Fundamentos teórico-técnicos para la comprensión y detección de la simulación de déficits neurocognitivos / Theoretical-technical foundations for the understanding and detection of the simulation of neurocognitive deficits

La neuropsicología está desarrollándose y migrando a otras áreas tales como la judicial, en donde el neuropsicólogo forense ayuda al juez a tomar decisiones ecuánimes e imparciales, sin embargo, nace como problemática el fenómeno de la simulación de déficits neurocognitivos con el propósito de obtener ganancias secundarias. Este artículo tiene como objetivo abordar dicho fenómeno mediante una sistematización bibliográfica, estableciendo un marco teórico-comprensivo del fenómeno, así como también identificando las principales herramientas para su detección. Se esquematizan apartados que forman un hilo conductor que arrojan como resultado que la detección de la simulación de déficits neurocognitivos es una tarea compleja, multidimensional y que debería tener un enfoque holístico, por lo tanto, es necesario seguir investigando al respecto para perfeccionar sus métodos de identificación.

Neuropsychology is developing and migrating to other areas such as the judicial, where the forensic neuropsychologist helps the judge to make fair and impartial decisions, however, the phenomenon of the simulation of neurocognitive deficits with the purpose of obtaining secondary gains is born as a problem. This article aims to address this phenomenon through a bibliographic systematization, establishing a theoretical-comprehensive framework of the phenomenon, as well as identifying the main tools for its detection. Thus, sections are outlined that form a common thread that show as a result that the detection of the simulation of neurocognitive deficits is a complex, multidimensional task and that it should have a holistic approach, therefore, it is necessary to continue researching in this regard. to perfect its results identification methods.

Simulation for damaged parts recognition of sports injury biological images / Simulação para reconhecimento de partes danificadas em imagens biológicas de lesões esportivas de alta intensidade / Simulación para el reconocimiento de partes dañadas en imágenes biológicas de lesiones deportivas

ABSTRACT Introduction To reduce or avoid injuries during high-intensity sports and help treat the injured part, the method of recognizing biological images of the damaged part is a crucial point of current research. Objective To reduce the damage caused by high-intensity sports and improve the efficiency of injury treatment, this article explores the method of identifying damaged parts in biological imaging of high-intensity sports injuries. Methods A method is proposed to recognize damaged parts of biological images of high-intensity sports injuries based on an improved regional growth algorithm. Results A rough segmented image developed in black and white is obtained with the main body as the objective and background. Based on approximate segmentation, the region growth algorithm is used to accurately recognize the damaged region by improving the selection of the hotspots and the growth rules. Conclusion The recognition accuracy is high, and the recognition time is shorter. The algorithm proposed in this work can improve the precision of recognizing the damaged parts of the biological image of the sports injury and shorten the recognition time. It has the feasibility to determine the damaged parts of sports injuries. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução Para reduzir ou evitar lesões durante esportes de alta intensidade e auxiliar no tratamento da parte lesada, o método de reconhecimento de imagens biológicas da parte lesada é um ponto crucial das pesquisas atuais. Objetivo Para reduzir os danos causados por esportes de alta intensidade e melhorar a eficiência do tratamento de lesões, este artigo explora o método de identificação de partes danificadas em imagens biológicas de lesões esportivas de alta intensidade. Métodos é proposto um método para reconhecer partes danificadas de imagens biológicas de lesões esportivas de alta intensidade com base em um algoritmo de crescimento regional aprimorado. Resultados Uma imagem áspera segmentada desenvolvida em preto e branco é obtida com o corpo principal como objetivo e fundo. Com base na segmentação aproximada, o algoritmo de crescimento da região é usado para reconhecer com precisão a região danificada, melhorando a seleção de pontos quentes e regras de crescimento. Conclusão a precisão do reconhecimento é alta e o tempo de reconhecimento é menor. O algoritmo proposto neste trabalho pode melhorar a precisão do reconhecimento das partes danificadas da imagem biológica da lesão esportiva e encurtar o tempo de reconhecimento. Tem a viabilidade de determinar as partes danificadas de lesões esportivas. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Para reducir o evitar lesiones durante los deportes de alta intensidad y ayudar a tratar la parte lesionada, el método de reconocimiento de imágenes biológicas de la parte dañada es un punto crucial de la investigación actual. Objetivo Para reducir el daño causado por los deportes de alta intensidad y mejorar la eficiencia del tratamiento de lesiones, este artículo explora el método de identificación de partes dañadas en imágenes biológicas de lesiones deportivas de alta intensidad. Métodos Se propone un método para reconocer partes dañadas de imágenes biológicas de lesiones deportivas de alta intensidad basado en un algoritmo de crecimiento regional mejorado. Resultados Se obtiene una imagen segmentada rugosa revelada en blanco y negro con el cuerpo principal como objetivo y fondo. Basado en la segmentación aproximada, el algoritmo de crecimiento de la región se utiliza para reconocer con precisión la región dañada mejorando la selección de los puntos calientes y las reglas de crecimiento. Conclusión la precisión del reconocimiento es alta y el tiempo de reconocimiento es más corto. El algoritmo propuesto en este trabajo puede mejorar la precisión del reconocimiento de las partes dañadas de la imagen biológica de la lesión deportiva y acortar el tiempo de reconocimiento. Tiene la viabilidad de determinar las partes dañadas de las lesiones deportivas. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Simulação de esquizofrenia no Teste de Rorschach (R-PAS) / Schizophrenia simulation in the Rorschach Test (R-PAS) / Simulación de esquizofrenia en el Teste Rorschach (R-PAS)

