Prevalence of poor effort and malingered neurocognitive dysfunction in litigating patients in Switzerland

2017 ◽  
Vol 28 (2) ◽  
pp. 97-116
Author(s):  
Andrea M. Plohmann ◽  
Max Hurter
Keyword(s):  
Depressive Disorders ◽  
Psychiatric Patients ◽  
Binary Logistic Regression ◽  
Cognitive Test ◽  
Performance Validity ◽  
Neurocognitive Dysfunction ◽  
Education Levels ◽  
Slick Criteria ◽  
First Generation Migrants ◽  
Validity Tests

Abstract. To determine the prevalence of inauthentic cognitive test results, the data of 455 examinees who had finished at least two performance validity tests (PVTs) were analyzed retrospectively. The PVTs administered were the WMT, MSVT, NV-MSVT, ASTM, BSV, RMT, and RDS. Classification as “definite” or “probable” malingering was done according to the Slick criteria. Sociodemographic variables and diagnoses were described using binary logistic regression. Poor effort in at least two PVTs correlated significantly with education levels, immigration, and origin. Irrespective of education level, the highest risk of definite malingering was found in first-generation migrants. Cervical spine dysfunction, normal cerebral imaging, PTSD, somatoform, and/or depressive disorders also correlated with negative response bias. The probability that psychiatric patients fulfill criteria of probable malingering was higher than in patients with isolated organic mental disorders.

Mechanisms of Possible Neurocognitive Dysfunction

2017 ◽  
Author(s):  
Daniel L. Drane ◽  
Dona E. C. Locke
Keyword(s):  
Neuropsychological Testing ◽  
Psychological Theory ◽  
Future Research ◽  
Performance Validity ◽  
Post Traumatic Stress ◽  
Neurocognitive Dysfunction ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Performance Validity Measures ◽  
Validity Tests

This chapter covers what is known about the possible mechanisms of neurocognitive dysfunction in patients with psychogenic nonepileptic seizures (PNES). It begins with a review of all research examining possible cognitive deficits in this population. Cognitive research in PNES is often obscured by noise created by a host of comorbid conditions (e.g., depression, post-traumatic stress disorder, chronic pain) and associated issues (e.g., effects of medications and psychological processes that can compromise attention or broader cognition). More recent studies employing performance validity tests raise the possibility that studies finding broad cognitive problems in PNES may be highlighting a more transient phenomenon secondary to these comorbid or secondary factors. Such dysfunction would likely improve with successful management of PNES symptomatology, yet the effects of even transient variability likely compromises daily function until these issues are resolved. Future research must combine the use of neuropsychological testing, performance validity measures, psychological theory, neuroimaging analysis, and a thorough understanding of brain–behavior relationships to address whether there is a focal neuropathological syndrome associated with PNES.

A-184 Performance Validity Test Failure Rates in Bilingual Individuals Evaluated in English

2021 ◽  
Vol 36 (6) ◽  
pp. 1239-1239
Author(s):  
Jeremy Davis ◽  
Gabrielle Hromas ◽  
Summer Rolin
Keyword(s):  
False Positive ◽  
Mmse Score ◽  
Secondary Analysis ◽  
Diagnostic Group ◽  
Cognitive Test ◽  
Failure Rates ◽  
Performance Validity ◽  
Impaired Group ◽  
Positive Threshold ◽  
Validity Tests

