Making Sure Neuropsychological Data Are Meaningful: Use of Performance Validity Testing in Medicolegal and Clinical Contexts

Performance validity testing (PVT) is a standard of practice in situations where there are prominent secondary gain issues; however, it is suggested that their use may benefit neuropsychological evaluations in clinical contexts, as engagement in neuropsychological evaluations can affect the validity of testing and can occur for a variety of reasons outside of secondary gain issues. Several methods of embedded index development, as well as methods to combine them are discussed, including issues related to use of multiple indices. The potential limitations to administration of multiple indices are also explored. It is suggested that neuropsychological evaluations can benefit from PVT in regular clinical practice to assist with reaching firmer diagnostic conclusions by assuring test result validity.     

Neuropsychological and Psychological Aspects of Malingered Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that is frequently encountered in litigation, and as such, there is an increased risk for poor effort on cognitive tests, symptom exaggeration, or frank malingering. These are particularly problematic for accurate diagnosis. This article is divided into four sections. First, we address why individuals malinger PTSD as well as the challenges in detecting an invalid PTSD symptom presentation. Second, we discuss issues of cognitive functioning in PTSD and then the prevalence of and common patterns of poor effort on neuropsychological testing among individuals feigning PTSD. Third, we discuss psychological functioning in PTSD and then the prevalence and patterns of functioning on psychological measures of malingering in this population. Finally, recommendations for detecting invalid PTSD symptom presentations are provided.     

Ethical, Legal and Risk Management Considerations in the Neuropsychological Assessment of Veterans

This article examines the ethical and regulatory issues facing neuropsychologists practicing within the Department of Veterans Affairs (VA) system, either as Veteran Health Administration neuropsychologists or as consultants. The focus is proactive, with an emphasis on preparation consistent with a positive approach to ethical practice and risk management. Given the sheer magnitude of applicable Federal regulations and guidelines, the scope is limited to an overview of select ethical complexities involved in the professional practice of neuropsychology with veterans within VA settings. The article uses a top-down structure, with each section (a) identifying the relevant core biomedical ethical principles, followed by (b) an elaboration of the relevant ethical requirements as defined by the American Psychological Association’s Code of Ethics, and (c) applicable Federal regulations. Suggestions for translating core ethical principles and relevant ethical requirements into pragmatic action consistent with Federal regulation follow. Topics include (a) establishing professional competence, (b) understanding the type of assessment, (c) understanding consent requirements, and (d) understanding the ethical and regulatory issues in assessing veteran symptom presentation.     

Medicolegal aspects of infanticide in Hokkaido District, Japan

Since 1978, a total of 55 infanticides were investigated by our department (16.9% of the total number of medicolegal autopsies). This article describes the infanticides in the Hokkaido district of northern Japan. The characteristic finding for the cause of death was drowning in the toilet. This mode of killing seems to be chosen because of the style of toilet in the district, which includes a collecting tank for feces and urine under the commode.     

Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries,Respiratory Distress,Cerebral Blood Hypoperfusion,and Major Surgeries

Pulmonary injuries, respiratory distress, blood loss-related cerebral blood perfusion, and major surgeries are common features of medical histories in forensic neuropsychological assessments. Unless the explicit reason for referral is determination of the cognitive impact of one of these adverse medical conditions, their contribution to neuropsychological causality determination can be overlooked, minimized, or misattributed to other causes. Given the underlying common denominator among these conditions, that is, sub-optimal oxygen delivery to the brain, transient or long-term debilitating injuries causing neuropsychological change of various degrees can result. A thorough understanding of the impact of these medical events is paramount in forensic neuropsychological assessment for diagnosis, causality, and functional impact determination, prognosis, rehabilitation, and recommendations. In this paper, we critically review the available empirical evidence regarding anoxia and hypoxia arising from pulmonary injuries and respiratory distress, cerebral blood hypoperfusion, and major surgeries, together with evidence of their impact on cognitive functioning. Medical and psychological electronic search engines [PubMed, PsycINFO, and Google Scholar (up to January 2018)] have been screened for neuroscience-related and neuropsychological literature pertaining to pulmonary injuries and respiratory distress, cerebral blood perfusion, and major surgeries, and subsequently optimized for the issue under review.     

