Differences

Last edited on January 28, 2022

This shows you the differences between two versions of the page.

--- teaching:malingering [on April 12, 2020]
+++ teaching:malingering [on January 28, 2022]
psychdb [Cognitive]
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 ====== Malingering ======
+{{INLINETOC}}
 ===== Primer =====
 **Malingering** is the intentional production false or grossly exaggerated physical or psychological complaints with the goal of receiving a reward. Malingering is //not// a mental disorder or diagnosis.
-<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[somatic:home|]]**</alert>
 ==== Incidence ====
-  * [[https://www.ncbi.nlm.nih.gov/pubmed/12650234|Mittenberg, W., Patton, C., Canyock, E. M., & Condit, D. C. (2002). Base rates of malingering and symptom exeggeration. Journal of clinical and experimental neuropsychology, 24(8), 1094-1102.]]
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.ncbi.nlm.nih.gov/pubmed/12650234|Mittenberg, W. et al. (2002). Base rates of malingering and symptom exeggeration. Journal of clinical and experimental neuropsychology, 24(8), 1094-1102.]]**
+</alert>
+  * The true rates of malingering is difficult to determine, as the nature of malingering involves deception.
+    * There is estimated to be a prevalence of 1% in psychiatric patients, 5% in military personnel, and between 10 to 20% in medicolegal cases.[(Benjamin JS, Virginia AS (editors): Kaplan & Sadock's Synopsis of Psychiatry, Ed 10. Philadelphia, Lippincott Wiliams & Wilkins, 2007.)]
+  * The incidence of malingering in forensic assessment settings is as high as 50%.[([[https://pubmed.ncbi.nlm.nih.gov/17886149/|Ardolf, B. R., Denney, R. L., & Houston, C. M. (2007). Base rates of negative response bias and malingered neurocognitive dysfunction among criminal defendants referred for neuropsychological evaluation. The Clinical Neuropsychologist, 21(6), 899-916.]])]
+==== Not a Diagnosis ====
+  * Malingering is not a diagnosis, even though it is encountered in the clinical setting.
+  * To establish malingering is difficult. Symptoms from malingering are intentional, and the motivation behind it is also intentional.
+  * The individual //consciously// fakes, profoundly exaggerates, or claims to have a disorder or symptoms in order to attain a specific secondary (external) gain.
+    * This gain could be avoiding work, getting worker's compensation, or obtaining something of material value. Complaints from malingerers will end after they have achieved their gain (in comparison to [[somatic:dsm-5:factitious|factitious disorder]], which is not always the case).
+===== Assessment =====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.psychiatrictimes.com/view/malingering-key-points-assessment|Lebourgeois III, H. W. (2007). Malingering: Key points in assessment. Psychiatric Times, 24(5), 21-21.]]**
+</alert>
+===== Detecting Malingering =====
+  * Even health professionals and professional "lie detectors" (e.g. - police officers, judges, border officers) are very poor at detecting malingering in most cases.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308182/|Walczyk, J. J., Sewell, N., & DiBenedetto, M. B. (2018). A review of approaches to detecting malingering in forensic contexts and promising cognitive load-inducing lie detection techniques. Frontiers in psychiatry, 9, 700.]])]
+  * More structured and detailed psychometric testing may aid in improving detection, using detailed tests such as the:
+    * Structured Interview of Reported Symptoms (SIRS)
+    * Minnesota Multiphasic Personality Inventory, Revised (MMPI-2)
+    * Miller Forensic Assessment of Symptoms Test (M-FAST)
+==== Cognitive ====
+Individuals with malingering may feign cognitive impairment; several tests to detect for cognitive malingering include:
+  * Coin-in-hand test[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072844/|Kapur, N. (1994). The coin-in-the-hand test: a new" bed-side" test for the detection of malingering in patients with suspected memory disorder. Journal of neurology, neurosurgery, and psychiatry, 57(3), 385.]])]
+  * Tests of Memory Malingering (TOMM)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308182/|Walczyk, J. J., Sewell, N., & DiBenedetto, M. B. (2018). A review of approaches to detecting malingering in forensic contexts and promising cognitive load-inducing lie detection techniques. Frontiers in psychiatry, 9, 700.]])]
+  * Rey Fifteen-Item Test (FIT)
+  * Word Memory Test (WMT)
+<panel type="info" title="Conversion Disorder vs. Malingering*" subtitle="" no-body="true" footer="* = Note that these are only suggested features and is by no means definitive!">
+^ Malingering                                                                                                                                                                                                                                                                                                      ^ Conversion Disorder                                                                                                                                                                                                                                                    ^
