Brechje Dandachi-FitzGerald

Cognitive underperformance and symptom over-reporting in a mixed psychiatric sample.

The current study examined the prevalence of cognitive underperformance and symptom over-reporting in a mixed sample of psychiatric patients (N = 183). We employed the Amsterdam Short-Term Memory Test (ASTM) to measure cognitive underperformance and the Structured Inventory of Malingered Symptomatology (SIMS) to measure the tendency to over-report symptoms. We also administered neuropsychological tests (e.g., Concept Shifting Task; Reys Verbal Learning Test) and the Symptom Checklist-90 (SCL-90) to the patients. A total of 34% of them failed the ASTM, the SIMS or both tests. ASTM and SIMS scores were significantly, albeit modestly, correlated with each other (r = −.22). As to the links between underperformance, over-reporting, neuropsychological tasks, and the SCL-90, the association between over-reporting on the SIMS and SCL-90 scores was the most robust one. The subsample that only failed on the ASTM performed significantly worse on a compound index of memory performance. Our findings indicate that underperformance and over-reporting are loosely coupled dimensions and that particularly over-reporting is intimately linked to heightened SCL-90 scores.

Symptom Validity and Neuropsychological Assessment: A Survey of Practices and Beliefs of Neuropsychologists in Six European Countries

During the last decades, symptom validity has become an important topic in the neuropsychological and psychiatric literature with respect to how it relates to malingering, factitious disorder, and somatoform complaints. We conducted a survey among neuropsychologists (N = 515) from six European countries (Germany, Italy, Denmark, Finland, Norway, and the Netherlands). We queried the respondents about the tools they used to evaluate symptom credibility in clinical and forensic assessments and other issues related to symptom validity testing (SVT). Although the majority of the respondents demonstrated technical knowledge about symptom validity, a sizeable minority of the respondents relied on outdated notions (e.g., the idea that clinicians can determine symptom credibility based on intuitive judgment). There is little consensus among neuropsychologists on how to instruct patients when they are administered SVTs and how to handle test failure. Our findings indicate that the issues regarding how to administer and communicate the SVT results to patients warrant systematic research.

Feigning ≠ Feigning a Memory Deficit: The Medical Symptom Validity Test as an Example

The Medical Symptom Validity Test (MSVT) is a widely used memory test with three built-in effort measures that aim to detect feigning. We evaluated the merits of the MSVT as a broad screening tool for symptom validity. In study 1, we interviewed participants (N = 54) about the symptoms that they would and would certainly not feign. Non-specific somatic symptoms and depression were mentioned most frequently. Nearly 10% of the participants stated that they would certainly not feign memory problems. Study 2 contrasted the diagnostic accuracy of the MSVT with that of a broad index of symptom exaggeration (Structured Inventory of Malingered Symptomatology; SIMS) in experimental malingerers (N = 42) who were free to choose which psychological symptoms to feign. Although both tests correctly identified all honest controls (100% specificity), the SIMS surpassed the MSVT in correctly identifying experimental malingerers (91% versus 45%). In study 3, we explored the overlap between MSVT effort parameters and SIMS scores in a psychiatric sample (N = 21). Only one MSVT parameter (Delayed Recognition) was significantly related to SIMS scores (φ = -.52, p < .05). The results indicate that memory-oriented symptom validity tests such as the MSVT may be useful for detecting feigned memory deficits but that such tests perform less well as screening tools for other types of feigned psychopathology.

Exaggerating Psychopathology Produces Residual Effects That Are Resistant to Corrective Feedback: An Experimental Demonstration

We explored the effects of feedback on symptom reporting. Two experimental groups (n = 15 each) were given a scenario with the option to exaggerate symptoms. Compared with a control condition (n = 15), both groups scored significantly higher on the Structured Inventory of Malingered Symptomatology. Next, one group was confronted in a sympathetic way about their symptom validity test failure, whereas the other group was confronted in a neutral manner. Both groups subsequently completed the Brief Symptom Inventory (BSI). BSI scores of both feedback groups remained significantly higher than those of control participants. Participants who had been provided with sympathetic feedback or neutral feedback did not differ in their BSI scores. Even participants who indicated during the exit interview that they had given up symptom exaggeration attained significantly higher BSI scores than those of controls, indicating that exaggeration has residual effects that are resistant to corrective feedback. We discuss cognitive dissonance as a model for understanding the residual effects of symptom exaggeration.

Symptom validity assessment in European countries: Development and state of the art

In the past, the practice of symptom validity assessment (SVA) in European countries was considerably lagging behind developments in North America, with the topic of malingering being largely taboo for psychological and medical professionals. This was being changed in the course of the past decade with a growing interest in methods for the assessment of negative response bias. European estimates of suboptimal test performance in civil and social forensic contexts point at base rates similar to those obtained in North America. Symptom over-reporting and underperformance in neuropsychological examinations appear to occur in a sizable proportion of patients. Although there is considerable progress in establishing SVA as an integral and indispensable part of psychological and neuropsychological assessment in some countries, others appear to lag behind. In some countries there is still enormous resistance against SVA from part of the neuropsychological and psychiatric communities.

Neuropsychologists' ability to predict distorted symptom presentation.

