Te službe še ne potrebuje. Potrebovala jo bo pa v trenutku, ko/če ji bodo odvzeli diagnozo shizofrenija. Potem se socialka zmanjša in bo morala takoj na grad, jim razložiti, da je kraljica, da naj takoj privedejo vso njeno služnjičad in kralja, ker se z Adhamom ni izšlu, ko zahtevi ne bodo ugodili, bo potebno noreti vse dokler ne pride rešilc in jo odpelje na psihiatrino, kjer ji nazaj potrdijo diagnozo in povišek socialke. Tako se to dela! Vedno je potrebno imeti plan B!
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bi lahko igrala nimfo plodnosti, vsak dan po 8 ur. Turisti bi ti v špranjo metali kovančke.
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Na kratko:
How can you tell if someone is faking schizophrenia?
In medicine, it’s called “malingering” if a patient is trying to deceive someone by faking, feigning or exaggerating symptoms.
Doctors try to discover fakers the same way that people good at detecting lies discover liars. They look for inconsistencies, or things that don’t quite match.
For instance, if a supposed schizophrenic can tell you clearly and without confusion that they’re extremely confused, their actions don’t correspond with what they are saying. A very confused person can’t clearly say how confused they are.
Or, if they act mentally disorganized while talking with a psychiatrist, yet later they can play chess with another patient, something doesn’t match.
It’s considered an advanced skill to detect a malingering schizophrenic, because a psychiatrist must know in detail the difference between real and fake psychotic symptoms.
So how do doctors catch the fakers?
A malingerer is like an beginning actor who’s overacting. A beginning actor may try to play a drunk person by slurring every word and swaying and falling down, but an experienced actor knows what a drunk is like, and plays the drunk as someone who is drunk, but is trying to act normal.
Many people who try to fake a mental illness try to “play crazy.”
A faker will try to make their illness front and center, and make their psychosis the first thing they want to discuss, while a real patient will be reluctant to explain their symptoms.
A faker will be hostile and act as if nobody believes him or her, which is rare in genuine psychotics.
A faker will act stupider than they should be, not realizing that intelligence will not diminish just because he or she is psychotic.
Fakers will be vague about details. Instead of saying that a voice was male or female, the faker might say “I don’t know.” Real psychotics would know the answer.
It’s also difficult to fake certain schizophrenic symptoms, such as getting off track while speaking, coining new words, finding associations between unrelated things, or speech which is so disorganized that at first it sounds correct but which actually makes no sense.
In acting, a beginning actor will keep trying to add things to a performance. To play the emotion “sad,” a bad actor will add heavy sighs and crying, while a good actor will subtract emotion, such as letting the character smile just a little, but making it a tight smile with no happiness showing around the eyes.
An inexperienced faker will do the same, by adding symptoms of “craziness,” forgetting that there are also many things that get subtracted from an individual with schizophrenia.
Faking it: How to detect malingered psychosis - Feigned schizophrenia symptoms usually won’t deceive the clinician who watches for clues and is skilled in recognizing the real thing, The Journal of Family Practice>>
Na dolgo:
http://www.currentpsychiatry.com/home/article/faking-it-how-to-detect-malingered-psychosis/1f0b6df2e4bfb2d0683acd01d26a07d0.html faking schizophrenia
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Iz revije Current Psychiatry
Faking it: How to detect malingered psychosis
Feigned schizophrenia symptoms usually won’t deceive the clinician who watches for clues and is skilled in recognizing the real thing.
Vol. 4, No. 11 / November 2005
Phillip J. Resnick, MD
Professor of psychiatry, Case School of Medicine, Director of forensic psychiatry, University Hospitals, Cleveland, OH
James Knoll, MD
Director of forensic psychiatry, New Hampshire Department of Corrections, assistant professor of psychiatry, Dartmouth Medical School, Hanover, NH
Reputed Cosa Nostra boss Vincent “The Chin” Gigante deceived “the most respected minds in forensic psychiatry” for years by malingering schizophrenia.1 Ultimately, he admitted to maintaining his charade from 1990 to 1997 during evaluations of his competency to stand trial for racketeering.
A lesson from this case—said a psychiatrist who concluded Gigante was malingering—is, “When feigning is a consideration, we must be more critical and less accepting of our impressions when we conduct and interpret a psychiatric examination…than might be the case in a typical clinical situation.”2
Even in typical clinical situations, however, psychiatrists may be reluctant to diagnose malingering3 for fear of being sued, assaulted—or wrong. An inaccurate diagnosis of malingering may unjustly stigmatize a patient and deny him needed care.4
Because psychiatrists need a systematized approach to detect malingering,5 we offer specific clinical factors and approaches to help you recognize malingered psychosis.
What is Malingering?
No other syndrome is as easy to define yet so difficult to diagnose as malingering. Reliably diagnosing malingered mental illness is complex, requiring the psychiatrist to consider collateral data beyond the patient interview.
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.6 In practice, malingering commonly must be differentiated from factitious disorder, which also involves intentional production of symptoms. In factitious disorders, the patient’s motivation is to assume the sick role, which can be thought of as an internal or psychological incentive.
