References and Abstracts:

Article References & Abstracts
MALINGERING 1998

1. Author Reznek L
Institution Toronto Hospital, University of Toronto, Canada.
Title On the epistemology of mental illness.
Source Pubbl Stn Zool Napoli II 1998;20(2): p215-32
ISSN 0391-9714
Abstract

The most important epistemological problem in psychiatry is the detection of malingering. This is a consequence of the fact that there is no objective way to confirm any psychiatric diagnosis. Psychiatric diagnosis is based on subjective complaints. The discovery of objective markers for psychiatric diagnosis is problematic because it presupposes we can tell valid from faked subjective symptoms. But this is the difficulty. If we use pervasive irrationality as a sign of mental illness, we encounter the problem of identifying pervasive irrationality. To understand someone's behaviour, we have to assume it is largely rational. This precludes us from using behaviour to separate genuine from faked mental illness. There are a number of strategies used to solve any epistemological problem, and the most successful is the hypothetico-deductive method. If we use this, we can solve our epistemological problem. Genuine mental illness can be identified when it is the best explanation of the person's overall behaviour. Consilience of inductions is critical in supporting the validity of such explanations. This implies that it is merely a hypothesis that mental illness exists, and that we might discover that many mental illnesses, perhaps all, do not exist. We must embrace this possibility--only if we take a risk will we gain any knowledge.
2. Author Schmand B; Lindeboom J; Schagen S; Heijt R; Koene T; Hamburger HL
Institution Department of Psychology, Slotervaartziekenhuis, Amsterdam, The Netherlands. b.schmand@amc.uva.nl.
Title Cognitive complaints in patients after whiplash injury: the impact of malingering.
Source J Neurol Neurosurg Psychiatry 1998 Mar;64(3): p339-43
ISSN 0022-3050
Abstract

OBJECTIVES: The validity of memory and concentration complaints that are often reported after a whiplash trauma is controversial. The prevalence of malingering or underperformance in post-whiplash patients, and its impact on their cognitive test results were studied. METHODS: The Amsterdam short term memory (ASTM) test, a recently developed malingering test, was used as well as a series of conventional memory and concentration tests. The study sample was a highly selected group of patients, who were examined either as part of a litigation procedure (n=36) or in the normal routine of an outpatient clinic (n=72). RESULTS: The prevalence of underperformance, as defined by a positive score on the malingering test, was 61% (95% CI: 45-77) in the context of litigation, and 29% (95% CI: 18-40) in the outpatient clinic (p=0.003). Furthermore, the scores on the memory and concentration test of malingering post-whiplash patients (n=43) and non-malingering post-whiplash patients (n=65) were compared with the scores of patients with closed head injury (n=20) and normal controls (n=46). The malingering post-whiplash patients scored as low as the patients with closed head injury on most tests. CONCLUSIONS: The prevalence of malingering or cognitive underperformance in late post-whiplash patients is substantial, particularly in litigation contexts. It is not warranted to explain the mild cognitive disorders of whiplash patients in terms of brain damage, as some authors have done. The cognitive complaints of non-malingering post-whiplash patients are more likely a result of chronic pain, chronic fatigue, or depression.
3. Author Fishbain DA; Rosomoff HL; Cutler RB; Rosomoff RS
Institution Department of Psychiatry, University of Miami School of Medicine, Florida, USA.
Title Secondary gain concept: a review of the scientific evidence.
Source Clin J Pain 1995 Mar; 11 (1): p6-21
ISSN 0749-8047
Abstract

The "secondary gain" concept originated in the psychoanalytic literature, where it was never vigorously examined. The purpose of this review is to determine if there are scientific studies that have explored the validity of this concept. DESIGN: A computer and manual literature review yielded 166 references in which primary, secondary, and tertiary gain were mentioned. Twenty-four (14.5%) of these reports were "secondary gain" studies. Fourteen "reinforcement" studies were also found. These 38 studies were grouped according to topics and reviewed in detail. SETTING: Any medical treatment setting including pain treatment was utilized in the review procedure, i.e., no exclusion criteria. PATIENTS: Any patient type, including those suffering from chronic pain, were utilized in the review procedure, i.e., no exclusion criteria. RESULTS: A significant but limited number of studies have investigated the "secondary gain" concept, and the results of some of these studies are in conflict. Results of some studies, however, are remarkably consistent in supporting the importance of "secondary gain" to behavior. Some studies have methodological flaws, usually relating to how the presence of secondary gain was established. CONCLUSIONS: Overall the results of the reviewed studies support the potential importance of the "secondary gain" concept to understanding illness behavior and underscore a need for future research in this area.
4. Author Ferguson E
Institution WHO Collaborating Centre for Organizational Health & Development, Department of Psychology, University of Nottingham, UK.
Title Hypochondriacal concerns, symptom reporting and secondary gain mechanisms.
Source Br J Med Psychol 1998 Sep; 71 ( Pt 3): p281-95
ISSN 0007-1129
Abstract

Hypochondriacal concerns (HCs) and somatic symptom reporting (SSR) are associated. However, HCs are believed to be linked to the ego-defence coping strategy of avoiding help and SSR is believed to be linked to secondary gain. One hundred and twenty undergraduate students completed measures of HCs, SSR and the Desire for Control (DC) Scale. Subscales of the DC scale were used as indices of help avoidance and secondary gain. Both hierarchical multiple linear regression and LISREL structural modelling were used to control for the confound between HCs and SSR and explore the links with help avoidance and secondary gain. HCs were found to be primarily associated with an increased desire to strive for independence (avoid help) and levels of SSR were associated with the desire to have others make decisions (secondary gain).
5. Author Ben-Avi I; Rabin S; Melamed S; Kreiner H; Ribak J
Institution Behavioral Toxicology Program, Occupational Health and Rehabilitation Institute, Raanana, Israel.
Title Malingering assessment in behavioral toxicology: what, why, and how.
Source Am J Ind Med 1998 Oct;34(4): p325-30
ISSN 0271-3586
Abstract

Neurobehavioral assessment is frequently made in a forensic context. The cognitive assessment may be biased due to an international manipulation of data by the patient motivated by attainment of compensation, that is, malingering. Although malingering is highly relevant in behavioral toxicology, the issue and its assessment are underrepresented in the literature. A routine assessment of malingering is important to reduce false-positive and false-negative errors in assessment, thereby establishing the credibility and validity of behavioral assessment. In the long run, the routine inclusion of malingering measurements might reduce claims and encourage employers to be more cooperative in behavioral toxicology studies. Guidelines for malingering assessment and research, inferred from the clinical and research literature, are discussed. Sensitivity to the problematic issues involved in assessing malingering behavior is an important step toward malingering detection in the clinical setting and to the establishment of assessment methods that are less confounded by these issues.
6. Author Kwan O, Ferrari R, Freil J.
Title The forensic examiner in psychology and accident claimants.
Source Hippocrates' Lantern, 1998, 5(4), 16-23.
ISSN 1520-8176.