The Performance of Psychiatric Patients Claiming for Labor Insurance Disability Allowance on Cognitive Tests for Detecting Simulated Cognitive Impairments

• Main Authors: Sheng Feng Lin, 林聖峰
• Other Authors: M. Y. Ho
• Format: Others
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/54955260797459936806

碩士 === 長庚大學 === 職能治療學系 === 99 === The number of psychiatric patients claiming for the Labor Insurance Disability Allowance has been escalating in recent years. It is possible that some patients may simulate or exaggerate their deficits under the influence of monetary incentives. However, there is general lack of standardized or objective tools for detecting this possibility. The aims of the present study intend to examine the applicability of a set of neuropsychological tests for detecting the likelihood of deliberate exaggeration of symptoms or simulation of cognitive impairments. The present study was based on a between-participant design. The participants were allocated to four groups: (1) the non-claimant patient group (patient group, n = 25); (2) analogue dissimulated group (dissimulated group, n = 25); (3) the healthy volunteer group (control group, n = 24); and (4) the allowance-claiming patient group (claiming group, n = 27). In addition to the standardized tools for testing malingering, some neuropsychological tests were also used for this present study (the Mini-Mental Status Examination, Digit Span of the Wechsler Adult Intelligence Scale-III, Raven’s Standard Progressive Matrices, Chinese Graded Word Reading Test, California Verbal Learning Test-II, Brief Visual Memory Test-Revised, Color-Word Interference Task, the Test of Memory Malingering [TOMM], Rey 15-Item Memory and Recognition Tests, and Choice Reaction Time Task). The performance of the patient group, dissimulated group and control group on all the cognitive tests were compared first. If the testing scores revealed significant differences between the dissimulated group and the other two groups, respectively, but not for those differed significantly between the patient and control groups, the measures were selected for testing the sensitivity and specificity for detecting simulation of deficits and deriving the cutoff scores. The results showed the Trial 2 and the Retention Trial of the Test of Memory Malingering (TOMM) and the error index of a Choice Reaction Time Task were the most useful tests, with the values of sensitivities and specificity all well above76%and 93%, respectively. In addition, the detection rates for exaggeration of cognitive deficits were calculated for participants in the patient and claiming groups. There were 51.85% of the allowance-claiming patients failed on the TOMM, but only 8.00% of the patient group failed on this test. In the case of the measure for the Choice Reaction Time Task, there were 30.77% of the allowance-claiming patients failed, whereas there were only 8.00% of patients without allowance-claiming failed on this test. Although it is difficult to verify that the patients in the claiming group intended to simulate or exaggerate their deficits in the present study, the proportion of suspected dissimulators in this group was significantly higher than that of the non-claiming patients. The present study suggested the psychiatric patients who intended to claim for the Disability Allowance were very likely to simulate or exaggerate their deficits; and the proportion of these patients may be much higher than the non-claiming patients. This phenomenon is noteworthy for the clinical practitioners.