Malingering in a correctional setting: the use of the Structured Interview of Reported Symptoms in a jail sample.

The ability to detect malingering in the correctional setting is of paramount importance. The burgeoning jail and prison population combined with statutory requirements for the provision of mental health treatment require that only those most in need receive these services. Several structured assessments have been developed to assist in the identification of individuals more likely to be feigning psychiatric symptoms. Prior to the development of these specialized assessments, subscales of standard psychological tests were used as an indicator of assessment attitudes, for both malingering and other dissimulation. At the Sacramento County (CA) Jail, the Structured Interview of Reported Symptoms (SIRS) is routinely administered when clinicians feel there is a possibility that an inmate receiving psychiatric services may be feigning or exaggerating his/her symptoms. Our study examined data from these evaluations of inmates in conjunction with other clinical data (e.g., psychiatric diagnosis, educational level) to determine those factors most associated with malingering in jail inmates. Our results indicate that the prevalence of malingering in our sample was quite high: over 66% were found to be malingering based on the scoring criteria for the SIRS. Inmates diagnosed with Antisocial Personality Disorder were no more likely to feign symptoms than inmates without this diagnosis. Inmates designated as malingering in their charts were no more likely to be found malingering on the SIRS, suggesting that they may have adopted an effective strategy.

Categorization of aggressive acts committed by chronically assaultive state hospital patients.

OBJECTIVE: This study examined factors motivating inpatient aggression in a sample of chronically assaultive state hospital patients. METHODS: Inpatients who had committed three or more assaults over a one-year period were identified by using an incident report database. Aggressive episodes were categorized as impulsive, organized, or psychotic by using a procedure for classifying assaultive acts based on record review. Each assault type was further subcategorized. The relationship between assault type, victim (staff or patient), and legal status of the assaulter was also assessed. RESULTS: A total of 839 assaults committed by 88 chronically aggressive patients were reviewed. Although most patients had a primary psychotic disorder, the most common type of assault was impulsive (54%), rather than psychotic or organized. Staff were most often victimized by impulsive assaults in situations involving attempts to change a patient's unwanted behavior and refusal of a patient request. Organized and psychotic assaults occurred less frequently (29% and 17%, respectively) and were more likely to target other patients. Organized assaults were most often motivated by a desire to seek revenge. Psychotic assaults were most often committed by an assailant acting under the influence of paranoid ideations. Civilly committed patients were overrepresented in the sample. Criminally committed patients committed more acts of organized aggression, although this finding did not reach significance. CONCLUSIONS: These findings indicate that assaultive behavior among state hospital inpatients is complex and heterogeneous. Because each type of assault requires a different management approach, characterizing aggressive behavior may be important in determining which institutional programs and treatment-plan interventions to implement when addressing inpatient aggression.