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PubMed1999

Compensation-seeking and extreme exaggeration of psychopathology among combat veterans evaluated for posttraumatic stress disorder.

We extended the work of Smith and Frueh (1996) by evaluating whether combat veterans classified as "extreme exaggerators" were more likely to be compensation-seeking, and to report greater levels of psychopathology across self-report instruments than "nonexaggerators." Of 119 veterans who completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) at an outpatient posttraumatic stress disorder (PTSD) clinic, 26 (22%) and 17 (14%) were identified as extreme exaggerators using two MMPI-2 validity indicators with stringent cutoffs (F-K > or = 22; F(p) > or = 8). These veterans were much more likely to be compensation seeking and scored much higher on self-report measures of various psychological symptoms than nonexaggerators, despite having lower rates of PTSD diagnoses and similar rates of other comorbid diagnoses. Findings suggest that the validity indices of the MMPI-2 can play a critical role, as a screening instrument, in identifying veterans who may be exaggerating their psychopathology to gain disability compensation.

Adult↗
PubMed1991

Low-back injuries in a heavy industry. II. Labor market forces.

Trends in rates of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of a petroleum drilling company, 1979-1985, were examined to investigate the relationship between economic factors and the incidence of low-back and other injuries. Economic indicators included the rate of resignations, a surrogate for turnover, and the rate of layoffs. Only lost-time low-back strain rates increased during times of worker layoffs. Non-low-back injury rates were highest during periods of high turnover and no layoffs. Although the increasing age of the work force and the anxiety generated by an industry-wide depression may have played a role, it is likely that the increase in lost-time low-back strain injuries was a worker response to possible layoff.

Accidental Falls↗
PubMed1998

Behavioral responses to examination. A reappraisal of the interpretation of "nonorganic signs".

Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and understanding. Isolated signs should not be overinterpreted. Multiple signs suggest that the patient does not have a straightforward physical problem, but that psychological factors also need to be considered. Some patients may require both physical management of their physical pathology and more careful management of the psychosocial and behavioral aspects of their illness. Behavioral signs should be understood as response affected by fear in the context of recovery from injury and the development of chronic incapacity. They offer only a psychological "yellow-flag" and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking.

Disability Evaluation↗
PubMed2006

Late onset of Wilson's disease in a family with genetic haemochromatosis.

We report the coexistence of Wilson's disease and genetic haemochromatosis in one family. The diagnosis of genetic haemochromatosis was established in a 52-year-old man. Among his siblings, one 57-year-old sister and one 55-year-old brother had decreased copper and ceruloplasmin levels in serum and increased urinary copper excretion. The sister shared the same human leucocyte antigen haplotypes and was homozygous for the HFE mutation C282Y, like the propositus. However, she had normal liver iron content and increased liver copper content. Her dietary copper intake was probably excessive. The association of Wilson's disease and genetic haemochromatosis is rare and has only been described twice. The onset of Wilson's disease after 50 years of age is rare; Wilson's disease should be considered in any patient with unexplained chronic liver disease; an excess in liver copper content might be induced by excessive dietary input in a susceptible individual.

Age of Onset↗
PubMed1993

Consistency of sincere and feigned grip exertions with repeated testing.

Our purpose was to test the hypothesis that feigned exertions would show greater variability in both force and electromyograms than would sincere exertions over repeated testing sessions. Eleven normal subjects made sincere and feigned exertions while performing the five-handle position Jamar grip test. The subjects were tested 6 times in a 3- to 5-week period. Contrary to the hypothesis, feigned exertions did not show greater variability than sincere exertions. Both sincere and feigned exertions were highly consistent over the six sessions. However, the sincere and feigned exertions did differ in the patterns of force and electromyogram on the five-handle position test. These results and those of previous studies suggest that clinicians should use more than one type of test when testing suspected malingerers.

Adult↗
PubMed2002

Can posturography identify informed malingerers?

