The detection of malingered mental illness lecture Flashcards
Delusions are suspect if: (choose all correct)
- The patient is eager to call attention to them
- They are impossible
- They have an abrupt onset
- The patient believes he/she is being controlled
- The patient is eager to call attention to them
- They have an abrupt onset
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
1) May have residual schizophrenia
2. Rarely show perseveration
3. Are able to imitate the content of a delusions
In assessing a criminal defendant for insanity, the examiner should: (choose all correct)
- Imply confidentiality
- See the defendant as soon as possible
- Not consider malingering unless there are suspect delusions or suspect hallucinations
- Confirm reports of past hallucinations
- See the defendant as soon as possible
- Confirm reports of past hallucinations
Malingerers alleging PTSD are more likely than patients with true PTSD to: (choose all correct)
- Volunteer information about sexual dysfunction.
- Say repetitive dreams exactly re-enact the original trauma
- Have a history of steady employment
- Depict their prior functioning in exclusively complimentary terms
- Say repetitive dreams exactly re-enact the original trauma
- Depict their prior functioning in exclusively complimentary terms
Major purposes of malingering include: (choose all correct)
- Avoiding military duty.
- Escaping criminal responsibility
- Financial gain
- Admission to psychiatric hospitals.
- Avoiding military duty.
- Escaping criminal responsibility
- Financial gain
- Admission to psychiatric hospitals.
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.
B) Tactile hallucinations are usually associated with alcohol withdrawal or cocaine psychosis
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
C) Hear only male voices
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
E) Are often monsters
What is the intentional production or gross exaggeration of symptoms motivated by external incentives?
Malingering
What is the falsification of symptoms in the absence of external incentives?
Factitious disorder
What is the deliberate fabrication or gross exaggeration of symptoms without any assumptions about its goals?
feigning
What are the possible purposes of malingering?
Avoid criminal punishment, avoid military duty, financial gain, transfer from prison, hospital admission for homeless
What are the major purposes for malingering while incarcerated?
Relocation, medication, compensation, attention, amusement
What is the average age of onset for nonpsychotic hallucinations? Psychotic hallucinations?
12; 21
What are the characteristics of nonpsychotic hallucinations?
- Attribute to spirits of the dead or guardian angels
- limited negative content
- Voices do not cause distress or disturbance in daily life
- less likely to be afraid of the voices.
- voices are less troublesome
- Are in control of the voices
What is the typical pattern of hallucination in schizophrenia?
2/3 auditory; 1/3 visual
Visual hallucinations in the absence of auditory hallucinations is unusual in schizophrenia
What is the typical pattern of hallucination in mania?
47% auditory; 23% visual
What are the characteristics of feigned hallucinations?
- More frightening and abusive
- More uncontrollable
- Less predictable
- Less context dependent
What are the characteristics of command hallucinations?
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
What are common auditory hallucinations?
Gender slurs
1/3 ask questions about what they are doing
What tends to make voices worse?
being alone, watching TV, listening to radio, anxiety
What are the characteristics of visual hallucinations?
- humanoid
- limited animals or objects
- rarely seen before
- initial response is to be overwhelmed by fear
5 normal sized people - seen in color
- occur when eyes are closed
- Well formed
What causes lilliputian hallucinations?
alcoholic hallucinosis
toxic hallucinations
atropine intoxication
Charles bonnet Syndrom - peduncular
What are the features of suspicious auditory hallucinations?
- no strategy to cope
- obey all commands
- hallucinations seeking questions
- Extreme severity
What would be an atypical hallucination? (<5%)
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
What are suspicious visual hallucinations?
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
What are the clues to malingered psychosis?
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
