Postnatal depression - a review of the research

A review of studies into postnatal depression has found that the most recent estimate of its prevalence in new mothers is 13%. Mothers' experiences of the condition included feelings of loneliness, anxiety, hopelessness and a loss of control at a time when they expected to feel joy and happiness. Research on treatment options showed limited success with antidepressants and slightly more success with psychotherapy. As important as anything in terms of making a recovery was mothers' network of social support from friends and families.

Leahy-Warren, Patricia and McCarthy, Geraldine - Postnatal depression : prevalence, mothers' perspectives, and treatments Archives of Psychiatric Nursing April 2007, 21(2), 91-100

Helping patients back into the community

The Transitional Discharge Model was first developed in Canada by the Bridge to Discharge Project. The pilot study took place in 1993 on a long-term ward at Hamilton Psychiatric Hospital in Ontario. It was aimed at helping people move back into the community and is based on maintaining relationships while people settle back into the outside world. These relationships include both staff and service user involvement. Hospital inpatient staff continue to remain involved with the client until a therapeutic relationship is established with a community care team and peer support is provided by a former service user who has been successfully re-integrated into the community. A review of studies on the model has found that it allows more people to be discharged from hospital, leads to lower readmission rates and saves money.

Forchuk, Cheryl ... [et al] - Transitional discharge based on therapeutic relationships : state of the art Archives of Psychiatric Nursing April 2007, 21(2), 80-86

Eating disorders and OCD

Many studies have shown a link between eating disorders and obsessive-compulsive disorder (OCD). People with eating disorders are more likely to have OCD than the rest of the population and people with OCD are more likely to develop eating disorders than other people. Some researchers have even gone so far as to suggest that eating disorders should be regarded as a sub-group of OCD. A study of 2,971 female eating disorder inpatients compared those with OCD to those without and found that those with OCD suffered more severe eating disorder symptoms. However, in both the short and medium term both groups responded equally well to treatment.

Cumella, Edward J., Kally, Zina and Wall, A. David - Treatment responses of inpatient eating disorder women with and without co-occuring obsessive-compulsive disorder Eating Disorder March-April 2007, 15(2), 111-124

Self-determination, self-control and eating disorders

Self-determination is the ability to define one's own goals in life, to decide how to achieve them and to begin the process of change for one's own sake rather than to please other people. Self-determination is associated with enhanced learning, greater interest, more persistence, better performance, higher self-esteem, increased life satisfacion and enhanced health. It could also help protect young women against social pressures relating to body image and the endorsement of damaging ideas about thinness and obesity which in turn could lead to them going on to develop eating disorders. A study of 447 students in Ottawa found that women's general level of self-determination was linked to an autonomous regulation of eating behaviours (i.e. the young women felt in control of their eating) and made people less likely to restrict what they ate or enter into a cycle of dieting and bingeing.

Pelletier, Luc G. and Dion, Stephanie C. - An examination of general and specific motivational mechanisms for the relations between body dissatisfaction and eating behaviors Journal of Social and Clinical Psychology March 2007, 26(3), 303-333

At work but not up to it

Many studies have shown that an unfavourable psychological or social environment can increase the incidence of absenteeism. However, presenteeism (where people remain at work even when affected by a mental or physical illness) has been shown to be more costly than absenteeism. A study of 3,825 employees of a government organization in Canada found that workers went to work in spite of illness 50% of the time. Those workers who were ill most often were more likely to come into work when they were feeling unwell. Heavier workloads, skill discretion (the opportunity to learn and develop new skills), harmonious relationships with colleagues, role conflict and a precarious job position all increased presenteeism but the ability (or lack thereof) to take decisions didn't. Those workers who were experiencing high levels of psychological distress and more severe psychosomatic complaints were also more prone to presenteeism.

Biron, Caroline ... [et al] - At work but ill : psychosocial work environment and well-being determinants of presenteeism propensity Journal of Public Mental Health December 2006, 5(4), 26-37

When patients turn to stalkers

Stalking involves recurrent and persistent unwanted communication or contact that generates fear for safety in the victims. Stalking of health professionals has been defined as 'patients making unwanted communications or contacts repeatedly (on more than ten occasions) and persistently (for more than four weeks) such that the behaviour produced some anxiety'. Stalking activities can include loitering, following, making approaches, giving unwanted gifts, engaging in unwanted communication and damaging property. The effects of stalking can include increased anxiety and depression and intrusive recollections and flashbacks. A survey of New Zealand mental-health clinicians has found that women were more likely than men to have been stalked and were more frightened by the experience. Less than half of the stalkers were clients ; the rest were former partners, colleagues or acquaintances. In client-related cases the majority of respondents told their colleagues or supervisors first and the majority found them to be the most helpful resource.