Three categories of malingering include:
pure malingering (feigning a nonexistent disorder)
partial malingering (consciously exaggerating real symptoms)
false imputation (ascribing real symptoms to a cause the individual knows is unrelated to the symptoms).7
Motivations. Individuals usually malinger to avoid pain (such as difficult situations or punishment) or to seek pleasure (such as to obtain compensation or medications) (Table 1). In correctional settings, for example, inmates may malinger mental illness to do “easier time” or to obtain drugs. On the other hand, malingering in prison also may be an adaptive response by a mentally ill inmate to relatively sparse and difficult-to-obtain mental health resources.8
Table 1
Common motives of malingerers
Motives
Examples
To avoid pain
To avoid:
Arrest
Criminal prosecution
Conscription into the military
To seek pleasure
To obtain:
Controlled substances
Free room and board
Workers’ compensation or disability benefits for alleged psychological injury
Interview Style
When you suspect a patient is malingering, keep your suspicions to yourself and conduct an objective evaluation. Patients are likely to become defensive if you show annoyance or incredulity, and putting them on guard decreases your ability to uncover evidence of malingering.9
Begin by asking open-ended questions, which allow patients to report symptoms in their own words. To avoid hinting at correct responses, carefully phrase initial inquiries about symptoms. Later in the interview, you can proceed to more-detailed questions of specific symptoms, as discussed below.
If possible, review collateral data before the interview, when it is most helpful. Consider information that would support or refute the alleged symptoms, such as treatment and insurance records, police reports, and interviews of close friends or family.
The patient interview may be prolonged because fatigue may diminish a malingerer’s ability to maintain fake symptoms. In very difficult cases, consider monitoring during inpatient assessment because feigned psychosis is extremely difficult to maintain 24 hours a day.
Watch for individuals who endorse rare or improbable symptoms. Rare symptoms—by definition—occur very infrequently, and even severely disturbed patients almost never report improbable symptoms.10 Consider asking malingerers about improbable symptoms to see if they will endorse them. For example:
“When people talk to you, do you see the words they speak spelled out?”11
“Have you ever believed that automobiles are members of an organized religion?”12
Watch closely for internal or external inconsistency in the suspected malingerer’s presentation (Table 2).
Table 2
Clues to identify malingering during patient evaluation
Internal inconsistencies
Example
In subject’s report of symptoms
Gives a clear and articulate explanation of being confused
In subject’s own reported history
Gives conflicting versions
External inconsistencies
Example
Between reported and observed symptoms
Alleges having active auditory and visual hallucinations yet shows no evidence of being distracted
Between reported and observed level of functioning
Behaves in disorganized or confused manner around psychiatrist, yet plays excellent chess on ward with other patients
Between reported symptoms and nature of genuine symptoms
Reports seeing visual hallucinations in black and white, whereas genuine visual hallucinations are seen in color
Between reported symptoms and psychological test results
Alleges genuine psychotic symptoms, yet testing suggests faking or exaggeration
Malingered Psychotic Symptoms
Detecting malingered mental illness is considered an advanced psychiatric skill, partly because you must understand thoroughly how genuine psychotic symptoms manifest.
Hallucinations. If a patient alleges atypical hallucinations, ask about them in detail. Hallucinations are usually (88%) associated with delusions.13 Genuine hallucinations are typically intermittent rather than continuous.
Auditory hallucinations are usually clear, not vague (7%) or inaudible. Both male and female voices are commonly heard (75%), and voices are usually perceived as originating outside the head (88%).14 In schizophrenia, the major themes are persecutory or instructive.15
Command auditory hallucinations are easy to fabricate. Persons experiencing genuine command hallucinations:
do not always obey the voices, especially if doing so would be dangerous16
usually present with noncommand hallucinations (85%) and delusions (75%) as well17
Thus, view with suspicion someone who alleges an isolated command hallucination without other psychotic symptoms.
Genuine schizophrenic hallucinations tend to diminish when patients are involved in activities. Thus, to deal with their hallucinations, persons with schizophrenia typically cope by:
engaging in activities (working, listening to a radio, watching TV)
changing posture (lying down, walking)
seeking interpersonal contact
taking medications.
If you suspect a person of malingered auditory hallucinations, ask what he or she does to make the voices go away or diminish in intensity. Patients with genuine schizophrenia often can stop their auditory hallucinations while in remission but not during acute illness.
Malingerers may report auditory hallucinations of stilted or implausible language. For example, we have evaluated:
an individual charged with attempted rape who alleged that voices said, “Go commit a sex offense.”
a bank robber who alleged that voices kept screaming, “Stick up, stick up, stick up!”
Both examples contain language that is very questionable for genuine hallucinations, while providing the patient with “psychotic justification” for an illegal act that has a rational alternative motive.
Visual hallucinations are experienced by an estimated 24% to 30% of psychotic individuals but are reported much more often by malingerers (46%) than by persons with genuine psychosis (4%).18
Genuine visual hallucinations are usually of normalsized people and are seen in color.14 On rare occasions, genuine visual hallucinations of small people (Lilliputian hallucinations) may be associated with alcohol use, organic disease, or toxic psychosis (such as anticholinergic toxicity) but are rarely seen by persons with schizophrenia.
Psychotic visual hallucinations do not typically change if the eyes are closed or open, whereas drug-induced hallucinations are more readily seen with eyes closed or in the dark. Unformed hallucinations—such as flashes of light, shadows, or moving objects—are typically associated with neurologic disease and substance use.19
Suspect malingering if the patient reports dramatic or atypical visual hallucinations. For example, one defendant charged with bank robbery calmly reported seeing “a 30-foot tall, red giant smashing down the walls” of the interview room. When he was asked detailed questions, he frequently replied, “I don’t know.” He eventually admitted to malingering.
