Contribution of objectively measured grating acuity by sweep visually evoked potentials to the diagnosis of unexplained visual loss.

PURPOSE: To investigate the diagnostic contribution of grating visual acuity (GVA) measured by sweep pattern-reversal visually evoked potentials (SPRVEP) in unexplained visual loss (UVL). METHODS: This case-control study included adult patients under suspicion of UVL referred to SPRVEP and transient pattern-reversal visually evoked potentials (TPRVEP) testing. Optotype visual acuity (OVA) was measured by ETDRS 4-meter chart and GVA by SPRVEP. UVL patients were assigned into three distinctive categories, according to the presence of ocular disease, motivation, and electrophysiological evaluation, as follows: exaggerators, malingerers, and psychogenic. Healthy controls and patients with organic visual loss were also tested. Receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance of GVA and TPRVEP parameters. RESULTS: A total of 76 patients with UVL were analyzed: 60 (79.0%) exaggerators, 11 (14.4%) malingerers, and 5 (6.6%) psychogenic. Controls were 49 subjects evaluated for TPRVEP and 28 subjects for SPRVEP. There were 13 patients with organic visual loss enrolled. Mean difference between OVA and GVA was 1.19±0.67 (median=0.84; 95% CI: 1.04 to 1.34) in UVL and 0.14 ±0.09 (median= 0.14; 95% CI: 0.08 to 0.20) in organic visual loss. The area under the ROC curve (AUC) of GVA to distinguish UVL from healthy controls was 0.998 with a cutoff of 0.09 logMAR showing specificity of 100% and sensitivity of 96.0%. CONCLUSIONS: GVA measured by SPRVEP had good diagnostic validity to discriminate patients with unexplained visual loss from healthy controls and patients with organic visual loss, demonstrating its contribution to the diagnosis of this condition.

Simulação de esquizofrenia no Teste de Rorschach (R-PAS) / Schizophrenia simulation in the Rorschach Test (R-PAS) / Simulación de esquizofrenia en el Teste Rorschach (R-PAS)

Este trabalho teve como objetivo comparar o desempenho no Teste de Rorschach (R-PAS), de pessoas instruídas sobre os sintomas da esquizofrenia e solicitadas a responder ao Rorschach, tentando se passar por um paciente com esse diagnóstico (n = 40), com o de pacientes diagnosticados com esquizofrenia (n = 35). Os participantes responderam ao Teste de Rorschach (R-PAS), a Magical Ideation Scale (MIS) e ao Inventory of Problems-29 (IOP-29) tentando simular esquizofrenia. Os resultados das comparações entre os grupos evidenciaram diferenças estatisticamente significativas para as variáveis (Hd), An, FQo, FQu, FQ-, P, M, PEC, WSumCog, MAH, GHR e Complexity. Encontrou-se também associação positiva e de forte magnitude entre os escores obtidos no IOP-29 e os escores brutos da MIS (r = 0,73, p = 0,0001). Os achados evidenciaram que, mesmo diante das tentativas de distorção das respostas ao teste, simuladores não conseguem distanciar da própria precisão perceptiva. (AU)

This study compared the performance in the Rorschach Test (R-PAS) of people informed about the symptoms of schizophrenia and asked to respond to the Rorschach trying to impersonate a patient with this diagnosis (n = 40) with that of patients diagnosed with schizophrenia (n = 35). Participants responded to the Rorschach Test (R-PAS), the Magical Ideation Scale (MIS) and the Inventory of Problems-29 (IOP-29) trying to simulate schizophrenia. The results of the comparisons between the groups showed statistically significant differences for the variables (Hd), An, FQo, CFQ, CF-, P, M, PEC, WSumCog, MAH, GHR and Complexity. A positive and strong association was also found between the scores obtained in the IOP-29 and the gross scores of the MIS (r=.73, p=.0001). The findings show that even faced with attempts to distort the responses to the test, simulators cannot distance themselves from their perceptual accuracy. (AU)

Este estudio tuvo como objetivo comparar el rendimiento en el Test de Rorschach (R-PAS) de personas educadas sobre los síntomas de la esquizofrenia y solicitadas a responder al Rorschach, tratando de pasar por un paciente con este diagnóstico (n = 40) con el de los pacientes diagnosticados con esquizofrenia (n = 35). Los participantes respondieron al Test de Rorschach (R-PAS), a la Magical Ideation Scale (MIS) y al Inventory of Problems-29 (IOP-29) intentando simular la esquizofrenia. Los resultados de las comparaciones entre los grupos mostraron diferencias estadísticamente significativas para las variables (Hd), An, FQo, CFQ, CF-, P, M, PEC, WSumCog, MAH, GHR y Complexity. También se encontró una asociación de magnitud positiva y fuerte entre los scores obtenidos en la IOP-29 y los scores brutos del MIS (r = 0,73, p = 0,0001). Los hallazgos muestran que, incluso frente a los intentos de distorsionar las respuestas del test, los simuladores no son capaces de distanciarse de su precisión perceptiva. (AU)

In situ simulation in the permanent education of the intensive care nursing team / Simulación in situ en la educación permanente del equipo de enfermería de cuidados intensivos / Simulação in situ na educação permanente da equipe de enfermagem de terapia intensiva

ABSTRACT Objective: to know the perception of nursing professionals about the in situ strategy in continuing education in intensive care. Method: a descriptive, exploratory and qualitative study, conducted with 15 nursing professionals from an Intensive Care Unit. Data was collected from December 2018 to February 2019, by means of semi-structured interviews, after in situ simulations that occurred in the work environment and involving two settings, one on septic shock and the other, cardiorespiratory arrest. For analysis, the collective subject discourse technique was applied using a software program. Results: from the 15 nursing professionals participating in the study, eight were nurses and seven were nursing technicians. Their age varied from 23 to 56 years old and their time in intensive care ranged from two months to 17 years. The in situ simulation was perceived as an opportunity to update and acquire professional knowledge, skills and competencies, especially for those without experience, favoring the gain of self-confidence, communication, decision-making and clinical reasoning. The simulated in situ strategy was also portrayed as a possibility of training in the professional practice and in real time, unlike traditional training, and also, as a safe environment to make mistakes of diverse magnitudes because it is a training setting. Conclusion: the professionals understand the in situ simulation as being valid for professional update and practical learning in a safe setting.