Hughes, Frances A., Thom, Katey and Dixon, Robyn - Nature and prevalence of stalking among New Zealand mental health clinicians Journal of Psychosocial Nursing and Mental Health Services April 2007, 45(4), 33-39

Clozapine reduces violence but with side effects

Clozapine is an antipsychotic drug which can often be effective in treating schizophrenia where other drugs have failed. A UK study of patients admitted to a low-secure psychiatric unit compared their levels of violence before and after they were prescribed clozapine. The researchers found that the number of violent incidents per month was reduced by 75%. Before their drug treatment there was an average of 1.22 violent incidents per patient per month whereas after treatment this had fallen to 0.26 incidents. However great care needs to be taken in monitoring patients who are prescribed the drug as it has been known to cause a fatal reduction in white blood cells and heart problems.

Beer, M. Dominic, Khan, Al Aditya and Ratnajothy, Kalaanithi - The effect of clozapine on adverse incidents in a low-secure challenging behaviour unit Journal of Psychiatric Intensive Care December 2006, 2(2), 65-70

Intensive therapy gets results for bipolar disorder

Bipolar disorder is an extremely debilitating condition mostly because of the difficulty in treating the depressive phase of the illness. Drugs have only a limited effect so recently attention has switched to psychological treatments. A U.S. study of 293 patients compared different kinds of intensive psychotherapy (weekly and twice weekly for up to 30 session in a 9-month period) with collaborative care where patients were given 3 sessions of therapy in 6 weeks to see what was most effective. The study found that about a third of patients dropped out of collaborative care and the intensive psychotherapy but that those patients who received intensive psychotherapy were more likely to have recovered by the end of the year, recovered more quickly and were 1.58 times more likely to be well at any given time in the study than those in collaborative care. Three types of intensive psychotherapy were examined - family-focused therapy, interpersonal and social rhythym therapy and cognitive behaviour therapy - but there was little difference in the effectiveness of these approaches. The researchers concluded that future studies needed to look at balancing the extra cost of intensive therapy against its increased effectiveness in dealing with the condition.

Miklowitz, David J. ... [et al] - Psychosocial treatments for bipolar depression Archives of General Psychiatry April 2007, 64(4), 419-427

Twin studies confirm brain differences in schizophrenia patients

Schizophrenia is known to be associated with subtle changes in brain anatomy. Postmortem studies have shown that the brain as a whole is smaller in people who have suffered from schizophrenia with less grey matter in the medial, temporal and frontal lobes, the cerebellum and the thalamus. A British study looked at pairs of twins. Some twins both suffered from schizophrenia, in other pairs one twin had the disease and the other did not and some pairs were both well. The researchers gave all the twins MRI scans and looked at the thalamus and the area of brains cells linking the two halves of the thalamus called the adhesion interthalamica. The study found that schizophrenia was linked to a reduction in the size of the thalamus although the adhesion interthalamica was not affected. This led the researchers to conclude that a smaller thalamus could be a good indicator of the genetic link to schizophrenia.

Ettinger, Ulrich ... [et al] - Magnetic resonance imaging of the thalamus and adhesio interthalamica in twins with schizophrenia Archives of General Psychiatry April 2007, 64(4), 401-409

Bipolar disorder and genes

Like many other psychological conditions there is thought to be a genetic element which can predispose people to developing bipolar disorder. People who suffer with bipolar disorder often have difficulties with their thought processes including impairments in verbal learning and memory, poor decision making and short attention spans. A Finnish study of 127 people looked at people suffering with bipolar disorder, their close relatives without the condition and a control group to see whether the relatives of bipolar disorder sufferers also had problems with their thought processes. If the relatives also had cognitive problems these could be caused by the same genes which led to people developing bipolar disorder and could be an important clue in helping researchers isolate the genes responsible for the condition. The study found that both the bipolar sufferers and their relatives had poor coordination and decision making (in psychological tests rather than major life decisions) although only the bipolar patients suffered from poor verbal learning and memory. The researchers concluded that poor coordination and decision making were the most important clues to a genetic link between bipolar patients and their relatives.

