Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach.

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24-30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.

Biased Symptom Reporting and Antisocial Behaviour in Forensic Samples: A Weak Link.

In two studies (one with 57 forensic inpatients and one with 45 prisoners) the connection between biased symptom reporting and antisocial behaviour is explored. The findings are as follows: 1) the association between symptom over-reporting and antisocial features is a) present in self-report measures, but not in behavioural measures, and b) stronger in the punitive setting than in the therapeutic setting; and 2) participants who over-report symptoms a) are prone to attribute blame for their offence to mental disorders, and b) tend to report heightened levels of antisocial features, but the reverse is not true. The data provide little support for the inclusion of antisocial behaviour (i.e. antisocial personality disorder) as a signal of symptom over-reporting (i.e. malingering) in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5). The empirical literature on symptom over-reporting and antisocial/psychopathic behaviour is discussed and it is argued that the utility of antisocial behaviour as an indicator of biased symptom reporting is unacceptably low.

An evaluation of irreversible psychosurgical treatment of patients with obsessive-compulsive disorder in the Netherlands, 2001-2008.

Admissions for irreversible psychosurgical treatment of obsessive-compulsive disorder (OCD) by the Working Group for Indication Psychosurgery in the Netherlands were analyzed, and the postsurgical effects on symptom severity and quality of life were evaluated. The data were extracted from patient records in the period 2001-2008, and there was a postoperative assessment with a semistructured interview. Fourteen patients applied, having severe OCD with mostly one or more comorbid disorders. The mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 32 points. Four of seven patients in whom psychosurgery was deemed useful were operated on. The decrease of the Y-BOCS score from registration to after surgery was 9 points (range, 3-17 points). An improvement in social function was present in three of four patients. In conclusion, psychosurgery can be a valuable treatment option for patients with severe OCD in whom other treatments fail.

Psychosis reactivity to cannabis use in daily life: an experience sampling study.

BACKGROUND: Little is known about the experiential dynamics of the interaction between cannabis and vulnerability to psychosis. AIMS: To examine the effects of cannabis on psychotic symptoms and mood in patients with psychosis and healthy controls. METHOD: Patients with a psychotic disorder (n = 42) and healthy controls (n = 38) were followed in their daily lives using a structured time-sampling technique. RESULTS: Daily life cannabis use predicted subsequent increases in positive affect and in patients, but not in controls, decreases in negative affect. In patients, but not in controls, cannabis use predicted increased levels of hallucinatory experiences. Mood-enhancing properties of cannabis were acute, whereas psychosis-inducing effects were sub-acute. There was no direct evidence for self-medication effects in daily life. CONCLUSIONS: Patients with psychosis are more sensitive to both the psychosis-inducing and mood-enhancing effects of cannabis. The temporal dissociation between acute rewarding effects and sub-acute toxic influences may be instrumental in explaining the vicious circle of deleterious use in these patients.

The cumulative needs for care monitor: a unique monitoring system in the south of the Netherlands.

INTRODUCTION: Patients diagnosed with severe mental illness (SMI) have a complex combination of psychiatric, somatic and social needs for care, requiring an integrated, multidisciplinary health care approach. The present paper describes the methods of the cumulative needs for care monitor (CNCM), a monitoring system in operation in a geographically defined area. METHODS: The CNCM provides information on need for care, functioning and other outcomes in SMI patients in the area. This information can be used not only to plan treatment at the individual level, but also to conduct health services research at the group level.

Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum.

OBJECTIVE: Failing of mentalising has been suggested to underlie certain symptoms of psychosis. An as yet unresolved issue is whether mentalising deficits reflect a characteristic which can also be detected in people at risk for psychosis or people with evidence of subclinical expression of psychosis. This study wanted to assess an aspect of mentalising in four groups with different levels of psychosis vulnerability, and to examine associations between mentalising and symptoms of psychosis. METHOD: The study included i) 40 patients with psychosis, ii) 49 non-psychotic first-degree relatives (familial risk), iii) 41 subjects from the general population with a high level of positive psychotic experiences (psychometric risk) and iv) 54 healthy controls. All subjects performed the 'Hinting Task'. RESULTS: There was a significant association between psychosis risk and impairment on the Hinting Task (beta linear trend=0.37, p<0.001). Using the control group as the reference, the association with impairment on the Hinting Task was highest for the patient group (beta=0.46, p<0.001), whereas the familial risk group (beta=0.16, p=0.06) displayed an intermediate probability of failure. The psychometric risk group did not significantly differ from the control group (beta=0.04, p=0.653). In the patient group, impairment on the Hinting Task was associated with current hallucinations and paranoid symptoms. In the familial risk group, there was an association between the Hinting Task and paranoid symptoms. DISCUSSION: These results suggest that vulnerability to psychosis is expressed as an impairment in mentalising, which may have a mediating role in the formation of certain positive symptoms of psychosis.

The urge to change appearance in different psychopathological categories.

BACKGROUND: In professional literature, mainly anecdotic descriptions can be found of striking, sometimes even bizarre manipulations of the appearance by psychiatric patients. OBJECTIVE: In this study, it was examined whether the inclination to (drastically) change the appearance is related to (pre)psychotic symptoms. METHODS: By means of a questionnaire, the frequency and nature of changing the appearance was studied among a sample of healthy volunteers (n = 38) and psychiatric patients (n = 61). The psychiatric group consisted of 1) patients with schizophrenia (n = 22), 2) patients with a borderline personality disorder (n = 20) and 3) patients with a depressive disorder (n = 19). RESULTS: In accordance with previous findings, self-reports of drastic changes of appearance were associated with scores on various schizotypy scales. Psychiatric patients reported more changes of appearance, compared with healthy volunteers. Patients with schizophrenia reported most changes, followed by the group of patients with borderline personality disordered. CONCLUSIONS: Perhaps, drastic changes of the appearance are a visible expression of the loss of ego boundaries and/or of the sense of reality.