RESUMEN Objetivo: conocer la percepción de los profesionales de Enfermería sobre la estrategia de la simulación in situ en la educación permanente en cuidados intensivos. Método: estudio descriptivo, exploratorio y cualitativo, realizado con 15 profesionales de Enfermería de una Unidad de Cuidados Intensivos. Los datos se recolectaron entre diciembre de 2018 y febrero de 2019 por medio de entrevistas semiestructurada, después de simulaciones in situ que tuvieron lugar en el ámbito laboral e incluyeron dos situaciones hipotéticas, una sobre shock séptico y otra, sobre parada cardiorrespiratoria. Para el análisis se aplicó la técnica del Discurso del Sujeto Colectivo con el uso de un programa de software. Resultados: de los 15 profesionales de Enfermería que participaron del estudio, ocho eran enfermeros y siete técnicos de enfermería. La edad varió entre 23 y 56 años y la experiencia en cuidados intensivos osciló entre dos meses y 17 años. La simulación in situ se percibió como oportunidad de actualización y adquisición de conocimientos, habilidades y competencias profesionales, principalmente para quienes carecían de experiencia, favoreciendo así una mejoría en los niveles de autoconfianza, comunicación, toma de decisiones y raciocinio clínico. La estrategia simulada in situ también se representó como una posibilidad de capacitación en la práctica profesional y en tiempo real, a diferencias de sistemas tradicionales de capacitación e, incluso, como un ámbito seguro para cometer errores de diversas magnitudes, por tratarse de una situación de entrenamiento. Conclusión: los profesionales perciben la estrategia de la simulación in situ como válida para la actualización profesional y el aprendizaje práctico en un ámbito seguro.

RESUMO Objetivo: conhecer a percepção dos profissionais de enfermagem sobre a estratégia da simulação in situ na educação permanente em terapia intensiva. Método: estudo descritivo, exploratório, qualitativo, realizado com 15 profissionais de enfermagem de uma Unidade de Terapia Intensiva. Os dados foram coletados de dezembro de 2018 a fevereiro de 2019, por meio de entrevista semiestruturada, após as simulações in situ ocorridas no ambiente de trabalho e que envolveram dois cenários, um sobre choque séptico e outro, parada cardiorrespiratória. Para a análise aplicou-se a técnica Discurso do Sujeito Coletivo com o emprego de um software. Resultados: dos 15 profissionais de enfermagem participantes do estudo, oito eram enfermeiros e sete técnicos de enfermagem. A idade variou de 23 a 56 anos e o tempo de atuação em terapia intensiva oscilou de dois meses a 17 anos. A simulação in situ foi percebida como uma oportunidade de atualização e aquisição de conhecimentos, habilidades e competências profissionais, principalmente para aqueles sem experiência, favorecendo o ganho de autoconfiança, a comunicação, a tomada de decisão e o raciocínio clínico. A estratégia simulada in situ também foi retratada como possibilidade de treinamento na prática profissional e em tempo real, diferentemente de treinamentos tradicionais e, ainda, como um ambiente seguro para cometer erros de várias magnitudes por se configurar um cenário de treinamento. Conclusão: os profissionais percebem a estratégia da simulação in situ como válida para a atualização profissional e aprendizado prático em ambiente seguro.

Medicalizing delinquents or turning the mad into criminals?: Practices of alienation and legal medicine in Colombia in the early the 20th century. / ¿Medicalizar al delincuente o hacer del loco un criminal?: Prácticas de alienismo y medicina legal en Colombia a comienzos del siglo XX.

This article analyzes medical-legal associations between madness and criminality in department of Antioquia (Colombia) during the three first decades of 20th century. The analysis was oriented by two overlapping axes: discourses and practices. The ideas of four doctors, generated between 1917 and 1925, were examined in order to identify the theoretical debates that delimited and defined mental illnesses in legal cases. The use of qualified knowledge and their place as experts were analyzed in a judicial case, initiated in 1921, in which theoretical confrontations surfaced among the doctors that debated the possible insanity of the defendant.

Este artículo analiza algunas asociaciones médico-jurídicas entre locura y criminalidad en el departamento de Antioquia (Colombia), en las primeras tres décadas del siglo XX. El análisis se orientó por dos ejes imbricados: el de los discursos y el de las prácticas. Se examinaron las ideas de cuatro médicos, planteadas entre 1917 y 1925, para identificar los debates teóricos desde los cuales se delimitaban y definían las enfermedades mentales en casos judiciales. La puesta en escena del saber de los peritos y su lugar como expertos se analizaron en un caso judicial, que inició en 1921, y en cuyo desarrollo afloraron las confrontaciones teóricas entre los médicos que debatieron sobre la posible locura del acusado.

The effect of literacy and culture on cognitive effort test performance: An examination of the Test of Memory Malingering in Colombia.

