Evaluating the Clinical Utility of the Medical Symptom Validity Test (MSVT): A Clinical Series

Abstract

Performance validity tests (PVTs) are not widely used beyond medico-legal contexts in the UK. A UK survey suggests clinicians have reservations about their accuracy in clinical settings. This study sought to explore the validity of PVTs in an acute adult neuropsychology setting and to establish a potential "false positive" (FP) base rate. Failures on the Medical Symptom Validity Test (MSVT) in a consecutive clinical series of 405 patients were evaluated systematically and allocated to groups depending on clinical context. All failures were checked against the test's "dementia profile". Of the 405 participants, 329 passed the MSVT (81.2%), while 76 participants (18.8%) failed based on standard criteria. A 5.2% rate of potentially 'unexplained' failures was found. Other reasons for failure were classified as: presumed malingered neurocognitive dysfunction (4.6%), dementia/significant cognitive impairment (3.7%), technical/visual problems (1.8%), and "unexplained failure" with contributory factors (2.4%). These results suggest test specificity between 0.95 and 0.90. Most of the clinically significantly impaired patients matched the dementia profile (86.7%). Our results support the sensitivity, but not the specificity, of the dementia profile. However, approximately 1 in 20 patients failed the MSVT despite an otherwise unremarkable neuropsychological presentation; moreover, mood and pain may affect MSVT performance. Clinical implications for interpreting test scores are discussed.

Symptom and Performance Validity Assessment in European Countries: an Update

“…The position described for Great Britain (GB) in the 2013 review paper was that the majority of research focused on PVTs, and most studies utilized non-forensic clinical populations. There has been a paucity of test validation research since this time, but again the few studies that have been conducted have used non-forensic clinical populations (Hampson et al, 2014;Suesse et al, 2015).…”

“…In the previous review, noted that neuropsychologists remained skeptical about the use of PVTs, although the majority of neuropsychologists were using them in medico-legal settings (McCarter et al, 2009). The trend continues, and they are still not widely adopted in clinical settings (Suesse et al, 2015).…”

Performance validity assessment: Disentangling dementia from the disinterested and disingenuous.

“…if, however, a patient were to demonstrate normal learning and retention but impaired recognition or floor-level list learning despite normal simple attention span, the pattern of performance would be a bit more unusual. integrating additional information from the relevant medical history such as structural neuroimaging can further support this effort and, in essence, be used to build a conceptual confidence interval around PVT scores (Suesse et al, 2015). Even "near passes" should be thoroughly vetted to determine whether or not the obtained scores may be plausible in the context of known disease characteristics and clinical syndromes (Axelrod & Schutte, 2010;Larrabee, 2012).…”

Executive Functioning and Health

“…Such a broad-based multi-level framework captures reciprocal feed-forward associations between EF and pain over time. However, as a cautionary note, chronic pain can in some cases represent a psychiatric, rather than physical, condition, and in such cases cognitive dysfunction itself may need to be explained by other (i.e., behavioral and psychiatric) mechanisms (Suesse, Wong, Stamper, Carpenter, & Scott, 2015…”