Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in personal injury, (n = 6,371). disability (n = 3,688), criminal (n = 1,341), or medical (n = 22,131) matters. Base rates did not differ among geographic regions or practice settings, but were related to the proportion of plaintiff versus defense referrals. Reported rates would be 2-4% higher if variance due to referral source was controlled. Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).

An affective, somatic, and memory checklist of symptoms was administered to subjects who had no personal experience or knowledge of head injury. Subjects indicated their current experiences of symptoms, then imagined having sustained a mild head injury in a motor vehicle accident, and endorsed symptoms they expected to experience six months after the injury. (SD) education, 14-6 (2 3) years], who were recruited by canvassing local businesses, apartment complexes, shopping centres, evening or weekend adult education classes, and a local community college. Twenty eight per cent were employed in professional and technical occupations, 34% held management, administration, clerical, or sales positions, 8% were craftsmen or foremen, 10% were employed as service workers, farmers, or operatives, 4% were labourers or farm foremen, and 16% were homemakers, students, or retirees. Predicted mean (SD) IQ for the group was 107-2 (6 8) as estimated from demographic variables.20 Subjects who reported a history of head injury or who knew a head injured individual well were excluded from the control group.The comparison group was made up of a sample of 100 patients with head injuries [mean (SD) age = 33.4, (13-1); mean (SD) education = 13-5, (3.1)]. The subjects were consecutive outpatient referrals for neuropsychological examination subsequent to head trauma. They were seen either at the outpatient clinic of a hospital neurology department, a university neuropsychology clinic, or the private offices of a neurologist. The group thus constitutes a sample of patients with postconcussion complaints or suspected complications rather than a random sample of individuals with head injuries. Fifteen per cent were employed in professional and technical occupations, 26% held management, administration, clerical, or sales positions, 20% were craftsmen or foremen, 17% were employed as service workers, farmers, or operatives, 1 % were labourers or farm foremen, and 21 % were homemakers, students, or retirees. Predicted IQ for the group was 103-2 (7-4) as estimated from demographic variables.20Sixty four of the patients had sustained closed head injuries in motor vehicle accidents, eight were struck by blunt objects, and 28 had sustained head trauma in falls. Patients were 200 on 12 May 2018 by guest. Protected by copyright.

Approximately 38% of patients who sustain head trauma characterized by a brief disturbance of consciousness and clinically unremarkable neuroradiologic findings meet International Classification of Diseases 10th edition (ICD-10) diagnostic criteria for postconcussion syndrome (PCS). Physicians treat a majority of cases with nonsteroidal analgesics or antidepressants, and refer about 40% for psychological consultation. Psychological treatment typically involves education, reassurance, and reattribution of symptoms to benign causes. A review of controlled treatment outcome studies conducted over the past 2 decades in Scandinavia, Great Britain, Canada, and the United States suggests that early single session treatment can prevent the syndrome as effectively as traditional outpatient therapy. Several standardized, empirically supported treatment manuals are available.

Memory disturbance is common in patients with multiple sclerosis (MS), as previously demonstrated on clinical memory tests of explicit learning using effortful retrieval paradigms. To better understand the mechanisms underlying memory failure, we compared the performance of 46 MS patients and 47 demographically matched normal controls on experimental tests of working memory, semantic encoding, and implicit memory. On the working memory task, MS patients demonstrated an exaggerated word length effect, which indicates a deficit in the control process of articulatory rehearsal. In contrast, MS patients demonstrated a normal buildup and release from proactive inhibition, which suggests intact semantic encoding. Finally, on priming and procedural memory tasks, MS patients performed without difficulty. The MS patients' test performance was not correlated with illness duration or course, severity of physical disability, or psychoactive medication use.Memory impairment is the most common form of cognitive dysfunction observed in patients with multiple sclerosis (MS). From 40% to 60% of MS patients perform below expectations on learning and memory

The consensus of evidence published since 1924 suggests that parents report attention deficits, hyperactivity, or conduct disorder after pediatric head injury rather than postconcussion syndrome. In this study, the symptoms reported by children after mild (n = 38) and moderate-severe (n = 27) head trauma were compared to those reported after orthopedic injury (n = 47) and to adults matched for injury severity and chronicity by using a structured interview based on diagnostic criteria for postconcussion syndrome. Pediatric head trauma caused significantly more subjective symptoms after 6 weeks than orthopedic injury. These symptoms were related to head injury severity and the child's anxiety level. When assessed in a similar manner, children report postconcussion syndrome similar to that seen in adults.