While the psychopathology of mental disorders during pregnancy and the postpartum period is a growing area of research, the prevalence and significance of catatonic symptoms has been relatively neglected. To address this gap in knowledge, a systematic review of articles on catatonia occurring during pregnancy and the postpartum period was conducted. PubMed, Excerpta Medica, (later EMBASE) databases were queried for articles published in English from their inception in 1966 and 1946, respectively to May 31. 2022 using the terms "catatonia", AND "perinatal", "puerperal", "postpartum", "antepartum" "lactation" "pregnancy" or "pregnancy-related", supplemented by a manual search of references. This review failed to identify any well-designed, prospective, or controlled studies addressing the subject of catatonia during pregnancy or the postpartum period; only one retrospective chart review, a single small case series, and twenty single case reports were found. The limited literature suggests that the clinical presentation and treatment response during pregnancy and after childbirth are similar to catatonia observed in other contexts. Catatonic signs and symptoms could affect physical and mental health, markedly compromising a mother's ability to take care of and bond with her infant. Further studies are needed to advance understanding of the role of catatonia in the pathogenesis, diagnosis and treatment of perinatal mental disorders.

The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

Background: There is a lack of data on the frequency and neuropsychological correlates of tinnitus in distinct clinical populations such as persons injured in high impact motor vehicle accidents (MVAs). Method: Tinnitus severity and frequency were analyzed statistically in de-identified data of 106 post-MVA patients (mean age=39.5, SD=13.1; 31 males and 75 females). Correlations of tinnitus to the patients’ scores on the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Brief Pain Inventory, Insomnia Severity Index, PTSD measure (PCL-5), and to ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire were evaluated. The patients were interviewed an average of 53.6weeks (SD=39.9) after their MVA; all continued to suffer from post-MVA symptoms requiring therapy. Results: Tinnitus was reported by 70 of the 106 post-MVA patients (66%). Slightly less than a half of the 70 rated their tinnitus as “frequent” or “persistent” and slightly more than a half as “occasional.” With respect to Rivermead and SNPSS items, the severity and frequency of tinnitus correlated significantly (at p<.01, 2-tailed) with oversensitivity to light, restlessness, word finding difficulty, hand tremor, stutter, and instances of reduced muscular control over hand or arm (rs ranging from .28 to .37). Tinnitus severity correlated also with tingling in the limbs (r=.31), and with impaired balance (r=.28). Tinnitus frequency correlated also with difficulty articulating words (r=.28). Tinnitus also significantly correlated with ratings of pain and of insomnia (rs ranging from .26 to .32), but not with variables such as PTSD, depression, or anxiety. Discussion and Conclusions: Tinnitus is correlated with some aspects of whiplash trauma and the post-concussion syndrome. However, the size of these relationships is rather weak.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD). Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers. Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview. Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.

Background:The symptom of double vision, known in ophthalmology as diplopia, is observed with various neurological conditions such as in multiple sclerosis, Parkinson's disease, and the post-concussion syndrome. Our study examines the correlates of diplopia in survivors of high impact motor vehicle accidents (MVAs).Method: Data on diplopia were available for 65 patients injured in MVAs (mean age of 38.1 years, SD=13.1;24 men, 41 women).All patients were assessed using the Rivermead Post-Concussion Symptoms Questionnaire, Immediate Concussion Symptoms scale, the Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, as well as selected items from the Brief Pain Inventory (ratings of worst, least, and of average pain) and from the Whiplash Disability Questionnaire (ratings of depression, anger, and anxiety).Results: Diplopia was reported by 27.7% of the patients.Ratings of diplopia correlated at a significant level (p<.05, 2-tailed) with the total Rivermead post-concussive score (r=.46) after the item "double vision" was removed from the Rivermead's total score, and also with the total score on the PMNS scale (r=.35).Diplopia also correlated significantly with Rivermead's post-concussive symptoms of blurred vision, oversensitivity to bright lights (photosensitivity), restlessness, dizziness, nausea, and problems with slow speed of thinking (the rs ranged from .30 to .57).With respect to individual items of the PMNS scale, diplopia correlated significantly to impaired balance, hand tremor, reduced control over hand or arm, and to some loss of bladder control (the rs ranged from .30 to .41).Discussion and Conclusions: Diplopia was reported by 27.7% of survivors of high impact MVAs and was correlated with various other post-concussive symptoms, especially blurred vision, photosensitivity, and impaired balance.

