The Test of Memory Malingering (TOMM) is among the most widely used performance validity tests in neuropsychological assessment; however, its psychometric properties have not been formally validated for telehealth administration. This study aimed to compare TOMM performance when administered in-office and via telehealth. This retrospective study included 940 adults aged 18-84 years who completed the TOMM as part of routine neuropsychological or psychological evaluation, either in-office (n = 517) or via telehealth (n = 423). Trial 2 served as the primary performance validity indicator, with a score below 45 constituting the standard failure threshold. Equivalence was operationalized using a convergent criterion approach encompassing group differences in trial scores, pass/fail classification rates, inter-trial reliability, distributional properties, and consistency of relationships with depression, anxiety, and cognitive ability. Results demonstrated acceptable equivalence and comparable performance across modalities. Trial 2 scores did not differ significantly between groups (d = .08), and pass/fail classification rates were comparable (8.5% vs. 10.8%, p = .237). Inter-trial reliability was good to excellent across both modalities (α = .77-.88), and distributional properties were similar. Trial 1 differences (d = .20) dissipated by Trial 2, suggesting clinically inconsequential modality effects. Relationships with depression, anxiety, and cognitive ability were consistent across groups. These findings support use of standard TOMM cutoff criteria in examiner-controlled telehealth evaluations and provide empirical justification for remote performance validity assessment when appropriate procedural safeguards are maintained. Limitations include the retrospective design, potential sampling differences between modality groups, and restriction to examiner-controlled administrations.

Objectives: This study aimed to examine the association between the dangling choroid plexus sign and fetal structural, chromosomal, and genetic abnormalities, as well as to define the normal range of lateral ventricular width and the ratio of choroid plexus width to lateral ventricular width at 14-17 weeks of gestation. Methods: This retrospective study analyzed ultrasound images from early fetal anatomy scans performed between January 2018 and July 2025 at two tertiary fetal medicine centres. In centre A, 6063 singleton pregnancies underwent routine scans at 11-13 and 14-17 weeks. In centre B, 776 fetuses with suspected abnormalities or increased nuchal translucency at 11-13 weeks were reassessed at 14-17 weeks. Additionally, 400 fetuses without obvious abnormalities at 14-17 weeks were used to determine normal ventricular measurements. Results: In normal fetuses, the mean lateral ventricular width was 6.90 mm (95% CI 6.81-6.99) and the mean choroid plexus-to-ventricle ratio was 0.85 (95% CI 0.84-0.86). A dangling choroid plexus was identified in 38 fetuses (0.16% in routine and 3.6% in high-risk populations). Out of 38 cases of dangling choroid plexus, 37 were associated with additional structural defects, chromosomal abnormalities, or single-gene disorders. Chromosomal abnormalities were found in 11/30 tested cases, most commonly trisomy 21. The most common defects observed on initial or subsequent scans were ventriculomegaly, cardiac defects, and abnormal posterior fossa. Conclusions: A dangling choroid plexus at 14-17 weeks is a sonographic marker associated with major fetal abnormalities and should prompt detailed anatomical assessment and consideration of genetic testing.

Objective: The accurate diagnosis of posttraumatic stress disorder (PTSD) is essential in both clinical and forensic contexts. Indices assessing for PTSD symptom invalidity have primarily been validated in Western nations, and more research about the equivalence of these measures is needed when utilized in other countries. Therefore, this study cross-validated existing PTSD Checklist for DSM-5 (PCL-5) symptom validity indices in an African forensic sample. Method: Examinees were 115 African (Ugandan, Kenyan, and Zimbabwean) foreign nationals who had been employed as contractors on U.S. military bases in Iraq and Afghanistan. Examinees were seen for evaluation in a forensic context for claimed PTSD under the purview of the Defense Base Act, a mechanism for pursuing Worker's Compensation type claims. Examinees were classified as credible or non-credible responders based on independent, established symptom validity test findings. Results: The credible and non-credible groups did not differ based on demographic and background variables. Conversely, all three PCL-5 validity indices significantly differentiated the groups with medium effect sizes, and additional validity measures also differentiated groups with medium to large effects, supporting the accuracy of the classifications. Optimal PCL-5 cutoffs closely mirrored those identified in North American samples. When specificity was held at ≥.90, two of the three PCL-5 validity indices yielded sensitivity rates of ≥.30. Conclusions: The findings provide cross‑cultural support for PCL‑5 symptom validity indices and contribute to a growing body of evidence demonstrating their utility across diverse international samples. Consistent patterns across geographic regions suggest these indices may have broader applicability than previously established.

The use of point-of-care testing (POCT) for patient-based biochemical measurements in blood is growing rapidly, and the number will likely increase dramatically outside hospitals in the coming years due to healthcare reform and pressure on various healthcare sectors. This literature review finds that it calls for attention to the analysis performance and its limitations, as well as with the skills of the equipment users (including citizens). The Danish Institute for Quality in Healthcare has recommended that national standards for the quality assurance of POCT be established, and we, as laboratories, would be happy to help identify which areas requires national standardisation.