Discounting Women: Context Matters in Risk and Need Assessment

Widely used risk/need assessment instruments assume that female offender risks for recidivism are essentially equivalent to those of male offenders. A look at the lives of female and male offenders reveals that there are important differences in the context of both offending and re-offending. This research draws on both quantitative and qualitative data to explore the effectiveness of a well known risk instrument to both predict recidivism and potentially direct intervention efforts. The results, particularly the in-depth interviews with offenders (both male and female) serving time on parole or felony probation reveal differences not detected by most contemporary risk and need assessment instruments. Ultimately, the gendered links among physical and sexual abuse, drugs, and crime are missed in risk and need assessments, thereby placing female offenders at risk for neglect and criminalization in an otherwise seemingly objective method of assessment.     

Medicolegal causation: a source of professional misunderstanding

The authors of this Comment--a lawyer and a physician--suggest that most physicians who are called upon to testify concerning medical issues in personal injury litigation do not understand that judges and attorneys view "causation" quite differently than do members of the medical community. For example, medical practitioners tend to be concerned with all possible causes of the patient's current medical condition, whereas legal practitioners in personal injury cases generally focus on a particular event as possibly precipitating, hastening, or aggravating a particular aspect of the patient's condition to the extent that the event in question is, in legal language, the "proximate cause" of an injurious result. The authors summarize and analyze the differences--and the occasional similarities--between the medical and the legal approaches to causation, in the hope that they will thereby (1) contribute to greater understanding by the two professions of each other's theory and practice, and (2) help the expert medical witness to be more comfortable and more effective in his courtroom role.     

Psychological Assessment of Symptom and Performance Validity,Response Bias,and Malingering: Official Position of the Association for Scientific Advancement in Psychological Injury and Law

Evidence-based forensic psychological opinions require thorough and accurate information about examinees. Psychometric instruments can facilitate diagnostic decision making, but they rely on examinees to respond honestly to questions and put forth good effort on cognitive tests. Given the strong incentives for examinees in psychological injury cases to minimize prior problems and emphasize postaccident or posttrauma problems, the assessment of validity as part of forensic psychological evaluations is essential. Best practices in forensic psychology have their foundation in ethical principles. The purpose of this position statement is to promote ethical psychological practice in legal contexts by reviewing validity assessment issues and their ethical foundations. Because no previously published document focused specifically on symptom and performance validity assessment in psychological injury evaluations performed in forensic contexts, such a position statement provided by a professional organization devoted to the interface of psychological injury and law was needed to inform and guide practitioners and to educate other interested parties. The position statement emphasizes (a) the need for ethical practice in assessing validity, (b) consideration of factors such as culture and functional limitations, and (c) the importance of adopting a comprehensive, impartial, and scientific approach to validity assessment. The position statement acknowledges areas of differing opinions and the need for further research.     

职业特点在犯罪心理痕迹中的反映

许多实际案例中现象表明职业特点与犯罪心理痕迹有内在联系,分析职业心理就要沿着现象——行为——行为定式——思维定式——职业训练的途径去思索。     

Resource Material for Ethical Psychological Assessment of Symptom and Performance Validity,Including Malingering

The present paper offers resource material for evaluation of malingering, response bias, and symptom and performance validity. The material mostly consists of noncontroversial, paraphrased excerpts from relevant consensus statements, guidelines, codes, books, and articles. The five principles of the American Psychological Association (APA) ethics code were used to integrate the material. In addition, five other principles were needed (e.g., on science). The companion article on a new consensus statement on the ethical use of symptom and performance validity written for the Association for Psychological Advancement in Psychological Injury and Law (ASAPIL) in the journal Psychological Injury and Law (PIL; Bush, Ruff, & Heibronner, 2014) was instigated by and written partly based on the resources described in the present paper. The resources offered in the present paper are divided into the following sections: I. Malingering; II. Related Terms; III. APA Ethics Code; IV. Other Ethics Guidelines; V. Practice Guidelines; VI. Assessment Guidelines; VII. Other Ethical Sources; IX. Biases, Fallacies, Errors; X. Prior SVT-M/PVT-M Statements; XI. A New Ethical Model of Ten Principles; and XII. Instrumentation, and followed by Conclusions. The ten principles of the present ethical guidelines could be used to help revise the APA ethics code. The companion statement constitutes a major advance in the field and the present resource material facilitates its use.     

