McMennemin, J.; (2005) Malingered cognitive symptoms in severe mental illness. Doctoral thesis , University of London.

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Abstract

Part I of this thesis comprises a review paper which will contextualise the empirical paper that forms Part II of the thesis. Section A of the literature review offers the reader an introduction to the often-misunderstood phenomenon of malingering. Although avoided by psychologists perhaps due to its seeming incompatibility with the establishment of a therapeutic alliance (Rogers, 1997), the case for the importance of research into improving malingering detection methods is presented. The reader is then orientated to the contemporary understanding of malingering as an elected means of adaptation to circumstance, and this adaptational perspective is used to elaborate on what and how individuals might malinger. Whilst thinking about malingering might be interesting of itself, the aim of any malingering research must be to improve upon the accuracy of classification and detection methods. Section B of the review paper provides the reader with a summary of the development of methodologies and strategies used in the clinical assessment of malingering. This is presented with reference to the theoretical account of the malingering construct elucidated in Section A. Detection methods used in malingered mental illness and malingered cognitive impairment are presented independently, and the distinct domains in which these assessments tend to focus is emphasised. Specifically, individuals suspected of malingering mental illness are assessed predominantly in the psychiatric (not cognitive) domain, and although corroborative evidence of malingering on cognitive tests is routinely sought in order to augment classification accuracy, no cognitive tests have been developed specifically to assess malingered mental illness. This constitutes a gap in the research literature since feigning on tests of cognition among persons malingering mental illness has been repeatedly evidenced (e.g. Boone et al., 2002). Advances in the literature on malingered cognitive impairment (in the context of traumatic brain-injury) are presented and considered then, in the context of developing bespoke cognitive instruments for the assessment of malingered cognitive symptoms in the context of mental illness. Part II of this thesis constitutes the empirical study that was designed and executed in the aim of investigating the utility and validity of a test battery designed to assess malingered cognitive symptoms in severe mental illness. A three-group "fully controlled" simulation study is described, in which psychiatric inpatients, simulating malingerers and healthy controls (total n = 105), were administered a multi-method malingered cognitive symptoms test battery, comprising interview- and performance-based tasks. Established malingering tests were also administered in order that simulated malingering could be externally validated, and also so that classification according to the cognitive battery, could be compared with that according to 'gold standard' instruments. Tests of true ability and pathology were administered in order to explore the potential confound of true mental illness with malingering measures, and also so that the true symptom status of simulating malingerers could be quantified. Results demonstrate a high degree of precision of discrimination between simulating malingerers and their genuine counterparts on the basis of composite scores on the cognitive symptoms battery. Results also show that composite scores on the cognitive symptoms battery are not correlated with true pathology in genuine patients, estimated IQ and level of educational attainment. Part in of this thesis constitutes the critical review section in which qualitative information pertaining to the execution processes of the study is discussed. This information pertains mainly to the engagement of acutely mentally ill patients in this research, and also includes personal reflections on conducting a study entailing simulation.

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