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PubMed2001

Strategies used in feigning hearing loss.

Thirty unsophisticated participants with normal hearing were paid to simulate a hearing loss according to their success in "deceiving" the examiner. The behaviors that these "malingerers" manifested are described. A post-examination interview revealed the strategies used by these participants, which may reflect those strategies used by patients who truly attempt to feign a hearing loss.

Adolescent↗
PubMed2001

[Somatoform pain disorder and work disability].

Over the past few years, the number of i.v. pensioners has risen drastically. According to BSV statistics the diagnosis for the new pensions was mainly based on psychological disorders and problems with the musculoskeletal system. A large portion of these people with new disabilities are probably suffering from somatoform disorder, whereby the insured person complains about pain for which there are no demonstrable organic findings. The author contests the fact that this condition automatically leads to disability and makes an appeal for stricter, more exacting diagnostic screening: psychiatric co-morbidity must be considered in order to be able to determine the degree of work disability. Due to its multiplicity and inconsistencies, current practice is no longer able to ensure equal handling of all insured persons.

Cross-Sectional Studies↗
PubMedDate not supplied

[The detection of possible cases of simulation after a traumatic brain injury].

OBJECTIVE: To show the degree of detection of simulation, defined as the conscious, intentional production of false or exaggerated physical and psychological symptoms, motivated by external rewards such as payments by insurance companies and compensations. DEVELOPMENT: In forensic circles, a major problem is under consideration, namely recognition of the existence and nature of cognitive alterations after mild head injury (HI), since it is estimated that in 5-10% of the cases of mild HI there may be simulation of cognitive and emotional deficit, with further difficulty of differential diagnosis between simulation and the post-concussion syndrome. CONCLUSIONS: The forensic assessment of cognitive alterations following HI should include a clinical interview and neuropsychological evaluation. The former helps to determine the causal relationship between the traumatic accident and the resulting damage, continuance of symptoms and the existence or not of a premorbid pathological state. Although there is still not completely reliable, valid marker which permits one to be completely certain that the person is a simulator, neuropsychological evaluation permits suspicion of it in three aspects: 1. General indicators showing lack of internal consistence in the results of the person evaluated. 2. Specific tests to detect possible cases of simulation. 3. Profiles of responses which characterize possible simulators and neuropsychological evaluation tests.

Affective Symptoms↗
PubMed2001

A new suicide.

Explore the source record for details and available documents.

Aged↗
PubMedDate not supplied

[The Stenger Test--its use and variations].

INTRODUCTION: Simulation, dissimulation and aggravation of partial hearing loss can refer to bilateral or unilateral hearing loss. Tests for detection can be divided into unilateral and bilateral. CASE DESCRIPTION: A patient aged 29, came for otolaryngological examination 13 days after hearing impairment and blast injury of the ear following detonation of an airplane-launched missile about 500 meters away. AT the moment of detonation he was not wearing a helmet. Two hours later he noticed bloody discharge and strong tinnitus in the left ear. During examination and audiometric test, we suspected aggravation. The patient was sent for sub-specialist audiological examination. The audiogram made during the first testing showed a perceptive hearing impairment on the right side, while the left ear was without response (Audiogram 1). We asked the patient to concentrate, repeated the test, and got Audiogram 2 (Curve I). After this the patient was informed that we would carry out another testing, using Stenger test, and we got Curve II. The patient was informed that he had done very successfully in the test, and that we would repeat it, Curve III. We got Curve IV by repeating the test reducing the tone volume by 10 dB again. The aggravation was obvious, and the audiogram was shown to the patient, explaining that his intention was detected, and he was asked to cooperate correctly so that adequate therapy could be applied, which he accepted, so that we got Curve V, the real condition of his hearing. CONCLUSION: We have shown the case of a patient injured in a missile explosion which caused perforation of the tympanic membrane and a sensorineural hearing loss. Suspecting aggravation, Stenger test was performed. The testing showed unexpected results not described with Stenger test and we simultaneously detected the patient's intention to simulate aggravation.

Adult↗
PubMed2001

Discrepancy between predicted and obtained WAIS-R IQ scores discriminates between traumatic brain injury and insufficient effort.

This study examines how well the discrepancy between predicted and obtained Wechsler Adult Intelligence Scale--Revised (WAIS-R) scores discriminate between insufficient effort (IE) and traumatic brain injury (TBI). The 27 IE patients performed significantly more poorly on the WAIS-R than the 48 moderate-severe TBI patients. Premorbid IQs were calculated with formulae that use demographics (Barona Index) or demographics and WAIS-R performance (Best-3 and the Oklahoma Premorbid Intelligence Estimation). Predictions were similar on the Barona, but IE patients' predicted IQs were lower than TBIs for measures with a performance component. IE patients demonstrated a greater discrepancy score (i.e., predicted IQ--obtained IQ) than TBIs; variable levels of sensitivity and specificity were obtained when discriminate functions were developed on these scores. The potential advantage of using discrepancy scores versus performance-based measures to detect insufficient effort is discussed.

Adult↗
PubMed2001

Effort testing in patients with fibromyalgia and disability incentives.

OBJECTIVE: To examine whether symptom exaggeration is a factor in complaints of cognitive dysfunction using 2 new validated instruments in patients with fibromyalgia (FM). METHODS: Ninety-six patients with FM and 16 patients with rheumatoid arthritis (RA) were administered 2 effort or symptom validity tests designed to detect exaggerated memory complaints as part of a battery of psychological tests and self-report questionnaires. RESULTS: A large percentage of patients with FM who were on or seeking disability benefits failed the effort tests. Only 2 patients with FM who were working and/or not claiming disability benefits and no patient with RA scored below the cutoffs for exaggeration of memory difficulties. CONCLUSION: This study illustrates the importance of assessing for exaggeration of cognitive symptoms and biased responding in patients with FM presenting for disability related evaluations.

Adult↗
PubMed2001

An overview of neurolaw for the clinician: what every potential witness should know.

This article reviews the field of medical jurisprudence known as neurolaw which deals with the medicolegal ramifications of brain and spinal cord injuries. Placing emphasis upon how clinicians may work effectively with trial lawyers, it provides practical guidance to neurorehabilitation professionals who testify in personal injury cases.

Brain Concussion↗