Forensic neuropsychological assessment.

With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.

Forensic assessment of somatoform and functional neurological disorders.

Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness-related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.

Performance and symptom validity assessment in attention deficit/hyperactivity disorder: Base rates of invalidity, concordance, and relative impact on cognitive performance.

Objective: Differential diagnosis of attention deficit/hyperactivity disorder (ADHD) is one of the most common referral questions for neuropsychological evaluation but is complicated by the presence of external incentives. Validity assessment is therefore critical in such evaluations, employing symptom validity tests (SVTs) and performance validity tests (PVTs) to assess the validity of reported symptoms and cognitive test performance, respectively. This study aimed to establish the base rate of symptom and performance invalidity in adults referred for ADHD, compare concordance between performance and symptom validity, and assess the impact of each type of validity on cognitive test performance. Method: This consecutive case series included data from 392 demographically-diverse adults who underwent outpatient neuropsychological evaluation for ADHD. All patients were administered the Clinical Assessment of Attention Deficit-Adult (CAT-A) and a uniform cognitive test battery, including seven PVTs. Results: Invalid symptom reporting and PVT performance were found in 22% and 16% of the sample, respectively. Sixty-eight percent had concordantly valid SVTs/PVTs and 6% had invalid SVTs/PVTs, whereas the remaining 26% had either invalid SVTs or PVTs (but not both). Invalid PVT performance resulted in a significant decrease across all cognitive test scores, with generally large effects (ηp2=.01-.18). Invalid symptom reporting had minimal effects on cognitive test performance (ηp2= ≤.04). Conclusions: PVTs and SVTs are dissociable and therefore should not be used interchangeably in the context of adult ADHD evaluations. Rather, symptom and performance validity should continue to be assessed independently as they provide largely non-redundant information.

[Validity of the "Structured Inventory of Malingered Symptomatology" [SIMS] in the Assessment of Healthy Individuals and Patients with Psychiatric Disorders Outside the Forensic Context]. / Validität des "Strukturierten Fragebogens Simulierter Symptome" [SIMS] bei gesunden Probanden und Patienten mit psychiatrischen Erkrankungen außerhalb eines forensischen Kontexts.

OBJECTIVE: Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context. METHODS: Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated. RESULTS: Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF). CONCLUSION: If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.

Contribution of the neuropsychological assessment in concussion.

INTRODUCTION: The neuropsychological assessment is a cornerstone in the care management of concussion or mild traumatic injury. OBJECTIVE: To present the different stages of an exhaustive neuropsychological assessment exploring cognitive and behavioral domains. METHOD: Description of the value of the main tests available for behavioral and cognitive assessment. The choice of tests is based on the clinical experience and expertise of the authors. RESULTS: Questionnaires are mainly used to explore the behavioral sequelae (depression, anxiety or fatigue) and the impact of these potential difficulties in daily life. Four cognitive abilities could be impaired by concussion: attention, memory, visuospatial functions and executive functions. These abilities could be explored with "paper and pencil" tests or with computerized test batteries. While cognitive sequelae in the context of a moderate or a severe traumatic brain injury are consolidated, in the context of concussion, neuropsychological sequelae tend to resolve in a short time. As a consequence, several neuropsychological assessments could be conducting in a short period involving some methodological considerations. Moreover, as concussion could be reported in a Whiplash injury from a car crash with forensic consequences, it is crucial to propose tests to be sure that the weak performance obtained into the neuropsychological assessment is not explained by poor effort and/or malingering. DISCUSSION/CONCLUSION: This article revises these aspects of a neuropsychological assessment in the specific context of concussion.

Evaluating the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) over-reporting scales in a military neuropsychology clinic.

Introduction: This study examines the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales to detect invalid responding within a sample of active duty United States Army soldiers referred for neuropsychological evaluations.Method: This study examines the relationship between performance validity testing and performance on the MMPI-2-RF over-reporting scales. Specifically, mean differences between those who passed (n = 152; 75.6%) or failed (n = 49; 24.4%) performance validity testing were compared. Receiver operator characteristic analyzes were also conducted to expand available information on the MMPI-2-RF over-reporting sensitivity and specificity in an Army sample.Results: This study has two distinct findings. First, effect size differences between those passing and failing performance validity testing are classified as small to medium in magnitude (ranging from d = . 30/g = .32 on F-r to d = .66/g = .73 on RBS). Second, over-reporting scales have higher specificity and poorer sensitivity. Likewise, performance of the over-reporting scales suggests that those who exceeding recommended cut scores are likely to have failed extra-test performance validity measures.Conclusion: These findings suggest that many who fail external performance measures may be undetected on the MMPI-2-RF over-reporting scales and that those exceeding recommended cut scores are likely to have failed extra-test performance validity testing. Implications for research on, and practice with, the MMPI-2-RF in military populations are discussed.

