Detection of Malingered PTSD: An Overview of Clinical,Psychometric, and Physiological Assessment: Where Do We Stand?

ABSTRACT: Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.     

Association for Methodology and Documentation in Psychiatry Profiles Predict Later Risk for Criminal Behavior and Violent Crimes in Former Inpatients with Affective Disorder*

Abstract: Few studies have investigated criminal and violent behavior in patients with affective disorders. We reviewed the national crime register for records of criminal offenses committed by 1561 patients with affective disorders and studied the predictive value of certain psychopathological symptoms assessed with the Association for Methodology and Documentation in Psychiatry (AMDP) system concerning future criminal behavior. Sixty‐five (4.2%) patients had been convicted in the 7–12 years after discharge (307 cases). Patients with the AMDP syndrome mania had a significantly higher risk for later criminal behavior. The combination with the hostility syndrome further increased the risk. These findings are in line with previous data indicating a higher risk for later criminal behavior in patients with a manic/bipolar disorder compared to depressive disorder. As previously demonstrated in another sample of schizophrenic patients, the AMDP syndromes mania (and hostility) is associated with a higher risk of later criminal behavior.     

限定刑事责任能力评定量表扩展应用的信效度

目的探讨限定刑事责任能力评定量表在责任能力评定中的扩展运用价值。方法采用DCRRS（内容包括现实作案动机,先兆,诱因,时间、地点、对象、工具选择,作案时情绪反应,作案后各种行为表现,生活自理能力、工作学习能力、自知力、现实检验能力损害和自我控制能力等）对108例符合要求的患者进行评定并与专家鉴定结果进行比较。结果DCRRS各条目间及其与总量表分间的相关均具有统计学意义（r=0.145～0.944,P〈0.001）,分半信度为0.868。根据DCRRS参考划界分分组,无、限定和完全责任能力3组间及两两间量表总分均具有显著统计学差异（P〈0.001）。DCRRS与专家鉴定结果一致性较高（Kappa=0.958,P〈0.001）,经判别方程回代具有较高的正确率（97.2%）。结论DCRRS的信效度良好,可作为辅助参考使用。     

MAO基因遗传多态性及与精神疾病相关性研究进展

单胺氧化酶(monoamine oxidase,MAO)是调控儿茶酚胺和5-羟色胺等单胺类氧化脱氨的一类重要酶,广泛分布于包括神经系统在内的人体各种组织中,具有多种生物学功能。MAO有两种类型,MAO-A和MAO-B。MAO基因具有遗传多态性,其中部分多态性位点与某些精神疾病如严重抑郁障碍、酒精中毒、反社会情感障碍及精神分裂症等有一定的相关性。MAO基因遗传多态性的研究,可能为法医学个人识别与亲权鉴定提供新的遗传标记,并为司法精神病鉴定提供参考性遗传学指标。     

颅脑损伤致精神障碍的法医学鉴定

本文综述了国内外颅脑损伤致精神障碍的相关法医学现状,特别是对于鉴定中的常见问题进行了简要的综述。     

反社会人格障碍与暴力犯罪——对郑民生校园杀凶案件心理分析

反社会人格有很强的犯罪倾向,其所引起的违法犯罪行为最多。郑民生的犯罪心理体现了反社会人格犯罪的特点。反社会人格障碍引发的犯罪应当成为犯罪预防的重点。     

重复热应激致公兔性腺氧化损伤的研究

为探讨热应激对雄性兔性腺的氧化损伤机制,以体重相近的110日龄雄性新西兰兔为研究对象,每天在固定时间分别以31～34℃和38～40℃进行热应激,并分别在热应激后的第15、30、45及60天处死兔,取样检测性腺组织内总抗氧化酶活性、丙二醛及蛋白质羰基含量。结果显示,随着温度升高,睾丸和附睾组织丙二醛含量增加,总抗氧化酶活性降低,蛋白质羰基含量呈上升趋势,表现出明显的温度-时间效应。表明高热可改变兔睾丸和附睾的正常生理机能,使自由基在组织内累积,引起蛋白质氧化损伤,进而降低繁殖机能。     

Explaining Urban Social Disorder and Violence: An Empirical Study of Event Data from Asian and Sub-Saharan African Cities

By 2050, two thirds of the world's population will live in cities, and the greatest growth in urban populations will take place in the least developed countries. This presents many governments with considerable challenges related to urban governance and the provision of services and opportunities to a burgeoning urban population. In the current article, we use a new event dataset on city-level urban social disorder, drawing upon prominent theories in the conflict literature. The dataset spans the 1960–2009 period, covering 55 major cities in Asia and Sub-Saharan Africa and includes data on nonviolent actions such as demonstrations and strikes and violent political actions like riots, terrorism, and armed conflict. We find that urban social disorder is associated in particular with low economic growth rates and hybrid democratic regimes, while level of development, economic inequality, large youth bulges, and economic globalization do not seem to affect levels of urban social disorder.     

Violence,Guns, and Suicide in New Orleans: Results from a Qualitative Study of Recent Suicide Decedents

Many Americans own guns to protect themselves against other people, but there is evidence that both victimization and gun access increase suicide risk. We conducted qualitative interviews with informants of 17 suicide cases in New Orleans of the 60 who died between January 2015 and April 2016 to understand the relationship between past trauma, gun access and storage, and suicide. Nine cases had experienced a past trauma, including three who had recently had a family member killed by homicide. Eight died via firearm; of those, seven owned the guns they used to take their lives and stored them locked (but loaded) at home or in their cars. Preventing community violence and addressing its sequelae may be important for reducing suicides. A multi‐pronged strategy consisting of policies, education, and marketing will likely be needed to address the risk of suicide conferred by gun access.     

Witnessing an Accidental Shooting at the Police Training Academy

Abstract

After an accidental shooting at a police training academy, outcomes of the class involved (n = 45) were compared with those of several comparison classes (n = 154) immediately and one year later. Results revealed a modest impact, but an increase in PTSD symptomology was observed from academy training to the one-year follow-up. Recruits in the affected class demonstrated more prejudicial attitudes toward women in law enforcement, perhaps because the shooter was a woman. The findings suggest that mistakes made by women within law enforcement may be generalized as stereotypes, and that further research is needed on the psychological impact of becoming a police officer.