Does the disorder matter? Investigating a moderating effect on coached noncredible overreporting using the MMPI-2 and PAI.

The use of psychological tests to help identify the noncredible overreporting of psychiatric disorders is a long-standing practice that has received considerable attention from researchers. The purpose of this study was to experimentally determine whether feigning specific psychiatric disorders moderated the influence of coaching on the detection of noncredible overreporting using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI). Using a 2 × 3 experimental analogue design, 265 undergraduates were asked to feign schizophrenia, posttraumatic stress disorder, or generalized anxiety disorder and were either coached about validity scales and disorders or not. The results of this study indicated that the specific psychiatric disorder being feigned did moderate the impact coaching had on the detection of overreported psychopathology using several scales on the MMPI-2 and PAI. Future research examining noncredible overreporting should take into account the impact caused by the interaction of psychiatric disorder with coaching on the detection of symptom overreporting and also identify other important moderating/mediating variables in order to develop more effective means of identifying response bias.

The A-Test: a symptom validity indicator embedded within a mental status examination for Social Security Disability.

During the Psychological Consultative Examination (PCE) for Social Security Disability evaluations, there is a need for symptom validity measures to validate the findings for claims of disability (Chafetz, 2010 ). The "A" Random Letter Test of Auditory Vigilance (A-Test) is a simple auditory continuous performance test utilized as part of a comprehensive mental status examination (Strub & Black, 1993 ). The present study validates the use of the A-Test as a symptom validity measure easily administered as part of the PCE for Social Security Disability evaluations. This study shows that the A-Test is well correlated with other symptom validity measures, discriminates multiple symptom validity failure from nonmultiple failure, and has good classification accuracy statistics in two different studies of these claimants. The A-Test can thus easily be used as a symptom validity measure in professional psychological examinations of Social Security claimants without additional cost or much added time to the evaluation.

Auditory memory decrements, without dissimulation, among patients with major depressive disorder.

Questions have been raised about whether poor performance on memory tasks by individuals with major depressive disorder (MDD) might be the result of poor or variable effort or disease-related disruption of neural circuits supporting memory functions. The present study examined performance on a measure of task engagement and on an auditory memory task among 45 patients with MDD (M age = 47.82, SD = 19.55) relative to 32 healthy controls (HC; M age = 51.03, SD = 22.09). One-hundred percent of HC and MDD volunteers performed above the threshold for adequate effort on a formal measure of task engagement. The MDD subjects performed significantly more poorly than the HC subjects on an auditory learning and memory test. The present results suggest that auditory memory difficulties do occur among those with MDD and that decrements in performance in this group may be related to factors other than lack of effort.

[Recommendations for independent medical examinations of PTSD claimants]. / Empfehlungen für die Begutachtung von PTBS-Opfern.

In Germany, like in many Western countries, posttraumatic stress disorder (PTSD) is being diagnosed on an increased scale; it has become a major cost-producing factor of the healthcare and insurance industry. However, diagnosing PTSD may be problematic when it is primarily based on a symptom report. Although the forensic expert is expected to check the veracity of the symptoms reported, history taking, psychopathological assessment and diagnostic accuracy vary greatly among professionals. Thus, the diagnosis of PTSD often cannot be confirmed by later thorough inspection. Based on more than a decade of civil-forensic work in the area, the authors formulate recommendations for independent medical examinations in cases of claimed PTSD.

Detecting insufficient effort using the Seashore Rhythm and Speech-Sounds Perception Tests in head injury.

This study examined the capacity of the Seashore Rhythm Test (SRT) and the Speech-Sounds Perception Test (SSPT) to detect insufficient effort in a clinical sample. Forty-six participants with financially compensable mild head injury who obtained scores indicative of insufficient effort on multiple measures were compared to 49 participants with brain injury who were not involved in litigation. Receiver operating characteristic (ROC) curve analysis indicated that both the SRT (AUC = .84) and SSPT (AUC = .80) were significant (p < .001) predictors of insufficient effort. Maximizing sensitivity and specificity, the optimal cutoff scores were 8 errors on the SRT and 10 errors on the SSPT. Combining both variables into a logistic regression function increased the diagnostic efficiency.

The voluntary control of motor imagery. Imagined movements in individuals with feigned motor impairment and conversion disorder.

The ability to volitionally control motor imagery was investigated by comparing the chronometry of real and imagined movements in a patient (AB) with conversion disorder who presented with paralysis of the left arm and hand and in a patient (MM) with an actual injury to the left arm. Control experiments investigated voluntary control of motor imagery in a group of healthy individuals who feigned a motor impairment with one limb and in one group who were instructed to move carefully and slowly. The visually guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. In the healthy individuals, the speed for accuracy trade-off for both real and imagined performance on the motor task conformed to Fitts' law provided both the speed and accuracy of movements was emphasised. In MM, real and imagined performance was also within normal limits despite considerable pain and discomfort. In AB and in subjects feigning a motor impairment, motor task performance with the affected limb was slow and did not conform to Fitts' law. However, although imagined performance with the affected limb was generally slower than with the unaffected limb, it did conform to Fitts' law. These results suggest subjects cannot anticipate the effects of an actual limb injury. Furthermore, while they are able to control the general duration of imagined movements they have little voluntary control over their relative timing.

Multiple personality disorder in criminal law.

The authors review the recent literature on multiple personality disorder (MPD), the most severe and chronic of the dissociative disorders, in relation to court cases of competence to stand trial, the insanity defense, and research on malingerers feigning MPD. Issues relevant in the assessment of competency and insanity are described. Features characteristic of MPD, including amnesia and alterations in consciousness and personality, have varying degrees of influence over the criminal behavior of an individual with MPD. As in other psychiatric disorders, the influence of MPD on an individual's competence to stand trial, and sanity, can be evaluated systematically. This article discusses a specific diagnostic tool, the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), an extensively field tested instrument that is potentially quite useful in forensic assessment of suspects manifesting dissociative symptoms and disorders. The particular advantages of the SCID-D will be reviewed in the context of some well known criminal cases involving MPD. Further research using diagnostic interviews for the systematic assessment of dissociative symptoms and MPD in criminal cases will continue to clarify the influence of these symptoms in a forensic context.

The belief in the transmigration of souls: psychotherapy of a Druze patient with severe anxiety reaction.

In this paper the culture-sensitive psychotherapy of a 19-year-old Druze patient with severe anxiety reaction is described. The patient explained his anxiety and his symptoms as stemming from violent death in his former life and subsequent transmigration. The therapists joined the patient's explanatory model and previous traditional healing, adding hypnotic suggestion which relieved the symptoms. The relationship of patient symptomatology to cultural background, multiple personality disorder, possession and dissociation is discussed. The strategic combination of culture-specific and modern psychiatric approaches is advocated in similar cases.

Is it organic or is it functional. Is it hysteria or malingering?

Conversion hysteria, a common affliction, requires prompt diagnosis and treatment to prevent fixation of the incapacity and secondary contractures, and to protect the patient from unnecessary surgery. Diagnostic and therapeutic principles are outlined.