Antila, Mervi ... [et al] - Cognitive functioning in patients with familial bipolar I disorder and their unaffected relatives Psychological Medicine May 2007 37(5), 679-687

Eating disorders, puberty and genes

Anorexia nervosa and bulimia often begin during puberty or shortly afterwards. Significant increases in disordered eating have been found during puberty with girls becoming more preoccupied about their weight, more dissatisfied with their bodies and more likely to binge eat. One theory is that the physical changes which occur during puberty, specifically an increase in body fat, lead to girls becoming more dissatisfied with their bodies. Recent studies have also shown that there is a genetic influence on this process and a study of 510 twins in Minnesota has found that the further into puberty the girls were the more influence genetic factors had on their eating behaviour. The researchers concluded that although social and psychological factors remained important the genetic element to eating disorders should also be taken into account.

Klump, Kelly L. ... [et al] - Puberty moderates genetic influences on disordered eating Psychological Medicine May 2007, 37(5), 627-634

Suicide on the way down

Suicide has fallen to its lowest ever level according to new Government figures. The rate fell from 9.2 deaths per 100,000 people in 1995-7 to 8.5 deaths per 100,000 people in 2003-5. There were falls in the Government's main target groups of young men, mental health in-patients and prisoners.

Happy marriages, healthy people

Being married is associated with better physical and psychological health than being either single or separated. However, marital distress has proved to be an important risk factor for people's mental and physical health. This could be because the physical stress created when couples are unhappy can damage health and affect the immune system. Given the high divorce rate in the UK there is a high chance that marital distress could be making a significant contribution to ill health and mental illness. There are a number of programmes aimed at preventing marital problems and these have been shown to be effective in improving couples relationships but there has been no research into how this affects peoples' health. A Swiss trial of 118 couples divided them into two groups with half of the couples receiving marital therapy - aimed at improving their coping strategies, communication skills and problem-solving abilities - and the other couples forming a control group for comparison purposes. By the end of the study those who were receiving marital therapy were psychologically healthier and the women were happier with their lives. But there was no difference in physical health between the two groups.

Pihet, Sandrine ... [et al] - Can prevention of marital distress improve well-being? A 1 year longitudinal study Clinical Psychology and Psychotherapy March-April 2007, 14(2), 79-88

CBT for bulimia

Between 4-7% of young women in Western countries suffer from full or partial bulimia which typically develops in adolescence. If untreated bulimia can persist into adulthood creating other physical and mental health problems and placing a huge burden on families. Strangely no randomized controlled trials (the most rigorous form of research) have been conducted on adolescents with bulimia until a British study in this month's American Journal of Psychiatry which compared family therapy with cognitive behaviour therapy (CBT)/guided self care. Although both treatments were equally effective after a year the CBT led to a quicker improvement after six months and was cheaper and more acceptable to the girls.

Schmidt, Ulrike ... [et al] - A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders American Journal of Psychiatry April 2007, 164(4), 591-598

Bipolar disorder in adolescence - recovery, recurrence and risk factors

Bipolar disorder usually occurs for the first time in adolescence but there have been relatively few long-term studies into how children diagnosed with bipolar disorder get on in the future and what the risk factors are which can lead to their condition re-occuring. A study of 71 teenagers in the U.S. found that the chances of having syndromal (some but not all of the symptoms clearing up), symptomatic (all of the symptoms clearing up but not being able to return to 'normal' life) and functional (a complete return to 'normal' life) recovery were 86%, 43% and 41% respectively. Only 35% of the teenagers complied fully with their drug treatments over the course of the study. Factors which made a relapse more likely were also having Attention Deficit Hyperactivity Disorder (ADHD) or an anxiety disorder, disruptive behaviour, not taking one's medication and being from a 'lower' socioeconomic class. Drinking and not receiving psychotherapy were also associated with a higher rate of relapse. Boys were more than twice as likely as girls to make a symptomatic recovery.

DelBollo, Melissa P. ... [et al] - Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode American Journal of Psychiatry April 2007, 164(4), 582-590

Schizophrenia in children and adolescents

Schizophrenia is usually diagnosed in late adolescence or early adulthood but there are forms of the illness which occur in childhood (before 12) and adolescence (between 12 and 18). Such early-onset schizophrenia can be particularly debilitating and severe. There has been little research into the effectiveness of antipsychotic drugs for treating schizophrenia in such young age groups but a U.S. study of 16 children found that 12 of them, treated with olanzapine for 10 weeks showed significant improvements by the end of the trial. The children did gain quite a bit of weight (which is also a side effect in adults) and on average put on a stone. Two of the children also experienced other side effects from the drugs.

