Beschwerdenvalidierung bei Rehabilitanden mit Migrationshintergrund in der Psychosomatik

[Validity of the "Structured Inventory of Malingered Symptomatology" [SIMS] in the Assessment of Healthy Individuals and Patients with Psychiatric Disorders Outside the Forensic Context]

OBJECTIVE

Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context.

METHODS

Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated.

RESULTS

Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF).

CONCLUSION

If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.

[Response distortion or symptom severity? Symptom description by psychiatric patients and sociomedical assessment subjects]

BACKGROUND

Psychiatric disorders are the most frequent cause for premature retirement; however, trying to verify claims of performance deficits due to psychiatric disorders without the actual existence of the latter in sociomedical assessments is problematic. For this reason, differentiation between actual psychiatric disorders with real presence of symptoms and simulated or aggravated symptoms is of importance in sociomedical assessments. In recent years, symptom validity tests (SVT) have been increasingly utilized in psychiatric/psychological assessments; however, knowledge of the validity of these tests and the relation to symptom severity is still lacking.

OBJECTIVE

This study aimed to compare the validity of different SVTs depending on symptom severity (Structured Inventory of Malingered Symptomatology (SIMS), Word Memory Test (WMT), Symptom Checklist-90-R (SCL-90‑R), Minnesota Multiphasic Personality Inventory‑2 (MMPI-2)).

MATERIAL AND METHODS

Clinically treated inpatient psychiatric patients (n = 30) were compared with subjects of sociomedical assessments (n = 29) regarding their tendency to simulate or aggravate symptoms.

RESULTS

It could be shown that the WMT and the SIMS both failed in the differentiation between psychiatric patients and subjects of sociomedical assessments, regarding description of symptoms or (un)restricted performance motivation. Furthermore, 20% of psychiatric patients were classified as false positive in WMT. The results of the SIMS were significantly related to the severity of psychiatric symptoms in SCL-90‑R, therefore the severity of symptoms was assessed rather than the response distortion.

CONCLUSION

The results underline the importance of further research on SVTs in sociomedical assessments, especially regarding symptom severity and response distortion.

Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients

Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting.Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory-II (BDI-II) were analyzed.Results: At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI-II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement.Conclusions: The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.

Equivalence of the German and the French Versions of the Self-Report Symptom Inventory

Abstract. Against the background of the growing importance of symptom validity assessment both in forensic and clinical or rehabilitation contexts, a new instrument for identifying overreporting was developed. In order to study the equivalence of the German and the French versions, we divided the item pool of the Self-Report Symptom Inventory (SRSI) into two presumably equivalent half-forms. A sample of 40 adult bilingual Swiss nationals with a mean age of 39.9 years responded honestly to one of the half-forms in German and to the other in French. In a subsequent experimental malingering condition, they were asked to simulate sequelae of a whiplash injury and to respond to the SRSI again. In both conditions, they also filled out the Structured Inventory of Malingered Symptomatology (SIMS). The results showed no differences between the two language versions in both conditions. Classification accuracy was very high (100% specificity, 90% sensitivity for the standard cutoff score). Reliability estimates were 0.93 for endorsement of genuine symptoms and 0.97 for pseudosymptom endorsement. In the malingering condition, the correlation between the number of reported pseudosymptoms and the SIMS scores was 0.69. The current results add to the database available for the SRSI and support the appropriateness of the French version.

An International Perspective on Feigned Mental Disabilities: Conceptual Issues and Continuing Controversies

In forensic contexts, an increased prevalence of feigned symptom presentations should be expected, although it will probably vary by the context and specific forensic issue. Forensic experts should examine this possibility proactively while maintaining a balanced perspective that actively considers clinical data for both feigning and genuine responding. Psychological measures and standardized methods developed for feigning and other response styles can facilitate these often complex determinations. The current article provides an international perspective on the issue of feigned mental disabilities. In particular, important conceptual issues are discussed, such as the categorical versus dimensional approaches to feigning, and the advisability of well-defined rather than single-point cut scores for accuracy in clinical decision-making. Salient problems of differential diagnosis include a spectrum from malingering and factitious disorders to somatoform and conversion disorders. In rendering these important diagnostic distinctions, the questions of motivations and intentions remain key. However, the establishment of motivation cannot be facilely assumed from the context. Instead, forensic psychologists and psychiatrists bear the professional burden of carefully evaluating motivation and recognizing the clinical reality that sometimes the motivation in especially challenging cases may not be fully determined. Copyright © 2017 John Wiley & Sons, Ltd.

Europäische Umfrage zum Einsatz von Beschwerdenvalidierungstests: Ergebnisse der deutschen Teilnehmer

Zur Praxis der Beschwerdenvalidierung wurde 2011 eine Umfrage unter europäischen Neuropsychologen durchgeführt ( Dandachi-FitzGerald, Ponds & Merten, 2013 ). Die Ergebnisse der deutschsprachigen Teilstichprobe werden berichtet (n = 211). Obwohl die Teilnehmer die Bedeutung einer sorgfältigen Beurteilung der Beschwerdenvalidität anerkannten, dominieren nichtstandardisierte Ansätze. Die am häufigsten eingesetzten Beschwerdenvalidierungstests waren: Testbatterie zur Forensischen Neuropsychologie, Word Memory Test, Rey 15-Item-Test, Amsterdamer Kurzzeitgedächtnistest, Aggravations- und Simulationstest. Die Ergebnisse zeigen eine große Streuung bezüglich der Erwartungen über die Prävalenz negativer Antwortverzerrungen sowie zum Einsatz von Beschwerdenvalidierungstests.

Erhebliche Unterschiede gab es in der Praxis der Beschwerdenvalidierung in gutachtlichen gegenüber klinischen Untersuchungskontexten. Leitlinien für die Beurteilung der Beschwerdenvalidität fehlen im deutschen Sprachraum und sind in Europa bislang nur aus Großbritannien bekannt.

Die differentielle Validität neuropsychologischer Testverfahren zum Nachweis nicht-authentischer Störungen

Ziel dieser Studie ist es, die Eignung unterschiedlicher neuropsychologischer Verfahren zur Diagnostik von nicht-authentischen Störungen zu ermitteln. Darüber hinaus soll untersucht werden, ob Beschwerdenvalidierungstests (BVT) eine höhere Validität gegenüber anderen neuropsychologischen Verfahren zum Nachweis von nicht authentischen Störungen aufweisen. Dazu wurden 59 Probanden untersucht, die zwischen 2003 bis 2013 forensisch-neuropsychologisch begutachtet wurden. Sie wurden hinsichtlich ihrer Authentizität ihrer neuropsychologischen Beschwerden beurteilt. Neben neuropsychologischen Tests wurden auch BVT eingesetzt. Es zeigte sich, dass die BVT hoch signifikant mit der gutachterlichen Gesamtbeurteilung korrelieren. Zwischen den neuropsychologischen Standardverfahren und der gutachterlichen Gesamtbeurteilung konnten keine signifikanten Zusammenhänge nachgewiesen werden. Es sind demnach nur diejenigen Verfahren, die speziell für den Nachweis von nicht-authentischen Störungen entwickelt worden, dazu geeignet, die Authentizität der Beschwerdenschilderung zu messen.