Neuropsychological evidence of a factitious memory complaint

Abstract

The authors describe a patient who complained of a severe memory loss. Information gathered from the history, interview, and testing suggested malingering. The patient was then assessed by a strategy called Symptom Validity Testing. Her score was statistically worse than chance, which provided compelling evidence that she was faking bad.

DSM-5 and Malingering: a Modest Proposal

“…Several early tests for malingered neurocognitive deficit (MND) such as the Rey 15-Item Test were described in Lezak's influential text on neuropsychological assessment (Lezak 1976). However, a major breakthrough occurred with the adoption of forced-choice testing formats as described by Binder and Pankratz (1987). Typically, this involves posing a question or problem to a test-taker with two answers to choose from.…”

Refining the forced-choice method for the detection of malingering

“…However, the same principle also has been applied to cases of claimed memory loss (Binder & Pankratz, 1987;Pankratz, 1983). Binder and Pankratz (1987) were able to substantiate their suspicions of malingering in a 53-year-old woman by asking her to specify whether a black pen or a yellow pencil had been presented on each of 100 trials. Her 37% performance was significantly below chance at t h e 6 .…”

“…A more satisfactory approach has been described by Pankratz and his associates (Binder & Pankratz, 1987;Pankratz, 1979Pankratz, ,1983Pankratz, Fausti, & Peed, 1975). The basis of this approach is a two-alternative forced-choice test that provides a known chance level of performance, viz., 50%.…”

“…The premise of this test is that the highly redundant set of 15 characters can be recalled much more readily than a comparable set of unrelated items. Although a malingering patient may perform poorly on this easy test, one cannot be sure that the poor performance reflects an attempt to deceive rather than a severe cognitive, attentional, or motivational impairment.A more satisfactory approach has been described by Pankratz and his associates (Binder & Pankratz, 1987;Pankratz, 1979Pankratz, ,1983Pankratz, Fausti, & Peed, 1975). The basis of this approach is a two-alternative forced-choice test…”

Factitious Disorders in the Field of Neurology and Psychiatry

“…During the differential diagnosis, the facti tious neurological symptoms, in particular, have to be distinguished from conversion symptoms; in individual cases, this may be exceedingly difficult [5,19,27]. In patients suffering from factitious cerebroorganic sei zures, conversion disturbances (e.g., hysteri cal seizures) and psychogenic seizures also have to be ruled out.…”