Este trabalho teve como objetivo comparar o desempenho no Teste de Rorschach (R-PAS), de pessoas instruídas sobre os sintomas da esquizofrenia e solicitadas a responder ao Rorschach, tentando se passar por um paciente com esse diagnóstico (n = 40), com o de pacientes diagnosticados com esquizofrenia (n = 35). Os participantes responderam ao Teste de Rorschach (R-PAS), a Magical Ideation Scale (MIS) e ao Inventory of Problems-29 (IOP-29) tentando simular esquizofrenia. Os resultados das comparações entre os grupos evidenciaram diferenças estatisticamente significativas para as variáveis (Hd), An, FQo, FQu, FQ-, P, M, PEC, WSumCog, MAH, GHR e Complexity. Encontrou-se também associação positiva e de forte magnitude entre os escores obtidos no IOP-29 e os escores brutos da MIS (r = 0,73, p = 0,0001). Os achados evidenciaram que, mesmo diante das tentativas de distorção das respostas ao teste, simuladores não conseguem distanciar da própria precisão perceptiva. (AU)

This study compared the performance in the Rorschach Test (R-PAS) of people informed about the symptoms of schizophrenia and asked to respond to the Rorschach trying to impersonate a patient with this diagnosis (n = 40) with that of patients diagnosed with schizophrenia (n = 35). Participants responded to the Rorschach Test (R-PAS), the Magical Ideation Scale (MIS) and the Inventory of Problems-29 (IOP-29) trying to simulate schizophrenia. The results of the comparisons between the groups showed statistically significant differences for the variables (Hd), An, FQo, CFQ, CF-, P, M, PEC, WSumCog, MAH, GHR and Complexity. A positive and strong association was also found between the scores obtained in the IOP-29 and the gross scores of the MIS (r=.73, p=.0001). The findings show that even faced with attempts to distort the responses to the test, simulators cannot distance themselves from their perceptual accuracy. (AU)

Este estudio tuvo como objetivo comparar el rendimiento en el Test de Rorschach (R-PAS) de personas educadas sobre los síntomas de la esquizofrenia y solicitadas a responder al Rorschach, tratando de pasar por un paciente con este diagnóstico (n = 40) con el de los pacientes diagnosticados con esquizofrenia (n = 35). Los participantes respondieron al Test de Rorschach (R-PAS), a la Magical Ideation Scale (MIS) y al Inventory of Problems-29 (IOP-29) intentando simular la esquizofrenia. Los resultados de las comparaciones entre los grupos mostraron diferencias estadísticamente significativas para las variables (Hd), An, FQo, CFQ, CF-, P, M, PEC, WSumCog, MAH, GHR y Complexity. También se encontró una asociación de magnitud positiva y fuerte entre los scores obtenidos en la IOP-29 y los scores brutos del MIS (r = 0,73, p = 0,0001). Los hallazgos muestran que, incluso frente a los intentos de distorsionar las respuestas del test, los simuladores no son capaces de distanciarse de su precisión perceptiva. (AU)

In situ simulation in the permanent education of the intensive care nursing team / Simulación in situ en la educación permanente del equipo de enfermería de cuidados intensivos / Simulação in situ na educação permanente da equipe de enfermagem de terapia intensiva

ABSTRACT Objective: to know the perception of nursing professionals about the in situ strategy in continuing education in intensive care. Method: a descriptive, exploratory and qualitative study, conducted with 15 nursing professionals from an Intensive Care Unit. Data was collected from December 2018 to February 2019, by means of semi-structured interviews, after in situ simulations that occurred in the work environment and involving two settings, one on septic shock and the other, cardiorespiratory arrest. For analysis, the collective subject discourse technique was applied using a software program. Results: from the 15 nursing professionals participating in the study, eight were nurses and seven were nursing technicians. Their age varied from 23 to 56 years old and their time in intensive care ranged from two months to 17 years. The in situ simulation was perceived as an opportunity to update and acquire professional knowledge, skills and competencies, especially for those without experience, favoring the gain of self-confidence, communication, decision-making and clinical reasoning. The simulated in situ strategy was also portrayed as a possibility of training in the professional practice and in real time, unlike traditional training, and also, as a safe environment to make mistakes of diverse magnitudes because it is a training setting. Conclusion: the professionals understand the in situ simulation as being valid for professional update and practical learning in a safe setting.