Delusions. Genuine delusions vary in content, theme, degree of systemization, and relevance to the person’s life. The complexity and sophistication of delusional systems usually reflect the individual’s intelligence. Persecutory delusions are more likely to be acted upon than are other types of delusions.20
Malingerers may claim that a delusion began or disappeared suddenly. In reality, systematized delusions usually take weeks to develop and much longer to disappear. Typically, the delusion will become somewhat less relevant, and the individual will gradually relinquish its importance over time after adequate treatment. In general, the more bizarre the delusion’s content, the more disorganized the individual’s thinking is likely to be (Table 3).
With genuine delusions, the individual’s behavior usually conforms to the delusions’ content. For example, Russell Weston—who suffered from schizophrenia—made a deadly assault on the U.S. Capitol in 1998 because he held a delusional belief that cannibalism was destroying Washington, DC. Before he shot and killed two U.S. Capitol security officers, he had gone to the Central Intelligence Agency several years before and voiced the same delusional concerns.
Suspect malingering if a patient alleges persecutory delusions without engaging in corresponding paranoid behaviors. One exception is the person with long-standing schizophrenia who has grown accustomed to the delusion and whose behavior is no longer consistent with it.
Table 3
Uncommon psychosis presentations that suggest malingering
Hallucinations
Continuous
Voices are vague, inaudible
Hallucinations are not associated with delusions
Voices use stilted language
Patient uses no strategies to diminish hallucinations
Patient states that he obeys all commands
Visual hallucinations in black and white
Visual hallucinations alone in schizophrenia
Delusions
Abrupt onset or termination
Patient’s conduct is inconsistent with delusions
Bizarre content without disorganization
Patient is eager to discuss delusions
Where Malingerers Trip Up
Malingerers may have inadequate or incomplete knowledge of the mental illness they are faking. Indeed, malingerers are like actors who can portray a role only as well as they understand it. They often overact their part or mistakenly believe the more bizarre their behavior, the more convincing they will be. Conversely, “successful” malingerers are more likely to endorse fewer symptoms and avoid endorsing overly bizarre or unusual symptoms.21
Numerous clinical factors suggest malingering (Table 4). Malingerers are more likely to eagerly “thrust forward” their illness, whereas patients with genuine schizophrenia are often reluctant to discuss their symptoms.22
Malingerers may attempt to take control of the interview and behave in an intimidating or hostile manner. They may accuse the psychiatrist of inferring that they are faking. Such behavior is rare in genuinely psychotic individuals. Although DSM-IV-TR states that antisocial personality disorder should arouse suspicions of malingering, some studies have failed to show a relationship. One study has associated psychopathic traits with malingering.23
Malingerers often believe that faking intellectual deficits, in addition to psychotic symptoms, will make them more believable. For example, a man who had completed several years of college alleged that he did not know the colors of the American flag.
Malingerers are more likely to give vague or hedging answers to straightforward questions. For example, when asked whether an alleged voice was male or female, one malingerer replied, “It was probably a man’s voice.” Malingerers may also answer, “I don’t know” to detailed questions about psychotic symptoms. Whereas a person with genuine psychotic symptoms could easily give an answer, the malingerer may have never experienced the symptoms and consequently “doesn’t know” the correct answer.
Psychotic symptoms such as derailment, neologisms, loose associations, and word salad are rarely simulated. This is because it is much more difficult for a malingerer to successfully imitate psychotic thought processes than psychotic thought content. Similarly, it is unusual for a malingerer to fake schizophrenia’s subtle signs, such as negative symptoms.
Table 4
Clinical factors that suggest malingering
Absence of active or subtle signs of psychosis
Marked inconsistencies, contradictions
Patient endorses improbable psychiatric symptoms
Mixed symptom profile (eg, endorses depressive symptoms plus euphoric mood)
Overly dramatic
Extremely unusual (‘Do you believe that cars are a part of an organized religion?’)
Patient is evasive or uncooperative
Excessively guarded or hesitant
Frequently repeats questions
Frequently replies, ‘I don’t know’ to simple questions
Hostile, intimidating; seeks to control interview or refuses to participate
Psychological testing indicates malingering (SIRS, M-FAST, MMPI-2)
SIRS: Structured Interview of Reported Symptoms
M-FAST: Miller Forensic Assessment of Symptoms Test
MMPI-2: Minnesota Multiphasic Personality Inventory, Revised
Psychological Testing
Although many psychometric tests are available for detecting malingered psychosis, few have been validated. Among the more reliable are:
Structured Interview of Reported Symptoms (SIRS)
Minnesota Multiphasic Personality Inventory, Revised (MMPI-2)
Miller Forensic Assessment of Symptoms Test (M-FAST).11
SIRS includes questions about rare symptoms, uncommon symptom pairing, atypical symptoms, and other indices involving excessive symptom reporting. It takes 30 to 60 minutes to administer. Tested in inpatient, forensic, and correctional populations, the SIRS has shown consistently high accuracy in detecting malingered psychiatric illness.24
Faking it: How to detect malingered psychosis
Feigned schizophrenia symptoms usually won’t deceive the clinician who watches for clues and is skilled in recognizing the real thing.