Background: In medical psychology, the Brief Pain Inventory (BPI) allows for a separate assessment of pain intensity (scales of worst, least, and average pain) and of daily functional limitations due to pain (impairments of mood, ability to walk, work, interpersonal relations, sleep, and enjoyment of life). The present study evaluates the convergent validity of BPI’s measure of such functional limitations by calculating its correlations to other relevant clinical measures of psychological impairments caused by motor vehicle accidents (MVAs). Method: De-identified archival data were available on 50 persons injured in MVAs (age 20 to 86 years, mean=42.1 years, SD=16.4; 23 males, 27 females). Their MVA occurred 11 to 280 weeks prior to psychological testing with the BPI (average time lapse 73.3 weeks, SD=53.8). All patients were still experiencing active post-MVA symptoms requiring medical attention and therapy. With respect to convergent validity, we examined Pearson correlations of the BPI to the Insomnia Severity Index (ISI), Rivermead Post-Concussion Symptoms Scale, Subjective Neuropsychological Symptoms Scale (SNPSS), and to measures of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results: Functional interference of pain with daily activities (sum of BPI Items 9B to 9G) correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.39), post-MVA subjective neuropsychological symptoms (r=0.45), insomnia scores (r=0.41), and ratings of depression (r=0.52), anger (r=0.46), and anxiety (r=0.44). When the sum of BPI ratings of worst, least, and average pain was added to the functional interference/limitations score, then this sum of 9 BPI items correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.36), post-MVA subjective neuropsychological symptoms (r=0.46), insomnia scores (r=0.37), and ratings of depression (r=0.53), anger (r=0.50), and anxiety (r=0.40). Discussion and Conclusion: The results lend support to convergent validity of the BPI when applied to persons injured in vehicular accidents.

Background: Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms. Method: De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.” Results and Discussion: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably, formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p>.05). Conclusion: The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Background:The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is used widely in clinical assessments.Its 16 items describe subjective neuropsychological symptoms.This study evaluates the criterion validity, convergent validity, and internal consistency of the RPQ in a sample of survivors of high impact motor vehicle accidents (MVAs).Method: De-identified data on 65 post-MVA patients (mean age 38.1 years, SD=13.1;24 men, 41 women) were available.Their data include scores on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Subjective Neuropsychological Symptoms Scale (SNPSS), Insomnia Severity Index (ISI), Whetstone's and Steiner's measures of post-MVA driving anxiety, and the PCL-5 measure of PTSD.The data also included ratings of the worst pain, least pain, and of average pain (Items 3, 4, and 5 of the Brief Pain Inventory) and ratings of depression, anger, and of anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire). Results:The patients' average RPQ score was 45.5 (SD=9.8)and that of the normal controls 8.3 (13.2): the effect size corresponds to point biserial coefficient of .84,thus indicating a very satisfactory criterion validity.The convergent validity is also satisfactory (r=.79 to the SNPSS).Cronbach alpha coefficient for the full 16 item RPQ was excellent (.97) and would not be improved by evaluating separately the first 3 RPQ items and the next 13 items. Discussion and Conclusions:We recommend that the RPQ be employed jointly with SNPSS in clinical assessments and research.The SNPSS includes important post-concussive symptoms missing in the RPQ as well as other subjective neuropsychological symptoms.

Background: The incidence of NMS is rare. Relative frequencies of symptoms that are most valuable in making a diagnosis of NMS can be assessed statistically only if a large sample of suspected NMS cases is available. Similarly, the relationship of such NMS symptoms to temperature (a cardinal symptom of NMS) can be meaningfully evaluated only by studying large samples. Method: De-identified archival data on 212 suspected NMS cases were obtained from professionals across the USA and Canada or were extracted from studies published in medical journals. We recorded the symptoms frequencies. The patients’ temperature ranged from 37.20C to 43.00C, with the mean at 39.50 (SD=1.3). All cases were caused by older first-generation antipsychotics (FGAs). We evaluated the frequencies of symptoms reported in these cases. These included symptoms in the realm of mental status, rigidity, and autonomic symptoms. We calculated the frequency of abnormal blood pressure, respiration and heart rate, symptoms such as Dysarthria, Dysphagia, Rigidity, Focal Dystonia, Waxy Flexibility, Myoclonus, Masked Facies, Bradykinesia, Akinesia, Cogwheeling, Stupor, Coma, Obtundation, Mutism, Decrease in Consciousness, Disorientation, Diaphoresis, Sialorrhea, and Seizures. We also calculated their correlations with temperature elevations, the most spectacular symptom of this dangerous syndrome. Results: The highest symptom frequencies (those > 10%) were found for Rigidity (91.0% of patients), Autonomic Instability (66.5%), Diaphoresis (45.8%), Mutism (34.4%), Tremor (31.6%), Stupor (20.3%), Confusion (15.6%), Incontinence (15.6%), Sialorrhea (14.6%), Coma (13.2%), and Dysphagia (11.3%). Other symptoms were too rare within the sample of the 212 suspected NMS cases to calculate the statistical significances of their relationships to temperature. The only significant correlations found of temperature were to increased heart rate and to the severe cases of coma. Discussion and Conclusion: Besides the elevated temperature, the most frequently reported symptoms in this sample of suspected NMS caused by FGAs were Rigidity, Autonomic Instability, Diaphoresis, Mutism, and Tremor. Higher temperature was associated with tachycardia as well as profound impairment of consciousness or coma. Reviews and database studies of second generation antipsychotics (SGAs), also referred to as atypical antipsychotics, suggest a lower incidence of NMS and milder severity of symptoms such as hyperthermia and rigidity. It would be of clinical interest to generate similar de-identified files of archival data for suspected cases of NMS in patients treated with SGAs. Furthermore, a similar profile derived from archival data on milder or prodromal NMS cases could enhance our understanding of this syndrome from a spectrum perspective.