OBJECTIVE: This study evaluated whether information about computed dynamic posturography given to subjects instructed to feign vestibular impairment (malingerers) improved their attempts to display test patterns consistent with vestibular weakness. STUDY DESIGN: The study design was prospective, with blinded scoring of tests. SETTING: The study was conducted at a university hospital. PATIENTS: Sixty volunteer subjects, 20 to 59 years old, were randomly assigned to one of two equal groups: naïve subjects and subjects informed about computed dynamic posturography. INTERVENTIONS: Computed dynamic posturography was performed twice. First, subjects were instructed to feign a vestibular weakness. Second, subjects were instructed to perform the test normally. One group was given additional information about computed dynamic posturography before the first test (informed faking). MAIN OUTCOME MEASURES: The computed dynamic posturography test summaries were scored as normal, aphysiologic, or vestibular by two methods: the scoring method published by Cevette et al. in 1995 and blinded clinical scoring. The computed dynamic posturography test summaries of patients referred for vestibular disorders were included with the test summaries collected from subjects during scoring. These additional tests of possible "true" vestibular disorder allowed evaluation of scoring accuracy. RESULTS: The scoring method of Cevette et al. classified about one-third of the test results of feigned vestibular weakness as either normal (16.7%) or vestibular weakness (18.3%). The remaining two thirds of the test results of feigned vestibular weakness were classified as aphysiologic (65.0%). Blinded clinical scoring gave similar figures. Additional information about computed dynamic posturography did not increase the number of feigned test results scored as a vestibular weakness. CONCLUSION: When additional information about computed dynamic posturography was provided, the subjects did not improve their ability to feign vestibular weakness. This investigation supports the use of scoring computed dynamic posturography results by the formulae of Cevette et al. in separating aphysiologic behavior from vestibular impairment.

Adult↗
PubMed2004

A new clinical evaluation for hysterical paralysis.

STUDY DESIGN: A cross-sectional study was performed to elucidate the usefulness of a new clinical evaluation, and a prospective study was performed to detect hysterical paralysis using this evaluation method. OBJECTIVES: To make a correct diagnosis of hysterical paralysis, a new clinical evaluation was developed. SUMMARY OF BACKGROUND DATA: Hysterical paralysis is a conversion disorder. Its diagnosis must be ruled out when encountering a patient with paralysis, therefore imaging and electrophysiological studies are often necessary, but costly. The principal salient diagnostic features for diagnosing hysterical paralysis are thought to be the preservation of a normal reflex pattern, normal rectal sensation, and normal bladder and bowel functions; however, these features are not always successfully identified. METHODS: A new clinical evaluation named the "Spinal Injuries Center" test was developed. The lower extremities of the patients were divided into two groups as follows: in group A, the patients were able to lift up the knee; in group B, the patients were unable to lift up the knee. The 96 legs of the 48 patients who had obvious myelomalacia were randomly chosen. All legs were investigated using the Spinal Injuries Center test, and the association between each group and the Spinal Injuries Center test was examined. The 28 legs of the 14 patients in whom hysterical paralysis was diagnosed were prospectively evaluated using the Spinal Injuries Center test, and the association between the groups and the Spinal Injuries Center test was examined. RESULTS: Forty-eight legs were classified as group A, and 48 legs were classified as group B. In group A, 45 legs were judged to be positive for the Spinal Injuries Center test, and 3 legs were negative. In group B, 1 leg was judged to be positive for the Spinal Injuries Center test, and 47 legs were negative. All legs of the patients with hysterical paralysis were classified as group B; however, all legs were positive for the Spinal Injuries Center test. CONCLUSIONS: The Spinal Injuries Center test is a new clinical evaluation method that can help make a correct diagnosis of hysterical paralysis. When a patient is unable to lift up his knees by himself, the result of the Spinal Injuries Center test is considered to be positive, and hysterical paralysis is diagnosed in such patients. The diagnosis of hysterical paralysis must be ruled out when encountering patients with paralysis, and as a result, imaging and electrophysiological studies are often necessary. Unfortunately, such tests are costly. Thus, a new clinical evaluation for the diagnosis of hysterical paralysis, named the Spinal Injuries Center test, was developed. When patients who are unable to lift up their knees by themselves test positive using the Spinal Injuries Center test, then they are considered to have ether hysterical or simulated paralysis.

Adolescent↗
PubMed2005

Psychological evaluation of the emotional effects of a community toxic exposure.

OBJECTIVE: We sought to assess the emotional effects of a major community toxic release while controlling the potential effects of response bias associated with litigation. METHODS: Participants included 152 exposed adult litigants and a matched unexposed comparison group (n = 76). Psychological assessment methods included: (1) Minnesota Multiphasic Personality Inventory-2; (2) Symptom Checklist-90-Revised; and (3) Impact of Event Scale-Revised. RESULTS: Ten to 40% of the exposed group demonstrated emotional distress (compared with a 5% comparison baseline) depending on indicator and cutoff score used. CONCLUSIONS: The psychological consequences of a community toxic exposure were present even when exaggeration was carefully controlled. Accounting for exaggeration in the assessment of subjective psychological complaints provides a more accurate view of the subjective emotional state of persons who have experienced toxic exposure thereby facilitating appropriate clinical management of their mental health needs.

Accidents↗