Vol. 4, No. 11 / November 2005
Phillip J. Resnick, MD
Professor of psychiatry, Case School of Medicine, Director of forensic psychiatry, University Hospitals, Cleveland, OH
James Knoll, MD
Director of forensic psychiatry, New Hampshire Department of Corrections, assistant professor of psychiatry, Dartmouth Medical School, Hanover, NH
Reputed Cosa Nostra boss Vincent “The Chin” Gigante deceived “the most respected minds in forensic psychiatry” for years by malingering schizophrenia.1 Ultimately, he admitted to maintaining his charade from 1990 to 1997 during evaluations of his competency to stand trial for racketeering.
A lesson from this case—said a psychiatrist who concluded Gigante was malingering—is, “When feigning is a consideration, we must be more critical and less accepting of our impressions when we conduct and interpret a psychiatric examination…than might be the case in a typical clinical situation.”2
Even in typical clinical situations, however, psychiatrists may be reluctant to diagnose malingering3 for fear of being sued, assaulted—or wrong. An inaccurate diagnosis of malingering may unjustly stigmatize a patient and deny him needed care.4
Because psychiatrists need a systematized approach to detect malingering,5 we offer specific clinical factors and approaches to help you recognize malingered psychosis.
What is Malingering?
No other syndrome is as easy to define yet so difficult to diagnose as malingering. Reliably diagnosing malingered mental illness is complex, requiring the psychiatrist to consider collateral data beyond the patient interview.
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.6 In practice, malingering commonly must be differentiated from factitious disorder, which also involves intentional production of symptoms. In factitious disorders, the patient’s motivation is to assume the sick role, which can be thought of as an internal or psychological incentive.
Three categories of malingering include:
pure malingering (feigning a nonexistent disorder)
partial malingering (consciously exaggerating real symptoms)
false imputation (ascribing real symptoms to a cause the individual knows is unrelated to the symptoms).7
Motivations. Individuals usually malinger to avoid pain (such as difficult situations or punishment) or to seek pleasure (such as to obtain compensation or medications) (Table 1). In correctional settings, for example, inmates may malinger mental illness to do “easier time” or to obtain drugs. On the other hand, malingering in prison also may be an adaptive response by a mentally ill inmate to relatively sparse and difficult-to-obtain mental health resources.8
Table 1
Common motives of malingerers
Motives
Examples
To avoid pain
To avoid:
Arrest
Criminal prosecution
Conscription into the military
To seek pleasure
To obtain:
Controlled substances
Free room and board
Workers’ compensation or disability benefits for alleged psychological injury
Interview Style
When you suspect a patient is malingering, keep your suspicions to yourself and conduct an objective evaluation. Patients are likely to become defensive if you show annoyance or incredulity, and putting them on guard decreases your ability to uncover evidence of malingering.9
Begin by asking open-ended questions, which allow patients to report symptoms in their own words. To avoid hinting at correct responses, carefully phrase initial inquiries about symptoms. Later in the interview, you can proceed to more-detailed questions of specific symptoms, as discussed below.
If possible, review collateral data before the interview, when it is most helpful. Consider information that would support or refute the alleged symptoms, such as treatment and insurance records, police reports, and interviews of close friends or family.
The patient interview may be prolonged because fatigue may diminish a malingerer’s ability to maintain fake symptoms. In very difficult cases, consider monitoring during inpatient assessment because feigned psychosis is extremely difficult to maintain 24 hours a day.
Watch for individuals who endorse rare or improbable symptoms. Rare symptoms—by definition—occur very infrequently, and even severely disturbed patients almost never report improbable symptoms.10 Consider asking malingerers about improbable symptoms to see if they will endorse them. For example:
“When people talk to you, do you see the words they speak spelled out?”11
“Have you ever believed that automobiles are members of an organized religion?”12
Watch closely for internal or external inconsistency in the suspected malingerer’s presentation (Table 2).
Table 2
Clues to identify malingering during patient evaluation
Internal inconsistencies
Example
In subject’s report of symptoms
Gives a clear and articulate explanation of being confused
In subject’s own reported history
Gives conflicting versions
External inconsistencies
Example
Between reported and observed symptoms
Alleges having active auditory and visual hallucinations yet shows no evidence of being distracted
Between reported and observed level of functioning
Behaves in disorganized or confused manner around psychiatrist, yet plays excellent chess on ward with other patients
Between reported symptoms and nature of genuine symptoms
Reports seeing visual hallucinations in black and white, whereas genuine visual hallucinations are seen in color
Between reported symptoms and psychological test results
Alleges genuine psychotic symptoms, yet testing suggests faking or exaggeration
Malingered Psychotic Symptoms
Detecting malingered mental illness is considered an advanced psychiatric skill, partly because you must understand thoroughly how genuine psychotic symptoms manifest.
Hallucinations. If a patient alleges atypical hallucinations, ask about them in detail. Hallucinations are usually (88%) associated with delusions.13 Genuine hallucinations are typically intermittent rather than continuous.
Auditory hallucinations are usually clear, not vague (7%) or inaudible. Both male and female voices are commonly heard (75%), and voices are usually perceived as originating outside the head (88%).14 In schizophrenia, the major themes are persecutory or instructive.15
Command auditory hallucinations are easy to fabricate. Persons experiencing genuine command hallucinations:
do not always obey the voices, especially if doing so would be dangerous16
usually present with noncommand hallucinations (85%) and delusions (75%) as well17
Thus, view with suspicion someone who alleges an isolated command hallucination without other psychotic symptoms.
