The Relationship Between Performances on Neuropsychological Symptom Validity Testing and the MCMI-III in Patients With Fibromyalgia

Abstract

Fibromyalgia is a disorder that frequently presents with both cognitive complaints and psychiatric symptoms. This study investigated the association between Symptom Validity Test (SVT) performance and psychiatric symptoms as measured by the Millon Clinical Multiaxial Inventory-III (MCMI-III), a common measure of psychopathology. A total of 72 fibromyalgia patients at a tertiary care clinic completed the MCMI-III, an embedded cognitive symptom validity test (Reliable Digit Span), and a stand-alone cognitive symptom validity test (the Word Memory Test or Test of Memory Malingering). Of these patients, 21% failed a stand-alone SVT, whereas an additional 15% failed both a stand-alone and embedded SVT. Individuals who failed both stand-alone and embedded cognitive SVTs had higher scores on a number of MCMI-III personality subscales and had elevated scores on MCMI-III modifying indices compared to individuals who passed cognitive SVTs. Moreover, SVT performance was significantly correlated with multiple MCMI-III scores, including modifying indices, as well as the somatoform, depression, and anxiety subscales. In sum, cognitive and psychological symptom validity scores were significantly related. Given the new emphasis on cognitive complaints as part of the fibromyalgia diagnostic criteria, neuropsychological evaluation of both cognitive and psychological symptom validity should be a part of a comprehensive diagnostic assessment.

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

“…The percentage of patients with FM passing PVT ranged from 63% in Johnson-Greene et al 148 and Brooks et al ,147 which included subjects receiving or seeking disability benefits or with possible secondary gains, to up to 100% in Iverson et al ,145 where patients were not involved in disability benefits assessments. In Gervais et al ,146 65% patients with FM who were on or seeking benefits performed in the normal range on PVT, and this percentage increased to 96% among those not seeking or receiving benefits.…”

Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria

“…Although these conditions have not been as well studied as others, studies suggest that it is the presence of secondary gain that causes PVT failure in somatoform conditions rather than primary gain. Regarding the role of PVTs, studies on a number of somatoform conditions such as medically unexplained symptoms, fibromyalgia, chronic fatigue syndrome, and functional neurological disorder indicate a relatively low rate of PVT failure unless there is a substantial external incentive such as disability benefits present ( Brooks, Johnson-Greene, Lattie, & Ference, 2012 ; Johnson-Greene, Brooks, & Ference, 2013 ; Kemp et al, 2008 ; Teodoro, Edwards, & Isaacs, 2018 ). In contrast, there is a much higher rate of PVT failure in pain patients incentivized by external gain (e.g., Gervais et al, 2001 ; Greffenstein, Gervais, Baker, Artiola, & Smith, 2013 ).…”

Simulación de psicopatología y su detección en el contexto médico-legal: valoración de la capacitación laboral en el ámbito español

“…La escala V cuenta con tres índices modificadores que constituyen indicadores fiables en la determinación de la validez de respuesta (Bagby, Gillis, Toner, y Goldberg, 1991;Brooks y Johnson-Greene, 2012). …”

“…La magnitud del impacto psicológico, social y económico de la simulación de psicopatología en el contexto médico-legal, y, en el área de la IT, con tasas de prevalencia estimadas de alrededor del 30% (Brooks et al, 2012;Greve et al, 2009;Mittenberg et al, 2002), exige la investigación de este comportamiento para su estudio y diseño de posibles medidas y, protocolos estandarizados de detección, con el objetivo de incrementar la calidad, la fiabilidad y gestión eficaz de la valoración de la IT por causa de salud mental (Martin-Fumadó, Martí Amengual, Puig Bausili, y ArimanyManso, 2014). Todo ello, con el objetivo último de dispensar una más adecuada atención socio-sanitaria tanto a los pacientes genuinos, como al propio simulador evitando que se convierta en un enfermo real a través de procesos de introyección.…”