Psychiatric diagnosis and chronic pain: DSM-III-R and beyond.
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Anxiety Disorders↗
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Results for “MALINGERING”
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Symptom validity testing of feigned amnesia for a mock crime.
Perpetrators sometimes claim loss of memory for the crimes they have committed. For the neuropsychologist, the veracity of such crime-related amnesia is difficult to assess. The aim of the present study was to investigate whether Symptom Validity Testing (SVT) can be used to detect feigning of crime-related amnesia. Undergraduate students (N = 39) were instructed to commit a mock crime and asked to feign complete amnesia for the event. Subsequently, they were given 25 forced-choice items about the "crime" that were always followed by the correct answer and an equally plausible alternative. To counteract chance performance, test items were intermixed with 25 bogus questions that contained two equally plausible alternatives. Results show that a majority of participants (59%) scored below chance level on the critical items of the SVT. In addition, debriefing interviews showed that understanding the rationale behind the SVT was not related to chance performance. SVT procedures therefore might be helpful in identifying feigned crime-related amnesia.
Adolescent↗
Commentary on Butcher, Arbisi, Atlis, and McNulty (2003) on the Fake Bad Scale.
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Deception↗
Response to Butcher et al., The construct validity of the Lees-Haley Fake-Bad Scale...
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Deception↗
Detection of feigned head injury symptoms on the MMPI-2 in head injured patients and community controls.
MMPI-2 results from 39 moderately to severely head injured (HI) and 44 community volunteer (CV) participants given instructions to feign symptoms or answer honestly during an analog forensic neuropsychological examination were compared. No significant effects for HI or the interaction between the HI and instruction set (IS) factors were noted on either clinical or selected validity scales (F, Fb, Fp, Ds2, FBS). However, the main effect of IS was significant for both clinical and validity scales (median Cohen's d=1.34 and 1.39, respectively). Most validity scales were characterized by perfect specificity rates but low to modest sensitivity, whereas FBS had both moderate sensitivity and specificity. Logistic regressions showed that the F and Ds2 scales made a significant contribution independent of motivational tests to the identification of feigning during neuropsychological examination.
Adult↗
Comparison of various RAVLT scores in the detection of noncredible memory performance.
Sixty-one noncredible patients (as documented by psychometric and behavioral criteria) scored significantly below 25 controls and 88 credible clinic patients with no motive to feign on most RAVLT scores, including added indices of implicit and "automatic" memory. A combination of true recognition (i.e., recognition minus false positives) + implicit memory score (i.e., the number of word stems completed with RAVLT items) + "automatic" memory score (i.e., the number of correct temporal order judgments) < or =22 was associated with 75.7% sensitivity with specificity at 91.5%. However, sensitivity was nearly as high when scores available from the standard RAVLT administration alone (i.e., no word stem or temporal order trials) were combined. Specifically, a cut-off of < or =12 for true recognition (recognition minus false positives) + primacy recognition (i.e., number of words recognized from the first third of the test) was associated with 73.8% sensitivity at 90% specificity. These results indicate that combined indices of recognition memory from the RAVLT are effective in identifying noncredible memory performance in "real world" samples and are modestly superior to the 67.2% sensitivity obtained with the standard recognition score.
Adolescent↗
Symptom validity assessment: practice issues and medical necessity NAN policy & planning committee.
Symptom exaggeration or fabrication occurs in a sizeable minority of neuropsychological examinees, with greater prevalence in forensic contexts. Adequate assessment of response validity is essential in order to maximize confidence in the results of neurocognitive and personality measures and in the diagnoses and recommendations that are based on the results. Symptom validity assessment may include specific tests, indices, and observations. The manner in which symptom validity is assessed may vary depending on context but must include a thorough examination of cultural factors. Assessment of response validity, as a component of a medically necessary evaluation, is medically necessary. When determined by the neuropsychologist to be necessary for the assessment of response validity, administration of specific symptom validity tests are also medically necessary.
Diagnosis, Differential↗
Analog validation of German-language symptom validity tests and the influence of coaching.
Although symptom validity testing is an integral part of the repertory of neuropsychologists in a number of countries, this is not yet true for Germany. The German adaptations of two effort tests, the Medical Symptom Validity Test (MSVT) by Green and the Amsterdam Short-Term Memory Test (ASTM) by Schmand et al., were investigated with a German-language sample. An analog study was performed with 18 healthy experimental malingerers and 18 controls with a mean age of 25.4 years. The scenario contained detailed information about mild post-traumatic cognitive impairment, as well as an explicit warning against symptom exaggeration. In addition to MSVT and ASTM, the Trail Making Test (TMT), the Complex Figure Test (CFT), and Digit Span were performed. Half of the sample were also given Rey's 15-Item-Test (FIT). Both groups were significantly different in all effort and performance measures, with the exception of the ratio TMT-B:TMT-A. With MSVT and ASTM, correct classification of group membership was between 97 and 100%. For the ratio TMT-B:TMT-A, there was a considerable overlap in the test scores for the two groups and the sensitivity of the FIT was too low. Although the ASTM and the MSVT were identified by a number of subjects as possible effort measures, both tests obtained very good results within this analog design.
