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Validation of a rational malingering test using evoked potentials.

Paul Zarkowski1, Brian Esparza, Joan Russo

  • 1Department of Psychiatry & Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. pzark@u.washington.edu

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|October 4, 2007
PubMed
Summary

Detecting malingering in patients with psychotic symptoms is challenging. The Structured Interview of Reported Symptoms (SIRS) showed validity using evoked potentials, differentiating malingering from genuine symptoms.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Psychometrics

Background:

  • Malingering, the feigning of illness, presents a significant challenge in healthcare systems due to its difficulty in detection.
  • The Structured Interview of Reported Symptoms (SIRS) was developed using rational strategies to aid in identifying malingering among individuals reporting psychotic symptoms.

Purpose of the Study:

  • To validate the Structured Interview of Reported Symptoms (SIRS) in detecting malingering in patients with psychotic symptoms.
  • To assess the SIRS's validity using objective neurophysiological measures (evoked potentials).

Main Methods:

  • Nineteen patients diagnosed with schizophrenia and 15 healthy controls underwent auditory evoked potential testing (oddball and paired click protocols).
  • Symptom severity was assessed using the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS).

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  • Participants were categorized based on their probability of malingering as determined by the SIRS.

    • Main Results:

    • Patients with a high probability of malingering, as indicated by the SIRS, exhibited significantly greater P3 amplitude compared to those with a low probability (P = 0.006).
    • Individuals with a high probability of malingering also demonstrated significantly more P50 suppression than those with a low probability (P = 0.044).
    • No significant differences in P3 amplitude or P50 suppression were observed between patients with a high probability of malingering and healthy controls.

    Conclusions:

    • The findings provide empirical support for the validity of the SIRS as a tool for detecting malingering in patients with psychotic symptoms.
    • Evoked potential measures (P3 amplitude and P50 suppression) offer objective evidence supporting the SIRS's ability to differentiate malingering, independent of self-report.