Stratified performance on the Test of Memory Malingering (TOMM) is associated with differential responding on the Personality Assessment Inventory (PAI).

Introduction: This study evaluated symptom endorsement patterns in participants at various stratified performance levels on the Test of Memory Malingering (TOMM). It was hypothesized that the lowest stratum (chance performance and below) would have the most pathological (i.e., elevated item endorsement) responding on the Personality Assessment Inventory (PAI) validity and clinical scales. This study was primarily a replication of previous work with emphasis on the PAI scales and consideration of varying degrees of performance on TOMM Trial 2.Methods: Participants were 760 (54% female, 85.4% Caucasian, mean age = 42.01 (SD = 15.89), mean education = 13.55 (SD = 2.35)) consecutively referred neuropsychological outpatients who completed the TOMM and PAI. Participants were placed in one of 5 stratified TOMM Trial 2 performance level groups (High Pass, Low Pass, High Fail, Low Fail, and Chance). No significant differences were found between the demographic variables except for referral source, which was overrepresented in the Chance group relative to the other groups.Results: Due to the highly skewed nature of TOMM Trial 2, Spearman rank order correlations were calculated for the 5 stratified levels of TOMM performance and all the main PAI scales. The NIM, SOM, DEP, ANX, SCZ and SUI scales had significant correlations, so a series of One-way ANOVAs were calculated to examine these scales at different TOMM stratified performance levels. Results indicated that the Chance group had the highest level of responding on all scales, with NIM, SOM, DEP, SCZ and SUI having mean elevations above the clinical cutoff (T = 70).Conclusions: Results were consistent with previous pass-fail PVT research, but extended earlier research to provide evidence that Chance performance group had more pathological PAI responding. The results provide preliminary evidence to support the notion that patients who fail PVTs at different levels do not have the same characteristics.

Indicators to distinguish symptom accentuators from symptom producers in individuals with a diagnosed adjustment disorder: A pilot study on inconsistency subtypes using SIMS and MMPI-2-RF.

In the context of legal damage evaluations, evaluees may exaggerate or simulate symptoms in an attempt to obtain greater economic compensation. To date, practitioners and researchers have focused on detecting malingering behavior as an exclusively unitary construct. However, we argue that there are two types of inconsistent behavior that speak to possible malingering-accentuating (i.e., exaggerating symptoms that are actually experienced) and simulating (i.e., fabricating symptoms entirely)-each with its own unique attributes; thus, it is necessary to distinguish between them. The aim of the present study was to identify objective indicators to differentiate symptom accentuators from symptom producers and consistent participants. We analyzed the Structured Inventory of Malingered Symptomatology scales and the Minnesota Multiphasic Personality Inventory-2 Restructured Form validity scales of 132 individuals with a diagnosed adjustment disorder with mixed anxiety and depressed mood who had undergone assessment for psychiatric/psychological damage. The results indicated that the SIMS Total Score, Neurologic Impairment and Low Intelligence scales and the MMPI-2-RF Infrequent Responses (F-r) and Response Bias (RBS) scales successfully discriminated among symptom accentuators, symptom producers, and consistent participants. Machine learning analysis was used to identify the most efficient parameter for classifying these three groups, recognizing the SIMS Total Score as the best indicator.

[Assessment of Mental Disorders]. / Begutachtung psychischer Erkrankungen in der gesetzlichen Renten- und Unfallversicherung.

Psychiatric expertise is necessary for a variety of legal expert opinion orders. Psychiatric assessment requires high professional competence and basic knowledge in the relevant areas of law. General conditions for comprehensive psychiatric assessment procedures are outlined. The problem of aggravation and simulation is discussed.

Evaluating new supplemental indicators for the Personality Assessment Inventory: Standardization and cross-validation.

As the research literature on the Personality Assessment Inventory (PAI; Morey, 1991) has expanded, several supplemental indicators have been introduced to aid in the interpretation of PAI results for the purpose of addressing particular assessment questions, such as protocol validity or treatment-related considerations. However, many of these indicators have remained largely unexamined beyond the initial validation studies in which they were derived. The purpose of the present study was to provide normative data for these new supplemental indicators, as well as to cross-validate these indicators in other existing PAI data sets and provide information about incremental validity beyond existing PAI scales and indices. Comparison effect sizes indicated that nearly all of the new supplemental indicators discriminated as intended, with the majority of indicators also contributing significantly beyond existing PAI indicators. These results suggest that some of these supplemental indicators may prove to be useful additions to the standard scoring of the PAI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).