Failure on effort tests usually implies insufficient effort to produce valid cognitive test scores. However, many people with very severe cognitive impairment, such as dementia patients, will produce failing scores on nearly all effort tests. In such patients, effort tests have low specificity. The Medical Symptom Validity Test (MSVT) and the nonverbal MSVT (NV-MSVT) were designed to address this problem. They produce profiles of scores across multiple subtests to facilitate discrimination between low scores from people trying to feign impairment and low scores attributable to severe impairment. To study the specificity of the MSVT and NV-MSVT in people with very severe memory impairment, we tested (a) 10 institutionalized patients with dementia and (b) 10 volunteers who were asked to simulate memory impairment. It was hypothesized that the "possible dementia profile" would be found significantly more often in the dementia patients than in the simulators. The MSVT and the NV-MSVT both displayed 100% specificity in the dementia group, while retaining a combined sensitivity of 80% to suboptimal effort in the simulator group.

This study employed an independent-groups design (4 conditions) to investigate possible biases in the suicide risk perception of mental health professionals. Four hundred participants comprising doctors, nurses and social workers viewed a vignette describing a fictitious patient with a long-term mental illness. The case was presented as being drawn from a sample of twenty similar clinical case reports, of which 10 were associated with an outcome of suicide. The participant tasks were (i) to decide whether the presented vignette was one of those cases or not, and (ii) to provide an assessment of confidence in that decision. The 4 conditions were used to investigate whether the presence of an associated face, and the nature of the emotional state expressed by that face, affected the response profile. In fact, there were no significant differences between conditions, but there was a significant bias across all conditions towards associating the vignette with suicide, despite the base rate being pre-determined at 50%. The bias was more pronounced in doctors and in male respondents. Moreover, many participants indicated substantial confidence in their decisions. The results are discussed in terms of availability bias and over-confidence bias.

7 Davidson K, Norrie J, Tyrer P, Gumley A, Tata P, Murray H, et al. 2 The functional model includes many changes, but its core feature is that consultants work either on the in-patient or the community side, with one specialist team rather than in the old-styled geographical sectors. Closely related to this functional division is the status of in-patient psychiatry. Currently, acute psychiatric in-patient care is one of the top priorities. 3 Recently there has been a lot of Aims and method To investigate, through a semi-qualitative survey at three geographical sites, health professionals' and service users' opinion about the impact of providing separate consultants for in-patient and community settings. It looked at the perceived affect on various issues such as the course of the illness, service delivery, patients' satisfaction as well as the skills and training of psychiatrists.Results Opinion was divided about the level of satisfaction, advantages, consultants' skills and success of this model. The most consistent theme related to the problems with the continuation of care and therapeutic relationship. Most of the respondents were not fully informed about this change. An overwhelming majority believed that in-patient psychiatry is not a separate specialty.Clinical implications Communication and the sharing of information between the two consultants is the key to success in this model.Declaration of interest None.

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