Introduction: Cognitive efforts tests, such as the Test of Memory Malingering (TOMM), are widely used internationally, yet emerging research suggests that performance on the TOMM can be affected by culture and education. This study examined the specificity of the TOMM and performance differences among Colombian adults, contrasting those with varying levels of literacy in order to evaluate the impact of these variables on error rates. It was hypothesized that literacy would be positively correlated with TOMM scores. Method: The sample consisted of 256 participants: the Absolute Illiterate participants had no formal education and no ability to read or write (n = 58), Functional Illiterate participants had no formal education and only basic reading and writing skills (n = 66), Literate participants had up to 12-years of education (n = 66), and Highly Literate participants had some post-secondary education (n = 66). Group differences for Trial 1 (T1) and Trial 2 (T2) were analyzed using ANOVAs and chi-square tests, along with post-hoc comparisons. Results: Mean T2 scores for the four groups were all above the suggested cutoff score of 45: the Highly Literate group had the highest mean score (49.3, range 41 to 50), and the Absolute Illiterate group had the lowest mean score (45.5, range 30 to 50). The Absolute and Functional Illiterate groups performed significantly worse on the TOMM trials than the literate participants. Cognitive performance as measured by indicators of verbal fluency and executive control significantly correlated with TOMM performance. However, when evaluated together in hierarchical logistic regressions, only age and literacy significantly predicted TOMM scores. Conclusions: Although the performance of Colombian adults suggests that the TOMM can be used cross-culturally with literate individuals, Colombian adults with poorer literacy skills performed significantly worse, raising concerns regarding the use of this measure with educationally-diverse samples. Research and clinical implications are discussed.

¿Medicalizar al delincuente o hacer del loco un criminal?: Prácticas de alienismo y medicina legal en Colombia a comienzos del siglo XX / Medicalizing delinquents or turning the mad into criminals?: Practices of alienation and legal medicine in Colombia in the early the 20th century

RESUMEN Este artículo analiza algunas asociaciones médico-jurídicas entre locura y criminalidad en el departamento de Antioquia (Colombia), en las primeras tres décadas del siglo XX. El análisis se orientó por dos ejes imbricados: el de los discursos y el de las prácticas. Se examinaron las ideas de cuatro médicos, planteadas entre 1917 y 1925, para identificar los debates teóricos desde los cuales se delimitaban y definían las enfermedades mentales en casos judiciales. La puesta en escena del saber de los peritos y su lugar como expertos se analizaron en un caso judicial, que inició en 1921, y en cuyo desarrollo afloraron las confrontaciones teóricas entre los médicos que debatieron sobre la posible locura del acusado.

ABSTRACT This article analyzes medical-legal associations between madness and criminality in department of Antioquia (Colombia) during the three first decades of 20th century. The analysis was oriented by two overlapping axes: discourses and practices. The ideas of four doctors, generated between 1917 and 1925, were examined in order to identify the theoretical debates that delimited and defined mental illnesses in legal cases. The use of qualified knowledge and their place as experts were analyzed in a judicial case, initiated in 1921, in which theoretical confrontations surfaced among the doctors that debated the possible insanity of the defendant.

Opiniones de los inspectores médicos acerca de la distorsión clínica en la valoración de la incapacidad laboral en España / Opinions of medical inspectors about clinical distortion in assessment of work disability in Spain

El contexto médico-legal en el que se desarrolla la medicina evaluadora, permitiendo el acceso a prestaciones económicas, obliga a considerar la validez en las consultas de valoración médica de incapacidad para tratar de evitar el fraude por simulación. Por otra parte, en el ámbito médico asistencial son habituales los casos biomédicamente inexplicables que se acompañan de elevados niveles subjetivos de sufrimiento, para los que se ha propuesto el término MUPS (medically unexplained physical symptoms). Objetivos: Profundizar en el fenómeno de la distorsión clínica en la valoración médica de incapacidad, basado en los dos primeros criterios de Simulación del DSM-IV-TR, referido al marco teórico del Análisis de Conducta en Medicina. Métodos: Encuesta en línea dirigid el colectivo de los inspectores médicos evaluadores del Instituto Nacional de la Seguridad Social (INSS) de España para conocer sus opiniones acerca de estos casos, presentes en su práctica diaria, su manejo de los mismos y su grado de concordancia con respecto a la bibliografía de referencia. Resultados: Incluyen a una proporción representativa de dichos inspectores médicos (15 por ciento), que aparecen como un colectivo variado, por su distinta formación profesional, experiencia previa y práctica diaria en las diferentes Unidades Médicas. Conclusiones: Consideran la distorsión clínica y sus cuadros anexos como situaciones frecuentes y relevantes en sus consultas, principalmente el fraude por simulación. Pese a ello, los inspectores médicos no parecen contar actualmente con referencias específicas suficientes ni con un discurso científico común estructurado para estos casos, que son abordados según criterios individuales más o menos ajustados al estado actual del conocimiento.(AU)

The forensic context in which disability assessment medicine is practiced in Spain, allowing access to workers' compensation benefits, requires consideration of the validity of disability assessment examinations. On the other hand, in clinical medicine biomedically unexplained cases ­for which the term medically unexplained physical symptoms (MUPS) was proposed­ are common, often accompanied by high levels of subjective suffering. Aim: To deepen in the phenomenon of clinical distortion in disability assessment examinations, based on the first two criteria of Malingering in DSM-IV-TR, referring to the theoretical framework of the Behavior Analysis in Medicine. Methods: Online survey addressed to the group of medical examiners of the National Institute of Social Security (INSS) of Spain to know their opinions on these cases, present in their everyday practice, their management and the extent of agreement to the literature of reference. Results: Collected a representative proportion of medical examiners (15 percent), they appear as a miscellaneous group due to their different professional training, previous experience and everyday practice in their different Medical Units. Conclusions: medical examiners consider the clinical distortion and related cases as frequent and relevant situations in their practice, mainly malingering. Nonetheless, medical examiners do not seem to have sufficient specific references or a structured common scientific discourse for these cases, which are approached according to individual criteria more or less adjusted to the current state of knowledge. (AU)

