SISA Malingering copy - Self Insurers of South Australia Doesn't Add Up... ·...
Transcript of SISA Malingering copy - Self Insurers of South Australia Doesn't Add Up... ·...
IT DOESN'T ADD UP!
MALINGERING IN PSYCHIATRYDr Wasim Shaikh
!Fellow, Royal Australian and NZ College of Psychiatrists
Member, Royal College of Psychiatrists, UK Cer@fied Independent Medical Examiner (ABIME)
Comcare Trained Assessor of Permanent Impairment Trained Assessor of Impairment via GEPI
Approved IME -‐ Workcover and TAC, Victoria Trained Expert Witness
IT DOESN'T ADD UP!
THE ‘QUATTRO’
PURPOSE
§ TALK ABOUT THE ELEPHANT IN ROOM
§ UNDERSTAND TERMINOLOGY
§ LEARN OF CLINICAL/ FORMAL TOOLS
§ DISCUSS IMPLICATIONS
IMPORTANT!
§ INTEREST NOT EXPERTISE
§ BIGGER PICTURE
§ CASES
§ REFERENCES AVAILABLE
§ PRIVACY OF CONTENT
CASE
§ 36 YR OLD OFFICE ASSISTANT
§ BULLYING RELATED DEPRESSION
§ CLAIMED IMPAIRMENT BUT INCONSISTENCY
§ HESITANT TO DISCUSS PREVIOUS HISTORY
§ LIMITED TREATMENT
TERMINOLOGY
§ ILLNESS BEHAVIOUR (+-‐) ABNORMAL
§ MALINGERING
§ FACTITIOUS DISORDER
§ FEIGNING
ILLNESS BEHAVIOUR
ADAPTIVE BEHAVIOURAL CHANGES IN SICK !
NORMAL PHENOMENON
ABNORMAL ILLNESS BEHAVIOUR
MALADAPTIVE MANNER OF EXPERIENCING, EVALUATING, OR ACTING, IN RESPONSE TO HEALTH AND ILLNESS !ILLNESS AFFIRMING OR DENYING !DISPROPORTIONATE TO EVIDENT PATHOLOGY !
MALINGERING
INTENTIONAL PRODUCTION OR GROSS EXAGGERATION OF SYMPTOMS, MOTIVATED BY EXTERNAL INCENTIVES !NOT A MENTAL ILLNESS
FACTITIOUS DISORDER
INTENTIONAL PRODUCTION OR GROSS EXAGGERATION OF SYMPTOMS, TO ASSUME A SICK-‐ROLE !CLASSED AS A MENTAL ILLNESS
FEIGNING
INTENTIONAL PRODUCTION OR GROSS EXAGGERATION OF PSYCHOLOGICAL OR PHYSICAL SYMPTOMS !NO ASSUMPTIONS REGARDING GOALS !NOT A MENTAL ILLNESS
MALINGERING
MALINGERING STATISTICS
§ 50% CLAIMANTS NOT GENUINE IN HISTORY REPORTS
§ REVIEW OF 11 STUDIES -‐ 30% MALINGERING
§ INCONSISTENT RELATIONSHIP -‐ SEVERITY/ DISABILITY
§ NON-‐RESPONSE/ INCAPACITY UNTIL SETTLEMENT
§ 1:4 INCORRECT DIAGNOSIS OF MALINGERING
CLINICIAN RELUCTANCE
§ PEJORATIVE NATURE OF TERM
§ LITIGATION FEAR
§ CONCERNS ABOUT ERROR
§ RISK ISSUES
§ CULTURE
FORMS OF MALINGERING
§ PRODUCTION OF SYMPTOMS WHERE THERE AREN’T
§ INTENTIONAL EXAGGERATION OF SYMPTOMS
§ MISATTRIBUTION OF SYMPTOMS
DSM - 5
§ REMOVAL OF MULTIAXIAL SYSTEM
§ NEW CATEGORY OF STRESS RELATED DISORDERS
§ CHANGES TO DEPRESSION CRITERIA
§ CHANGES TO PTSD CRITERIA
CLINICAL DETECTION
§ SIMILAR TO A CLINICAL SYNDROME
§ NO LITMUS TEST
§ CAN CO-EXIST WITH ILLNESS
§ REVIEW OF RECORDS VERY IMPORTANT
§ EXTENDED/ PROLONGED INTERVIEWS
FACTORS SUGG MALINGERING!
§ CIRCUMSTANCES
§ SYMPTOMS
§ EXAMINATION
§ OTHERS
FACTORS SUGG MALINGERING
CIRCUMSTANCES/ HISTORY
§ JOB DISSATISFACTION/ END OF EMPLOYMENT
§ ANTISOCIAL HISTORY/ HISTORY OF DISHONESTY
§ SUBSTANCE MISUSE
§ CHANGE IN DIAGNOSIS
FACTORS SUGG MALINGERING
SYMPTOMS
§ INCONGRUENCE WITH KNOWN HISTORY AND FACTS
§ INCONGRUENCE WITH JUXTAPOSITION
§ INCONGRUENCE WITH COURSE OF ILLNESS
§ CLAIM OF FUTURE DECOMPENSATION
FACTORS SUGG MALINGERING
INTERVIEW PRESENTATION
§ LACK OF COOPERATION, DISMISSIVE
§ MEDICAL JARGON/ KNOWLEDGE OF PI RATINGS
§ SPECIFIC MEMORY ISSUES
§ INCONSISTENCY IN EXAMINATION/ RISKS
FACTORS SUGG MALINGERING
OTHERS
§ SUDDEN CHANGES IN WORK CAPACITY
§ CAPACITY FOR SPECIFIC/NON-WORK ACTIVITY
§ NON-COMPLIANCE WITH TREATMENT
§ SURVEILLANCE
FACTORS AGAINST MALINGERING
§ PARTICIPATION IN AGGRESSIVE TREATMENT
§ PARTICIPATION IN AGGRESSIVE REHABILITATION
§ PRO/RETROSPECTIVE OBJECTIVE EVIDENCE
§ OBVIOUS LOSSES
§ SELF DEFEATING BEHAVIOUR/ SYMPTOMS
CASE 2
§ 48 YO MIDDLE-EASTERN LADY, RTA, DEPRESSION
§ SUPPORTIVE GP, DENIES PREVIOUS HISTORY
§ DOCUMENTATION - PSYCHOTIC, SUICIDAL
§ FAKED FOR HOUSING BENEFITS
TAKE HOME MESSAGES
§ SUFFERING EXISTS, AS DOES MALINGERING
§ THERE IS MORE TO PSYCHIATRIC EXAMINATIONS…
§ RIGHT QUESTIONS = RIGHT ANSWERS
§ BENEFIT OF DOUBT TO CLAIMANT
THANK YOU