Search Results (14)

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) has risen precipitously in recent years in the United States. This has been accompanied by a corresponding increase in rates of stimulant medication prescriptions, resulting in prescription drug shortages. These data raise concern that adult ADHD may be overdiagnosed. This article examines factors that can contribute to adult ADHD overdiagnosis. Sources of overdiagnosis include lack of adherence to DSM-5-TR diagnostic criteria, poor diagnostic practices, malingering, electronic distractions, cultural shifts in how the term “ADHD” has been used, and other health conditions that impair attention. More rigorous diagnostic practices are necessary to ensure appropriate diagnoses and treatments are offered. Adopting such practices will help optimize patient outcomes. Such practices include ruling out other conditions that impair attention, taking a careful developmental history, gathering information from collateral sources, and evaluating the patient for functional impairments. Full article

Introduction: Most audiometers have an in-built “Stenger test” setting. The test is sometimes applied in cases of single-sided deafness as an indicator of malingering. Although textbooks have been written about it, the underlying conditions remain enigmatic. The literature usually points to psychological problems, pointing to the patient as having “nonorganic hearing loss”, “malingering”, “false and exaggerated hearing loss”, “hysterical hearing loss”, or “pseudohypoacusis”. These are all non-objective features without a sound scientific base, and the test tends to blame the patient for providing non-repeatable hearing thresholds. Methods: This opinion piece looks at the literature surrounding the Stenger test and the factors that might cause hearing threshold variability and concludes that the test has a subjective basis that makes it unscientific. In our opinion, we also think it is ethically questionable to blame the patient for malingering when there are non-repeatable findings. In order to make the test scientifically valid, we frame a testable hypothesis: that the Stenger effect could be due to unrecognised contraction of the middle ear muscles in response to stimulation of the contralateral (worse-hearing) ear. That is, we suppose that bilateral contraction impairs thresholds in both the good and poor ear, so the subject can no longer hear a tone in their good ear which they previously could when their audiogram was established monaurally. Thus, we make the case that the subject is not malingering—they genuinely cannot hear the test tones in either ear. Discussion and Conclusions: We believe it is incorrect to blame the patient when the problem may lie with incomplete understanding of how the auditory system functions bilaterally. The test needs to be objectively investigated and perhaps reinterpreted in terms of hearing sensitivity in one ear being reduced by sound levels in the contralateral ear. If this is not possible, we suggest it would be better if the Stenger test were abolished. Full article

Background/Objectives: Feigning spectrum behavior (FSB) is the exaggeration, fabrication, or false imputation of symptoms. It occurs in compensable injury with great cost to society by way of loss of productivity and excessive costs. The aim of this study is to identify feigning by developing cut scores on the long and short forms (SF) of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ and OMPSQ-SF) and the Perceived Stress Scale (PSS and PSS-4). Methods: As part of pre-screening for a support program, 40 injured workers who had been certified unfit for work for more than 2 weeks were screened once with the OMPSQ and PSS by telephone by a mental health professional. A control sample comprised of 40 non-injured community members were screened by a mental health professional on four occasions under different aliases, twice responding genuinely and twice simulating an injury. Results: Differences between the workplace injured people and the community sample were compared using ANCOVA with age and gender as covariates, and then receiver operator characteristics (ROCs) were calculated. The OMPSQ and OMPSQ-SF discriminated (ρ < 0.001) between all conditions. All measures discriminated between the simulation condition and workplace injured people (ρ < 0.001). Intraclass correlation demonstrated the PSS, PSS-4, OMPSQ, and OMPSQ-SF were reliable (ρ < 0.001). Area Under the Curve (AUC) was 0.750 for OMPSQ and 0.835 for OMPSQ-SF for work-injured versus simulators. Conclusions: The measures discriminated between injured and non-injured people and non-injured people instructed to simulate injury. Non-injured simulators produced similar scores when they had multiple exposures to the test materials, showing the uniformity of feigning spectrum behavior on these measures. The OMPSQ-SF has adequate discriminant validity and sensitivity to feigning spectrum behavior, making it optimal for telephone screening in clinical practice. Full article