Adult↗
Detecting simulated memory impairment: further validation of the Word Completion Memory Test (WCMT).
The Word Completion Memory Test (WCMT) was developed to detect sophisticated attempts at simulating memory impairment. The primary purpose of the present study was to provide additional validity and reliability information about the WCMT. Seventy-one participants were recruited for this study: 30 normal volunteers and 11 memory-disordered patients instructed to perform their best, and 30 normal volunteers instructed to fake memory impairment. Normal volunteers were administered five tests of neuropsychological functioning and five tests of simulation to explore the convergent and divergent validity of the WCMT. Two weeks later, these participants completed all 10 measures a second time. Memory-disordered patients were administered the WCMT and two additional simulation measures as part of a comprehensive neuropsychological evaluation. The WCMT successfully discriminated simulators from nonsimulators with an overall classification accuracy of 97% and demonstrated good psychometric properties. In conclusion, the WCMT continues to show promise as a measure of simulated memory impairment.
Adolescent↗
The ecological validity of executive tests in a severely brain injured sample.
It is unclear how well performance on recently developed, specialized executive tests, reflects problems that patients and their relatives complain of in real life. The ecological validity of four specialised tests of executive function: the Hayling and Brixton Tests, and the Zoo Map and Key Search sub-tests from the Behavioural Assessment of Dysexecutive Syndrome (BADS) battery, was assessed against the Dysexecutive Questionnaire from the BADS in a sample of 59 severely brain injured individuals. Results indicated that only the Hayling C was significantly negatively correlated (r=-.26, P<.05) with the informant version of the Dysexecutive Questionnaire. An index of insight was not correlated with any of the executive tests. It is concluded that these tests have limited ecological validity when used to assess patients following severe head trauma.
Adolescent↗
Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in the second stage of labor.
OBJECTIVE: Precise determination of fetal head position in labor is a prerequisite for safe instrumental deliveries, and essential for the assessment of labor progress. Recent studies have cast serious doubts on the accuracy of the time-honored digital vaginal examination (DVE) in comparison to transabdominal ultrasound scans (TUS). However, transabdominal imaging is technically difficult with a deeply engaged fetal head in the second stage of labor. We examined the accuracy and time requirements of transvaginal scans (TVS) in the second stage of labor for determination of fetal head position. STUDY DESIGN: Sixty laboring women in the second stage of labor with a deeply engaged fetal head were examined by experienced nurse midwives and senior residents. Fetal head position was recorded as "time on a 12-hour clock." Subsequently, TUS and TVS were independently performed by a skilled sonographer. Accuracy and time requirements for all 3 examinations were recorded. RESULTS: Fetal head position could be determined in all cases by TVS, but not in 7 cases and 9 cases by DVE and TUS, respectively (P < .03; P < .008). A discrepancy of 60 degrees or more between the DVE and TUS or TVS was found in 13/60 cases (21.7%) and 14/60 cases (23.3%), respectively. A > or = 90 degrees discrepancy was found in 9/60 cases (15%) and 12/60 cases (20%), respectively (P < .02 for comparison of TUS and TVS). In 5 cases, the digital examination erroneously perceived an occiput posterior position as occiput anterior. No significant differences in fetal head position were detected between TUS and TVS, when the examination was technically feasible. The mean time (+/-SD) required for determining fetal head position was shortest for TVS (8.7 +/- 5.8 seconds) in comparison to DVE (22.7 +/- 14.6 seconds; P < .0001) or TAS (31.7 +/- 19.1 seconds; P < .0001). CONCLUSION: Transvaginal sonography was the most successful and accurate method for determination of fetal head position in the second stage of labor, and required the least time for performance. We believe that TVS should be routinely performed in the labor room setting for the determination of fetal head position.
Abdomen↗
[Anaesthesia and prostate surgery].
