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.

Functional neurological disorder (FND) presents disabling symptoms that fluctuate, migrate across systems, and yet routinely show preserved structural integrity-features that can frustrate diagnosis and patient education. Crucially, these symptoms are genuine and reflect altered brain regulation across multiple systems rather than tissue damage or conscious control. This paper offers a clinically usable account of these puzzles by reframing FND as a disorder of precision control within predictive coding. The brain's confidence (precision) in its own predictions is modelled as a dynamic quantity that can surge with arousal, settle back toward baseline, and slowly recalibrate over longer periods. Placing this mechanism in a four-level hierarchy (affective, interoceptive, proprioceptive, spinal) shows how arousal can temporarily make an unhelpful expectation dominate, suppress corrective feedback, and produce motor, sensory, cognitive, or visceral symptoms-often in combination. The same dynamics explain rule-in positive signs such as distractibility, entrainment, and give-way weakness, and clarify the lived experience of reduced agency without implying wilfulness or malingering. For clinicians, the framework provides an intuitive way to explain symptoms to patients ('a temporary gain miscalibration that overweights predictions and underweights sensory feedback'), and to justify why physiotherapy (amplifying proprioceptive feedback), psychotherapy (reducing arousal), and mindfulness or biofeedback (raising the effective threshold for arousal-driven 'gain spikes') can all help by recalibrating that weighting. The framework also yields concrete, falsifiable tests, linking bedside observation to measurable biomarkers and offering ways to refine it further. By centring dynamic precision, the account unifies diagnosis, communication, and treatment planning, and provides a mechanistic foundation for precision-guided care in FND.

Functional neurological disorder (FND) commonly arises in the context of injury, trauma, or litigation and poses distinctive medicolegal challenges. This review outlines how positive clinical signs and contemporary neurobiological models support FND as a robust diagnosis, while distinguishing it from factitious disorder and malingering. We discuss approaches to assessing authenticity of reported disability, the role and limitations of symptom and performance validity tests, and the pitfalls of equating inconsistency with deception. We then consider causation within common legal frameworks using a predisposing-precipitating-perpetuating model to analyze the contribution of index events, background vulnerabilities, and the litigation process itself. Finally, we summarize current evidence on treatment and prognosis, highlighting the limits of prediction and the need to offer courts transparent, probabilistic opinions on long-term outcome and care needs. Our aim is to support clinicians in providing balanced, clinically grounded expert evidence for patients with FND.

Intrafamilial homicide, particularly parricide, sits at a critical intersection of forensic psychiatry, criminal justice, and civil rights protection, and diagnostic labels generated in custodial settings may later shape high-stakes civil decisions. We report the case of a 24-year-old man imprisoned for parricide committed at age 19, who was referred to an independent forensic psychiatric evaluation within a Brazilian civil guardianship (curatela) action. The assessment integrated developmental and criminological reconstructions, collateral records (school and juvenile justice documentation, police and prison files), and a phenomenology-focused mental status examination with attention to secondary-gain contingencies. The longitudinal record supported early-onset conduct disorder, severe polysubstance use, instrumental violence, lack of remorse, and intact reality testing. Prison and telepsychiatry notes labeled the case "paranoid schizophrenia," but the reported psychotic symptoms were vague, internally inconsistent, and strategically framed, raising strong suspicion of malingering; there was no evidence of persistent delusions, formal thought disorder, negative symptoms, or psychosis-driven functional decline independent of substance use and antisocial behavior. The final formulation supported antisocial personality disorder with comorbid substance use disorder, without a chronic psychotic disorder, and preserved civil decision-making capacity. The opinion recommended against guardianship, highlighting how "psychiatrizing" antisocial conduct and importing thin prison diagnoses into civil proceedings can misdirect restrictions on rights and inadvertently function as a "back-door" route to penal reclassification. Rigorous, guideline-informed forensic reasoning is essential to distinguish psychosis from personality pathology and simulation.