• Title/Summary/Keyword: Malingering

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Current Issues in the Diagnosis of Malingering : Sensory and Motor Symptoms (꾀병 감별법 : 감각 및 운동 이상을 중심으로)

  • Song, Ji-Young
    • Korean Journal of Psychosomatic Medicine
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    • v.12 no.2
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    • pp.103-121
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    • 2004
  • Conversion disorder and factitious disorder should be ruled out before making diagnosis of malingering. For this work, inspection of patient's behavior along with complete neurological examinations, psychological tests, and meticulous psychiatric interview are necessary. Facial expression test, thermography, dynamometry were failed differentiating conversion disorders to the malingered pain and motor symptoms, however, controlled diagnostic block showed positive result partly in patients with regional or cervical pain syndrome. Chronic pain patients who are related to the process of litigation encounter stressful life situations which lead them into various neurobehavioral and psychosocial complications. Most of suspected malingered patients would not revealed pure form rather mixed with factitious and/or conversion features. At the time of increasing number of chronic patients associated with traffic accidents or industrial injuries who are involved in litigation, psychiatrist are needed sharp eyes and tenacity for evaluating malingering or medically unexplained symptoms.

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Pneumoparotitis

  • House, Laura Kathryn;Lewis, Andrea Furr
    • Clinical and Experimental Emergency Medicine
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    • v.5 no.4
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    • pp.282-285
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    • 2018
  • 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.

Development of a Cognitive Level Explanation Model in Brain Injury : Comparisons between Disability and Non-Disability Evaluation Groups

  • Shin, Tae-Hee;Gong, Chang-Bong;Kim, Min-Su;Kim, Jin-Sung;Bai, Dai-Seg;Kim, Oh-Lyong
    • Journal of Korean Neurosurgical Society
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    • v.48 no.6
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    • pp.506-517
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    • 2010
  • Objective : We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. Methods : Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. Results : In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. Conclusion : The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment.

Objective Visual Acuity Test Using Nystagmus (Nystagmus를 이용한 객관적 시기능 검사에 관한 연구)

  • 이인범;김민섭;박광석
    • Proceedings of the IEEK Conference
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    • 2000.06e
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    • pp.103-105
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    • 2000
  • Optokinetic nystagmus(OKN) testing is an useful tool for assessment of human visual function. Specially, this method has been used for assessing visual function in infants and malingering patients. OKN drum and OKN tape are the common devices currently used for clinical cases. In this paper, we present newly the automated and computerized method for the quantitative and objective assessment of visual acuity in OKN testing.

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Measuring Symptom Exaggeration in Posttraumatic Stress Disorder using the MMPI-2 and the Personality Assessment Inventory Symptom Validity Scales (MMPI-2와 Personality Assessment Inventory 타당도 척도를 이용한 외상후 스트레스 장애 환자의 증상과장 평가)

  • Kong, Sung-Whoi;Chae, Jeong-Ho;Lee, Jong-Hun;Hahn, Sang-Woo;Park, Eun-Jin;Choi, Kyeong-Sook
    • Anxiety and mood
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    • v.8 no.1
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    • pp.22-30
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    • 2012
  • Objective : We investigated whether Posttraumatic stress disorder patients have a higher tendency to exaggerate the extent of their psychological symptoms compared to other psychiatric patients. Methods : Medical records of patients, who had received psychiatric treatment at four university hospitals in Korea between January 2009 and December 2010, were retrospectively reviewed. We compared a group of 37 patients diagnosed with PTSD, and another group of 41 patients diagnosed with neurotic, stress-related and somatoform disorders according to the ICD-10. To compare the extent of malingering in the two groups, we compared the validity scales of MMPI-2 and Personality Assessment Inventory. We determined the number of participants in both groups feigning their responses by using various cutoff scores of the validity indicators. Results : The PTSD group showed significantly higher scores on the F (p=0.001), F (B)(p=0.000), F (P)(p=0.030), F-K (p=0.003) scale of the MMPI-2 compared to the other group of psychiatric patients. The PTSD group had a significantly higher NIM score (p=0.001) but a lower PIM score (p=0.020) of the PAI compared to the other group of psychiatric patients. Using the cutoff scores, the PTSD group showed a significantly higher number of patients who feigned responses compared to the other group ($Fb{\geq}75$ (p=0.010), $F-K{\geq}1$ (p=0.005), $F-K{\geq}10$ (p=0.011) from the MMPI-2, and $NIM{\geq}80$ (p=0.001) from the PAI). Conclusion : These results suggest that PTSD patients have a tendency to exaggerate their symptom. This group of patients overreported the severity of their condition during standardized personality assessment that included the MMPI-2 or PAI compared to patients diagnosed with other psychiatric disorders. Additional research is required to determine the factors influencing symptom exaggeration in PTSD.