Quintana, Humberto ... [et al] - An open-label study of olanzapine in children and adolescents with schizophrenia Journal of Psychiatric Practice March 2007, 13(2), 86-96

Depot treatments for bipolar disorder

Bipolar disorder has a very high rate of relapse and without drugs 90% of people relapse within 18 months following a manic episode with 70% relapsing after a depressive episode. Even with medication 70% of people relapse within five years. One of the main reasons behind this high relapse rate is that people stop taking their medication - nonadherence. Other patients take some but not all of their medication - partial adherence. Antipsychotic drugs are often used in conjunction with mood stabilizers and these can be given in a 'depot' format which releases the drugs slowly into the system over a period of time and can be administered via a pill, which breaks down slowly, or an injection. This means that people can either receive or take their medication less frequently which helps them to stick to their treatment regime. A review of studies into long-acting antipsychotic drugs for bipolar disorder has found that several trials have shown that depot antispsychotics are effective in reducing relapse in bipolar disorder and that further controlled trials are needed into their effectiveness.

El-Mallakh, Rif S. - Medication adherence and the use of long-acting antipsychotics in bipolar disorder Journal of Psychiatric Practice March 2007, 13(2), 79-85

Psychologists' childhoods : who becomes helpers and why ?

People can go into a career in psychology for many reasons ; altruism, the pursuit of personal growth and satisfaction and a wish for vocational achievement. It has also been suggested that people go into psychology to resolve personal distress, to fulfil needs for closeness and intimacy that were not met in childhood or to continue with a role in which they - rather than their parents - were the caretakers within the family ('parentification'). A study of 166 students in London found that those who wanted to become clinical psychologists did have higher rates of perceived childhood sexual abuse and neglect compared to other psychology students and business studies' students and they also reported more 'parentification' experiences between the ages of 14 and 16 than business students. However those students who wanted to become clinical psychologists were no more likely than other students to be suffering from mental health problems in the present.

Nikcevic, Ana V., Kramolisova-Advani, Jana and Spada, Marcantonio M. - Early childhood experiences and current emotional distress : what do they tell us about aspiring psychologists. Journal of Psychology January 2007, 141(1), 25-34

The pain in Spain falls mostly on the straying

Evolutionary psychology looks to trace the roots of human behaviour in our past evolution. So, for example, a preference for rich and sweet foods reflects a time when food was scarce and calories needed to be found wherever and whenever possible while our phobias of snakes and spiders go back to times when we lived in close proximity to dangerous creatures. Now, a study of 266 Spanish students has confirmed earlier theories about how the sexes' reactions to infidelity reflects evolutionary pressures. The researchers found that women were more distressed by emotional infidelity whereas men were more distressed by physical infidelity. This confirms earlier theories that women look for emotional commitment (to raising their children) in men while men look for biological commitment so that they know the child they are helping to raise is theirs.

Fernandez, Ana Maria ... [et al] - Distress in response to emotional and sexual infidelity : evidence of evolved gender differences in Spanish students Journal of Psychology January 2007, 14(1), 17-24

CBT and hearing voices

Most people with schizophrenia hear voices, even when they are sticking to their medication. Many of them report voices that are abusive, critical and out of touch with reality. People who are troubled by hearing voices often have a history of paranoia, abuse and suicidal thoughts and can become violent. Cognitive therapy for people who hear voices aims not at eliminating the voices but at reducing their perceived power to distress or harm and reducing the motivation of those who hear voices to 'buy into' or appease them. A trial on 65 patients in Canada found that those who were given 12, 90-minute sessions of cognitive therapy by nurses on top of their usual treatment showed significant improvements in their symptoms and self-esteem up to a year after the end of the study.

England, Margaret - Efficacy of cognitive nursing intervention for voice hearing Perspectives in Psychiatric Care April 2007, 43(2), 69-76

Memory and anxiety in childhood

Studies have shown a link between memory deficits and a variety of adult anxiety disorders. People with obsessive-compulsive disorder often have visual memory deficits while there is also a link between suffering from visual and verbal memory problems and social phobia, panic disorder and post-traumatic stress disorder. However, there has been little research into the links between memory problems and psychological ones in childhood. A study of 160 children and young people between the ages of 9 and 20 in the U.S. found that those children with social phobia had reduced visual but not verbal memory but that there was no other link between childhood anxiety disorders and poor memory. The researchers thought that the link between poor visual memory and social anxiety could be due either to differences in the part of the brain which governs memory or to the fact that socially-anxious children were so worried about the tests that they were being administered that this had an effect on their performance.