Abstract Objective Classification accuracy of embedded performance validity tests (PVTs) is unknown in cases involving bilingual examinees evaluated in English. This study examined false positive rates in bilingual individuals in an older adult sample. Method The project involved secondary analysis of a deidentified dataset (N = 22,688) from the National Alzheimer’s Coordinating Center (NACC). Exclusion criteria were diagnosis of mild cognitive impairment (MCI; n = 5160) or dementia (n = 5550). The initial sample included 11,513 participants grouped as cognitively normal (89.6%) or impaired but not MCI. A subset of 275 participants was identified with a primary language other than English who were evaluated in English. Propensity score matching was conducted by diagnostic group to match bilingual to monolingual participants on age, education, gender, and MMSE score. The final sample included 450 and 100 participants in normal and impaired groups, respectively. Failure rates on five embedded PVTs in the NACC cognitive test battery were examined by language and by diagnosis. Results Age, education, gender, and MMSE score were not significantly different by language in either diagnostic group. In the normal group, 4.9% of bilingual and 2.2% of monolingual participants failed two or more PVTs (n.s.). In the impaired group, 12% of bilingual and 6% of monolingual participants failed two or more PVTs (n.s.). Conclusions PVT failure rates were not significantly different between bilingual participants evaluated in English and monolingual participants in either diagnostic group. Failure rates, however, increased slightly above a common false positive threshold of 10% in bilingual participants in the impaired group.

scholarly journals Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria

2020 ◽  
Vol 35 (6) ◽  
pp. 735-764 ◽  
Author(s):  
Elisabeth M S Sherman ◽  
Daniel J Slick ◽  
Grant L Iverson
Keyword(s):  
Neuropsychological Assessment ◽  
Psychiatric Symptoms ◽  
Detection Methods ◽  
Performance Validity ◽  
Neurocognitive Dysfunction ◽  
Neuropsychological Dysfunction ◽  
Malingered Neurocognitive Dysfunction ◽  
Validity Tests ◽  
External Incentives

Abstract Objectives Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field’s operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545–561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field. Method The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms. Results The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment. Conclusions The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.

A Bayesian Approach to Mixed Group Validation of Performance Validity Tests

2014 ◽  
Author(s):  
Douglas Mossman ◽  
William Miller ◽  
Elliot Lee ◽  
Roger Gervais ◽  
Kathleen Hart ◽  
...  
Keyword(s):  
Bayesian Approach ◽  
Performance Validity ◽  
Mixed Group ◽  
Validity Tests ◽  
Performance Validity Tests

scholarly journals Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study

2021 ◽  
Vol 11 (6) ◽  
pp. 800
Author(s):  
Harriet A. Ball ◽  
Marta Swirski ◽  
Margaret Newson ◽  
Elizabeth J. Coulthard ◽  
Catherine M. Pennington
Keyword(s):  
Cognitive Abilities ◽  
Minnesota Multiphasic Personality Inventory ◽  
Verbal Learning ◽  
Cognitive Disorder ◽  
Control Group ◽  
Performance Validity ◽  
Immediate Recall ◽  
Trail Making ◽  
Learning Test ◽  
Validity Tests

Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology.

scholarly journals Combined Dexamethasone Suppression-Corticotropin-Releasing Hormone Stimulation Test in Studies of Depression, Alcoholism, and Suicidal Behavior

2006 ◽  
Vol 6 ◽  
pp. 1398-1404 ◽  
Author(s):  
Leo Sher
Keyword(s):  
Suicidal Behavior ◽  
Depressive Disorders ◽  
Psychiatric Patients ◽  
Suppressive Effect ◽  
Therapeutic Interventions ◽  
Psychiatric Research ◽  
Corticotropin Releasing Hormone ◽  
Releasing Hormone ◽  
Hormone Stimulation ◽  
Dexamethasone Suppression

The hypothalamic-pituitary-adrenal (HPA) axis controls the secretion of corticotropin-releasing hormone (CRH), corticotropin (adrenocorticotropic hormone, ACTH), and cortisol. The dexamethasone suppression test (DST) is the most frequently used test to assess HPA system function in psychiatric disorders. Patients who have failed to suppress plasma cortisol secretion, i.e., who escape from the suppressive effect of dexamethasone, have a blunted glucocorticoid receptor response. After CRH became available for clinical studies, the DST was combined with CRH administration. The resulting combined dexamethasone suppression-corticotropin-releasing hormone stimulation (DST–CRH) test proved to be more sensitive in detecting HPA system changes than the DST. There is a growing interest in the use of the DEX-CRH test for psychiatric research. The DEX-CRH test has been used to study different psychiatric conditions. Major depression, alcoholism, and suicidal behavior are public health problems around the world. Considerable evidence suggests that HPA dysregulation is involved in the pathogenesis of depressive disorders, alcoholism, and suicidal behavior. Over the past 2 decades, there has been a shift from viewing excessive HPA activity in depression as an epiphenomenon to its having specific effects on symptom formation and cognition. The study of HPA function in depression, alcoholism, and suicidal behavior may yield new understanding of the pathophysiolgy of these conditions, and suggest new approaches for therapeutic interventions. The combined DEX-CRH test may become a useful neuroendocrinological tool for evaluating psychiatric patients.