Genuine schizophrenic hallucinations tend to diminish when patients are involved in activities. Thus, to deal with their hallucinations, persons with schizophrenia typically cope by:
engaging in activities (working, listening to a radio, watching TV)
changing posture (lying down, walking)
seeking interpersonal contact
taking medications.
If you suspect a person of malingered auditory hallucinations, ask what he or she does to make the voices go away or diminish in intensity. Patients with genuine schizophrenia often can stop their auditory hallucinations while in remission but not during acute illness.
Malingerers may report auditory hallucinations of stilted or implausible language. For example, we have evaluated:
an individual charged with attempted rape who alleged that voices said, “Go commit a sex offense.”
a bank robber who alleged that voices kept screaming, “Stick up, stick up, stick up!”
Both examples contain language that is very questionable for genuine hallucinations, while providing the patient with “psychotic justification” for an illegal act that has a rational alternative motive.
Visual hallucinations are experienced by an estimated 24% to 30% of psychotic individuals but are reported much more often by malingerers (46%) than by persons with genuine psychosis (4%).18
Genuine visual hallucinations are usually of normalsized people and are seen in color.14 On rare occasions, genuine visual hallucinations of small people (Lilliputian hallucinations) may be associated with alcohol use, organic disease, or toxic psychosis (such as anticholinergic toxicity) but are rarely seen by persons with schizophrenia.
Psychotic visual hallucinations do not typically change if the eyes are closed or open, whereas drug-induced hallucinations are more readily seen with eyes closed or in the dark. Unformed hallucinations—such as flashes of light, shadows, or moving objects—are typically associated with neurologic disease and substance use.19
Suspect malingering if the patient reports dramatic or atypical visual hallucinations. For example, one defendant charged with bank robbery calmly reported seeing “a 30-foot tall, red giant smashing down the walls” of the interview room. When he was asked detailed questions, he frequently replied, “I don’t know.” He eventually admitted to malingering.
Delusions. Genuine delusions vary in content, theme, degree of systemization, and relevance to the person’s life. The complexity and sophistication of delusional systems usually reflect the individual’s intelligence. Persecutory delusions are more likely to be acted upon than are other types of delusions.20
Malingerers may claim that a delusion began or disappeared suddenly. In reality, systematized delusions usually take weeks to develop and much longer to disappear. Typically, the delusion will become somewhat less relevant, and the individual will gradually relinquish its importance over time after adequate treatment. In general, the more bizarre the delusion’s content, the more disorganized the individual’s thinking is likely to be (Table 3).
With genuine delusions, the individual’s behavior usually conforms to the delusions’ content. For example, Russell Weston—who suffered from schizophrenia—made a deadly assault on the U.S. Capitol in 1998 because he held a delusional belief that cannibalism was destroying Washington, DC. Before he shot and killed two U.S. Capitol security officers, he had gone to the Central Intelligence Agency several years before and voiced the same delusional concerns.
Suspect malingering if a patient alleges persecutory delusions without engaging in corresponding paranoid behaviors. One exception is the person with long-standing schizophrenia who has grown accustomed to the delusion and whose behavior is no longer consistent with it.
Table 3
Uncommon psychosis presentations that suggest malingering
Hallucinations
Continuous
Voices are vague, inaudible
Hallucinations are not associated with delusions
Voices use stilted language
Patient uses no strategies to diminish hallucinations
Patient states that he obeys all commands
Visual hallucinations in black and white
Visual hallucinations alone in schizophrenia
Delusions
Abrupt onset or termination
Patient’s conduct is inconsistent with delusions
Bizarre content without disorganization
Patient is eager to discuss delusions
Where Malingerers Trip Up
Malingerers may have inadequate or incomplete knowledge of the mental illness they are faking. Indeed, malingerers are like actors who can portray a role only as well as they understand it. They often overact their part or mistakenly believe the more bizarre their behavior, the more convincing they will be. Conversely, “successful” malingerers are more likely to endorse fewer symptoms and avoid endorsing overly bizarre or unusual symptoms.21
Numerous clinical factors suggest malingering (Table 4). Malingerers are more likely to eagerly “thrust forward” their illness, whereas patients with genuine schizophrenia are often reluctant to discuss their symptoms.22
Malingerers may attempt to take control of the interview and behave in an intimidating or hostile manner. They may accuse the psychiatrist of inferring that they are faking. Such behavior is rare in genuinely psychotic individuals. Although DSM-IV-TR states that antisocial personality disorder should arouse suspicions of malingering, some studies have failed to show a relationship. One study has associated psychopathic traits with malingering.23
Malingerers often believe that faking intellectual deficits, in addition to psychotic symptoms, will make them more believable. For example, a man who had completed several years of college alleged that he did not know the colors of the American flag.
Malingerers are more likely to give vague or hedging answers to straightforward questions. For example, when asked whether an alleged voice was male or female, one malingerer replied, “It was probably a man’s voice.” Malingerers may also answer, “I don’t know” to detailed questions about psychotic symptoms. Whereas a person with genuine psychotic symptoms could easily give an answer, the malingerer may have never experienced the symptoms and consequently “doesn’t know” the correct answer.