Background and Objectives: Assessing pain deception is challenging due to its subjective nature. The main goal of this study was to evaluate the diagnostic value of pain deception using machine learning (ML) analysis with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, considering accuracy, precision, recall, and f1-score as diagnostic parameters. Materials and Methods: This study was a single-blinded, randomized controlled trial. Subjects were randomly allocated into a non-deception (ND) group and a deception (D) group. Pain deception, as a form of psychological intervention, was taught to subjects in the D group to deceive the physician. MMPI-2, Waddell’s sign, and salivary alpha-amylase (SAA) were also measured. For analyzing the MMPI-2, the XGBoost ML algorithm was applied. Results: Of a total of 96 participants, 50 and 46 were assigned to the ND group and the D group, respectively. In the logistic regression analysis, pain and MMPI-2 did not show diagnostic value. However, in the ML analysis, values of the selected MMPI-2 (sMMPI-2) scales related to pain deception showed an accuracy of 0.724, a precision of 0.692, a recall of 0.692, and an f1-score of 0.692. Conclusions: Using MMPI-2 test results, ML can diagnose pain deception better than the conventional logistic regression analysis method by considering different scales and patterns together. Full article

Functional neurological disorder, or FND, is widely misunderstood, particularly when considering recent research indicating that the illness has numerous biological markers in addition to its psychiatric disorder associations. Nonetheless, the long-held view that FND is a mental illness without a biological basis, or even a contrived (malingered) illness, remains pervasive both in current medical care and general society. This is because FND involves intermittent disability that rapidly and involuntarily alternates with improved neurological control. This has in turn caused shaming, perceived low self-efficacy, and social isolation for the patients. Until now, biomarker reviews for FND tended not to examine the features that are shared with canonical neurological disorders. This review, in contrast, examines current research on FND biomarkers, and in particular their overlap with canonical neurological disorders, along with the encouraging outcomes for numerous physical rehabilitation trials for FND. These findings support the perspective endorsed here that FND is unquestionably a neurological disorder that is also associated with many biological markers that lie outside of the central nervous system. These results suggest that FND entails multiple biological abnormalities that are widely distributed in the body. General healthcare providers would benefit their care for their patients through their improved understanding of the illness and recourses for support and treatment that are provided in this review. Full article

Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder’s multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder. Full article

Malingering relates to intentionally pretending or exaggerating physical or psychologic symptoms to gain an external incentive, such as avoiding work, law prosecution or military service, or seeking financial compensation from insurance companies. Accordingly, various techniques have been developed in recent years by the scientific community to address this challenge. In this review, we discuss malingering within visual, auditory and olfactory domains, as well as in cognitive disorders and psychopathology. We provide a general, critical, narrative overview on the intermodal criteria for differential diagnosis, and discuss validated psychophysical tools and electrophysiology-based tests for its detection, as well as insights for future directions. Full article

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning. Malingering or feigning of symptoms can be a major challenge during ADHD assessment. Stimulant medication abuse, misuse and diversion may constitute another challenge during management. A literature search of the past 15 years on the topic continued to suggest that there are several reasons for malingering and faking ADHD symptoms. Some of the reasons include the intent to obtain prescriptions for stimulant medications for performance enhancement, to gain access to additional school services and accommodations, to use recreationally and to sell as a street drug. In some countries, patients may receive additional tax or student loan benefits. Several researchers suggested that self-report rating measures are easily simulated by patients without ADHD. They concluded that no questionnaire has proved sufficiently robust against false positives. Some clinical factors that may suggest malingering during the ADHD assessment are highlighted and some available tests to detect malingering are discussed. Full article

Although data and research on the topic are lacking, the phenomenon of feigned homicidality in short-term hospitalization appears to have increased in recent years. Inpatient psychiatrists not only assess the seriousness of homicidal threats, but also whether such threats are authentic. However, specific literature and diagnostic manuals provide virtually no clinical guidance for this. The authors present two case examples of homicidality feigned for self-serving purposes that had little to do with hostility against the would-be victim. They recommend an approach to assessment that first takes any threat of homicide seriously, and involves an attempt to assess the seriousness of the threat and risk of harm. Secondly, if feigned homicidality is suspected, clinicians can methodically assess for this using criterion that have been applied to the assessment of malingering. Full article