Vasa, Roma A. ...[et al] - Memory deficits in children with and at risk for anxiety disorders Depression and Anxiety 24(2), 2007, 85-94

Early treatment may halt memory loss

Mild cognitive impairment (MCI) - becoming forgetful and absent-minded - is often a feature of old age and can become a precursor to Alzheimer's disease. Some - though by no means all - studies have shown that cognitive training (games, practice and strategies to improve memory) and a class of drugs called cholesterinase inhibitors can help people with mild cognitive impairment and a recent study of 59 people with MCI in Italy has added a bit more weight to the case for these treatments. Subjects were divided into three groups. One group received no treatment, another just cholesterinase inhibitors and the third group received cholesterinase inhibitors and cognitive training. After a year those people who received no treatment were about the same. Those people who received cholesterinase inhibitors alone were less depressed but the group who received cholesterinase inhibitors and cognitive training showed improved memories, greater powers of reasoning and less symptoms of depression.

Rozzini, Luca ... [et al] - Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholesterinase inhibitors International Journal of Geriatric Psychiatry April 2007, 22(4), 356-360

Dementia and cause of death

A study into the causes of death of people with dementia has found that cachexia (loss of weight, muscle atrophy, fatigue, weakness and anorexia(a significant loss of appetite - not anorexia nervosa) ) and dehydration were the most common entries on death certificates (35.2%). Cardiovascular disorders accounted for 20.9% of deaths and acute pulmonary diseases made up 20.1%. The further advanced people's dementia was the more likely they were to die of cachexia or dehydration.

Koopmans, Raymond T.C.M., van der Sterren, Karin J.M.A. and van der Steen, Jenny T. - The 'natural' endpoint of dementia : death from cachexia or dehydration following palliative care International Journal of Geriatric Psychiatry April 2007, 22(4), 350-355

Panic, perception and psychotherapy

Behavioural treatment of agoraphobia - usually by a controlled exposure to the outside world - is one of the best-researched and most effective interventions in psychotherapy. However, even here, roughly one in three patients do not show any signs of improvement. Recent research in psychotherapy has drawn attention to the significance of the relationship between the therapist and their patient and in particular the working, or therapeutic alliance, i.e. both patient and therapist working together to solve the patient's problem(s). A study of 59 patients in Stockholm looked into patients' and therapists' perceptions of each other and what effect, if any, this had on the outcome of their treatment for agoraphobia. The researchers found that there was initially a low correspondence between therapists' and patients' perceptions of each other although their perceptions of each other grew closer as treatment went on. The clients' perceptions of their therapists showed virtually no link with the outcomes of their treatment whereas the therapists' ratings of their clients 'active participation' and 'goal direction' were linked to the outcomes of the treatment. There was no significant relationship between the quality of the working alliance and the outcome of the treatment at the time of the treatment although a year after the end of the treatment those patients who had had a good quality relationship with their therapists did better than those who had a less good relationship.

Ramnero, Jonas and Ost, Lars-Goran - Therapists' and clients' perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia Psychotherapy Research May 2007, 17(3), 320-328

Aripiprazole and agitation

Acute agitation is common in patients with bipolar disorder and usually occurs during the manic phase of the illness. It is characterized by physical destructiveness, threatening gestures, verbal abuse and threatening language. To calm patients down quickly before they hurt themselves or others they are often given injections of tranquilisers or antipsychotic drugs directly into their muscles. A trial of intramuscular injections of the newest antipsychotic drug - aripiprazole - was carried out on 301 patients in the U.S. Researchers compared different doses of aripiprazole to a benzodiazepine (lorazepam) and a placebo. Both lorazepam and aripiprazole were more effective than the placebo and both drugs were as effective as each other with the most effective dose of aripiprazole being 9.75 mg.

