No abstract available.
Malingering*

STUDY DESIGN: Patients who had had revision operation were classified according to their outcome. OBJECTIVES: Review a consecutive series of patients who had had a revision operation on the lumbar spine and determine which factors contributed to a successful outcome. SUMMARY OF LITERATURE REVIEW: The long-term rates of failure after primary operations of spine have been reported to be as high as 30 percents. MATERIALS AND METHODS: Twenty three patients who had had a revision operation on the lumbar spine between September 1995 and February 1997, were analyzed which patients had been followed for a mininum of two years and were available to exclude a questionable malingering. All twenty three patients had had decompression and instrumented fusion. These patients were followed for an average of thrity-seven months(range, twenty-four to forty-five months). There were seventeen men and six women. The patients had had one or more previous operative procedures and an average of thirty-seven months(range, three months to 18 years) had been elapsed since the most previous operation. The average age at the time of revision was 44 years(range, 28 to 65 years). The operative results were classified according to three primary criteria 1) return to ordinary activity, 2) analgesics use, 3) subjective satisfaction of patient. The outcome was considered to be success if the patient had met the all these three criteria. With use of a chi-square analysis(level of significance, P<0.05), several factors were evaluated to be determined which were related to a successful outcome. RESULTS: Statistical analysis revealed that the factors associated with a successful outcome were a younger age (P<0.02), fewer spinal levels operated on previously (P<0.05), a pain-free interval after index operation (P<0.01). We could detect no significant relationship between the outcome and gender, the number of previous procedures, the presence of preoperative neurological sign and intervals between the index operation and the revision. CONCLUSION: These results suggest that the prognostic factors are useful to evaluate the successful outcome of the revision operationof spine.
Analgesics ; Decompression ; Female ; Humans ; Male ; Malingering ; Spine* ; Surgical Procedures, Operative

The authors present a case of factitious disorder manifestating as a lumbar disc herniation. This 38-year-old woman has been operated on over ten times during a 20-year-period. Surgeons should be alert to avoid unnecessary operations for this uncommon but potentially serious disorder.
Adult ; Back Pain ; Female ; Humans ; Malingering ; Somatoform Disorders ; Spine

It can be difficult to distinguish posttraumatic stress disorder (PTSD) from malingering because a person's responses after experiencing trauma depend on self-report, such as subjective complaints, and it is easy to find the diagnostic criteria for PTSD through the internet or other mass media. Therefore, it is important for clinicians to perceive patients' motivations and determine whether they have external incentives. We reviewed clinicians' and patients' interview styles, which can be useful for reducing malingering intent and detecting malingering patterns. To help clinicians differentiate PTSD from malingering, we also reviewed the diagnostic criteria (re-experience, avoidance and numbing, and hyperarousal) and the typical symptoms of true and malingered PTSD.
Internet ; Malingering ; Mass Media ; Motivation ; Stress Disorders, Post-Traumatic

OBJECTIVE: We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. METHODS: Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. RESULTS: In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. CONCLUSION: The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment.
Brain ; Brain Injuries ; Denial (Psychology) ; Disability Evaluation ; Humans ; Intelligence ; Malingering ; Memory ; MMPI ; Neuropsychological Tests

We had carried out a retrospective analysis which consisted of 61 consecutive cases on disability evaluated and estimation of loss of efficiency in this hospital for the last five years. Factors in disability evaluation were decreased visual acuity (27 patients, 44.2%), contracted visual field (5 patients, 8.1%) and disabled ocular motility (15 patients, 24.5%). Estimation errors in disability evaluation occurred in 9 (14.7%) in all cases. The average error rate was 10.2%. The causes were confusion of efficiency with loss of efficiency, conversion deficiency of 75% visual efficiency in pseudophakic eye and estimation errors in diplopia field test. Beforehead estimation cases in disability evaluation were 9 cases (4.7%). The case which needed request of calculation of medical fee after this were 19 cases (31.3%). The incidence of malingering were observed in 11 patients (18.0%) and the major factor of malingering was decreased visual acuity (8 patients, 72.7%). In conclusion, with the use of the estimation of loss of efficiency, we presented many problems such as estimation errors, beforehead estimation cases in disability evaluation, maligerings, request of calculation of medicalfee after this, and etc. Therefore, in accord with the actual condition, we request the establishment of standardization, methods, articles of estimation.
Diplopia ; Disability Evaluation* ; Fees, Medical ; Humans ; Incidence ; Malingering ; Retrospective Studies ; Visual Acuity ; Visual Fields

