Teaching Psychiatric Trainees to “Think Dirty”: Uncovering Hidden Motivations and Deception

Beach, Scott R.; Taylor, John B.; Kontos, Nicholas

doi:10.1016/j.psym.2017.04.005

Cited by 21 publications

(20 citation statements)

References 20 publications

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“…For example, deceptive researchers falsify results to obtain funding or get published (33). Physicians in clinical practice encounter patients with factitious disorders and malingering (34, 35). …”

Section: Discussionmentioning

confidence: 99%

Safety, Science, or Both? Deceptive Healthy Volunteers: Psychiatric Conditions Uncovered by Objective Methods of Screening

Pavletic

Pao

2017

Psychosomatics

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Previous reports document a high prevalence of psychopathology and highlight the importance of mental health screening of healthy volunteers in psychiatric research. Psychiatric research has typically used self-report scales and structured clinical interviews to rule out psychopathology. These subjective methods are often unreliable as some volunteers conceal their psychiatric conditions and substance use. Here we describe illustrative cases of psychiatric conditions in healthy volunteers that were uncovered by objective methods of screening including physical exam, laboratory testing, toxicology screen, and chart review.

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Section: Discussionmentioning

confidence: 99%

Safety, Science, or Both? Deceptive Healthy Volunteers: Psychiatric Conditions Uncovered by Objective Methods of Screening

Pavletic

Pao

2017

Psychosomatics

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“…To be sure, medical staff should not try to serve as private detectives and examining the Slick et al criteria in each patient with external incentives and therapy‐resistant symptoms is not necessary. In the first case that we described, just obtaining collateral information from staff workers in the asylum seeker center already turned out to be informative (34). In the second case, a high error score on the MENT, even though by itself no proof of feigning or exaggeration, could have alerted the clinical staff to this possibility at a much earlier stage (35) and might have prevented her subsequent exposure to a protracted period of admission and the side effects of antipsychotic medication.…”

Section: A Remedy?mentioning

confidence: 98%

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Heide

Bošković

Harten

2020

Journal of Forensic Sciences

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Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post‐traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy‐resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.

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“…Through observation of faculty as they interview patients and attentiveness to group discussion during rounds, residents learn to “think dirty,”—that is, to recognize hidden motivations for symptoms or behaviors and to better regulate their own emotional responses to patients who engage in such behaviors. 14 Attendings often model curiosity for an individual patient's motives for deception and a skillful interview style which includes strategies for confrontation of the patient if appropriate. C-L psychiatry trainees learn that shame and fear are powerful nonpathologic reasons why a patient might deceive the provider and that finding empathy for the patient and seeking truth without embarrassing the patient are important clinical goals.…”

Section: What Is the Hidden Curriculum For Residents On C-l?mentioning

confidence: 99%

Optimizing Fit: Targeting a Residency Psychiatry Consultation-Liaison Rotation to Various Levels of Training

et al. 2020

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Background Determining the optimal timing and structure for a core residency rotation in consultation-liaison psychiatry (CLP) remains a key challenge for program directors and rotation leaders. Previous surveys have been conducted regarding these questions, and guidelines from national organizations have been issued, but practices remain varied among institutions. Methods We conducted a narrative review of the literature related to the timing of CLP rotations and generated consensus recommendations based on our experience as program directors, rotation leaders, and residents. Results Explicit goals of CLP training in residency include identifying and treating psychiatric manifestation of medical illness and communicating effectively with primary teams. Implicit goals of training may includeconflict management, limit setting, and “thinking dirty.” Discussion Although CLP rotations earlier in residency often create a better fit within the overarching curriculum and allow for generating early interest in the field, significant amounts of supervision are required, and consultees may look to attendings as the primary consultant. Conversely, while later rotations are sometimes challenging to structure with other outpatient responsibilities, they allow for greater autonomy and may map better onto the informal curriculum. A hybrid model, with training spread across multiple years, is another approach that may mitigate some of the disadvantages of confining consultation-liaison training to a single year. Compelling arguments can be made for placing the core CLP rotation in postgraduate year 2 or 3 or using a hybrid model. Regardless of placement, program directors and rotation leaders should be mindful of tailoring the rotation to the trainees' developmental stage.

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Teaching Psychiatric Trainees to “Think Dirty”: Uncovering Hidden Motivations and Deception

Cited by 21 publications

References 20 publications

Safety, Science, or Both? Deceptive Healthy Volunteers: Psychiatric Conditions Uncovered by Objective Methods of Screening

Safety, Science, or Both? Deceptive Healthy Volunteers: Psychiatric Conditions Uncovered by Objective Methods of Screening

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Optimizing Fit: Targeting a Residency Psychiatry Consultation-Liaison Rotation to Various Levels of Training

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