ABSTRACT
We report a case of a 41-year-old male diagnosed with pulmonary coccidioidomycosis and pulmonary embolism (PE) based on a point-of-care ultrasound (POCUS) finding who was suspected to be malingering for right-sided chest pain considering his psychiatric history. POCUS was performed and showed right ventricular strain with a D-shaped left ventricle and B-lines with subpleural consolidations, and PE was confirmed with computed tomography pulmonary angiography. No other risk factors for PE were found except for coccidioidomycosis. The patient was treated with apixaban and fluconazole and discharged in stable condition. We discuss the usefulness of POCUS in diagnosing PE and the very rare association between coccidioidomycosis and PE.
ABSTRACT
Malingered psychosis is problematic in many legal/forensic contexts and can have serious consequences such as wrongful competency to stand trial and criminal responsibility determinations, inaccurate violence/dangerousness risk assessments, unjust punishments/sentences, inappropriate prison placements, reduced culpability in prison rule violations, high recidivism risk, and inappropriate parole/probation readiness decisions. Given that malingering is most prevalent in forensic settings (Grossman & Wasyliw, 1988) and psychosis is the mental illness most frequently malingered by forensic populations (Broughton & Chesterman, 2001) the accurate assessment and identification of malingered versus true psychosis is imperative for appropriate responses/outcomes in these settings. Currently available measures used to detect malingered psychopathology are lengthy, time consuming, difficult to interpret, and lack straightforward consistent cutoff scores across different diagnostic categories. A within-subjects repeated measures design was used to validate using the newly published Inventory of Problems-29 (IOP-29) False Disorder Probability Scale (FDS) and five Modified Response Special Scores variables of the Rorschach Performance Assessment System (R-PAS) to detect feigned psychosis in a forensic sample of 13 adults on probation for lower-level sexual, domestic violence, and/or drug/alcohol-related convictions in the United States. Participants were instructed to complete the IOP-29 and R-PAS under two different test conditions: (1) Genuine condition (GEN) with standard administration instructions, and (2) Feigning condition (FGN) during which participants were instructed to feign psychosis based on a case vignette description of the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) schizophrenia criteria. As hypothesized, results were consistent with previous international studies on detecting psychosis on the IOP-29 in that FDS scores were significantly higher during the FGN condition compared to the GEN condition. The a priori cutoff of > .50 distinguished FGN from GEN. Specificity (92.3%) and sensitivity (84.6%) were high and consistent with past research. It was also predicted that raw scores on five Modified Response Special Scores R-PAS variables would be higher in the FGN condition than in the GEN condition and that a priori cutoffs would correctly distinguish FGN from GEN. These hypotheses were partially supported in that raw scores were significantly higher in the FGN condition and a priori cutoffs correctly distinguished FGN from GEN on three of the five Modified Response Special Scores variables. Limitations include small sample size resulting from COVID-19 pandemic in-person restrictions, absence of genuine psychotic patient group, and demographic characteristics (e.g., only 1 female, non-incarcerated, low level criminal offenses, etc.), which may reduce replicability and generalizability of the findings. Future research should replicate this study with larger sample sizes and examine gender differences and ecological validity in different types of forensic settings. Overall, the results of this study support the use of the IOP-29 and three R-PAS Modified Response Special Scores variables to detect malingered psychosis in forensic populations. The IOP-29 may be preferable to other available measures since it performs just as well, and has the benefits of being shorter, more straightforward, and easier to interpret with a single consistent cutoff score across diagnostic categories. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Background: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. Methods: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. Results: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. Conclusions: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
An introduction is presented in which the editor discusses various reports within the issue on topics including malingering during the pandemic, best treatment strategies for schizophrenic patients, and factors to consider when cross-titrating antipsychotic medications.
ABSTRACT
The article presents the discussion on doctors with long-haul Covid symptoms complaining about poor treatment by the colleagues. Topics include examination tools discriminating between physiologic and non-physiologic symptoms and signs;and other task-specific movement disorders being a form of focal dystonia and not treatable with psychotherapy.