The detection of malingered mental illness lecture

Question 1

Delusions are suspect if: (choose all correct)

1. The patient is eager to call attention to them
2. They are impossible
3. They have an abrupt onset
4. The patient believes he/she is being controlled

Answer 1

1. The patient is eager to call attention to them
2. They have an abrupt onset

Question 2

Persons malingering psychosis: (choose all correct)

1) May have residual schizophrenia
2. Rarely show perseveration
3. Are able to imitate the content of a delusions
4. Are able to imitate the form os schizophrenic thinking

Answer 2

1) May have residual schizophrenia
2. Rarely show perseveration
3. Are able to imitate the content of a delusions

Question 3

In assessing a criminal defendant for insanity, the examiner should: (choose all correct)

1. Imply confidentiality
2. See the defendant as soon as possible
3. Not consider malingering unless there are suspect delusions or suspect hallucinations
4. Confirm reports of past hallucinations

Answer 3

2. See the defendant as soon as possible
3. Confirm reports of past hallucinations

Question 4

Malingerers alleging PTSD are more likely than patients with true PTSD to: (choose all correct)

1. Volunteer information about sexual dysfunction.
2. Say repetitive dreams exactly re-enact the original trauma
3. Have a history of steady employment
4. Depict their prior functioning in exclusively complimentary terms

Answer 4

2. Say repetitive dreams exactly re-enact the original trauma
3. Depict their prior functioning in exclusively complimentary terms

Question 5

Major purposes of malingering include: (choose all correct)

1. Avoiding military duty.
2. Escaping criminal responsibility
3. Financial gain
4. Admission to psychiatric hospitals.

Answer 5

1. Avoiding military duty.
2. Escaping criminal responsibility
3. Financial gain
4. Admission to psychiatric hospitals.

Question 6

Choose the correct statement about hallucinations:

A) Olfactory hallucinations are usually pleasing or tempting smells
B) Tactile hallucinations are usually associated with alcohol withdrawal or cocaine psychosis
C) visual hallucinations are rare in schizophrenia
D) In mania, visual hallucinations are usually unaccompanied by auditory hallucinations.

Answer 6

B) Tactile hallucinations are usually associated with alcohol withdrawal or cocaine psychosis

Question 7

Atypical auditory hallucinations include all of the following EXCEPT:

A) Normal speaking voice is yelling
B) Hear only female voices
C) Hear only male voices
D) Hear only children’s voices
E) Hear animal voices

Answer 7

C) Hear only male voices

Question 8

Genuine visual hallucinations include all of the following EXCEPT:

A) usually humanoid
B) Rarely something seen before
C) Usually, normal size people
D) Usually seen in color
E) Are often monsters

Answer 8

E) Are often monsters

Question 9

What is the intentional production or gross exaggeration of symptoms motivated by external incentives?

Answer 9

Malingering

Question 10

What is the falsification of symptoms in the absence of external incentives?

Answer 10

Factitious disorder

Question 11

What is the deliberate fabrication or gross exaggeration of symptoms without any assumptions about its goals?

Answer 11

feigning

Question 12

What are the possible purposes of malingering?

Answer 12

Avoid criminal punishment, avoid military duty, financial gain, transfer from prison, hospital admission for homeless

Question 13

What are the major purposes for malingering while incarcerated?

Answer 13

Relocation, medication, compensation, attention, amusement

Question 14

What is the average age of onset for nonpsychotic hallucinations? Psychotic hallucinations?

Answer 14

12; 21

Question 15

What are the characteristics of nonpsychotic hallucinations?

Answer 15

1. Attribute to spirits of the dead or guardian angels
2. limited negative content
3. Voices do not cause distress or disturbance in daily life
4. less likely to be afraid of the voices.
5. voices are less troublesome
6. Are in control of the voices

Question 16

What is the typical pattern of hallucination in schizophrenia?

Answer 16

2/3 auditory; 1/3 visual

Visual hallucinations in the absence of auditory hallucinations is unusual in schizophrenia

Question 17

What is the typical pattern of hallucination in mania?

Answer 17

47% auditory; 23% visual

Question 18

What are the characteristics of feigned hallucinations?

Answer 18

1. More frightening and abusive
2. More uncontrollable
3. Less predictable
4. Less context dependent

Question 19

What are the characteristics of command hallucinations?

Answer 19

The most common is to encourage suicide
olfactory are unpleasant (80%)
obeyed if hallucination is related to the delusion
if the voice is familiar
if there is a history of compliance
if the command is not dangerous

Question 20

What are common auditory hallucinations?

Answer 20

Gender slurs
1/3 ask questions about what they are doing

Question 21

What tends to make voices worse?

Answer 21

being alone, watching TV, listening to radio, anxiety

Question 22

What are the characteristics of visual hallucinations?

Answer 22

1. humanoid
2. limited animals or objects
3. rarely seen before
4. initial response is to be overwhelmed by fear
   5 normal sized people
5. seen in color
6. occur when eyes are closed
7. Well formed

Question 23

What causes lilliputian hallucinations?

Answer 23

alcoholic hallucinosis
toxic hallucinations
atropine intoxication
Charles bonnet Syndrom - peduncular

Question 24

What are the features of suspicious auditory hallucinations?

Answer 24

1. no strategy to cope
2. obey all commands
3. hallucinations seeking questions
4. Extreme severity

Question 25

What would be an atypical hallucination? (<5%)

Answer 25

Normal speaking voice is yelling hear only female voices hear only children's voices never hear the same voice twice voices of animals robotic voices refer to as Mr. or Mrs increased voices when bloated all voices are vague or mumbling Lack of any control of voices being alone doesn't increase

Question 26

What are suspicious visual hallucinations?

Answer 26

Visual without auditory black and white dramatic, atypical, changes when eyes close miniature or giant unrelated to auditory hallucinations or delusions - psychosis tends to be themed

Question 27

What are the clues to malingered psychosis?

Answer 27

Overacting of part Call attention to the illness hard to imitate the form of psychosis does not fit diagnosis patterns sudden onset of delusions inconsistent behavior with delusions contradictions in story attempt to intimidate the evaluator Evasive answers rational alternative motives no perseveration absent negative symptoms pretend to have cognitive deficits