RESUMEN Objetivo: conocer la percepción de los profesionales de Enfermería sobre la estrategia de la simulación in situ en la educación permanente en cuidados intensivos. Método: estudio descriptivo, exploratorio y cualitativo, realizado con 15 profesionales de Enfermería de una Unidad de Cuidados Intensivos. Los datos se recolectaron entre diciembre de 2018 y febrero de 2019 por medio de entrevistas semiestructurada, después de simulaciones in situ que tuvieron lugar en el ámbito laboral e incluyeron dos situaciones hipotéticas, una sobre shock séptico y otra, sobre parada cardiorrespiratoria. Para el análisis se aplicó la técnica del Discurso del Sujeto Colectivo con el uso de un programa de software. Resultados: de los 15 profesionales de Enfermería que participaron del estudio, ocho eran enfermeros y siete técnicos de enfermería. La edad varió entre 23 y 56 años y la experiencia en cuidados intensivos osciló entre dos meses y 17 años. La simulación in situ se percibió como oportunidad de actualización y adquisición de conocimientos, habilidades y competencias profesionales, principalmente para quienes carecían de experiencia, favoreciendo así una mejoría en los niveles de autoconfianza, comunicación, toma de decisiones y raciocinio clínico. La estrategia simulada in situ también se representó como una posibilidad de capacitación en la práctica profesional y en tiempo real, a diferencias de sistemas tradicionales de capacitación e, incluso, como un ámbito seguro para cometer errores de diversas magnitudes, por tratarse de una situación de entrenamiento. Conclusión: los profesionales perciben la estrategia de la simulación in situ como válida para la actualización profesional y el aprendizaje práctico en un ámbito seguro.

RESUMO Objetivo: conhecer a percepção dos profissionais de enfermagem sobre a estratégia da simulação in situ na educação permanente em terapia intensiva. Método: estudo descritivo, exploratório, qualitativo, realizado com 15 profissionais de enfermagem de uma Unidade de Terapia Intensiva. Os dados foram coletados de dezembro de 2018 a fevereiro de 2019, por meio de entrevista semiestruturada, após as simulações in situ ocorridas no ambiente de trabalho e que envolveram dois cenários, um sobre choque séptico e outro, parada cardiorrespiratória. Para a análise aplicou-se a técnica Discurso do Sujeito Coletivo com o emprego de um software. Resultados: dos 15 profissionais de enfermagem participantes do estudo, oito eram enfermeiros e sete técnicos de enfermagem. A idade variou de 23 a 56 anos e o tempo de atuação em terapia intensiva oscilou de dois meses a 17 anos. A simulação in situ foi percebida como uma oportunidade de atualização e aquisição de conhecimentos, habilidades e competências profissionais, principalmente para aqueles sem experiência, favorecendo o ganho de autoconfiança, a comunicação, a tomada de decisão e o raciocínio clínico. A estratégia simulada in situ também foi retratada como possibilidade de treinamento na prática profissional e em tempo real, diferentemente de treinamentos tradicionais e, ainda, como um ambiente seguro para cometer erros de várias magnitudes por se configurar um cenário de treinamento. Conclusão: os profissionais percebem a estratégia da simulação in situ como válida para a atualização profissional e aprendizado prático em ambiente seguro.

Enhancement of plastic surgery training by including simulation in education and training programmes

plastic surgery education and training. The objectives entail determining the importance of simulation in plastic surgery training and identifying simulation modalities most suited to attain specific outcomes.Methods.Data were collected by means of a Delphi survey to obtain consensus from an expert panel comprising 9 plastic surgeons, supplemented by semi-structured interviews conducted with 8 national and international role players in simulation and postgraduate education.Results. Learning outcomes, levels of training, possible simulation modalities, cognitive levels and descriptive verbs and phrases were described, as these pertain to learning. Participants agreed that simulation in medical education can be used to enhance postgraduate plastic surgery training, with special reference to specific outcomes and cognitive levels. Participants made recommendations for the planning and support of the implementation, aimed at ensuring the quality of training.Conclusion.The objectives set were achieved and the results of the study serve as encouragement and guidance in the striving for the enhancement of postgraduate plastic surgery education and training, and in other medical disciplines

Simulation as an educational strategy to deliver interprofessional education

Background. Various educational methods are available to deliver interprofessional education (IPE) to prepare healthcare students for collaborative practice. One such method is simulation-based health education.Objectives. To identify current IPE methods used in undergraduate programmes in the Faculty of Health Sciences at the University of the Free State, Bloemfontein, South Africa, and to determine the opinions of module leaders on using simulation as a particular IPE teaching strategy.Methods. A quantitative, cross-sectional descriptive study design was employed. Structured interviews were conducted with 47 module leaders of the undergraduate programmes in the Faculty of Health Sciences. These programmes cover 66 modules in the Schools for Allied Health Professions (nutrition and dietetics, occupational therapy, physiotherapy and optometry), nursing and medicine.Results. At the time of the study, IPE activities were used in 29 (43.9%) of the modules, of which 17 (58.6%) were coincidental. Respondents' opinions on the potential use of simulation to address formalised IPE activities included the challenge of 'scheduling' (73.9%) and 'logistical and high cost issues' (19.6%). The most prominent advantage that was foreseen (41.3%) was better clarification of roles among the different professions.Conclusions. The module leaders had a positive attitude towards simulation and its potential use for IPE, with their major concern being logistical challenges. To improve role clarification, a scenario should be developed to engage students from all the relevant professions. The proposed type of simulation was to use standardised patients in a role-play scenario. The outcomes of these activities should be aligned with the principles of IPE

¿Medicalizar al delincuente o hacer del loco un criminal?: Prácticas de alienismo y medicina legal en Colombia a comienzos del siglo XX / Medicalizing delinquents or turning the mad into criminals?: Practices of alienation and legal medicine in Colombia in the early the 20th century

RESUMEN Este artículo analiza algunas asociaciones médico-jurídicas entre locura y criminalidad en el departamento de Antioquia (Colombia), en las primeras tres décadas del siglo XX. El análisis se orientó por dos ejes imbricados: el de los discursos y el de las prácticas. Se examinaron las ideas de cuatro médicos, planteadas entre 1917 y 1925, para identificar los debates teóricos desde los cuales se delimitaban y definían las enfermedades mentales en casos judiciales. La puesta en escena del saber de los peritos y su lugar como expertos se analizaron en un caso judicial, que inició en 1921, y en cuyo desarrollo afloraron las confrontaciones teóricas entre los médicos que debatieron sobre la posible locura del acusado.

