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العنوان
Evaluation of Malingering in Post Head Trauma Disability Claims by Using Three Neuropsychological Scales
At Suez Canal University Hospital /
المؤلف
Hashish, Rania Kamal Hassan.
هيئة الاعداد
باحث / رانيا كمال حسن حشيش
مشرف / ناهد محمد مصطفى على
مشرف / اسماعيل محمد يوسف
مشرف / امانى احمد مصطفى خفاجى
الموضوع
Toxciology. Forensic Medicine.
تاريخ النشر
2011
عدد الصفحات
115 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
علم الأمراض والطب الشرعي
تاريخ الإجازة
1/3/2011
مكان الإجازة
جامعة قناة السويس - كلية الطب - الطب الشرعى والسموم
الفهرس
Only 14 pages are availabe for public view

from 121

from 121

Abstract

Personal injury litigation has increased dramatically in the last 20 years. The actual number of malingerers in clinical setting is unknown, base rate estimates of malingering brain injuries range from 1-50%. The prevalence of malingering in mild traumatic brain injury litigants in a survey conducted in multiple American states with the American board of clinical neuropsychology (ABCN) members was 38.5% [Mittenberg et al.; 2002]. So malingering must be suspected in all disability claims and must be included in the differential diagnosis.
There are considerable debates in the literature as to which clinical and psychometric methods are most reliable and valid in detecting malingering. Thus studies of tools for detecting or ruling out malingering are of particular interest to forensic psychologists.
This descriptive study was done to evaluate malingering among mild and moderate traumatic brain injury (TBI) disability claimants admitted to neurosurgery department at Suez Canal University hospital and seeking for medical report about the recent trauma and its outcome, and to compare between infrequency [F] scale, infrequency psychopathology [F (p)] scale fake bad scale [FBS] to identify the most effective scale that will more successfully discriminate between malingerers and non-malingerers in traumatic brain injury claimants.
One hundred and fifty mild and moderate TBI patients were recruited based on their history, clinical examination and investigations. These patients’ age should be more than 16 years old (as the scale is not validated below this age), should agreed to participate in this study. Assessment of the outcome of TBI was done by using Ranchos Los Amigos cognitive scale and Glasgow outcome scale.
Questionnaire was filled by the study group; it includes demographic data : age, gender, marital status, education level and employment status, and suspected malingering risk factors data : history of a previous head injury, history of neurological or psychological illness, history of substance abuse and the presence of secondary gain [monetary benefits, personal attention, or escape from unpleasant situations and responsibilities].
The three studied scales (F, F (p) & FBS) were administered to the study group. The outcome of these scales was compared with the expert opinion (the study gold standard) based on DSM-IV criteria for diagnosis of definitive malingering. Upon this, the most effective scale that is more effective in discrimination between malingerers and non-malingerers in TBI claimants can be identified.
Chi-square test was accomplished to compare between malingering (according to expert opinion) and each of the demographic variables and suspected risk factors, and to compare between expert opinion and the three studied neuropsychological scales in detecting malingering. The sensitivity, specificity and accuracy were calculated for each of the three studied scales.
The study reveals that31 % of the study group are true malingerers (according to expert opinion), (67.4%) of malingerers have mild TBI and (32.6%) have moderate TBI.
Regarding the relationship between malingering (according to expert opinion) and demographic variables, the present study reveals a significant association between patients’ gender and malingering that malingering is over reported among males (84.8%). There is also a significant association between employment status and malingering that malingering is high among employee in governmental institutes (54.3%). The study reveals a non-significant relationship between patients’ age, marital status & educational level and malingering.
Concerning the association between malingering (according to expert opinion) and suspected risk factors, this study detects that there is statistically significant association between malingering and the presence of secondary gain, as (56.5%) of malingerers require secondary gain from obtaining medical reports. The study detects that there is statistically non-significant relationship between each of the presence of history of substance abuse, history of TBI & history of neurological or psychological illness and malingering.
Regarding the comparison between the expert opinion (the gold standard ) and the three studied neuropsychological scales, the present series finds that the only statistically significant association is between the expert opinion and FBS scale, while there is non-statistically significant relationship between the expert opinion and each of F scale & F (p) scales. FBS scale discriminates 43 malingerers, while F scale & F(p) scale discriminate 22 &18 malingerers respectively compared to 46 true malingerer (according to expert opinion).