Diagnóstico de Simulación de Disfunción Neurocognitiva en sujetos que presentan accidentes laborales / Simulation diagnostics of neurocognitive dysfunction in subjects that present occupational accidents

Objetivo: establecer la utilidad del Test de Simulación de la Memoria (TOMM) y las características psicométricas para determinar la Simulación de Disfunción Neurocognitiva (SND) en trabajadores que han sufrido Traumatismo Cráneo-Encefálico (TEC).Materiales y métodos: los participantes de esta investigación fueron por conveniencia.Se conformaron tres grupos no pareados, mayores de 18 años, de ambos sexos. El primer grupo se conformó con un total de 32 participantes que estuvieron activamente laborales antes de sufrir el TEC, mínimamente 6 meses antes de la evaluación.El segundo grupo estuvo conformado por 30 personas que ya se encontraban pensionados laboralmente y no poseían necesidades de SDN. El último grupo eran 31 participantes cognitivamente sanos, que voluntariamente desearon participar en el estudio. Resultados: el TOMM es capaz de diferenciar entre aquellas personas probables de tener SDN y de las que no lo tienen. Aplicando el punto de corte de 45 para el ensayo 2, el 92.04% de los participantes controles (81/88 participantes) y 5 de los 5 simuladores (100%) fueron correctamente identificados, lo que corresponde a una sensibilidad del 100% y una especificidad del 92%, es decir la probabilidad de clasificar correctamente a un individuo como simulador, siendo éste un real simulador es del 100%, sin embargo la probabilidad de clasificar a un individuo como simulador, sin realmente serlo, es del 8%. Conclusiones: el TOMM es una herramienta clínica de exploración que permite distinguir entre los sujetos que posiblemente presenten necesidad de obtención de ganancias secundarias a un accidente laboral...(AU)

Objetive: after a head trauma some people find themselves in a position in which they try to get some external benefits and often exaggerate some existing or made up cognitive or psychological symptoms. Purpose: To establish the usefulness of the Test of Memory Malingering (TOMM) as well as the psychometrics to determine the Simulation of Neurocognitive Dysfunction in workers that have suffered head trauma. Method:the participants in this research were convenient.There were three non-paired groups, adults over 18 and from both sexes. The first group was made up of 32 people who were active workers before the head trauma, at least 6 months before the evaluation.The second group was made up of 30 people who were retired and had no SND needs.And the last one, were 31 people cognitively healthy who wished to participate in the study. Results: the TOMM is able to differentiate those probable people that simulate neurocognitive dysfunctions and those that do not. 45 was the point for trial 2, 92.04% of controlled participants (81/88) and 5 out of the 5 simulators (100%) were correctly identified, which corresponds to a sensibility of 100% and a specificity of 92%, thatis the probability to correctly classify an individual as a simulator, when he or she is indeed a real simulator is 100%; however, the probability of classifying an individual as a simulator without really being one is 8%. Conclusions: the TOMM is a clinicalexploration tool that allows to distinguish between the subjects that possibly present a need to obtain profits secondary to an occupational accident...(AU)

Psicosis instrumental: a propósito de dos probables casos / A propos of two probable cases of instrumental psychosis

El Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5) define a la simulación como larepresentación intencional de síntomas físicos o psicológicos falsos o muy exagerados, motivada por incentivosexternos diversos, aunque reconoce que, en muchos casos, la simulación puede tener cierto valor adaptativo.Estrictamente hablando, la simulación no es un trastorno mental sino un problema que puede ser objeto de atenciónclínica. Sin embargo, se presume erróneamente que la simulación podría darse solamente en contextos forenses,lo que dificulta su identificación en ámbitos clínicos. La “psicosis instrumental” es una variante de simulaciónconsistente en el fingimiento de síntomas por parte de un individuo con diagnóstico subyacente de una psicosisprimaria y que simula sus síntomas en momentos de estabilidad clínica. Se presentan dos casos de personas condiagnóstico primario de esquizofrenia que pueden ser considerados también como aparentes casos de psicosisinstrumental. No existen reportes previos de este trastorno en nuestro país, aunque presumiblemente su número nodebe ser exiguo. Se revisa también la literatura pertinente a este interesante fenómeno que, más alláde su naturaleza psicopatológica, parece reflejar conductas de una definida índole psicosocial..

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines malingering as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives; under some circumstances, malingering may represent a sort of adaptive behavior. In fact, malingering is not a mental disorder but a problem that may be require clinical attention. Nevertheless, it is erroneously assumed that malingering could only occur in forensic contexts, therefore difficult to identify in clinical settings. “Instrumentalpsychosis” is a variant of malingering which consists in the intentional production of symptoms by an individualwith a diagnosis of primary psychosis, who feigns his/her symptoms during periods of clinical stability. Two cases of patients with a primary diagnosis of schizophrenia and who qualify as apparent cases of instrumentalpsychosis, are presented. There are no previous reports of this disorder in our country, although presumably itsnumber may not be small. Relevant literature on this interesting clinical phenomenon is reviewed as, beyond its mere psychopathological content, it seems to reflect behaviors of a definite psychosocial nature.