Psychotic symptoms such as derailment, neologisms, loose associations, and word salad are rarely simulated. This is because it is much more difficult for a malingerer to successfully imitate psychotic thought processes than psychotic thought content. Similarly, it is unusual for a malingerer to fake schizophrenia’s subtle signs, such as negative symptoms.
Table 4
Clinical factors that suggest malingering
Absence of active or subtle signs of psychosis
Marked inconsistencies, contradictions
Patient endorses improbable psychiatric symptoms
Mixed symptom profile (eg, endorses depressive symptoms plus euphoric mood)
Overly dramatic
Extremely unusual (‘Do you believe that cars are a part of an organized religion?’)
Patient is evasive or uncooperative
Excessively guarded or hesitant
Frequently repeats questions
Frequently replies, ‘I don’t know’ to simple questions
Hostile, intimidating; seeks to control interview or refuses to participate
Psychological testing indicates malingering (SIRS, M-FAST, MMPI-2)
SIRS: Structured Interview of Reported Symptoms
M-FAST: Miller Forensic Assessment of Symptoms Test
MMPI-2: Minnesota Multiphasic Personality Inventory, Revised
Psychological Testing
Although many psychometric tests are available for detecting malingered psychosis, few have been validated. Among the more reliable are:
Structured Interview of Reported Symptoms (SIRS)
Minnesota Multiphasic Personality Inventory, Revised (MMPI-2)
Miller Forensic Assessment of Symptoms Test (M-FAST).11
SIRS includes questions about rare symptoms, uncommon symptom pairing, atypical symptoms, and other indices involving excessive symptom reporting. It takes 30 to 60 minutes to administer. Tested in inpatient, forensic, and correctional populations, the SIRS has shown consistently high accuracy in detecting malingered psychiatric illness.24
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Fiddle, zanimiv članek, prepoznaven v številnih elementih, kot na primer: Numerous clinical factors suggest malingering (Table 4). Malingerers are more likely to eagerly “thrust forward” their illness, whereas patients with genuine schizophrenia are often reluctant to discuss their symptoms,
Toda - zaman 🙂 Številnim tu je tako ali tako vse jasno, kdor pa ne želi vedeti, pač ne bo. Dodaj k temu še brezvoljnost javnega zdravstva in specifično situacijo v določenih ustanovah, kjer vsakega, ki bi morebiti lahko miniral ustaljene kolektivne vzorce, izrinejo iz sistema in ga potisnejo v kakšno obrobno ambulanto (iz prve roke), pa dobiš realno podobo; enkrat bolnik, vedno bolnik. Seveda z obojestranskim strinjanjem.
Toda - zaman 🙂 Številnim tu je tako ali tako vse jasno, kdor pa ne želi vedeti, pač ne bo. Dodaj k temu še brezvoljnost javnega zdravstva in specifično situacijo v določenih ustanovah, kjer vsakega, ki bi morebiti lahko miniral ustaljene kolektivne vzorce, izrinejo iz sistema in ga potisnejo v kakšno obrobno ambulanto (iz prve roke), pa dobiš realno podobo; enkrat bolnik, vedno bolnik. Seveda z obojestranskim strinjanjem.
0
Tudi meni je ta stavek v oci padel. Na zalost mi ni pustilo, da vezem link na drugi clanek, kjer so v originalu bolj jasne tabele kot v moji kopiji.
0
Kaj konkretno je v ozadju takega izrinjanja na obrobje? Nadaljevanje ustaljene lezernosti, financne koristi, prestiz ali vse hkrati?
0
-sr-mini.jpg){kind=avatar}
Avtor: Fiddlesticks
Tudi meni je ta stavek v oci padel. Na zalost mi ni pustilo, da vezem link na drugi clanek, kjer so v originalu bolj jasne tabele kot v moji kopiji.
0
Micka, meni tudi tvoj link ne veze na clanek, ampak na drugo stran, ki ni vec clanek, razen seveda, ce se prijavis. Ocitno imajo omejeno stevilo ogledov brez registracije.
0
Avtor: Fiddlesticks
Micka, meni tudi tvoj link ne veze na clanek, ampak na drugo stran, ki ni vec clanek, razen seveda, ce se prijavis. Ocitno imajo omejeno stevilo ogledov brez registracije.sem pravkar enako pogruntala in zato izbrisala link...
no, saj se ga da zgooglati.
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Saj vecina ga itak ne bi prebrala.
Zame pa ni skrbi. Jaz znam fejkati. Sem imela dolgoletno izkusnje z originalom, izven in znotraj bolnice. Med aktivno fazo in remisijo.
Zame pa ni skrbi. Jaz znam fejkati. Sem imela dolgoletno izkusnje z originalom, izven in znotraj bolnice. Med aktivno fazo in remisijo.
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Avtor: Fiddlesticks
Kaj konkretno je v ozadju takega izrinjanja na obrobje? Nadaljevanje ustaljene lezernosti, financne koristi, prestiz ali vse hkrati?Ko veš, da se je nekdo z ogromno svežega znanja (med najboljšimi študenti na prestižni univerzi) in inovativnim-angažiranim pristopom do bolezni dlje časa postavljal po robu lobiranju in spletkam v osrednji psihiatrični ustanovi, nato pa položil orožje in se raje umaknil, je jasno. In ni bil edini. To se sicer dogaja tudi v drugih kolektivih, vendar je tu bolj pereče, saj gre za ljudi in njihovo zdravje. Ali se vdaš in ne-zdraviš kot ostali, ali odletiš.