OBJECTIVES: To review the current data about anaesthetic management in prostate surgery with special regards on analysis and prevention of specific risks, appropriate anaesthetic procedure keeping with surgery and patient, recognition and treatment of adverse events. DATA SOURCES AND EXTRACTION: The Pubmed database was searched for articles (1990-2004) combined with references analysis of major articles on the field. DATA SYNTHESIS: It is strongly recommended to settle germfree urine in the preoperative period. The thromboembolic risk of radical retropubic prostatectomy for cancer parallels lower abdomen oncologic surgery and is prolonged. Preoperative evaluation of cardiovascular, respiratory, neurological and metabolic comorbidity is a source of prognostic information and an essential tool in the management of elderly patients with prostate disease. Extreme patient positioning applied in prostate surgery induces haemodynamic and respiratory changes and are associated with severe muscular and nervous injuries. The laparoscopic access for radical prostatectomy is a growing alternative to the open surgical procedure. Acute normovolaemic haemodilution is a consistent and cost-effective blood conservation strategy in reducing allogenic blood transfusion for radical retropubic prostatectomy. Whether open transvesical or transurethral prostatectomy for treatment of benign hypertrophy depends on the size of the gland: transurethral resection is safe up to 80 g. Intrathecal anaesthesia with a T9 cephalad spread of sensory block, produces adequate conditions for transurethral prostatectomy and allows a rapid diagnosis of irrigating fluid absorption syndrome. In spite of recommended preoperative antibiotic prophylaxis, bacteriemias are frequent during transurethral prostate resection.
Adenoma↗
Prevention of delayed recovery and disability of work-related upper extremity disorders.
There is always a psychological component to any illness or injury, and unless it is appropriately addressed, such factors can complicate or delay the recovery from a work-related illness or injury. When a worker experiences delayed recovery and unexpected disability, significant contributing psychosocial factors must be assessed for and managed appropriately. A maladaptive belief or understanding about the condition and disability by a patient presents an obstacle to successful treatment. Using cognitive behavioral therapy techniques may be an effective means of managing this challenge for the clinician.
Adaptation, Psychological↗
Factitious disorders.
Factitious disorders reside under the broad umbrella of dysfunctional syndromes. This article is meant specifically to focus on common patterns of upper extremity factitious illness. It is intended to emphasize recognition, differential diagnosis, and problems related to misdiagnosis. It is not devoted to treatment, which is a separate issue.
Anxiety↗
Fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis.
Cerebellar haemorrhage is a rare prenatal event. Possible aetiologies for foetal intracranial haemorrhage include: trauma, asphyxia, infection, vascular defects, blood dyscrasias, ingestion of drugs and alloimmune and isoimmune thrombocytopenia. We report the ultrasonographic diagnosis of a cerebellar haematoma at 21 weeks of gestation. The foetus succumbed at 33 weeks of gestation following rupture of a subcapsular liver haematoma. An autopsy demonstrated a placental foetal thrombotic vasculopathy and thrombi in the chorionic vessels. We assume that hypercoagulability was responsible for the multiple infarcts in the foetus with haemorrhagic transformation in the cerebellum and liver. The differential diagnosis of foetal cerebellar haemorrhage includes maternal hypercoagulability; in this case multiple haemorrhagic/ischaemic events may be encountered during the pregnancy. A thorough investigation to elucidate the aetiology is pertinent in every case of foetal cerebellar haemorrhage in order to enable accurate counselling and correct management.
Adult↗
Normal and abnormal fetal brain development during the third trimester as demonstrated by neurosonography.
The multiplanar neurosonographic examination of the fetus enables superb visualization of brain anatomy during pregnancy. The examination may be performed using a transvaginal or a transfundal approach and it is indicated in patients at high risk for CNS anomalies or in those with a suspicious finding during a routine examination. The purpose of this paper is to present a description of the normal brain and of abnormal findings usually diagnosed late in pregnancy, including malformations of cortical development, infratentorial anomalies, and prenatal insults.
Brain↗
Successful twin pregnancy in a patient with complete uterine septum corrected during cesarean section.
OBJECTIVE: To describe a successful in vitro fertilization (IVF) twin pregnancy in a patient with complete uterine septum who underwent partial correction during cesarean section. DESIGN: Case report. SETTING: An IVF unit at a university hospital. PATIENT(S): A 29-year-old female patient with complete uterine septum undergoing IVF-intracytoplasmic sperm injection. INTERVENTION(S): In vitro fertilization-intracytoplasmic sperm injection with single embryo transfer to each uterine cavity. MAIN OUTCOME MEASURE(S): Pregnancy course and outcome. RESULT(S): Both transferred embryos underwent implantation, resulting in twin pregnancy with a single embryo in each hemi-uterus. Cesarean section was performed at 34 weeks' gestation. Two healthy neonates were born. Resection of the uterine septum by electrocauterization was attempted during cesarean section. Diagnostic hysteroscopy performed 6 months later demonstrated the presence of the uterine septum reaching approximately 40% of the cavity. CONCLUSION(S): Whether prophylactic metroplasty should be performed in patients with uterine septae without prior history of miscarriage or pregnancy complications is still under debate. Successful implantation and fetal development might occur without prior metroplasty, as described in our case report. Metroplasty during cesarean section might be only partly successful because part of the septum might be confined in the stretched gravid uterus.
Adult↗
Saving PTSD from itself in DSM-V.
Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.
Diagnosis, Differential↗