Neurotoxic complaint base rates of personal injury claimants: Implications for neuropsychological assessment

Abstract

This study reports base rate data for 113 family practice patients with no history of head trauma or toxic exposure, 68 family practice patients with a history of head trauma or toxic exposure, and 156 personal injury claimants with no history of toxic exposure or head trauma who presented for a psychological evaluation due to emotional distress. Personal injury claimants reported suffering from significantly more neurotoxic and neuropsychologic symptoms than subjects with a reported history of head trauma and/or toxic exposure. The authors urge that evaluating psychologists consider the base rate of these symptoms in litigating populations and use caution in relying on self‐reported symptoms as evidence of injury when patients are in litigation.

Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury

“…It is well known that various clinical groups (e.g., psychiatric disorders, personal injury claimants, chronic pain, posttraumatic stress disorder, and soft-tissue injuries) [38][39][40][41][42][43][44][45][46][47] and even healthy adults [48][49][50][51][52][53][54][55] often report cognitive symptoms in the absence of brain injury. Finally, we cannot exclude the effects of expectancy.…”

Perception of illness: Nonspecificity of Postconcussion Syndrome symptom expectation

“…In all, results suggest that numerous nonneurologic factors, including sex, chronic pain, presence of medical illness, treatment seeking, depression, and negative affectivity, may be more closely related to the self-report of PCS symptoms than is head injury status. Despite these findings, self-report of symptoms frequently comprises a majority of the evaluation for PCS diagnosis (Dunn et al, 1995).…”

“…Subjects were then asked to complete a 97-item symptom checklist comprised of common neuropsychological symptoms and distracter items. As suggested by Dunn et al (1995), distracter items allow a comparison of expected symptoms not typically associated with head injury. Use of the same instrument as Gunstad and Suhr (2001) allowed the possibility of a direct comparison to groups employed in that study.…”

“…Victims of minor head injury report similar symptoms, with headaches, anxiety, memory problems, dizziness, and emotional changes being among those complaints most commonly reported (Alves et al, 1993;Dunn et al, 1995;Fox et al, 1995b;Gouvier et al, 1988). This cluster composes the core symptomology of postconcussion syndrome (PCS).…”

Rates of symptom reporting following traumatic brain injury

“…First, while PTS occur more often in those with TBI, they are not specifi c to TBI. These are common symptoms also reported by people in general (Gouvier, Uddo-Crane, & Brown, 1988 ;Iverson & Lange, 2003 ;Machulda, Bergquist, Ito, & Chew, 1998 ;McLean et al, 1984 ;Mittenberg, DiGiulio, Perrin, & Bass, 1992 ;Sawchyn, Brulot, & Strauss, 2000 ;Trahan, Ross, & Trahan, 2001 ;Wong, Regennitter, & Barrios, 1994 ), those with depression (Iverson, 2006 ), pain (Gasquoine, 2000 ;Iverson & McCracken, 1997 ;Radanov, Dvorak, & Valach, 1992 ;Smith-Seemiller, Fow, Kant, & Franzen, 2003 ), litigation (Binder & Rohling, 1996 ;Dunn, Lees-Haley, Brown, Williams, & English, 1995 ;Lees-Haley & Brown, 1993 ;Paniak et al, 2002 ), patients receiving care, and those with other system injuries, as reported in this study and by others (Mickeviciene et al, 2004 ). Such symptoms are also reported to a greater extent by persons with preexisting conditions such as prior alcohol abuse, and psychiatric difficulties as seen in the present study.…”