OBJECTIVE: The diagnosis of myofascial pain syndrome (MPS) is commonly made by Simons' clinical diagnostic criteria which is mainly based on patients' complaints, so it is difficult to distinguish from malingering. The purpose of this study is to evaluate local twitch response by needling (LTR) as an objective diagnostic criterion of MPS. METHOD: Forty four industrial designers complaining of regional pain in neck, shoulder, or upper arm were examined by a physiatrist. If trigger point was detected, local twitch response by needling was confirmed and than severity was measured by 4 grades. Sensitivity, specificity, and positive predictive value of local twitch response was calculated with diagnosis made by Simons' clinical diagnostic criteria. Correlation between grade of local twitch response and sum of clinical features in Simons' criteria was also evaluated. RESULTS: Local twitch response by needling was corresponding with the diagnosis of MPS by Simons' criteria (sensitivity 100%, specificity 96.7%, positive predictive value 93.3%), and the severity of local twitch response was significantly associated with sum of clinical features in Simons' criteria (Spearman correlation 0.950; p=0.048) CONCLUSION: Local twitch response by needling is an important and objective diagnostic criterion of MPS.
Arm ; Diagnosis ; Malingering ; Myofascial Pain Syndromes* ; Neck ; Sensitivity and Specificity ; Shoulder ; Trigger Points

Assessment of post-traumatic stress disorder is a frequently encountered problem in forensic practices. Detection of malingering has become a focus in these assessments. While it is a difficult task due to kinds of traumatic events, complex clinical symptoms, subjective medical information, and presence of diverse psychotic disorders. The clinical traits, detecting methods and testing instruments of PTSD malingering were reviewed so as to help practical management and assessment.
Forensic Psychiatry ; Humans ; Lie Detection ; Malingering/diagnosis* ; Stress Disorders, Post-Traumatic/diagnosis*

PURPOSE: To describe the characteristics of the disabled patients visiting the eye clinic in our institute. METHODS: We carried out a retrospective analysis of 35 cases in our clinic from April 2004 to June 2008 using the McBride disability evaluation. We investigated the clinical features and the causes of disorders through visual acuity, visual field and ocular motility. RESULTS: Thirty-three (94.3%) of the 35 patients had disabilities due to trauma; twelve (34.3%) of them were caused by traffic accidents, and 21 (60%) of them were due to blows or lacerations. Other causes of disability were glaucoma and retinal break (5.8%). Nine patients (25.7%) had abnormal findings in the visual field examination, and nine other patients (25.7%) had limitations in ocular motility. Twenty-eight patients (80%) had decreased visual acuity, and nine (25.7%) had multiple symptoms. CONCLUSIONS: Considering the contribution of disability estimation of visual field and ocular motility in McBride disability evaluations, we considered the importance of repetitive examinations and evaluations. When patients complained of unexplained decreased visual acuity with no anatomical abnormalities, multifocal ERG and multifocal VEP should be considered in order to distinguish it from malingering or functional visual loss.
Accidents, Traffic ; Disability Evaluation ; Eye ; Glaucoma ; Humans ; Lacerations ; Malingering ; Retinal Perforations ; Retrospective Studies ; Visual Acuity ; Visual Fields

There has been a considerable increase in the number of patients with olfactory disorder due to head and facial injuries. Conventional olfactory function evaluation methods, such as T&T olfactometer, the Schneider test and the Alinamin test have been widely used in clinical practice. Among these, the Schneider test can determine whether the patient is a malingerer. A woman who sustained head and facial injuries visited our department with the chief complaint of anosmia. The patient underwent conventional olfactory function tests, including T&T olfactometer and the Schneider test. T&T olfactometer revealed olfactory loss, but the Schneider test did not. Thus, she was diagnosed with malingering. However, her diagnosis of olfactory disorder and concurrent trigeminal nerve injury was made definite during the follow-up period. We herein report a 30-year-old female patient with olfactory disorder who was misdiagnosed with olfactory malingering based on the negative result of the Schneider test. A brief review of the literature has been included.
Adult ; Craniocerebral Trauma ; Facial Injuries ; Female ; Follow-Up Studies ; Head ; Humans ; Malingering ; Olfaction Disorders ; Thiamine ; Trigeminal Nerve ; Trigeminal Nerve Injuries