Zimbroff, Dan L. ... [et al] - Management of acute agitation in patients with bipolar disorder Journal of Clinical Psychopharmacology April 2007, 27(2), 171-176

Queries over fluoxetine for PTSD

Post-traumatic stress disorder (PTSD) occurs after an individual has been exposed to a traumatic event. Symptoms of PTSD include flashbacks, nightmares and intrusive thoughts, avoidance of anything that reminds people of the original trauma and anxiety and jumpiness. A number of trials of selective serotonin reuptake inhibitors (SSRIs) have shown that these can be effective in treating PTSD but in recent years several studies have been published with ambiguous or even negative results and some negative trials remain unpublished. Now a new study of 411 patients in the U.S. has also found no significant difference between fluoxetine (an SSRI more familiarly known as Prozac) and a placebo.

Martenyi, Ferenc, Brown, Eileen B. and Caldwell, Catherine D. - Failed efficacy of fluoxetine in the treatment of posttraumatic stress disorder Journal of Clinical Psychopharmacology April 2007, 27(2), 166-170

Drugs, depression and CBT

Many people with alcohol and/or substance abuse problems also suffer from depression. Unfortunately people who suffer from depression have poorer treatment outcomes whether the treatment targets their drug/alcohol problems or their depression. Integrated treatments - which address both the depression and the drug abuse at the same time - may be more effective but little research has been done on this so far. A U.S. study of 66 people compared the effectiveness of an integrated Cognitive Behaviour Therapy (ICBT) programme to a 12-step programme similar to that used by Alcoholics Anonymous. The researchers found both ICBT and 12-step effective at the time of treatment but depression increased again in 12-step patients six months after treatment. At the time of treatment 12-step produced a greater decline in drug use but after six months those in the ICBT group were faring better.

Brown, Sandra A. ... [et al] - Integrated cognitive behavioural therapy versus twelve-step facilitation therapy for substance-dependent adults with depressive disorders Journal of Psychoactive Drugs December 2006, 38(4), 449-460

Avoidance and coordination

Avoidant personality disorder is an extreme form of shyness characterised by marked social anxiety and an avoidance of social activities. Reduced childhood and adolescent athletic achievement is often remembered as a feature of shy people's childhoods. One explanation is that shyness stops children taking part in sports, however, it could also be the case that children with poor coordination withdraw from play situations in order to prevent failure and bad coordination in childhood has been associated with anxiety and withdrawal in adolescence. A third possibility is that both the poor coordination and the social anxiety are caused by a common neurological problem yet to be discovered. A study of 150 11-12 year-old children in Norway found that avoidant personality traits were associated with motor impairment and that children who fulfilled the criteria for avoidant personality disorder showed a significantly poorer motor performance than other children with half of them scoring in the bottom 5% of the population.

Kristensen, Hanne and Torgersen, Svenn - The association between avoidant personality traits and motor impairment in a population-based sample of 11-12-year-old children Journal of Personality Disorders 21(1), 87-97

Group therapy for panic disorder

Panic disorder is the most common anxiety disorder affecting between 2 and 6% of the population. Drug treatment has proved effective for many users but there are problems with people's fear of taking drugs, non-compliance, side effects, high-drop out rates and relapses once people stop taking their medication. Cognitive behaviour therapy has shown promise in treating this condition but can be expensive. Group therapy is more cost effective as several patients can be seen at once but there has been little research into how effective group therapy is for this condition. A trial on 76 patients in Italy gave patients 14 weekly 2-hour group sessions of CBT. At the end of the treatment patients had improved significantly and these improvements were still there six months after the treatment had finished.

Galassi, Ferdinando ... [et al] - Cognitive-Behavioral Group Treatment for Panic Disorder with Agoraphobia Journal of Clinical Psychology April 2007, 63(4), 409-416

Test for malingerers sorts the sheep from the goats

Malingering is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. In a criminal-justice setting this can include fabricating psychiatric symptoms, exaggerating the extent of psychiatric symptoms and feigning mental disability. In a survey of forensic psychologists the prevalence of malingering was estimated at 17.4%. One test aimed at screening out malingerers is the Test of Memory Malingering which is designed to appear much more difficult than it actually is. Those who are not malingering score highly but those who are deliberately trying to score a low mark get a suspiciously low result. A recent trial on 21 mildly-retarded forensic patients in the U.S. has found that even people with a learning disability score more highly on the test than those who are deliberately trying to get a low score in an attempt to feign mental disability.

Simon, Michael J. - Performance of mentally retarded forensic patients on the Test of Memory Malingering Journal of Clinical Psychology April 2007, 339-344