+| • Malingering: Aware of purpose of symptoms\\ • Usually uncooperative, suspicious, aloof\\ • Avoids examinations and investigations (unless there is a financial benefit)\\ • Refuses employment with partial disability\\ • Describes accident in full "perfect" detail  | • Not aware of purpose of their symptoms\\ • Cooperative, appealing, and more dependent\\ • Welcomes examinations and investigations\\ • Accepts employment with partial disability\\ • Describes accident with gaps and inaccuracies  |
+</panel>
+==== Delusions and Hallucinations ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also:
+  * **[[http://jaapl.org/content/early/2019/09/13/JAAPL.003867-19|Pierre, J. M. (2019). Assessing malingered auditory verbal hallucinations in forensic and clinical settings. The journal of the American Academy of Psychiatry and the Law, 47(4), 448-456.]]**
+  * **[[https://pubmed.ncbi.nlm.nih.gov/10083952/|Resnick, P. J. (1999). The detection of malingered psychosis. Psychiatric Clinics of North America, 22(1), 159-172.]]**
+</alert>
+  * Individuals may also feign psychotic symptoms such as [[teaching:delusions-hallucinations|hallucinations or delusions]].
+  * If a patient alleges unusual hallucinations, ask about them in detail. There are several key things to note:[([[https://pubmed.ncbi.nlm.nih.gov/10083952/|Resnick, P. J. (1999). The detection of malingered psychosis. Psychiatric Clinics of North America, 22(1), 159-172.]])]
+    * Hallucinations are almost always associated with delusions.
+    * Genuine hallucinations are typically intermittent rather than continuous.
+    * In [[psychosis:schizophrenia-scz|schizophrenia]], the major themes are persecutory or instructive (command).[([[https://pubmed.ncbi.nlm.nih.gov/10083952/|Resnick, P. J. (1999). The detection of malingered psychosis. Psychiatric Clinics of North America, 22(1), 159-172.]])]
+    * Auditory hallucinations are usually clear, not vague (7%) or inaudible
+    * Both male and female voices are commonly heard (75%)
+    * Voices are usually perceived as originating outside the head (88%)
+    * Real hallucinations tend to diminish when patients are involved in activities (patients typically cope by engaging in activities, changing posture, seeking interpersonal contact, taking medication)
+    * Visual hallucinations are experienced by an estimated 24% to 30% of psychotic individuals but are reported much more often by malingerers (46%) than by persons with genuine psychosis (4%)
+      * True visual hallucinations are usually of normal size and in colour
+  * Timeline of symptoms:
+    * Malingerers may claim that a delusion began or disappeared suddenly.
+    * In reality, systematized delusions usually take weeks to develop and much longer to disappear.
+  * Other features:
+    * Malingerers are more likely to give vague or "hedge" their answers to straightforward questions.
+    * Malingerers are more likely to eagerly “thrust forward” their illness, whereas patients with schizophrenia are often reluctant to discuss their symptoms.
+<panel type="info" title="Uncommon Psychotic Presentations" subtitle="Adapted from: Resnick, P. J., Knoll, J. (2005). Faking it: How to detect malingered psychosis. Current Psychiatry, 4(11), 12." no-body="true" footer="">
+^ Hallucinations                                                                                                                                                                                                                                                                                                                                                                                                                      ^ Delusions                                                                                                                                                                                 ^
+| • Continuous\\ • Voices are vague, inaudible\\ • Hallucinations are not associated with delusions\\ • Voices use stilted language\\ • Patient uses no strategies to diminish or cope with hallucinations\\ • Patient states that they obey all commands\\ • Visual hallucinations in black and white\\ • Visual hallucinations alone in schizophrenia\\ • Visual hallucinations are exaggerated in size (very small or very large)  | • Sudden/abrupt onset or termination\\ • Patient's behaviour is inconsistent with delusions\\ • Bizarre content without disorganization\\ • Patient is overly eager to discuss delusions  |
+</panel>
+===== Other Diagnoses =====
+  * [[teaching:cognitive-bias-misdiagnosis-overdiagnosis|Misdiagnosis]]
+    * Malingering should not be considered until all other diagnoses have been considered!
+  * [[somatic:home|]]
+==== Comparison of Somatic Disorders ====
+<imgcaption image1|>{{ :somatic:dsm-5:comparison_somatic_factitious_malingering.png?direct&800 |Comparison of Somatic Symptom Disorders, Factitious Disorder, and Malingering}}
+</imgcaption>
 {{tag>ssx}}