Pattern-reversal visual evoked potentials as a diagnostic tool for ocular malingering / Potenciais visuais evocados por padrões reversos como uma ferramenta diagnóstica de simulação

ABSTRACT Purpose: To investigate the contributions of transient pattern-reversal visual evoked potentials in the diagnosis of ocular malingering at a Brazilian university hospital. Methods: Adult patients with suspected malingering in one or both eyes were referred for visual evoked potential testing. Data from patients' medical records were reviewed and analyzed retrospectively. Data analysis included the distance optotype visual acuity based on a ETDRS retro-illuminated chart and the transient pattern-reversal visual evoked potential parameters of latency (milliseconds) and amplitude (microvolts) for the P100 component, using checkerboards with visual subtenses of 15' and 60'. Motivations for malingering were noted. Results: The 20 subjects included 11 (55%) women. Patient ages ranged from 21 to 61 years (mean= 45.05 ± 11.76 years; median= 49 years). In 8 patients (6 women), both eyes exhibited reduced visual acuity with normal pattern-reversal visually evoked potential parameters (pure malingerers). The remaining 12 patients (7 men) exhibited reduced vision in only 1 eye, with simulated reduced vision in the contralateral eye (exaggerators). Financial motivation was noted in 18 patients (9 men). Conclusion: Normal pattern-reversal visually evoked potential parameters with suspected ocular malingering were observed in a 20 patient cohort. This electrophysiological technique appeared to be useful as a measure of visual pathway integrity in this specific population.

RESUMO Objetivo: Investigar a contribuição dos potenciais visuais evocados por padrões reversos no diagnóstico de simulação de baixa de visão em um hospital universitário do Brasil. Métodos: Um grupo de pacientes adultos com suspeita de simulação de baixa de visão em um ou ambos os olhos foi avaliado e os dados analisados retrospectivamente. Foram medidos: acuidade visual de optotipos informada para longe utilizando a tabela ETDRS, parâmetros dos potenciais visuais evocados por padrões reversos de latência (milissegundos) e amplitude (microvolts) para o componente P100 com estímulos de ângulos visuais de 15' e 60'. A motivação do paciente para a simulação foi anotada. Resultados: Os participantes foram 20 indivíduos com 11 (55%) do sexo feminino. A idade variou de 21 a 61 anos (média= 45,05 ± 11,76 anos; mediana= 49 anos). Em 8 pacientes (6 mulheres) ambos os olhos tinham acuidade visual reduzida com parâmetros dos potenciais visuais evocados por padrão reverso normais para ambos os olhos (simuladores puros). Uma subsérie separada de 12 pacientes (7 homens) tinha visão reduzida em apenas um olho e estavam simulando redução da visão no outro olho (exacerbadores). A motivação financeira foi observada em 18 pacientes (9 homens). Conclusões: Parâmetros dos potenciais visuais evocados por padrões reversos normais foram encontrados neste grupo de 20 pacientes com suspeita de simulação. Esta técnica eletrofisiológica pode ser útil como uma medida da integridade do sistema visual nesta população de doentes.

Specificity data for the b Test, Dot Counting Test, Rey-15 Item Plus Recognition, and Rey Word Recognition Test in monolingual Spanish-speakers.

The current study provides specificity data on a large sample (n = 115) of young to middle-aged, male, monolingual Spanish speakers of lower educational level and low acculturation to mainstream US culture for four neurocognitive performance validity tests (PVTs): the Dot Counting, the b Test, Rey Word Recognition, and Rey 15-Item Plus Recognition. Individuals with 0 to 6 years of education performed more poorly than did participants with 7 to 10 years of education on several Rey 15-Item scores (combination equation, recall intrusion errors, and recognition false positives), Rey Word Recognition total correct, and E-score and omission errors on the b Test, but no effect of educational level was observed for Dot Counting Test scores. Cutoff scores are provided that maintain approximately 90% specificity for the education subgroups separately. Some of these cutoffs match, or are even more stringent than, those recommended for use in US test takers who are primarily Caucasian, are tested in English, and have a higher educational level (i.e., Rey Word Recognition correct false-positive errors; Rey 15-Item recall intrusions and recognition false-positive errors; b Test total time; and Dot Counting E-score and grouped dot counting time). Thus, performance on these PVT variables in particular appears relatively robust to cultural/language/educational factors.

Simulación de síntomas psicóticos y su evaluación para ayudar a establecer inimputabilidad / Simulation of psychotic symptoms and evaluation to help establish criminal responsibility

El profesional en psicología debe conocer sobre la versatilidad que su rol puede tener en diversos contextos, sobre todo cuando se enfrente a una pregunta jurídica como ayudar a determinar dinámicas de simulación para ayudar a decidir sobre inimputabilidad en un sistema de justicia. Por ello se brinda una recopilación bibliográfica basada en el trabajo final de graduación para optar al grado de psicólogo clínico, titulado “Simulación de síntomas psicóticos y su evaluación psicológica: algunos elementos psicojurídicos y su relación con aspectos clínicos y forenses en el contexto costarricense”, en la cual se reflexiona sobre estos temas. En primera instancia se brindará una ubicación general del rol del psicólogo en estas circunstancias, pasando a describir diversas dinámicas de simulación de síntomas psicóticos que abarcan las concepciones de simulación y como se han registrado en síntomas positivos y negativos. Se brindan ejemplos de sintomatología atípica, extraña o exagerada y se concluye con un resumen de pruebas psicológicas que generan tanto indicadores indirectos como otras que tienen como fin específico detectar simulación de psicosis. Una reflexión final abarca la necesidad integrar estos datos con la revisión exhaustiva de información colateral, escogencia y aplicación adecuada de pruebas psicológica y los cuidados pertinentes al describir dinámicas de simulación en una persona, por las delicadas implicaciones que conllevan su diagnóstico.