scholarly journals Determination of combination therapy prescribing patterns for the treatment of acute agitation in psychiatric patients: A regression model of patient diagnoses and demographics

2019 ◽  
Vol 9 (5) ◽  
pp. 298-303
Author(s):  
Mark S. Maas ◽  
Karen E. Moeller ◽  
Brittany L. Melton
Keyword(s):  
Combination Therapy ◽  
Regression Model ◽  
Psychiatric Patients ◽  
A Priori ◽  
Young Male ◽  
Binary Logistic Regression ◽  
Prescribing Patterns ◽  
Cardiovascular Comorbidity ◽  
Logistic Regression Models ◽  
Acute Agitation

Abstract Introduction Guidelines for the treatment of acute agitation typically recommend monotherapy with an antipsychotic or a benzodiazepine, but combination therapy is frequently used in practice. We created a regression model to identify which factors lead to the prescribing of combination therapy for acute agitation on a psychiatry unit. Methods We collected retrospective data from hospitalized patients in the psychiatry unit. An a priori alpha of 0.05 was used for binary logistic regression models to determine if and how the number of prescribed medications for acute agitation was influenced by: age, sex, race, cardiovascular comorbidities, and psychiatric diagnoses. Results We identified 1998 encounters from 1200 patients. Patients are significantly more likely to be prescribed combination therapy if they are young, male, and of non-white race or have a diagnosis of central nervous system stimulant use, hallucinogen use, depression, bipolar, cluster B personality, or psychosis. Patients are significantly more likely to be prescribed monotherapy if they have cardiovascular comorbidity or have neurocognitive disorder. Discussion Several demographic or diagnostic factors predict combination therapy prescribing. Acute agitation guidelines should be reviewed to include more clear instructions on combination therapy use.

The Rey Dot Counting Test as a Tool for Detecting Suboptimal Performance in Athlete Baseline Testing

2020 ◽  
Author(s):  
Andrew DaCosta ◽  
Frank Webbe ◽  
Anthony LoGalbo
Keyword(s):  
Cognitive Testing ◽  
Performance Validity ◽  
Baseline Assessment ◽  
Baseline Testing ◽  
Validity Measures ◽  
Significant Disagreement ◽  
Two Measures ◽  
Validity Tests ◽  
Performance Validity Tests ◽  
Suboptimal Effort

Abstract Objective The limitations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)’s embedded validity measures (EVMs) are well-documented, as estimates suggest up to 35% of invalid baseline performances go undetected. Few studies have examined standalone performance validity tests (PVT) as a supplement to ImPACT’s EVMs. Method College athletes (n = 1,213) were administered a preseason baseline assessment that included ImPACT and the Rey Dot Counting Test (DCT), a standalone PVT, among other measures. Results Sixty-nine athletes (5.69%) met criteria for suboptimal effort on either ImPACT or the DCT. The DCT detected more cases of suboptimal effort (n = 50) than ImPACT (n = 21). A χ2 test of independence detected significant disagreement between the two measures, as only two individuals produced suboptimal effort on both (χ2(2) = 1.568, p = .210). Despite this disagreement, there were significant differences between the suboptimal effort DCT group and the adequate effort DCT group across all four ImPACT neurocognitive domains (U = 19,225.000, p < .001; U = 17,859.000, p < .001; U = 13,854.000, p < .001; U = 17,850.500, p < .001). Conclusions The DCT appears to detect suboptimal effort otherwise undetected by ImPACT’s EVMs.

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