ABSTRACT This article analyzes medical-legal associations between madness and criminality in department of Antioquia (Colombia) during the three first decades of 20th century. The analysis was oriented by two overlapping axes: discourses and practices. The ideas of four doctors, generated between 1917 and 1925, were examined in order to identify the theoretical debates that delimited and defined mental illnesses in legal cases. The use of qualified knowledge and their place as experts were analyzed in a judicial case, initiated in 1921, in which theoretical confrontations surfaced among the doctors that debated the possible insanity of the defendant.

Pneumoparotitis

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

Instituto de simulación clínica y quirúrgica, una necesidad urgente de la Facultad de Medicina / Institute of clinical and surgical simulation, an urgent need of the Faculty of Medicine

En la gestión académica 2016, se presentó el Proyecto para la Creación del Instituto de Simulación Clínica y Quirúrgica de la Facultad de Medicina de la U.M.S.A., con la finalidad de mejorar las competencias clínicas en la formación de los estudiantes de las cuatro Carreras, a fin de cumplir por un lado, con la Misión Facultativa de formar profesionales con capacidad de resolución de los problemas de salud del país y de la región, y por otro lado, acatar las recomendaciones de la última Acreditación MERCOSUR (ARCU - SUR); de esta forma respondemos a los cambios globales y los desafíos de la educación del siglo XXI. Se inició con el diagnóstico de la situación real de la práctica clínica en ambientes hospitalarios de Convenio Docente-Asistencial, a través de entrevistas personalizadas realizadas a 312 estudiantes. Los resultados nos obligaron a plantear otras estrategias que complementen y fortalezcan la práctica, entre éstas la Simulación Clínica. A partir de la aceptación de esta estrategia docente, analizamos la viabilidad, la pertinencia y la sostenibilidad; estructuramos las etapas y las fases, su impacto y el costo. En todo momento contamos con la orientación de Instituciones de prestigio y experiencia en Enseñanza Simulada, como el Instituto de Simulación Clínica (INSIMED), la Universidad Católica y la Fundación Instituto de Educación Superior (I.E.S.) "Dr. Néstor Kirchner de Buenos Aires Argentina. Las Autoridades Facultativas aprobaron la iniciativa y ofrecieron el apoyo para lograr su creación. En la actualidad se encuentra en fase de organización a cargo de un Comité de Enseñanza Simulada.

Summary In the 2016 academic management, the Project for the Creation of the Institute of Clinical and Surgical Simulation ofthe Faculty of Medicine ofthe U.M.S.A. was presented, with thepurpose ofimproving the clinical competences in the training of the students of the four careers, in order to achieve at first, with the Facultative Mission to train professionals with capacity to solve the health problems of the country and the region, and on the other side, to comply with the recommendations of the last MERCOSUR Accreditation (ARCU - South); In this way we respond to the global changes and challenges of 21 st century education. It began with the diagnosis of the actual situation of clinical practice in hospital environments of Teaching-Assistance Convention, through personalized interviews conducted to 312 students. The results forced us to propose other strategies that complement and strengthen the practice, among them the Clinical Simulation. With the acceptance of this teaching strategy, we analyze the viability, the pertinence and the sustainability; We structure the stages and phases, their impact and their cost. Every phase we have the guidance of institutions of prestige and experience in Simulated Teaching, such as the Institute for Clinical Simulation (INSIMED), the Catholic University and the Foundation Institute of Higher Education (I.E.S.) "Dr. Néstor Kirchner of Buenos Aires Argentina. The Faculty Authorities approved the initiative and offered the support to achieve its creation. Atpresent it is in the phase of organization in charge ofa Committee of Simulated Teaching.

Pseudoloucura e loucura moral: um caso histórico sobre simulação / False madness and moral insanity: a historical case of simulation / La pseudo-locura e la locura moral: um caso histórico de simulación

A simulação da doença mental pode ocorrer quando alguém tenta evitar uma condenação judicial. Há mais de um século, tal problema já existia no âmbito do sistema judicial. O correto diagnóstico sobre a ocorrência de uma doença mental em um acusado ou, de outro modo, a identificação de que o mesmo está simulando sempre se revelou um empreendimento difícil. Este artigo analisa um caso emblemático envolvendo a dificuldade de diagnóstico em um casal que vivia na cidade no sul do Brasil no início do século passado. A pesquisa foi realizada em periódicos e processos-crime relativos a esse período. Os autores inferem que aspectos inconclusivos dessa discussão no contexto forense são muito similares a outros tantos ocorridos na atualidade