Malingering is falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among others. It is not a psychiatric illness according to DSM-5 (Diagnostic and Statistical Manual of Mental Diseases, Fifth edition). The DSM-IV-TR failed to provide any precise criteria because malingering is not considered a psychiatric diagnosis, but the manual does state it is a “condition that may be a focus of clinical attention.” Although malingering was excluded from the index in DSM-5, it remains a "V" code, and the criteria for when to consider malingering remains unchanged. External (secondary) gain is necessary for differentiating malingering from factitious disorder (a disorder in which patient consciously creates physical or psychological symptoms to assume sick role, the primary gain). Malingerers show poor compliance with treatment and stop complaining about the assumed illness only after gaining the external benefit.

Functional neurological disorder (FND) is a common clinical condition that is associated with a wide range of neurological, mental health, and physical symptoms, as well as reduced quality of life. There is growing recognition of frequent cognitive difficulties across the spectrum of FND presentations, which are related to impairment and disability for many patients. However, uncertainty regarding the potential clinical utility of cognitive testing continues to hold back optimal assessment and treatment. Specific issues that are in need of additional clarity include contributions of cognitive testing beyond the initial FND diagnosis; overall rates of failed performance validity tests in patients with FND; and conflicting notions about whether cognitive impairments based on testing are either incompatible with the diagnosis or ubiquitous in FND. The current manuscript reviews evidence pertaining to each of these issues, outlines contexts in which cognitive testing is indicated or contraindicated, and provides recommendations for how neuropsychologists can use test results to benefit patients and their families.

Objective The rate of prescription stimulant misuse has steadily risen over the past few decades. Medical students are at significant risk; however, limited data exist surrounding misuse in this population. This cross-sectional survey aimed to investigate prescribing practices, behaviors, and motivations contributing to medical student prescription stimulant misuse. Methods An electronic survey was distributed via university email to all medical students enrolled at an allopathic medical school. Survey assessed prescribing practices, malingering, diversion, provider counseling, perceived medication safety, knowledge of adverse effects and consequences of diversion, pressure to use medication, and normality of peer misuse. Sample t-tests, chi-square tests, and Kendall's Tau-b tests were used for analysis. Results Of the approximately 600 students eligible for inclusion in the study, 290 (48.3%) completed the survey. 256 (88.3%) respondents reported no prescription stimulant use, 29 (10.0%) reported use with a prescription, and 5 (1.7%) reported use without a prescription. 12 (41.4%) of the 29 respondents with a prescription received their first prescription while in medical school, 3 (10.3%) were prescribed without a complete evaluation for attention deficit hyperactivity disorder (ADHD), and 2 (7.4%) engaged in malingering. A total of 16 users (55.2%) received medication counseling, and 15 users (51.7%) received legal counseling at the time of prescription. Receiving legal and medication counseling was associated with a significantly higher average understanding of consequences of diversion (p = 0.012) and medication side effects (p = 0.017), respectively. There were no significant differences in motivations for use or behaviors of use between users with and without a prescription. The year of medical school was significantly associated with stimulant use behavior (p = 0.03). Students experiencing greater pressure to use medication to compete academically were significantly more likely to indicate an interest in matching into psychiatry (p = 0.036), obstetrics & gynecology (p = 0.025), interventional radiology (p = 0.044), urology (p < .0001), and physical medicine & rehabilitation (p = 0.050) residencies. Among non-users, there was a statistically significant positive correlation between pressure to use medication and both the frequency of witnessing peers use medication without a prescription (+0.336, p < 0.0001) and the likelihood of malingering (+0.422, p < 0.0001). Conclusions The prevalence of non-prescription stimulant use was lower than what has been reported in previous studies; however, cases of malingering and potentially inappropriate prescribing of stimulants were observed among students with prescriptions. Efforts should be taken to increase provider counseling on the medical risks of use and the implications of diversion. Mitigating the perceived normalcy of stimulant misuse may be an effective strategy for reducing misuse among medical students.

The forensic determination of malingering is primarily guided by performance validity tests (PVTs), symptom validity tests (SVTs), and discrepancies in the examinee's presentation. A determination of malingering may occur when PVT or SVT scores fall within the invalid range. Additionally, such determinations may arise from discrepancies between (neuro) psychological test results and established information about the examinee, or from discrepancies within the examinee's presentation. Current diagnostic frameworks incorporate differential diagnosis considerations intended to preclude a malingering determination despite the presence of discrepancies or invalid PVT and SVT scores. However, these differential diagnosis considerations are largely conceptual and remain insufficiently supported by empirical evidence. Drawing on prior literature, this narrative review examines research concerning 21 additional factors which are currently absent from existing malingering criteria, but which may compromise diagnostic accuracy. These factors include distraction, abuse history, ethnocultural and linguistic diversity, substance use, various comorbidities, fatigue, stress, and various interpersonal and situational factors. To reduce the risk of false-positive malingering determinations, recommendations for modifications to forensic assessment practices and directions for future research are proposed.