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Saj ti ni treba bit ravno doktor znanosti, da veš, da je osebje bolnišnic večkrat bistveno bolj potrebno zdravljenja kot pa bolniki. Vsi mislite, da so zdravniki neka moralna in načelna bitja, v resnici pa tahujš skorumpirana sodrga. Korupcije, komolčarstva in lobiranja pa jih učijo že na fakulteti.
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komentarju
Točno, na gradu :: 12 ur nazaj
bi lahko igrala nimfo plodnosti, vsak dan po 8 ur. Turisti bi ti v špranjo metali kovančke.
Točno, na gradu :: 12 ur nazaj
bi lahko igrala nimfo plodnosti, vsak dan po 8 ur. Turisti bi ti v špranjo metali kovančke.
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Glede clanka - malingering psychosis etc
( psihoza Ni Enako shizofrenija, je simptom, oz. skupek simptomov in se pojavlja pri vec boleznih).
Zakaj se ljudje pretvarjajo, da imajo psihozo -
free room and board - clanek je ameriski tukaj je najbrz misljeno v kaksni instituciji.
Sicer pa, v danem primeru - statistika pravi, da se v slo. zenske osamosvojijo pri 29.5 letu, moski se pozneje. Torej je ogromno "otrok", ki med 25 in
35 letom zivijo pri starsih. Ne-psihoticnih otrok.
workmen comp- tule gre najbrz za odskodnino, ce naj bi psihoza nastala zaradi delovnih okoliscin.
dostop do psihoaktivnih substanc - ne vem kako, ampak nekateri si ocitno se zmeraj predstavljajo, da so antipsihotiki droge, ki omogocajo zadetost in uzitek. To niso rekreacijske droge in dolgorocno zelo skodijo zdravju.
izogibanje bolecini - jp, v najvec primerih se ljudje, ki fejkajo psihozo, zelijo izogniti zaporni kazni ali hujse, in se zato pretvarjajo, da so nepristevni.
Sicer pa, kot navaja tudi clanek, obstojajo testi, ki izlocijo lazno psihozo, in predstavljam si, da dosegli cello slovensko psihiatrijo.
Nedvomno pa je, da so shizofreniji lahko pridruzene ostale bolezni oz motnje, torej mornje razpolozenja in motnje osebnosti.
( psihoza Ni Enako shizofrenija, je simptom, oz. skupek simptomov in se pojavlja pri vec boleznih).
Zakaj se ljudje pretvarjajo, da imajo psihozo -
free room and board - clanek je ameriski tukaj je najbrz misljeno v kaksni instituciji.
Sicer pa, v danem primeru - statistika pravi, da se v slo. zenske osamosvojijo pri 29.5 letu, moski se pozneje. Torej je ogromno "otrok", ki med 25 in
35 letom zivijo pri starsih. Ne-psihoticnih otrok.
workmen comp- tule gre najbrz za odskodnino, ce naj bi psihoza nastala zaradi delovnih okoliscin.
dostop do psihoaktivnih substanc - ne vem kako, ampak nekateri si ocitno se zmeraj predstavljajo, da so antipsihotiki droge, ki omogocajo zadetost in uzitek. To niso rekreacijske droge in dolgorocno zelo skodijo zdravju.
izogibanje bolecini - jp, v najvec primerih se ljudje, ki fejkajo psihozo, zelijo izogniti zaporni kazni ali hujse, in se zato pretvarjajo, da so nepristevni.
Sicer pa, kot navaja tudi clanek, obstojajo testi, ki izlocijo lazno psihozo, in predstavljam si, da dosegli cello slovensko psihiatrijo.
Nedvomno pa je, da so shizofreniji lahko pridruzene ostale bolezni oz motnje, torej mornje razpolozenja in motnje osebnosti.
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Malingering is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a condition not attributable to a mental disorder. It is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.1 Thus, malingering requires a deceitful state of mind. No other syndrome is so easy to define but so difficult to diagnose.
Many authors, especially when psychoanalytic influence was at its peak, labeled malingering a form of mental disease. Eissler (p. 252),14 for example, stated, “It can be rightly claimed that malingering is always a sign of a disease often more severe than a neurotic disorder because it concerns an arrest of development at an early phase.” Others have pointed out the irrationality of this view and favored the adaptational model.46 Wertham (p. 49)61 noted, “There is a strange, entirely unfounded superstition even among psychiatrists that if a man simulates insanity, there must be something mentally wrong with him in the first place. As if a sane man would not grasp at any straw if his life were endangered by the electric chair.”
Persons usually malinger psychosis for one of the following five purposes: First, criminals may seek to avoid punishment by pretending to be incompetent to stand trial, insane at the time of the crime, worthy of mitigation at sentencing, or incompetent to be executed. Second, malingerers may seek to avoid conscription into the military, be relieved from undesirable military assignments, or avoid combat. Third, malingerers may fake psychosis to seek financial gain from social security disability, veterans' benefits, workers' compensation, or damages for alleged psychological injury. Fourth, prisoners may malinger to obtain drugs or to be transferred to a psychiatric hospital to facilitate escape or do “easier time.” Finally, malingerers may seek admission to a psychiatric hospital to avoid arrest or to obtain free room and board, known colloquially as “three hots and a cot.”