Simulation of mental disease can occur when people attempt to escape criminal conviction. More than one century ago, this problem already existed in the court system. It has always been difficult to correctly diagnose whether the accused suffered from a real disease or if simulated the disorder. This article analyzes an emblematic case characterized by a difficulty to diagnose a couple involved in a murder in a city in the south of Brazil in the beginning of the last century. The research was conducted in periodicals and judicial processes from that period. The authors conclude that the inconclusive discussions regarding this subject, in a forensic context, are very similar to some current cases

La simulación de enfermedad mental puede ocurrir cuando alguien trata de evitar una condena judicial. Durante más de un siglo, este problema existía en el sistema judicial. El diagnóstico correcto en un acusado en la aparición de una enfermedad mental real, o por el contrario, la identificación de la simulación siempre ha sido difícil. En este artículo se examina un caso histórico que implica la dificultad del diagnóstico en una pareja que vivía en sur de Basil, al comiezo del siglo pasado. La investigación se llevó a cabo en periódicos y procesos de principios de siglo XX. Los autores concluyen que muchos aspectos de este debate inconcluso son muy similares a las situaciones que existen en la actualidad

Los simuladores: verdad y poder en la psiquiatría de José Ingenieros / The simulators: truth and power in the psychiatry of José Ingenieros

Resumen Tomando como punto de partida el curso de Michel Foucault “El poder psiquiátrico”, se analiza el libro Simulación de la locura, publicado en 1903 por el psiquiatra argentino José Ingenieros. Foucault afirma que el problema de la simulación recorre transversalmente toda la historia de la psiquiatría moderna. Inicialmente se analizan las referencias que José Ingenieros dedica a la cuestión de la simulación en la lucha por la vida, para luego abordar la temática de la simulación en los estados patológicos en general y, por fin, la simulación de la locura y la problemática de la degeneración. Ingenieros participa de esa lucha epistemológica y política que se establece entre peritos-psiquiatras y simuladores en torno a la cuestión de la verdad.

Abstract Using Michel Foucault’s lectures on “Psychiatric power” as its starting point, this article analyzes the book Simulación de la locura (The simulation of madness), published in 1903 by the Argentine psychiatrist José Ingenieros. Foucault argues that the problem of simulation permeates the entire history of modern psychiatry. After initial analysis of José Ingenieros’s references to the question of simulation in the struggle for existence, the issue of simulation in pathological states in general is examined, and lastly the simulation of madness and the problem of degeneration. Ingenieros participates in the epistemological and political struggle that took place between experts-psychiatrists and simulators over the question of truth.

Psicosis instrumental: a propósito de dos probables casos / A propos of two probable cases of instrumental psychosis

El Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5) define a la simulación como larepresentación intencional de síntomas físicos o psicológicos falsos o muy exagerados, motivada por incentivosexternos diversos, aunque reconoce que, en muchos casos, la simulación puede tener cierto valor adaptativo.Estrictamente hablando, la simulación no es un trastorno mental sino un problema que puede ser objeto de atenciónclínica. Sin embargo, se presume erróneamente que la simulación podría darse solamente en contextos forenses,lo que dificulta su identificación en ámbitos clínicos. La “psicosis instrumental” es una variante de simulaciónconsistente en el fingimiento de síntomas por parte de un individuo con diagnóstico subyacente de una psicosisprimaria y que simula sus síntomas en momentos de estabilidad clínica. Se presentan dos casos de personas condiagnóstico primario de esquizofrenia que pueden ser considerados también como aparentes casos de psicosisinstrumental. No existen reportes previos de este trastorno en nuestro país, aunque presumiblemente su número nodebe ser exiguo. Se revisa también la literatura pertinente a este interesante fenómeno que, más alláde su naturaleza psicopatológica, parece reflejar conductas de una definida índole psicosocial..

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines malingering as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives; under some circumstances, malingering may represent a sort of adaptive behavior. In fact, malingering is not a mental disorder but a problem that may be require clinical attention. Nevertheless, it is erroneously assumed that malingering could only occur in forensic contexts, therefore difficult to identify in clinical settings. “Instrumentalpsychosis” is a variant of malingering which consists in the intentional production of symptoms by an individualwith a diagnosis of primary psychosis, who feigns his/her symptoms during periods of clinical stability. Two cases of patients with a primary diagnosis of schizophrenia and who qualify as apparent cases of instrumentalpsychosis, are presented. There are no previous reports of this disorder in our country, although presumably itsnumber may not be small. Relevant literature on this interesting clinical phenomenon is reviewed as, beyond its mere psychopathological content, it seems to reflect behaviors of a definite psychosocial nature.

Pattern-reversal visual evoked potentials as a diagnostic tool for ocular malingering / Potenciais visuais evocados por padrões reversos como uma ferramenta diagnóstica de simulação

ABSTRACT Purpose: To investigate the contributions of transient pattern-reversal visual evoked potentials in the diagnosis of ocular malingering at a Brazilian university hospital. Methods: Adult patients with suspected malingering in one or both eyes were referred for visual evoked potential testing. Data from patients' medical records were reviewed and analyzed retrospectively. Data analysis included the distance optotype visual acuity based on a ETDRS retro-illuminated chart and the transient pattern-reversal visual evoked potential parameters of latency (milliseconds) and amplitude (microvolts) for the P100 component, using checkerboards with visual subtenses of 15' and 60'. Motivations for malingering were noted. Results: The 20 subjects included 11 (55%) women. Patient ages ranged from 21 to 61 years (mean= 45.05 ± 11.76 years; median= 49 years). In 8 patients (6 women), both eyes exhibited reduced visual acuity with normal pattern-reversal visually evoked potential parameters (pure malingerers). The remaining 12 patients (7 men) exhibited reduced vision in only 1 eye, with simulated reduced vision in the contralateral eye (exaggerators). Financial motivation was noted in 18 patients (9 men). Conclusion: Normal pattern-reversal visually evoked potential parameters with suspected ocular malingering were observed in a 20 patient cohort. This electrophysiological technique appeared to be useful as a measure of visual pathway integrity in this specific population.