Research for the Buddhist Thought of Ancient Medical Record -Focus on Medical Ethics and Psychotherapy- (고대(古代) 의안(醫案)에 나타난 불교사상 연구 -의료윤리와 정신치료를 중심으로-)

  • Kim, Geun-Woo;Park, Seo-Yeon
    • Journal of Oriental Neuropsychiatry
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    • v.24 no.1
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    • pp.109-122
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    • 2013
  • Objectives : To research the needed Buddhistic ethical beliefs and psychotherapy from representative medical records of oriental medicine. Methods : The baseline data this research used is Myeong-Ui-Lyu-An, Sok-Myeong-Ui-Lyu-An, Ui-Bu-Jeol-Lok and from the variety of medical records; we extracted 22 medical records that refer to Buddhist thoughts. The sequence of medical records is determined by analyzing the contents of all medical records and grouping them by their categories. Results : The representative ethical mind that a doctor needs is the 'mercy thought' from Buddhism. This way, the doctor has 'pity' on patients and expects no reward for what he had done. 'Spells and religious beliefs developed into medical treatment procedures by Buddhism and oriental medicine psychotherapy. Using the belief that everything is made of the mind, which is the point of the 'Hwa-Eum' theory and the realization that the psychotic factors have a big role in the occurrence and progress of sicknesses, we emphasized supportive psychotherapy or more specifically, the suggestive therapy. 'Anguish' is an important point in the occurrence and progress of illnesses. To solve this, we used 'Zen family's 'Zen self-discipline' and ascetic life from Buddhism. According to Buddhism, a human's metal conflict and love or malingering from obsession is the cause of all mind illnesses. To heal these, a doctor must have an insight of the patient's mind more than the symptoms. Conclusions : Buddhistic thoughts suggested clearly the mentality necessary for oriental medical psychotherapist and medical ethics for a doctor.

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

  • Jung, Young-Jin;Kim, Oh-Lyong;Kim, Min-Su;Cheon, Eun-Jin;Bai, Dai-Seg
    • Journal of Korean Neurosurgical Society
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    • v.55 no.1
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    • pp.18-25
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    • 2014
  • 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.

Relaxation Training for psychogenic tremor patient with anger;A Case Report (분노증세를 동반한 심인성 진전 환자에 대한 이완요법과 한방치료를 실시한 1례 보고)

  • Kim, Sang-Ho;Park, So-Jung;Byun, Soo-Nim;Kim, Ji-Young;Kim, Jong-Woo;Chung, Sun-Yong;Hwang, Wei-Wan;Kim, Ji-Hyouck
    • Journal of Oriental Neuropsychiatry
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    • v.17 no.3
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    • pp.87-96
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    • 2006
  • Psychogenic neurological conditions account for 1% to 9% of admissions at neurological unit. They are considered manifestations of underlying psychiatry disorders such as somatoform disorders and factitious disorders or malingering. Diagnosis for psychogenic tremor is difficult because mimic tremor is occurred at the secondary of the organic disorders or coexist in a patient with tremors of organic origin. A patient in this case report was diagnosed as psychogenic tremor, and she also complained the severe anger. A patient did not improved with the chemical medication for a long time. The patient received relaxation training, herbal medication and acupuncture for 20 days and showed short-term alleviation on tremor and decreased anger problem and other somatic problems.

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The Study of the Subjective Symptoms according to Frontal Lobe Damage and Change in Neurocognitive Function in Traumatic Head Injury Patients (두부외상 환자에서 전두엽 손상과 신경인지기능 변화에 따른 주관적인 증상 연구)