Medicolegal use of placental alkaline phosphatase in infanticide

By means of starch gel electrophoresis and an improved staining technique for the demonstration of isoenzyme bands, placental alkaline phosphatase types were demonstrated in placenta tissue and birth blood traces, which had been stored for several days at room temperature. This method was successfully applied in a case of infanticide and secret delivery to identify the mother of the child. The results of a study on a Japanese population are also reported.     

心肌致密化不全及其法医学鉴定

心肌致密化不全(noncompaction of ventricular myocardium,NVM)是一种罕见的特殊类型的心肌病.近年来对于NVM的临床报道和研究越来越多,已成为临床心血管方面研究的热点问题之一.虽然NVM较为罕见,但因其猝死发生较多,加上目前我国大多数法医工作者对此认识不足,同时,现阶段还没有非常成熟的法医病理学检查方法,且其易与其他类型心脏疾病相混淆,因此对NVM的法医病理学鉴定需要充分的认识和格外谨慎.现重点对NVM的病理学特点、常用的临床诊断方法及与其他类型心脏疾病的鉴别诊断进行综述,并总结其法医学鉴定要点.     

二分髌骨影像学征象及其法医学意义

二分髌骨较罕见,系因青春期二个或多个髌骨骨化中心(化骨核)未融合而形成,临床误诊为骨折的屡有报道。为提高对二分髌骨影像征象的认识,避免法医学鉴定失误,现分析行法医学鉴定的3例二分髌骨资料并结合文献,阐述其形成原因、组织学变化、影像学征象及临床症状体征。3例被鉴定人均为成年,因膝关节外伤后出现膝部疼痛,曾被医疗单位诊断为髌骨骨折,委托损伤鉴定2例,伤残评定1例。依据Saupe’s分型法,其中Ⅲ型2例,Ⅱ型加Ⅲ型1例。在法医学鉴定实践中,熟知二分髌骨影像学征象并与髌骨骨折鉴别,可确保鉴定结论的客观、准确。     

Factors Predicting Relationship Satisfaction,Investment, and Commitment When Women Report High Prevalence of Psychological Abuse

Relationship satisfaction, investment, and commitment in women experiencing extensive psychological abuse were examined to determine predictive factors. Participants were the top quartile of a national sample of women in conflictual relationships (N = 81) experiencing psychological maltreatment. Relationship satisfaction, investment, and commitment were each used as criterion variables with conceptually related factors as the predictors (e.g., reactions to the psychological abuse; mental health indicators; personality variables; perceived harm; problematic relationship schemas; response styles; demographics). These relationship markers were differentially predicted within this group of women. Three independent clusters of women, based on patterns of satisfaction, investment, and commitment scores, were compared regarding physical abuse, reactions to psychological abuse, ratings of perceived harm, endorsement of relationship schemas, psychological distress variables, and personality variables. The cluster of women reporting higher satisfaction, investment, and commitment in these seemingly aversive relationships frequently demonstrated differences from the other two clusters. Implications for clinical applications are discussed.     

Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims

The Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims was published on the Ontario Psychological Association website in July, 2010 (Smith, A., and OPA Auto Task Force, 2010, Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims. Ontario Psychological Association, Toronto, Ontario. Retrieved from http://www.psych.on.ca/files/members/OPA_Auto_Practice_Guidelines_July292010_July_30_2010.pdf). Excerpts are reproduced in the journal because of the comprehensive nature of the document. To our knowledge, this is the first time that state or provincial guidelines have included all the major psychological diagnoses in rehabilitation work with motor vehicle accident survivors (chronic pain, post-traumatic stress disorder, traumatic brain injury, depression). Space limitations preclude publishing of the full document, but it should be consulted. The present excerpt focuses on the nature of the psychological injuries and the best practices in treating them, along with cautions for assessment, comorbidities and polytrauma, litigation distress and barriers and complications in recovery.     

Medicolegal aspects of tornadic storms in Kansas, U.S.A.

Kansas is known for its fierce whether, including tornados in the spring and fall and blizzards in the winter. A recent series of tornados cut a path of destruction a mile wide for greater than 40 miles (64 km), killed 20 people, and caused several hundred casualities on the evening of April 26, 1991, in Tornado Alley, which runs from the northern border of Oklahoma through southern Kansas past Wichita toward Emporium, Kansas. The wind velocity was greater than 200 mph. Twenty people were killed, 17 of these in Andover, Kansas, a small town east of Wichita. Injuries caused by the tornados and the excellent emergency response and care provided by medical, law-enforcement, and volunteer personnel in the wake of the storms are described here.