Development of a Cognitive Level Explanation Model in Brain Injury : Comparisons between Disability and Non-Disability Evaluation Groups

Abstract

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. KEY WORDS :Disability evaluation˙ Brain injury˙ Malingering.

Malingering assessment after severe traumatic brain injury in forensic psychology with a potential embedded symptom validity indicator of Symptom Checklist 90

“…In addition, the PC-G showed more severe subjective symptoms on Som, OC, Host, and Phob than the CC-G. This means that participants with malingering tendencies prefer to fake bad symptoms about these aspects, which may be unconscious (or passive) exaggeration due to a defense mechanism (for example, the conversation of psychological confliction into somatic symptoms, that is, Som) or simply because of how easily the symptom can be simulated ( Shin et al, 2010 ; Sullivan and King, 2010 ). These results were consistent with the previous findings that psychopathologies such as posttraumatic stress disorder, somatic complaints, depression, psychoticism, and phobic anxiety were more susceptible to malingering ( Sullivan and King, 2010 ).…”

“…Objectively speaking, this contradiction was not incomprehensible. In addition to the poor effort due to interests pursued ( Shin et al, 2010 ; Silver, 2012 ), the bad influences on different aspects of cognitive functions, including IQ (executive functions, information processing speed, attention and visuomotor functioning, memory, naming, and verbal knowledge), are related to the diverse localization of brain lesions ( Miotto et al, 2010 ; Königs et al, 2016 ). As the cases were collected, the injured areas of the brain varied among the included participants.…”

“…Conversely, there was a profile of a wide range of abnormalities from moderate to serious in the mild-damage ones in most subscales. This may not be surprising, since in addition to psychological factors, other factors (e.g., recovery expectation, stereotype threat, negative injury perceptions, stress of pain, hospital procedures, litigation involvement, and disability evaluation) can also play a role in neuropsychological testing ( Shin et al, 2010 ; Silver, 2012 ; Osborn et al, 2014 ; Wortzel and Granacher, 2015 ). On one hand, compared with mild TBI, participants with more severe TBI were confident that they would be compensated, and the reduction in motivation to exaggerate can reduce the number of positive symptoms endorsed on the self-report scales ( Starkstein and Pahissa, 2014 ).…”

Prognostic Factors of Neurocognitive and Functional Outcomes in Junior and Senior Elderly Patients with Traumatic Brain Injury Undergoing Disability Evaluation or Appointed Disability Evaluation

“…Adult patients that had undergone disability evaluation after TBI showed differences in neurocognitive outcomes according to the cause of visit, and showed lower performance than the treatment group (patients who were scheduled to undergo disability evaluation after recovering from TBI). This suggested that disability evaluation process has an effect on the test-taking attitude or will affect the attitude of the clinician administering the test or the patient actually taking the test intentionally or unintentionally 20) . Therefore, clinicians should not assume that old aged patients with TBI are "faking" their symptoms or injuries as adult patients with TBI, but assume that they could faking their performance in a test set available visual feedback.…”

Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury

“…Almost all the patients with mild TBI in this study had external incentives to malinger and displayed definite or probable malingered neurocognitive dysfunction 23) . 40.3% of DE patients with mild and moderate brain injuries display typical or passive malingering patterns and behaviors, sometimes involving denial of symptoms and resistance to treatment 22) .…”