KEVIN J. BIANCHINI, PH.D., ABPN - Health and...

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KEVIN J. BIANCHINI, PH.D., ABPN

Transcript of KEVIN J. BIANCHINI, PH.D., ABPN - Health and...

KEVIN J. BIANCHINI, PH.D., ABPN

Slick et al., 1999

Bianchini et al., 2005

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• Criterion A: Evidence of significant external incentive

• Criterion B: Evidence from physical evaluation 1. Probable effort bias 2. Discrepancy between subjective report of pain and physiological reactivity 3. Non-organic findings 4. Discrepancy between the patient’s physical presentation during formal evaluation and their physical

capacities documented when they are not aware of being observed

• Criterion C: Evidence from cognitive/perceptual (neuropsychological) testing 1. Definite negative response bias 2. Probable response bias 3. Discrepancy between cognitive/neuropsychological test data and known patterns of brain functioning 4. Discrepancy between test data and observed behavior

Criterion D: Evidence from self-report

1. Compelling inconsistency 2. Self-reported history is discrepant with documented history 3. Self-reported symptoms are discrepant with known patterns of physiologic or neurological functioning 4. Self-reported symptoms are discrepant with observations of behavior 5. Evidence from formal psychological evaluation that the person has significantly misrepresented their current

status

• Criterion E: Behavior meeting necessary criteria from groups B, C, and D are not fully • accounted for by psychiatric, neurological or developmental factors

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I. Definite MPRD Presence of substantial external incentive [Criterion A] “Definitive” evidence of intent [Criterion C1 or D1] Behaviors meeting the criteria for “definitive” intent [C1 or D1] are not fully accounted for by psychiatric,

neurological or developmental factors. [Criterion E]

II. Probable MPRD Evidence of significant external incentive [Criterion A] Two or more types of “probable” evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5] and/or

Criterion D [D2-D6]. This evidence must be well-validated and have a known error rate. Behavior meeting necessary criteria from groups B, C, and D are not fully accounted for by psychiatric,

neurological or developmental factors. [Criterion E]

III. Possible MPRD Evidence of significant external incentive [Criterion A] Evidence does not rise to the level sufficient for a diagnosis of Probable MPRD.

Only one type of quantitative “probable” evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5] and/or Criterion D [D2-D6].

OR One or more forms of qualitative evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5]

and/or Criterion D [D2-D6]. OR

Evidence sufficient for a diagnosis of MPRD is present BUT Criterion E is not met.

More symptoms (SVTs) Worse performances on “measures” of ability (PVTs)

The majority (54%) of these patients had traumatic brain injuries (TBI) with

neuroimaging evidence of intracranial injury and/or Glasgow Coma Scale

scores in the moderate or severe range (scores less than 13). None of the head

trauma patients were in the mild category.

Most of the remaining brain dysfunction patients (31% of the total

of 120) had medically intractable epilepsy confirmed by intensive EEG monitoring and 14% had a variety of

other diagnoses with neurologic evidence and brain injury.

PDRT Cutoff Scores

Easy Items 19 Correct Hard Items 18 Correct Total Score 39 Correct

Cutoff Scores are the worst scores

obtained among 120 adult patients without financial incentives who had

unambiguous evidence of brain dysfunction

Classification Accuracy of the

Portland Digit Recognition Test in Traumatic Brain Injury:

Results of a known-Groups Analysis

Greve, K., & Bianchini, K.

The Clinical Neuropsychologist 2006:20:816-830

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Effort Test Self-Report Malingering

No IncState WCFederal WC

Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship? The Clinical Neuropsychologist, 20, 831 - 847.

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Effort Test Self-Report Malingering

State WCFederal WC

Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship? The Clinical Neuropsychologist, 20, 831 - 847.

Detecting Malingering in

Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice

Symptom Validity Tests

Greve, K., Ord, J., et al.

The Clinical Neuropsychologist

2008:22:896-918

Detecting Malingered

Pain-Related Disability: Classification Accuracy of the

Portland Digit Recognition Test

Greve, K., Bianchini, K., et al.

The Clinical Neuropsychologist 2009:23:5,850-869

Detecting Malingering in

Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice

Symptom Validity Tests

Greve, K., Ord, J., et al.

The Clinical Neuropsychologist

2008:22:896-918

Classification Accuracy of

MMPI-2 Validity Scales In the Detection

of Pain-Related Malingering: A Known-Groups Study

Bianchini, K., Etherton, J., et al.

Assessment

2008:15:435-449

Prevalence of Malingering in Patients With Chronic Pain

Referred for Psychologic Evaluation in a Medico-Legal Context

Greve, K., Ord, J., et al.

Archives of Physical Medicine and Rehabilitation

2009:90:117-26

A. Studied Indicators Only B. Could Set Criteria Level (Based on False

Positive Error Rates)

C. Titration of the use of this evidence with objective medical evidence of damage

D. Require adherence to a diagnostic system

E. . If these approaches are applied system wide, there will be efforts to avoid detection strategies can be put in place to counteract

this

F. Once in place, a program of research could be undertaken to study the uses of these methods & the extent of the problem of disability exaggeration with this population