- Ethical Challenges in Acute Evaluation of Suspected Psychogenic Stroke Mimics. [Journal Article]
- JCJ Clin Ethics 2018; 29(3):185-190
- Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms tha...
Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology.
- Differentiating factitious psychological presentations from malingering: Implications for forensic practice. [Journal Article]
- BSBehav Sci Law 2018 Sep 17
- Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. T...
Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Building on Rogers' central motivations for malingering, the current article provides four explanatory models for FPPs; three of these parallel malingering (pathogenic, criminological, and adaptational) but differ in their central features. In addition, the nurturance model stresses how patients with FPPs attempt to use their relationship with treating professionals to fulfill their unmet psychological needs. Relying on these models, practical guidelines are recommended for evaluating FPPs in a forensic context.
- Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering. [Journal Article]
- PTPsychol Trauma 2018 Sep 13
- CONCLUSIONS: The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record
- The Case: Medically Disabled or Malingering? [Journal Article]
- CQCamb Q Healthc Ethics 2018; 27(4):738
- Commentary: Doing the Most Good with the Least Harm in Cases of Suspected Malingering. [Journal Article]
- CQCamb Q Healthc Ethics 2018; 27(4):740-742
- Classification accuracy of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) and Effort Scale (ES) relative to the Test Of Memory Malingering (TOMM) in a mixed clinical sample. [Journal Article]
- ANAppl Neuropsychol Adult 2018 Sep 05; :1-5
- Performance Validity Testing has become an integral part of neuropsychological assessment, and a variety of embedded screening measures for performance validity have been proposed. Several performanc...
Performance Validity Testing has become an integral part of neuropsychological assessment, and a variety of embedded screening measures for performance validity have been proposed. Several performance validity indexes have been developed for the Repeatable Battery for the Assessment of Neuropsychological Status. Although the RBANS Effort Index (EI) and Effort Scale (ES) have garnered some empirical support, other research has raised questions regarding their accuracy in a number of assessment contexts. We evaluated the classification accuracy of the EI and ES against a standalone performance validity measure (Test of Memory Malingering; TOMM) in a mixed clinical patient sample. Our results showed limited utility for the ES in a mixed sample and modest classification accuracy for the EI, raising concerns about the appropriate scope of use for these scales in general clinical practice, which suggested that an alternate EI cutoff score of >0 may be most appropriate.
- WHO-AVLT recognition trial: Initial validation for a new malingering index for Spanish-speaking patients. [Journal Article]
- ANAppl Neuropsychol Adult 2018 Sep 05; :1-9
- Several methods for identifying suboptimal effort on Spanish neuropsychological assessment have been established. The purpose of this retrospective study was to determine whether recognition data fro...
Several methods for identifying suboptimal effort on Spanish neuropsychological assessment have been established. The purpose of this retrospective study was to determine whether recognition data from the WHO-AVLT could be employed for determination of malingering in a Spanish-speaking sample. Sixteen subjects in litigation, 25 neurological patients, and 14 healthy controls completed neuropsychological testing. All subjects completed the Test of Memory Malingering (TOMM). Inclusion criteria for neurological patients and controls included performance above the standard TOMM cutoff. Subjects in litigation were classified as probable malingering, through lower than cutoff performance on the TOMM and at least one other performance validity measure. Cut-off scores for classification of malingering were determined based on the number of recognition hits on the WHO-AVLT. The probable malingering group performed significantly worse than both groups on recognition hits. A score <10 was determined to be the optimal group cutoff, with 56.25% sensitivity and specificity greater than 92%. A combination score of 14 increased sensitivity to 68.75%. These findings provide initial validation of a new malingering index, based on the number of hits on the WHO-AVLT recognition trial. This index will provide valuable information to neuropsychologists conducting forensic or clinical evaluations on Spanish-speaking individuals.
- Differentiating epilepsy from psychogenic nonepileptic seizures using neuropsychological test data. [Journal Article]
- EBEpilepsy Behav 2018 Aug 29; 87:39-45
- CONCLUSIONS: Consistent with previous research, the utility of psychometric methods of differential diagnosis is limited by the complex neurocognitive profiles associated with ES and PNES. Although individual measures might help differentiate ES from PNES, multivariate assessment models have superior discriminant power. The strongest psychometric evidence for PNES appears to be a consistent lack of impairment on tests sensitive to diffuse neurocognitive deficits such as processing speed, working memory, and verbal fluency. While video-electroencephalogram (EEG) monitoring is the gold standard of differential diagnosis, psychometric testing has the potential to enhance clinical decision-making, particularly in complex or unclear cases such as patients with nondiagnostic video-EEGs. Adopting a standardized, fixed neuropsychological battery at epilepsy centers would advance research on the differential diagnostic power of psychometric testing.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Professor Gordon Waddell first described a group of eight clinical physical signs in 1980 known as Waddell signs. As an orthopedic surgeon, Waddell initially developed these signs as a method to i...
Professor Gordon Waddell first described a group of eight clinical physical signs in 1980 known as Waddell signs. As an orthopedic surgeon, Waddell initially developed these signs as a method to identify patients with low back pain who were likely to experience a poor surgical outcome from lower back surgery. More recently, clinicians have utilized Waddell signs to detect psychogenic, sometimes inappropriately labeled “non-organic,” manifestations of low back pain in patients. This practice has expanded to identify malingering in patients, such as discrediting the legitimacy of motor vehicle accident claims as well as identifying psychogenic components in other non-lumbar pain syndromes. In 1998, Main and Waddell stated that these physical signs have been misinterpreted and misused both clinically and medico-legally. In their article, they emphasize the importance of viewing back pain within a psychosocial context. They state that behavioral signs may be a response affected by fear from injury and development of chronic incapacity, and are not a test of credibility. They conclude that patients displaying Waddell signs may require both physical management of their physical pathology as well as careful therapy for the psychosocial and behavioral aspects of their illness.
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- Derivation of New Embedded Performance Validity Indicators for the Child and Adolescent Memory Profile (ChAMP) Objects Subtest in Youth with Mild Traumatic Brain Injury. [Journal Article]
- ACArch Clin Neuropsychol 2018 Aug 15
- CONCLUSIONS: This study yields promising new embedded PVTs for the ChAMP Objects subtest with strong sensitivity and specificity for detecting invalid performance in youth with MTBI.