RESUMO Objetivo: Investigar a contribuição dos potenciais visuais evocados por padrões reversos no diagnóstico de simulação de baixa de visão em um hospital universitário do Brasil. Métodos: Um grupo de pacientes adultos com suspeita de simulação de baixa de visão em um ou ambos os olhos foi avaliado e os dados analisados retrospectivamente. Foram medidos: acuidade visual de optotipos informada para longe utilizando a tabela ETDRS, parâmetros dos potenciais visuais evocados por padrões reversos de latência (milissegundos) e amplitude (microvolts) para o componente P100 com estímulos de ângulos visuais de 15' e 60'. A motivação do paciente para a simulação foi anotada. Resultados: Os participantes foram 20 indivíduos com 11 (55%) do sexo feminino. A idade variou de 21 a 61 anos (média= 45,05 ± 11,76 anos; mediana= 49 anos). Em 8 pacientes (6 mulheres) ambos os olhos tinham acuidade visual reduzida com parâmetros dos potenciais visuais evocados por padrão reverso normais para ambos os olhos (simuladores puros). Uma subsérie separada de 12 pacientes (7 homens) tinha visão reduzida em apenas um olho e estavam simulando redução da visão no outro olho (exacerbadores). A motivação financeira foi observada em 18 pacientes (9 homens). Conclusões: Parâmetros dos potenciais visuais evocados por padrões reversos normais foram encontrados neste grupo de 20 pacientes com suspeita de simulação. Esta técnica eletrofisiológica pode ser útil como uma medida da integridade do sistema visual nesta população de doentes.

Simulação de sintomas e transtornos mentais: uma revisão crítica do fenômeno para a psicologia / Symptoms and mental disorders simulation: a critical revision of the phenomenon for psychology / Simulación de síntomas y trastornos mentales: una revisión crítica del fenómeno de la psicología

A "arte de simular" com objetivo de obter ganhos tem se inserido em diversos contextos, desde situações do dia-dia até processos cíveis e criminais. É difícil delimitar fatores para definir sua presença, manifestando-se como um contínuo. Assim, sua avaliação consiste identificá-la como um fenômeno complexo, multidimensional e multifacetado que requer abordagem biopsicossocial. Ou seja, é um tema que requer atenção de todos os profissionais que lidam com ele. O presente estudo objetiva uma revisão crítica da literatura disponível sobre o problema na área da Psicologia. Realizou-se uma pesquisa nas principais bases de produção acadêmica utilizando os verbetes: "simulação", "sintomas" e "transtornos mentais". Encontrou-se 508 publicações, porém, somente 20 publicações atenderam os critérios de relevância. Neste sentido, é notória a escassez de publicações na área e pouca visibilidade do tema, principalmente no Brasil. Torna-se imperativo que esse tema seja mais pesquisado e que conquiste espaço na formação e na prática do psicólogo devido a sua importância e consequências.

The "art of simulating" in order to obtain advantages can be found in various contexts, from day to day situations to civil and criminal cases. Its prevalence varies according to the context and type of simulation, with higher rates in the prison context. It is difficult to delineate specific factors to define its presence, manifests itself as a continuum, and it is necessary to recognize the various scenarios where it occurs. The evaluation is a complex, multidimensional and multifaceted phenomenon that requires a biopsychosocial approach. The aim of this study was a critical review of the available literature on the subject in the area of psychology. Was conducted a survey in major academic production bases using the entries: "simulation", "symptoms" and "mental disorders". It was found 508 publications; however, only 20 publications met the relevancy criteria. Considering this, there are very few publications in the area and a little visibility for this theme, especially in Brazil. It is imperative that this theme be further researched, conquering space in the formation and in the psychologist's practice because of its importance and consequences.

El "arte del engaño" con fin de obtener ganancias se ha insertado en varios dominios, desde situaciones del día a día hasta los procesos civiles y criminales. Es difícil identificar los factores específicos para delimitar su presencia. Manifiestase en un continuo, siendo necesario reconocer los diferentes escenarios donde el mismo ocurre. Así, su evaluación consiste en la identificación de un fenómeno complejo, muldimensional y multifacético que requiere un abordaje biopsicosocial. En este sentido, la ausencia de tal práctica y su realización cuidadosa constituyese en un desafío y un recto para todos que trabajan con el fenómeno. Este artículo tiene como objetivo hacer una revisión crítica de la literatura disponible sobre el tema en Psicología. Se ha realizado una búsqueda en las principales bases de producción académicas utilizando las entradas: "simulación", "síntomas" y "trastornos mentales". Encontraranse 508 publicaciones, sin embargo, sólo 20 de las encontradas cumplían los criterios de pertinencia. Así, hay pocos estudios en el área y baja visibilidad, especialmente en Brasil. Es imprescindible que este asunto sea investigado más profundamente y conquiste espacio en la formación y la práctica del psicólogo debido a su importancia y consecuencias.

