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Court-mandated treatment: dilemmas for hospital psychiatry.

The authors present clinical material to illustrate the special treatment and management problems posed by different types of mentally ill offenders; they suggest that court-mandated hospital treatment is often destructive and unrelated to the needs of the patient, the community, and the mental institution. The failure to create new kinds of institutions, combining modalities derived from the hospital and correctional systems, is traced to poor communication among the disciplines involved. The "mentally ill offender" is caught in the interplay of these systems and is consequently both their victim and victimizer.

Adult↗

Assessment of Viet Nam veterans for posttraumatic stress disorder in Veterans Administration disability claims.

Since the Veterans Administration (VA) authorized compensation and other benefits for posttraumatic stress disorder, delayed type, in October 1980, the agency has received an increasingly large number of claims--mainly from Viet Nam veterans--for this disorder. An unprecedented challenge of the adequacy of psychiatric disability evaluation in the VA has thus been created. The authors describe efforts in one large program to meet this challenge and review 12 problems in the diagnostic process. Cooperation of all parties in claims transactions, thorough claimant assessment, reliance on DSM-III criteria and methods and consultation with examiners are essential principles for this work.

Adult↗

Factitious posttraumatic stress disorder.

A growing number of young men have reported an array of symptoms that suggest a diagnosis of posttraumatic stress disorder. Five such men, all claiming to be Viet Nam veterans, were treated at a VA medical center; three said they were former prisoners of war. In fact, none had been prisoners of war, four had never been in Viet Nam, and two had never even been in the military. Instead, all five suffered factitious disorders. The authors describe the five patients and discuss differential diagnoses; the value of verifying military histories is stressed.

Adult↗

Diagnostic legitimacy of factitious disorder with psychological symptoms.

The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.

Adult↗

Failure to detect fabricated posttraumatic stress disorder with the use of the MMPI in a clinical population.

The authors attempted to replicate previous studies that used the Frequency (F) scale and the posttraumatic stress disorder (PTSD) subscale of the MMPI to discriminate Vietnam veterans with PTSD from well-adjusted veterans and mental health professionals who feigned symptoms of PTSD. Profiles of veterans with PTSD were compared to those of veterans with non-PTSD psychiatric disorders and veterans with fabricated PTSD symptoms who sought treatment. Discriminant analysis of F scale and PTSD subscale scores correctly identified only 43.59% of the subjects, thus failing to support use of the MMPI in detecting fabricated symptoms of PTSD in a clinical population.

Adult↗

Money matters: a meta-analytic review of the effects of financial incentives on recovery after closed-head injury.

OBJECTIVE: The authors evaluated the impact of financial incentives on disability, symptoms, and objective findings after closed-head injury. METHOD: Meta-analysis was used to review the literature. Seventeen reports, covering 18 study groups and a total of 2,353 subjects, contained data from which effect sizes could be calculated. Effect sizes were aggregated after weighting for group size. After discussion, there was 100% agreement between the authors on all calculations. RESULTS: A moderate overall effect size, 0.47, was found. The effect was particularly strong for mild head trauma. The data showed more abnormality and disability in patients with financial incentives despite less severe injuries. CONCLUSIONS: Clinical evaluation of patients after closed-head injury, particularly mild head trauma, must include consideration of the effect of financial incentives on symptoms and disability.

Brain Concussion↗