ABSTRACT Objective. We explored to what extent experienced neuropsychologists can predict distorted symptom presentation of clinically referred hospital outpatients. Method. Using clinical files and interview results, 31 neuropsychologists made predictions as to how 203 patients would perform on two response validity tests. Their predictions were matched against actual passing or failing two such tests, of which one measured overreporting of symptoms and the other underperformance on cognitive tests. Results. Clinical predictions and test outcomes agreed in 76% of the cases, with Cohen’s kappa being .26, 95% confidence interval, CI [.08, .44]. Of the 152 patients for whom neuropsychologists had predicted nondistorted symptom presentations, 14 patients (9.2%) failed both response validity tests. Of the 51 patients for whom neuropsychologists had predicted problematic response validity, 35 patients (68.6%) passed both tests. Conclusions. Clinical prediction of distorted symptom presentation is far from perfect. Our findings show that response validity tests have incremental value in that they may correct initial clinical judgment.

Poor symptom and performance validity in regularly referred Hospital outpatients: Link with standard clinical measures, and role of incentives.

We investigated the frequency of symptom validity test (SVT) failure and its clinical correlates in a large, heterogeneous sample of hospital outpatients referred for psychological assessment for clinical purposes. We studied patients (N=469), who were regularly referred for assessment to the psychology departments of five hospitals. Background characteristics, including information about incentives, were obtained with a checklist completed by the clinician. As a measure of over-reporting, the Structured Inventory of Malingered Symptomatology (SIMS) was administered to all patients. The Amsterdam Short-Term Memory test (ASTM), a cognitive underperformance measure, was only administered to patients who were referred for a neuropsychological assessment. Symptom over-reporting occurred in a minority of patients, ranging from 12% to 19% in the main diagnostic patient groups. Patients with morbid obesity had a low rate of over-reporting (1%). The SIMS was positively associated with levels of self-reported psychological symptoms. Cognitive underperformance occurred in 29.3% of the neuropsychological assessments. The ASTM was negatively associated with memory test performance. We found no association between SVT failure and financial incentives. Our results support the recommendation to routinely evaluate symptom validity in clinical assessments of hospital patients. The dynamics behind invalid symptom reporting need to be further elucidated.

Modification of emotional states by bilateral stimulation of the subthalamic nucleus in a patient with Parkinson's disease

Bilateral stimulation of the subthalamic nucleus (STN) is an accepted treatment for advanced Parkinsons disease (PD) refractory to medical therapy.1 Despite motor improvement, postoperative changes in mood and behaviour have been reported.2 Besides a direct influence of STN stimulation, other factors such as changes in medication and maladaptation to motor improvement might be involved. Here we report a PD patient successfully treated with bilateral STN stimulation but showing postoperative gradual worsening of psychological status. By using a single case experiment design (SCED) we tried to find out whether these problems were stimulation-related. The patient is a 56-year-old woman with a 13-year history of PD. Before surgery, (neuro)psychological evaluation was normal, besides a slight depressive elevation (Beck Depression Inventory (BDI) total score=13 with scores from 10 to 16 indicating mild depression).3 Psychiatric evaluation, however, revealed no psychopathology. The patient underwent a one-staged bilateral stereotactical implantation of electrodes4 and was discharged with stimulation at pole 1 monopolar, pulse width 90 μs, frequency 130 Hz, 1.5 V right and 1.2 V left. In the 20 months following surgery, stimulation was adjusted up to 3.0 V bilaterally, to optimise motor function. During follow-up at 3, 6 and 12 months postoperatively, the patient increasingly complained of various psychological symptoms including depression, …

Evaluación de la validez de los síntomas en Europa: evolución y situación actual

In the past, the practice of symptom validity assessment (SVA) in European countries was considerably lagging behind developments in North America, with the topic of malingering being largely taboo for psychological and medical professionals. This was being changed in the course of the past decade with a growing interest in methods for the assessment of negative response bias. European estimates of suboptimal test performance in civil and social forensic contexts point at base rates similar to those obtained in North America. Symptom over-reporting and underperformance in neuropsychological examinations appear to occur in a sizable proportion of patients. Although there is considerable progress in establishing SVA as an integral and indispensable part of psychological and neuropsychological assessment in some countries, others appear to lag behind. In some countries there is still enormous resistance against SVA from part of the neuropsychological and psychiatric communities.

A case of misdiagnosis of mild cognitive impairment: The utility of symptom validity testing in an outpatient memory clinic

ABSTRACT Noncredible symptom reports hinder the diagnostic process. This fact is especially the case for medical conditions that rely on subjective report of symptoms instead of objective measures. Mild cognitive impairment (MCI) primarily relies on subjective report, which makes it potentially susceptible to erroneous diagnosis. In this case report, we describe a 59-year-old female patient diagnosed with MCI 10 years previously. The patient was referred to the neurology department for reexamination by her general practitioner because of cognitive complaints and persistent fatigue. This case study used information from the medical file, a new magnetic resonance imaging brain scan, and neuropsychological assessment. Current neuropsychological assessment, including symptom validity tests, clearly indicated noncredible test performance, thereby invalidating the obtained neuropsychological test data. We conclude that a blind spot for noncredible symptom reports existed in the previous diagnostic assessments. This case highlights the usefulness of formal symptom validity testing in the diagnostic assessment of MCI.