Correlation between Visual Acuity and Retinal Nerve Fiber Layer Thickness in Optic Neuropathies

PURPOSE: To assess the correlation between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT, Cirrus HD-OCT®) and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy. METHODS: Thirty-eight patients were recruited. RNFL thickness and visual acuity in optic neuritis, ischemic optic neuropathy and traumatic optic neuropathy were measured at least 6 months after the event. The correlation between log MAR best-corrected visual acuity (BCVA) and retinal nerve fiber thickness in each quadrant was analyzed. RESULTS: log MAR BCVA and RNFL thickness of each quadrant in optic neuropathy exhibited a statistically significant correlation. In optic neuritis, RNFL thickness of the superior quadrant was significantly thicker than in ischemic optic neuropathy and traumatic optic neuropathy (p = 0.009, 0.003). In addition, RNFL thickness of the inferior quadrant in optic neuritis was significantly thicker than in traumatic optic neuropathy (p = 0.012). CONCLUSIONS: There was a statistically significant correlation between log MAR BCVA and RNFL thickness by OCT in patients with optic neuropathies. The RNFL thickness may predict visual acuity after an optic neuropathy attack and help to differentiate malingering patients with impaired vision loss.

Simulación de síntomas psicóticos y su evaluación para ayudar a establecer inimputabilidad / Simulation of psychotic symptoms and evaluation to help establish criminal responsibility

El profesional en psicología debe conocer sobre la versatilidad que su rol puede tener en diversos contextos, sobre todo cuando se enfrente a una pregunta jurídica como ayudar a determinar dinámicas de simulación para ayudar a decidir sobre inimputabilidad en un sistema de justicia. Por ello se brinda una recopilación bibliográfica basada en el trabajo final de graduación para optar al grado de psicólogo clínico, titulado “Simulación de síntomas psicóticos y su evaluación psicológica: algunos elementos psicojurídicos y su relación con aspectos clínicos y forenses en el contexto costarricense”, en la cual se reflexiona sobre estos temas. En primera instancia se brindará una ubicación general del rol del psicólogo en estas circunstancias, pasando a describir diversas dinámicas de simulación de síntomas psicóticos que abarcan las concepciones de simulación y como se han registrado en síntomas positivos y negativos. Se brindan ejemplos de sintomatología atípica, extraña o exagerada y se concluye con un resumen de pruebas psicológicas que generan tanto indicadores indirectos como otras que tienen como fin específico detectar simulación de psicosis. Una reflexión final abarca la necesidad integrar estos datos con la revisión exhaustiva de información colateral, escogencia y aplicación adecuada de pruebas psicológica y los cuidados pertinentes al describir dinámicas de simulación en una persona, por las delicadas implicaciones que conllevan su diagnóstico.

A professional in psychology should know about the versatility that his or her role can have in various contexts, especially when faced with legal treatments as helping to determine dynamic simulation throughout the insanity justice system. Therefore, it provides a bibliography based on the final graduation to obtain the degree of clinical psychologist, entitled “Simulation of psychotic symptoms and psychological assessment: psycho-legal elements and their relationship to clinical and forensic on costarrican context “ in which we go on reflection on these kind of issues. First of all, we provide a general placement of the role as psychologists in these circumstances, reviewing and describing various dynamic simulations of psychotic symptoms that include the concepts of simulation and are reflected in positive and negative symptoms. Examples are given of atypical symptoms, strange or exaggerated and conclude with a summary of psychological tests that generate both indirect indicators and others that are designed to detect specific simulation of psychosis. One final thought concerns the need to integrate these data with an exhaustive review of collateral information, choice and proper application of psychological tests and appropriate care dynamics simulation to describe a person, by the delicate implications involving diagnosis.

Prognostic Factors of Neurocognitive and Functional Outcomes in Junior and Senior Elderly Patients with Traumatic Brain Injury Undergoing Disability Evaluation or Appointed Disability Evaluation

OBJECTIVE: This study explored the relationships among demographic (DVs) and clinical variables (CVs), neurocognitive (NOs) and functional outcome (FO) that could be used as prognostic factors for old aged patients with traumatic brain injury (TBI) undergoing or appointed disability evaluation (DE) after treatment. METHODS: A total of 162 subjects with TBI above the age of 55 years undergoing DE or appointed to do so after treatments were selected. The patients were divided into two subgroups according to age : a junior elderly group 55 to 64 years old and a senior elderly group over the age of 65. NOs and FO were evaluated using the Seoul Neuropsychological Screening Battery and Clinical Dementia Rating scale. RESULTS: Gender, age, and education level were shown to significantly impact the recovery of NOs after TBI. Other DVs and CVs such as area of residency, occupation, type of injury, or loss of consciousness were not found to significantly affect the recovery of NOs after TBI. Analysis of the relationships among DVs, CVs and NOs demonstrated that gender, age, and education level contributed to the variance of NOs. In FO, loss of consciousness (LOC) was included to prognostic factor. CONCLUSION: Gender, age and education level significantly influence the NOs of elderly patients with TBI. LOC may also serve as a meaningful prognostic factor in FO. Unlike younger adult patients with TBI, old aged patients with TBI did not show global faking-bad or malingering attitudes to DE for compensation, but assume that they could faking their performance in a test set available visual feedback.

