are client based or clinician based factors leading to misdiagnosis. Detailed history, observation, psychological testing and laboratory investigations are used for correct diagnosis. Pseudoseizures are not only to be differentiated from various forms of epilepsy but also from disorders like malingering, somatization disorder, hyperventilation, migraine, syncope etc. Management consists of making the patient and relatives aware about the causation and diagnosis. Psychotherapy (supportive and psycho-dynamic), behavior therapy (biofeedback, relaxation), drugs (anxiolytic and anti-depressants), hypnosis and placebo are used for treatment. The correct recognition is helpful in avoiding physical tests and the unnecessary use of antiepileptic drugs.

Adolescent↗
PubMed2005

[Posttraumatic headache. Pathophysiology, clinical, diagnostic and therapeutic aspects].

Posttraumatic headache (PTHA) is, usually, one of several symptoms of the posttraumatic syndrome and therefore may be accompanied by somatic, psychological or cognitive disturbances. The aetiology of these symptoms in individuals with mild traumatic brain injury or whiplash injury has been a subject of some controversy with explanations ranging from neural damage to malingering. PTHA can resemble a tension-type headache, migrainous or cervicogenic headaches. Post-whiplash headache habitually is a pain radiating from the neck to the forehead, with moderate intensity and benign, but prolonged course. The pathogenesis of PTHA is still not well-known but might share some common headache pathways with primary headaches. In this chapter, we review recent investigations in the pathophysiology of PTHA, review recognised risk factors for a poor outcome and give some recommendations of management. We also discuss the new diagnostic criteria of IHS Classification, 2004, for PTHA and Headache attributed to whiplash.

Brain Injuries↗
PubMedDate not supplied

The predictive utility of the orthopedic examination in identifying the low back pain patient with hysterical personality features.

Physical examination of the patient with low back pain routinely includes a number of tests which are useful clinically to the orthopedist as suggestive of the presence of hysteria or malingering. These include tests of light touch differences medially and laterally in the same foot or leg, vibratory sensation in the lower extremities, forward flexion, straight-leg raising differences between the supine and sitting positions, and the Burns' bench test. The present study examined the specific predictive utility of these tests individually and as a composite battery in identifying low back pain patients with hysterical personality features. Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination. Silight to moderate correlations were found for each of the subtests with a Composite Hysteria Index derived from the MMPI. The predictability was improved by the use of a weighted combination of the individual tests obtained by multiple regression analysis. The results lend empirical support to: the predictive value of these clinical tests in definitively identifying 60% of those low back pain patients with hysterical personality features; decision rules for use in clinical practice were also developed.

Adult↗
PubMed2005

[Patterns of hearing disorders in normal otoacoustic emissions].

OBJECTIVE: To analyze and outline patterns of hearing disorders in normal otoacoustic emissions. METHOD: Tests of pure tone audiometry, acoustic impedance test, auditory brainstem response (ABR), 40 Hz AERP,spontaneous otoacoustic emissions (SOAE), transient evoked otoacoustic emissions (TEOAE), distortion evoked otoacoustic emissions (DPEOAE)and imaging examinations of CT/MRI scan were performed on all 83 patients with hearing disorders. RESULT: Patterns of hearing disorders in normal otoacoustic emissions including (1) 68 patients with auditory neuropathy; (2) 2 patients with unilateral acoustic neuroma; (3) 3 patients with cortical deafness or central hearing loss; (4) 2 patients with hyperacusis; (5) 2 patients with functional deafness; (6) 6 patients with malingering. CONCLUSIONS: OAE tests play an important role in diagnosis and differential diagnosis of the patients with retrocochlear deafness, central hearing loss, nonorganic hearing loss and some other special hearing disorders.

Adolescent↗
PubMed2005

Sick leave aboard--a one-year descriptive study among crew on a passenger ship.

OBJECTIVES: To study crew sick leave aboard and medical sign-off during one year (2004) among crew on a passenger ship doing worldwide cruising. Methods - Patient data were registered continuously during the year and reviewed afterward. RESULTS: There was an average of 612 crew members (22% women) aboard. There were 6378 recorded crew visits (=17.5 per day), 3705 of which directly involved the doctor (=10.2 per day). Four-hundred-and-fifty-one crew were on sick leave aboard for a total of 829 days. One-hundred-and-thirty-eight crew were isolated for a total of 268 days (= 32% of all sick leave) to prevent spreading of gastroenteritis. Among the 142 reported injuries, 77 (54%) led to sick leave on board for a total of 182.5 days (=22% of all sick leave). Fifty-six crew were referred to dentists and 18 to medical specialists in port. Twenty-eight crew were medically signed off, 16 (57%) of them following injuries, and 7 (25%) for pre-existing conditions. Three crew were hospitalized in port prior to repatriation. CONCLUSIONS: Crew consultation rates were high and sick leave rates low. Many factors aboard promoted sick presenteeism, minimized absenteeism, prevented malingering and reduced the length of sick leave. A substantial part of the sick leave was imposed by management and doctor, and if it was up to the crew, the number of sick leave days would have been even lower. The crew was eager to work, and their work morale was high.

Adult↗
PubMed1991

[Fatigability and weakness from a neurological viewpoint].

Fatigue is a frequent but ill defined symptomatology in many disorders of the central and the peripheral nervous system. It is characterized as a fluctuating incapacity or weakness, often in the absence of overt paresis. Experimental or diagnostic evidence of fatigue is available only in disorders of the peripheral motor neuron, the neuromuscular junction and the muscle fibers, but not in CNS disorders. Fatigue, as a fluctuating symptomatology may be misdiagnosed as simulation or malingering not only by lay persons, but also by doctors.

Central Nervous System Diseases↗