  • Kim, Jun-Won;Han, Doug-Hyun;Kee, Baik-Seok;Park, Doo-Byung
    • Anxiety and mood
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    • v.8 no.1
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    • pp.31-40
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    • 2012
  • Objective : The purpose of this study was to analyze the correlation between symptom severity and neurocognitive factors in traumatic head injury patients. In addition, the effect of frontal lobe damage on these parameters was examined. Methods : We selected 18 patients who had brain damage for the moderate to severe traumatic brain injury (MSTBI) group, and 17 patients who met the diagnostic criteria for post-traumatic stress disorder (PTSD) without the finding of brain damage for the comparison group. For the evaluation of neurocognitive function, K-WAIS, Rey-Kim Memory Test, K-FENT, WCST, and MMPI-2 were used. Results : The results of the comparison (using the malingering scale) revealed that the values of PDS and PK, which express the severity of symptoms, and the values of the validity scale F, F (B), and F (P) were significantly higher in the overly-expressed group. F (B) in overly-expressed group and PK, Pt, and Sc in the properly-expressed group had significant correlation with the severity of symptoms. F (B), S, and Stroop error inhibition in PTSD, and PK, Pt, Sc, and MQ in MSTBI had significant correlation with the severity of symptoms. The results of the comparison based on the finding of frontal lobe damage revealed that PDS, EIQ, and MQ ware significantly higher in the group without brain damage. Conclusions : It was revealed that each neurocognitive factor was correlated with the severity of symptoms. There was a decrease in complaints or symptoms reported by the frontal lobe injury group, and this is believed to be due to degenerative change in the personality and emotional functioning of these patients following frontal lobe damage.

A comparison study of the characteristics of private and public security service of Koryo dynasty and modern security service (고려시대 공적·사적경호의 특성과 현대경호와의 비교연구)

  • Lee, Sung-Jin
    • Korean Security Journal
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    • no.36
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    • pp.417-442
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    • 2013
  • This study considers the characteristics of the separation of public and private security service during Koryo dynasty, and compares it with the modern security service. Modern day security service's definition of private and public security service was used to distinguish them. Given the different historical settings, it's difficult to argue that the distinction between public and private service during Koryo dynasty was clear, but it can be said that public security service was centered around palace guard and concerns the activities of protest, and military made for the relationship, and private security service was centered around power of DoBang and includes the activities of malingering, and Byolchogun. During the early days of Koryo, protest, district military and soldiers who stay in the palace were all parts of a palace revolt and this institutional improvement of soldiers who stay in the palace was accomplished during King Seongjong's rule. The tradition of a palace revolt can find its roots in the middle military, and after the unification, a palace revolt was reformed into the king's palace revolt of second and the 6th along the course of establishing the nation's system. All of the changes stem from the reformation for consolidating the royal authority. Gyung Dae Seoung wanted to protect himself and he slept with his army night and days and because of that, group of soldiers was created and it was called DOBANG. Some members were from dobang gyeonryong, The forced were powerful because it was gathered with a warriors with extraordinaire martial arts and competent management. Most of the soldiers followed gyeong dae seung because they believed that he has a strong leadership and loves his people, and had a strong faith in him. However, the general gyeong jang had a belief that politics must be reverted to the previous so the relationships between jungbang wasn't smooth. Because of the economic operational problems, due to fraud committed by the mens under his command failed to maintain integrity and was criticised.The misconception also fed up with the emperor and the deepening relationships between the soldiers, his dobang was dismantled. After he took over the dobang, for his personal safety and to strengthen his position he compensated gyeon dae seong's dobang and developed the organization. In the process of extending the dobang Choi chung heon recruited many talented people to strengthen the military base, and also accepted the advice and expanded the power of Dobang. Choi Chung Heon thus consolidated his political gains by weakening the power of the king's army and adjusting the myth, which could've threatened his regime, and this was called Dobang number 6th. Dobang number six got even more powerful by his son named Choi woo, and after ruling, he expanded into a room, and a substantial reorganization of Dobang was developed. And then the creation of yabyeolcho also showed the effect to prevent the crisis. Although the palace guards who were public security service of Koryo Dynasty was still maintained during the military rule era when the royal authority was incapacitated, it was only maintained to have a symbolic meaning as the actual authority including military power was with Choi, the master of Dobang, private security service group. Likewise, during the rule of Choi, private securty service could reign over public security service, and the noteworthy characteristic of Dobang is that it assisted the private soldier groups to seize the military power by reorganizing and modifying military system. Although both differences and similarities can be found when comparing the guards of Koryo Dynasty with those of contemporary society, they have a similarity in terms of the essence of guards that they guarantee the safety of their clients. As for differences, the royalty of Koryo Dynasty and the pursuit of profit of contemporary society are in contrast, and contemporary guards can be seen as the fulfillment of responsibility and duty by free will, whereas guards of Koryo Dynasty were ruled with military coercion.

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