Simulação clínica em cardiologia / Clinical simulation in cardiology

A educação continuada constitui um critério de avaliaçãode qualidade do ensino das instituições, sendo uma das ferramentasmais importantes na capacitação dos profissionaisda saúde, na atualização profissional e no aprimoramentoda equipe multidisciplinar. A simulação diminui a distânciaexistente entre o que se ensina na teoria e sua aplicabilidadena prática profissional. O treinamento com cenários é dividido,didaticamente, em três momentos: elaboração, execuçãoe debriefing. O debriefing é o momento utilizado para análisee reflexão do que foi vivido durante a simulação, para que sedescubra o que foi aprendido e sua aplicabilidade a partir deexperiências vividas em situações reais. A simulação clínicatambém permite que os profissionais estejam mais aptos a anteversituações clínicas adversas, possam cometer erros e, atémesmo, tirar suas dúvidas antes de lidar com situações reais,sempre em ambientes controlados e sob constante supervisão...

Continuing education is a major criterion for the evaluationof the quality of teaching institutions, so it is one of the mostimportant tools in the training of health professionals in professionalupdating and improving the multidisciplinary team.Simulation decreases the gap between what is taught in theoryand its applicability in practice. The training scenario is divideddidactically in three stages: preparation, execution anddebriefing. The debriefing is the time required for analysis andreflection of what was experienced during the simulation, sothat they disco ver what they have leamed and their applicabilityfrom experiences in real situations. Simulation also allowsclinical professionals to be more able to predict adverse clinicalsituations, so that they can make mistakes or even get therequestions solved before dealing with real situations, alwaysin controlled environments and under constant supervision...

Avaliação baseada em competências empregando a simulação (Elaboração de protocolos de observação de habilidades e de competências empregando a simulação) / Based assessment skills using simulation (Elaboration of protocls observation skills and competencies employing simulatio)

Um exame clínico objetivamente estruturado é ummoderno tipo de exame frequentemente usado em ciênciasda saúde e em cardiologia. Ele é projetado para testaro desempenho da habilidade clínica ecompetência emhabilidades como comunicação, atuação no pré-hospitalar,na sala de emergência, exame clínico, procedimentosmédicos/prescrição, prescrição de exercícios, técnicasde mobilização, avaliação de imagens radiográficas elaboratórios e interpretação dos resultados...

Changes in medical practice that lirnit instruction time andpatient availability, the expanding options for diagnosis andmanagement, and advances in technology are contributing togreater use of simulation technology in medical education.High-technology simulations currently being used a cardiovasculardisease simulator, which can be used to simulate cardiacconditions; multimedia computer systems, which includespatient-centered, case-based programs that constitute a generalistcurriculum in cardiology. Some benefits of simulationtechnology include improvements in certain surgical technicalskills, in cardiovascular examination skills, and in acquisitionand retention ofknowledge compared with traditionallectures.These systems help to address the problem of poor skills trainingand proficiency and may provide a method for physiciansto beco me self-directed lifelong leamers...

Revisión de dos instrumentos de simulación neurocognitiva y su utilidad en el contexto forense / Review of the neurocognitive malingering instrument and its useful in a forensic contex

Gran parte de la precisión de la evaluación neuropsicológica, depende que los instrumentos que utiliza, sean medidas estandarizadas, válidas y confiables. Sin embargo, la simulación, la exageración y el bajo esfuerzo son aspectos que pueden interferir en los resultados de los test. El objetivo de esta revisión pretende describir y analizar dos instrumentos en el contexto de la Neuropsicología Forense que evalúan simulación de síntomas cognitivos: el Test of Memory Malingering (TOMM) y el Victoria Symptoms Validity Test (VSVT). Se realizó una búsqueda dirigida no exhaustiva, en diversas bases de datos y libros afines. El criterio de inclusión fue la utilización o revisión de los test. Se seleccionaron 68 trabajos publicados. Cada uno de los cuales fue analizado en base a las características técnicas de los instrumentos. La revisión ha demostrado que el TOMM y el VSVT son instrumentos pertinentes para valorar simulación y exageración de sintomatología cognitiva. Estos instrumentos cuentan con un cúmulo de investigaciones que avalan sus propiedades, pero también las limitaciones y restricciones de su utilización.

Most of the accuracy in neuropsychological assessment depends that the instruments used are standardized, valid and reliable measures. However, malingering, exaggeration and poor effort are aspects that can interfere with the interpretation of the results. The aim of this review was to describe and analyze two instruments in the context of forensic neuropsychology that assess malingering of cognitive symptoms: Test of Memory Malingering (TOMM) and Victoria Symptoms ValidityTest (VSVT). Several scientific databases and related books were searched non-exhaustively. The criterion for inclusion in this review was the use of test. We selected 68 documents, each one was analyzed based on the technical characteristics of the instruments. Review showed that the TOMM and VSVT are relevant instruments for assessing malingering and exaggeration of cognitive symptoms. These instruments have several evidence that support their psychometric properties but also limitations and restrictions on their use.