Clinical Decision Making in Response to Performance Validity Test Failure in a Psychiatric Setting

This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingeri...

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Bibliographic Details
Published in:Clinical neuropsychologist 2014-01, Vol.28 (4), p.633-652
Main Authors: Marcopulos, Bernice A., Caillouet, Beth A., Bailey, Christopher M., Tussey, Chriscelyn, Kent, Julie-Ann, Frederick, Richard
Format: Article
Language:English
Subjects:
Adult
Age Factors
Clinical decision making
Decision Making
Female
Forensic
Humans
Male
Malingering - diagnosis
Memory
Memory Disorders - diagnosis
Middle Aged
Motivation
Neuropsychological Tests
Performance validity testing
Psychiatry
Reproducibility of Results
Schizophrenia
Sex Factors
Test engagement
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Summary:This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingering (TOMM) pass/fail (355/81) and secondary gain present/absent (181/255) to examine pass rates associated with patient demographic, clinical and forensic status characteristics. Of the 81 failed PVTs, 48 had secondary gain defined as active criminal legal charges; 33 failed PVTs with no secondary gain. These individuals tended to be older, female, Caucasian, and civilly committed compared with the group with secondary gain who failed. From estimations of TOMM False Positive Rate and True Positive Rate we estimated base rates of neurocognitive malingering for our clinical population using the Test Validation Summary (TVS; Frederick & Bowden, 2009 ). Although PVT failure is clearly more common in a group with secondary gain (31%), there were a number of false positives (11%). Clinical ratings of patients without gain who failed suggested cognitive deficits, behavioral issues, and inattention. Low scores on PVTs in the absence of secondary gain provide useful information on test engagement and can inform clinical decisions about testing.
ISSN:1385-4046
1744-4144
DOI:10.1080/13854046.2014.896416