Malingered Syndromes (Worker's Comp)

Question 1

% MDD Claimants in Civil Litigation - Malingering

Answer 1

25-30%

Question 2

BDI Reliability from Malingering

Answer 2

Not - like 96% faked depression and 58% severe depression

Question 3

7 Areas to Investigate Objective Signs of Depression

Answer 3

1. Review weights
2. Watch MSE signs
3. Able to concentrate/attend lengthy interview, while also claiming poor concentration impairing work?
4. Other life activities req’ing focusing concentration: working on computer, managing affairs, etc
5. Daily activities? Socializing, exercising, etc
6. Sleep disturbance - see if sleep during day
7. Exaggerated memory/concentration deficits?

Question 4

PTSD Percentages (exposed and develop)

Answer 4

Approx 80% US pop exposed to traumatic event, < 10% develop PTSD

Question 5

5 PTSD Trajectories

Answer 5

Subsyndromal - elevated sx below dx threshold
Gradual recovery - prolonged, ultimately waning distress/impairment
Delayed onset
Chronic sx
Minimal impact resilience - stable psychologica/physical before and after

Question 6

Resilience

Answer 6

Modal response to adversity

Question 7

Malingering % PTSD Claimaints (PI and Compensation/Pension Combat Vets)

Answer 7

PI: 20-30%
Vets: At least 20%

Question 8

PTSD Prevalence by Specific Stressor:
Accident
Seeing others Killed
Physical Assault
Rape

Answer 8

Accident: 12%
Seeing others killed: 25%
Physical Assault: 25%
Rape: 80%

Question 9

F and G Criteria for PTSD

Answer 9

Duration of sx > 1 month, clinically sig distress/impairment, when applied in addition to PTSD sx, drops those meeting criteria from 20% to 3%

Question 10

2 Associations with Stressor More Likely to Develop PTSD

Answer 10

Increased duration of exposure and closer proximity

Question 11

Injury 3 Associated Factors w/ Developing PTSD

Answer 11

Injury severity
Head/face injuries
Visible injuries

Question 12

Genuine PTSD nightmares vs. Malingered (4)

Answer 12

Genuine increased nocturnal awakenings, awakening earlier in evening, increased body movements, increase in REM abnormalities (although can also be NREM changes too)

Question 13

PTSD Nightmares After Tx

Answer 13

Genuine generally ameloriate

Question 14

Replicative Nightmares (2)

Answer 14

Unclear if more associated with genuine vs. malingered PTSD
1 study found replicative nightmares greatest predictor of PTSD dx

Question 15

Mild TBI Rates of Malingered Cognitive Deficits

Answer 15

As high as 39% (another study said 33-52% of those seeking VA benefits)

Question 16

2 Strategies to Detect Cognitive Malingering

Answer 16

Floor Effect
Symptom Validity Testing

Question 17

Floor Effect

Answer 17

Ask very basic Qs (severe cognitive impairment defines lower boundaries of credible performance) that maybe don’t seem, so malingerers “try too hard” and miss. Like “Which has 4 legs, a human or a dog?”

Question 18

Symptom Validity Testing (SVT)

Answer 18

Presentation of stimuli, followed by forced-choice, see if they do worse than chance (TOMM, Coin in Hand Test)

Question 19

Evidentiary Standard for Malingering

Answer 19

SVT, but some feigners can avoid failing on more than 50%

Question 20

5 Components of Suspicious Amnesia Claims

Answer 20

Recognition memory worse than recall memory
Focal retrograde memory loss
Inconsistency with tests
Memory worsens with testing
Evasive and non-cooperative