In assessing malingering, clinicians must consider the implications of an inaccurate diagnosis. If a malingerer is wrongly diagnosed as truly ill, the person will have achieved his or her goals of obtaining unjustified compensation or avoiding criminal responsibility. On the other hand, the false classification of malingering is likely to result in injustice and the refusal of psychiatric care for someone truly in need of treatment for his or her psychosis. Furthermore, it may be difficult to shed an incorrect diagnosis of malingering.
http://www.psych.theclinics.com/article/S0193-953X(05)70066-6/abstract http://www.psych.theclinics.com/article/S0193-953X(05)70066-6/abstract
Psychological Testing
Although many psychometric tests are available for detecting malingered psychosis, few have been validated. Among the more reliable are:
Structured Interview of Reported Symptoms (SIRS)
Minnesota Multiphasic Personality Inventory, Revised (MMPI-2)
Miller Forensic Assessment of Symptoms Test (M-FAST).11
SIRS includes questions about rare symptoms, uncommon symptom pairing, atypical symptoms, and other indices involving excessive symptom reporting. It takes 30 to 60 minutes to administer. Tested in inpatient, forensic, and correctional populations, the SIRS has shown consistently high accuracy in detecting malingered psychiatric illness.
Two MMPI-2 scales—F-scale and F-K Index—are the most frequently used test for evaluating suspected malingering. When using the MMPI-2 in this manner, consult the literature for appropriate cutoff scores (see Related resources). Although the MMPI-2 is the most validated psychometric method to detect malingering, a malingerer with high intelligence and previous knowledge of the test could evade detection.25
M-FAST was developed to provide a brief, reliable screen for malingered mental illness. This test takes 10 to 15 minutes to administer and measures rare symptom combinations, excessive reporting, and atypical symptoms.11 It has shown good validity and high correlation with the SIRS and MMPI-2..
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Zanimivo bi bilo videti kakšno raziskavo o tem, kako zanesljiva je metoda prepoznavanja shizofrenije in koliko je možnosti napake pri postavljanju diagnoze.
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Eno je teorija, drugo praksa, čeprav nek osnovni vpogled človek dobi ob prebiranju statistik, nekih splošnih ocen in opažanj. A kot vsi bolniki s cerebralno paralizo niso nujno na invalidskem vozičku, tako ni enotne šablone za psihične bolnike.
Ko bi kdo znal povedati primer iz prve roke ali vsak druge, potem bi lahko primerjali bolezni, simptome, dejanja nekih posameznikov, tako na splošno je pa bolj tako tako, še zlasti, ker bi spet vsi bili radi zdravniki, psihologi, psihiatri in kaj vem, kaj še vse, pa človeka niti osebno ne poznate (poznamo). Se je pa fino izživljat!
Vem samo, da večina bolnikov, takih in drugačnih (ki sem jih imela možnost spoznati v življenju) dela na tem, da bolezen prikrije, čim bolj želi parirati zdravim ljudem in se za to trudijo na vse možne načine. Redko kdo od teh ljudi na veliko poudarja svoj manjko ali se skriva za njim. Taki, ki jim pa neka diagnoza koristi (ali finančno ali sicer v življenju), pa jo še kako poudarjajo (seveda, ko jim "zagusti").
Tako da...ljudje smo si blazno različni..tisti zdravi in oni malo manj, takole v isti koš metati vse počez in se delati pametne tudi na področjih, ki so nam tuja, pa je res brez veze. Kdor ima resničen interes, si bo prebral, net je prepoln takih in drugačnih info, a tukaj imam občutek, da gre bolj za norčevanje in izražanje svoje kao superiornosti.
Ko bi kdo znal povedati primer iz prve roke ali vsak druge, potem bi lahko primerjali bolezni, simptome, dejanja nekih posameznikov, tako na splošno je pa bolj tako tako, še zlasti, ker bi spet vsi bili radi zdravniki, psihologi, psihiatri in kaj vem, kaj še vse, pa človeka niti osebno ne poznate (poznamo). Se je pa fino izživljat!
Vem samo, da večina bolnikov, takih in drugačnih (ki sem jih imela možnost spoznati v življenju) dela na tem, da bolezen prikrije, čim bolj želi parirati zdravim ljudem in se za to trudijo na vse možne načine. Redko kdo od teh ljudi na veliko poudarja svoj manjko ali se skriva za njim. Taki, ki jim pa neka diagnoza koristi (ali finančno ali sicer v življenju), pa jo še kako poudarjajo (seveda, ko jim "zagusti").
Tako da...ljudje smo si blazno različni..tisti zdravi in oni malo manj, takole v isti koš metati vse počez in se delati pametne tudi na področjih, ki so nam tuja, pa je res brez veze. Kdor ima resničen interes, si bo prebral, net je prepoln takih in drugačnih info, a tukaj imam občutek, da gre bolj za norčevanje in izražanje svoje kao superiornosti.
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Odgovor lahko oddate kot gost. Vgrajena je časovna omejitev 40 sekund za oddajo novega sporočila.
Opozorilo: po 297. členu
Kazenskega zakonika je vsak posameznik kazensko odgovoren za javno spodbujanje sovraštva, nasilja ali nestrpnosti.
22.06.2015 ob 20:42