A professional in psychology should know about the versatility that his or her role can have in various contexts, especially when faced with legal treatments as helping to determine dynamic simulation throughout the insanity justice system. Therefore, it provides a bibliography based on the final graduation to obtain the degree of clinical psychologist, entitled “Simulation of psychotic symptoms and psychological assessment: psycho-legal elements and their relationship to clinical and forensic on costarrican context “ in which we go on reflection on these kind of issues. First of all, we provide a general placement of the role as psychologists in these circumstances, reviewing and describing various dynamic simulations of psychotic symptoms that include the concepts of simulation and are reflected in positive and negative symptoms. Examples are given of atypical symptoms, strange or exaggerated and conclude with a summary of psychological tests that generate both indirect indicators and others that are designed to detect specific simulation of psychosis. One final thought concerns the need to integrate these data with an exhaustive review of collateral information, choice and proper application of psychological tests and appropriate care dynamics simulation to describe a person, by the delicate implications involving diagnosis.

Revisión de dos instrumentos de simulación neurocognitiva y su utilidad en el contexto forense / Review of the neurocognitive malingering instrument and its useful in a forensic contex

Gran parte de la precisión de la evaluación neuropsicológica, depende que los instrumentos que utiliza, sean medidas estandarizadas, válidas y confiables. Sin embargo, la simulación, la exageración y el bajo esfuerzo son aspectos que pueden interferir en los resultados de los test. El objetivo de esta revisión pretende describir y analizar dos instrumentos en el contexto de la Neuropsicología Forense que evalúan simulación de síntomas cognitivos: el Test of Memory Malingering (TOMM) y el Victoria Symptoms Validity Test (VSVT). Se realizó una búsqueda dirigida no exhaustiva, en diversas bases de datos y libros afines. El criterio de inclusión fue la utilización o revisión de los test. Se seleccionaron 68 trabajos publicados. Cada uno de los cuales fue analizado en base a las características técnicas de los instrumentos. La revisión ha demostrado que el TOMM y el VSVT son instrumentos pertinentes para valorar simulación y exageración de sintomatología cognitiva. Estos instrumentos cuentan con un cúmulo de investigaciones que avalan sus propiedades, pero también las limitaciones y restricciones de su utilización.

Most of the accuracy in neuropsychological assessment depends that the instruments used are standardized, valid and reliable measures. However, malingering, exaggeration and poor effort are aspects that can interfere with the interpretation of the results. The aim of this review was to describe and analyze two instruments in the context of forensic neuropsychology that assess malingering of cognitive symptoms: Test of Memory Malingering (TOMM) and Victoria Symptoms ValidityTest (VSVT). Several scientific databases and related books were searched non-exhaustively. The criterion for inclusion in this review was the use of test. We selected 68 documents, each one was analyzed based on the technical characteristics of the instruments. Review showed that the TOMM and VSVT are relevant instruments for assessing malingering and exaggeration of cognitive symptoms. These instruments have several evidence that support their psychometric properties but also limitations and restrictions on their use.

Detecção de simulação com o uso do wisconsin card sorting test e do trail making test / Detection of malingering using the wisconsin card sorting test and the trail making test

Neste trabalho, tentamos identificar índices de simulação na avaliação neuropsicológica forense, através da avaliação dos padrões de resposta em provas neuropsicológicas. A amostra foi constituída por 56 sujeitos com traumatismo crânioencefálico. Todos se encontravam numa situação de possível recompensa monetária por incapacidade. Utilizamos os instrumentos Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Inventário de Sintomas Psicopatológicos (BSI), e a grelha de análise dos autos do processo. Cerca de 30% da amostra enquadrou-se no grupo de prováveis simuladores. Essa porcentagem é congruente com a literatura. Verificou-se uma grande homogeneidade entre os indivíduos com e sem indicadores de simulação, a nível sintomatológico e características sócio-demográficas, o que reforça a necessidade de desenvolvimento de métodos eficazes na detecção da simulação.

The objective of this study was to identify indicators of malingering in forensic neuropsychological assessment by identifying response patterns in neuropsychological tests. The sample was composed by 56 subjects diagnosed with a cranioencephalic trauma. All subjects were in a situation of monetary reward if incapacity was proven. The instruments used were the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Brief Symptom Inventory (BSI), and a legal process data file. Approximately 30% of the studied sample was identified as probable malingerers. This percentage is consistent with the literature. We identified a high level of homogeneity of psychological symptoms and socio-demographic features in the group of subjects with indicators of malingering and in the group without such indicators. These results reinforce the necessity to develop efficient methods to detect malingering.

Detecção de simulação com o uso do wisconsin card sorting test e do trail making test / Detection of malingering using the wisconsin card sorting test and the trail making test

Neste trabalho, tentamos identificar índices de simulação na avaliação neuropsicológica forense, através da avaliação dos padrões de resposta em provas neuropsicológicas. A amostra foi constituída por 56 sujeitos com traumatismo crânioencefálico. Todos se encontravam numa situação de possível recompensa monetária por incapacidade. Utilizamos os instrumentos Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), Inventário de Sintomas Psicopatológicos (BSI), e a grelha de análise dos autos do processo. Cerca de 30% da amostra enquadrou-se no grupo de prováveis simuladores. Essa porcentagem é congruente com a literatura. Verificou-se uma grande homogeneidade entre os indivíduos com e sem indicadores de simulação, a nível sintomatológico e características sócio-demográficas, o que reforça a necessidade de desenvolvimento de métodos eficazes na detecção da simulação.(AU)

The objective of this study was to identify indicators of malingering in forensic neuropsychological assessment by identifying response patterns in neuropsychological tests. The sample was composed by 56 subjects diagnosed with a cranioencephalic trauma. All subjects were in a situation of monetary reward if incapacity was proven. The instruments used were the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Brief Symptom Inventory (BSI), and a legal process data file. Approximately 30% of the studied sample was identified as probable malingerers. This percentage is consistent with the literature. We identified a high level of homogeneity of psychological symptoms and socio-demographic features in the group of subjects with indicators of malingering and in the group without such indicators. These results reinforce the necessity to develop efficient methods to detect malingering.(AU)