Performance validity tests (PVTs) are used for the detection of noncredible performance in neuropsychological assessments. The aim of the study was to assess the efficacy (i.e., discrimination capacity) of a novel PVT, the Multi-Level Pattern Memory Test (MPMT). It includes stages that allow profile analysis (i.e., detecting noncredible performance based on an analysis of participants’ performance across stages) and minimizes the likelihood that it would be perceived as a PVT by examinees. In addition, it utilizes nonverbal stimuli and is therefore more likely to be cross-culturally valid. In Experiment 1, participants that were instructed to simulate cognitive impairment performed less accurately than honest controls in the MPMT (n = 67). Importantly, the MPMT has shown an adequate discrimination capacity, though somewhat lower than an established PVT (i.e., Test of Memory Malingering—TOMM). Experiment 2 (n = 77) validated the findings of the first experiment while also indicating a dissociation between the simulators’ objective performance and their perceived cognitive load while performing the MPMT. The MPMT and the profile analysis based on its outcome measures show initial promise in detecting noncredible performance. It may, therefore, increase the range of available PVTs at the disposal of clinicians, though further validation in clinical settings is mandated. The fact that it is an open-source software will hopefully also encourage the development of research programs aimed at clarifying the cognitive processes involved in noncredible performance and the impact of PVT characteristics on clinical utility. Full article

Socio-emotional abilities have been proposed as an extension to models of intelligence, but earlier measurement approaches have either not fulfilled criteria of ability measurement or have covered only predominantly receptive abilities. We argue that faking ability—the ability to adjust responses on questionnaires to present oneself in a desired manner—is a socio-emotional ability that can broaden our understanding of these abilities and intelligence in general. To test this theory, we developed new instruments to measure the ability to fake bad (malingering) and administered them jointly with established tests of faking good ability in a general sample of n = 134. Participants also completed multiple tests of emotion perception along with tests of emotion expression posing, pain expression regulation, and working memory capacity. We found that individual differences in faking ability tests are best explained by a general factor that had a large correlation with receptive socio-emotional abilities and had a zero to medium-sized correlation with different productive socio-emotional abilities. All correlations were still small after controlling these effects for shared variance with general mental ability as indicated by tests of working memory capacity. We conclude that faking ability is indeed correlated meaningfully with other socio-emotional abilities and discuss the implications for intelligence research and applied ability assessment. Full article

Visual evoked potential (VEP) has been used as an alternative method to assess visual acuity objectively, especially in non-verbal infants and adults with low intellectual abilities or malingering. By sweeping the spatial frequency of visual stimuli and recording the corresponding VEP, VEP acuity can be defined by analyzing electroencephalography (EEG) signals. This paper presents a review on the VEP-based visual acuity assessment technique, including a brief overview of the technique, the effects of the parameters of visual stimuli, and signal acquisition and analysis of the VEP acuity test, and a summary of the current clinical applications of the technique. Finally, we discuss the current problems in this research domain and potential future work, which may enable this technique to be used more widely and quickly, deepening the VEP and even electrophysiology research on the detection and diagnosis of visual function. Full article

Symptom exaggeration and feigned cognitive impairment occur commonly in forensic and medicolegal evaluations. As a result, methods to detect feigned cognitive impairment are an indispensable component of neuropsychological assessments. This study reports the results of two neurophysiological experiments using a forced-choice recognition task built from the stimuli of the Word Memory Test and Medical Symptom Validity Test as well as a new linguistically informed stimulus set. Participant volunteers were instructed either to do their best or to feign cognitive impairment consistent with a mild traumatic brain injury while their brain activity was monitored using event-related potentials (ERP). Experiment 1 varied instructions across individuals, whereas Experiment 2 varied instructions within individuals. The target brain component was a positive deflection indicating stimulus recognition that occurs approximately 300 ms after exposure to a stimulus (i.e., the P300). Multimodal comparison (P300 amplitude to behavioral accuracy) allowed the detection of feigned cognitive impairment. Results indicate that, for correct responses, P300s were equivalent for the simulated malingering and good effort conditions. However, for incorrect responses, feigned impairment produced reliable but significantly reduced P300 amplitudes. Although the P300 is an automatic index of recognition—even when knowledge is hidden—its amplitude appears capable of modulation by feigning strategies. Implications of this finding are discussed for research and clinical applications. Full article

Previous research has demonstrated that jurors show a bias towards treatment for veterans with post-traumatic stress disorder (PTSD). The present research examines this bias when jurors are faced with cases of potential malingering, in which the defendant’s claim of PTSD is a perceived attempt to escape legal punishments. Trial vignettes, in which veteran status and PTSD diagnosis timing were manipulated, were used to explore this phenomenon. It was found that veterans who received their diagnosis after being arrested were found guilty more often, and were diverted to treatment less often, than those who were diagnosed before an arrest. This has critical implications for mental healthcare in that it is crucial to properly diagnose and treat people before they find themselves in court. Further, the negative outcomes in court demonstrate one of the severe social impacts of untreated or late-diagnosed PTSD. Full article