Atitude faking e as escalas de verificação da versão adaptada do MCMI-III para o Brasil / Faking responses and modifying scales of brazilian portuguese version of MCMI-III / Actitud faking y las escalas de modificación de la versión adaptada de MCMI-III para Brasil

Os inventários objetivos de autorrelato têm sido amplamente utilizados nas últimas décadas. Padrões de resposta enviesados dão espaço à simulação, se constituindo como um importante problema desses instrumentos. O MCMI-III é um instrumento para avaliação da personalidade amplamente utilizado no mundo, em diversos contextos onde a simulação pode estar presente. Assim, o presente trabalho objetiva investigar as escalas Desejabilidade Social e Valorização negativa do instrumento, colaborando para a adaptação do MCMI-III para o Brasil. Os participantes (n = 2570) são originários de todo o país, com faixa etária e de escolaridade diversas. Após resposta ao instrumento, foram categorizados de acordo com sua pontuação nas escalas supracitadas nos grupos Baixo, Médio e Alto para comparação estatística através de Analise Univariada. Foram encontradas diferenças entre os grupos, com maiores médias clínicas para os grupos de maior Valorização Negativa e menor Desejabilidade Social, indicando indícios de validade de constructo das escalas estudadas.

Self-report inventories have been widely used since last decades. Malingering by response bias are an important matter about such psychological tests. The MCMI-III is a personality assessment inventory that has been widely used in the world, including when malingering is highly suspected. So, this article aims to investigate Desirability and Debasement Scales of MCMI-III, thus contributing to the test adaptation for Brazil. Study sample (n = 2570) comes from the whole country, and has a large spectrum of age and education. After administration of the test, participants were categorized according to scores obtained in Low, Medium and High groups, to comparison by One-way ANOVA. Statistical differences has been found among groups, and highest clinical scores found was that from high Debasement and low Desirability groups, signing to construct validity of scales.

Los inventarios de autoinforme han sido ampliamente utilizados en las últimas décadas. Algunos de sus problemas se relacionan con patrones de respuestas sesgadas y con la posibilidad de simulación. El MCMI-III es un inventario de personalidad ampliamente utilizado, aun cuando existe un alto grado de sospecha de simulación. El objetivo fue investigar sus escalas de Deseabilidad Social y Valorización Negativa a fin de contribuir con la adaptación de dicha prueba para Brasil. La muestra (n = 2570) estuvo constituida por participantes de todo el país con diferentes edades y niveles de educación. De acuerdo con las respuestas brindadas en el instrumento, los participantes fueron clasificados en diferentes grupos denominados bajo, medio y alto para su comparación mediante análisis de varianza (ANOVA). Se encontraron diferencias estadísticamente significativas entre los grupos, y también puntajes más altos en las escalas clínicas en los grupos que presentaron mayor grado de Valorización Negativa y menor grado de Deseabilidad Social, mostrando evidencias de la validez teórica de las escalas.

Simulación de un brote de Influenza A H1N1 en una escuela primaria de Camagüey / Simulation of an outbreak of Influenza A H1N1 in a primary school from Camagüey

Fundamento: la dinámica de la vida moderna demuestra la necesidad del uso de modelos matemáticos y simulaciones para el análisis de la dispersión de enfermedades. Objetivo: mostrar el comportamiento de un posible brote epidémico de Influenza A H1N1, en una escuela primaria a partir de la entrada de un enfermo sin tomar ninguna medida de contención. Método: se realizó una simulación con el modelo Susceptible, Expuesto, Infectado y Recuperado, durante el mes de septiembre de 2009. Se asume en la primera simulación que no se tomó ninguna medida preventiva, en la segunda, que se tomaron medidas sólo a partir de los siete días de comenzar el brote. Se toma un índice de transmisibilidad de 0.35, una duración de la enfermedad de siete días y un período latente de un día. Resultados: el modelo de simulación mostró en el caso de no tomar ninguna medida, cómo se produciría un pico máximo de la enfermedad a los trece días de iniciado el mismo, con un total de 190 enfermos, con 99 recuperados y sólo declina de forma espontánea a los 50 días con el último enfermo, el número reproductivo básico fue de 2.22 Conclusiones: existe de forma libre y gratuita un conjunto de herramientas de cálculos y simulaciones que se pueden utilizar en la provincia por parte de los epidemiólogos y los profesores de esta rama de la Salud Pública.

Background: the dynamics of modern life has demonstrated the need for the use of mathematical models and simulations for the analysis of the spread of diseases. Objective: to show the behavior of a possible outbreak of Influenza A H1N1 in a primary school. Method: a simulation using the model Susceptible, Exposed, Infected and Recovered was performed, during September 2009. It is assumed in the first simulation that was not taken any preventive action, in the second one, those measures were taken only after a week of the outbreak onset. The transmission index of 0.35, the duration of the disease of seven days and a latent period of one day was taken. Results: the simulation model showed in the case of not taking any action, how there would be a peak of the disease to the 13 days of being initiated, with a total of 190 patients, 99 recovered; only decline spontaneously to 50 days with the last patient, the basic reproductive number was 2.22. Conclusions: there is a set of tools for calculations and simulations that may be used in the province by epidemiologists and teachers of this branch of public health for free.

La simulación de disfunción neurocognitiva en el campo de la neuropsicología forense. Aproximaciones teóricas / Malingering neurocugnitive dysfunction in the field of forensic neuropsychology. Theoretical approximations

Se presenta una revisión teórica de aspectos cruciales en el peritaje neuropsicológico que permita evaluar y detectar la posible Simulación de Disfunción Neurocognitiva (SDN) en ambientes jurídicos-legales. En los últimos años la neuropsicología ha aportado un gran número de estudios relacionados con la exageración o desproporción de síntomas cognitivos motivados por incentivos externos y este conocimiento brindará la oportunidad de una actuación relevante de los neuropsicólogos en el Sistema Penal Acusatorio colombiano, de tal manera que se pueda contribuir con la administración de la justicia con aportes científicos y claramente delimitados en el campo de la neuropsicología forense (Doerr & Carlin, 1991), de acuerdo con los criterios diagnósticos establecidos para la detección de la simulación contemplados en el Manual de Diagnóstico y Estadística de los Trastornos Mentales-IV (APA, 1994) y por Slick, Sherman e Iverson (1999).

In this article, a revision of the fundamental theoretical issues in neuropsychological expert witness participation are explored with particular emphasis on the evaluation and detection of possible Malingering Neurocognitive Dysfunction (MND) in forensic settings. Within the past few years, the field of neuropsychology has produced an ample number of studies related to the exaggeration and disproportionate reporting of neurocogntive symptoms motivated by external incentives and it is this knowledge that will allow neuropsychologists to participate in a meaningful way in the Colombian Accusatory Penal System. This is made in such a way as to allow a contribution to the administration of justice with scientific information that is clearly within the field of forensic neuropsychology (Doerr & Carlin, 1991), according to the criteria for the identification of malingering set forth in the Diagnostic and Statistical Manual of Mental Disorders-IV (APA, 1994) as well as Slick, Sherman e Iverson (1999).

Simulación en trabajadores que solicitan pensión por invalidez laboral / Malingering among workers seeking disability insurance

Objetivo: Describir la frecuencia y características de los trabajadores afiliados a la Seguridad Social con trastornos de simulación que solicitan pensión por invalidez. Material y métodos: Encuesta comparativa realizada en 136 trabajadores atendidos durante 2001, en quienes se identificaron tres grupos: trabajadores simuladores (TS), trabajadores sin invalidez (TSI), y trabajadores con invalidez (TCI). Para identificar las diferencias entre grupos, se aplicó la prueba z para variables escalares, y prueba de χ2 para variables nominales. Resultados: La incidencia de simuladores fue de 2.2/100,000 trabajadores. La edad media de los trabajadores fue: 41.9 ± 10.1 años, 440 fue el promedio de días de incapacidad laboral; 51(37%) trabajadores presentaron simulación. 35(26%) trabajadores fueron invalidados para el trabajo y 50(37%) sin invalidez. Los trabajadores simuladores tienen mayor nivel de escolaridad que TSI y TCI (p < 0.02); laboran mayoritariamente en la seguridad social (p < 0.05), con menor número de empleos previos (p < 0.05), presentan incapacidad laboral de mayor duración, (p<0.05), los síntomas depresivos son infrecuentes (p < 0.025) con electroencefalograma y tomografía normales. Conclusiones: Los trabajadores simuladores que demandan pensión por invalidez para el trabajo presentan características particulares diferentes a otros trabajadores que solicitan un estado de invalidez.

OBJECTIVE: Describe the frequency and characteristics of Mexican Social Security workers with malingering disorder that request disability pension. MATERIAL AND METHODS: Comparative survey made among 136 workers seen during 2001, which were divided into three groups: malingering workers (MW), workers without disability (WOD), and workers with disability (WWD). We administered the Z Test for scaled variables and Z2 Test for nominal variables to identify group differences RESULTS: The incidence ofmalingering was of 2.2/100,000 workers. Mean age was 41.9 +/- 10.1 years, 440 was the average number of days of labor disability; 51 (37%) workers were malingerers. 35 (26%) workers were work disabled and 50 (37%) without disability. Malingerers had higher level of schooling compared with WOD and WWD (p < 0.02); most worked at the Social Security (p < 0.05), with lower number of previous jobs (p < 0.05), presented longer work disability (p < 0.05). Depressive symptoms were not frequently noted (p < 0.025) and all had normal electroencephalogram and brain computed tomography studies. CONCLUSIONS: Malingering workers who request work disability pensions follow a particular pattern that differs from other workers that request disability assessment at the Social Security Institute of Mexico.

La entrevista piiquiátrica del sujeto simulador / The Malingerer’s Psychiatric Interview

Dentro de la práctica clínica diaria, así como en la actividad forense, con frecuencia es necesaria la realización de entrevistas que permitan obtener de información veraz y fiable, con el fin de adoptar conductas consecuentes; sin embargo, en muchas ocasiones se encuentra a un sujeto entrevistado que puede ganar algo respecto de la conducta que va a seguir, según la información que brinde, y tenderá a manipular la información que entrega o a engañar de manera deliberada. Hay entrevistadores que, por su trabajo y experticia, son capaces de reconocer los indicadores de engaño; pero no todos lo hacen. En esta revisión se describen algunas claves que pueden facilitar el ejercicio profesional a aquellos quienes en su práctica se ven enfrentados a la manipulación de información o a la simulación de trastornos mentales.

Both in everyday clinical practice and forensic settings, mental health professionals have to conduct interviews to obtain reliable and valid information in order to make decisions and take measures. However, sometimes, professionals are faced with subjects who may try to find some benefit from the interview by manipulating the data provided and deliberately deceiving the rater. Certain raters, given their experience and expertise, are able to detect these deceit markers or signs, but others are not. This paper offers a reviews of some key factors that may be helpful for those professionals who are confronted with information manipulation as well as mental disorders malingering.