Background: There is a need for scales for standardized assessments of subjective neuropsychological symptoms reported by diverse patient populations such as injured motorists, patients with multiple sclerosis, very severe anorexia, and neurotoxin exposure.This article introduces the Subjective Neuropsychological Symptoms Scale (SNPSS) and describes its validation on a sample of persons injured in high-speed motor vehicle accidents (MVAs).The SNPSS consists of post-concussion items not included in the Rivermead Post-Concussion Symptoms Questionnaire (that is, e.g., tinnitus, impaired balance, word finding difficulty), items to assess motor symptoms (e.g., hand tremor), and symptoms frequently observed in patients with spinal injury or deterioration (tingling, numbness, or reduced feeling in the limbs).Method: De-identified file data of 141 post-MVA patients (49 men, 92 women, average age 39.4 years, SD=13.0)included their responses to the SNPSS, the Rivermead Post-Concussion Symptoms Questionnaire, Insomnia Severity Index, the PCL-5 measure of PTSD according to DSM5,the ratings of worst, least, and average pain on the Brief Pain Inventory and ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire.The patients' responses to the SNPSS and the Rivermead were compared to those of a sample of 23 normal controls (11 men, 12 women, average age 45.0 years, SD=21.2).Results: Average SNPSS score of patients (20.3 points, SD=11.3) was significantly higher than of normal controls (average of 2.5 points, SD=4.8): the magnitude of this relationship (r=.51, p<.001) indicates satisfactory criterion validity of the SNPSS on post-MVA patients.With respect to convergent validity, the SNPSS correlated significantly (r=.79, p<.001) with the Rivermead scores.The SNPSS also correlated significantly with clinical variables often associated with neurological trauma in injured motorists: pain (r=.37), insomnia (r=.45), and PTSD (r=.56).Cronbach alpha coefficient of the SNPSS is very satisfactory (.90). Discussion and Conclusions: Criterion and convergent validity data of SNPSS on injured motorists in thisstudy are satisfactory.Validation data from populations other than injured motorists are much needed, e.g., survey data from patient groups with neurological disease such as multiple sclerosis or those accidentally exposed to neurotoxins.

Background: Case studies have shown that some persons develop an acute cauda equina syndrome from injuries to perispinal tissues and/or vertebral fractures in motor vehicle accidents (MVAs).It is of neuropsychological interest to examine if persistent subjective symptoms of injury to the area of cauda equina are present, in milder forms, even in post-MVA patients who have not sustained documented vertebral fractures, when such patients are interviewed many months after their accident.This study presents statistical data on a 5 item screening scale to measure such subjective persistent symptoms of cauda equina syndrome.This scale may be used by family physicians or by specialized medical psychologists to determine if a referral to a neurologist is warranted and necessary.Method: Archival de-identified data on 67 Canadian patients in the Toronto area (mean age 38.8, SD=11.7; 25 men and 42 women) who survived serious MVAs were evaluated for the presence of the following 5 symptoms: (1) pathological tingling extending over the gluteus, between the legs or on upper thighs, and over lower abdomen, (2) numbness extending over the gluteus, between the legs or on upper thighs, and over lower abdomen, (3) reduced control over leg muscles, (4) impaired control over the urinary bladder, and ( 5) impaired bowel control. Results:Frequencies of reports of moderate or severe symptoms involving these 5 items were as follows: reduced control over legs by 25.4% of patients, impaired bladder control by 18.0% of patients, tingling in lower body or legs by 16.5% of patients, impaired bowel control by 14.9% of patients, and numbness in lower body or legs by 9.0% of the patients.This 5 item scale has a satisfactory internal consistency (Cronbach's alpha = .77)and item-total correlations.This screening scale for cauda equina syndrome has satisfactory convergent validity as shown by its significant correlations, in our sample of patients, to other subjectively reported whiplash symptoms (r=.69) and also by significant positive correlations to various ratings of pain (rs of .33 to.42), insomnia (r=.43), post-concussive symptoms as operationalized by Rivermead scores (r=.40),PTSD as measured via and depression (r=.33).A Brief Rating Scale of Subjective Persistent Symptoms of the Cauda Equina Syndrome for Family Physicians or Medical Psychologists

Background:The Miller Forensic Assessment of Symptoms Test (M-FAST) [1] was originally developed for detection of malingering of psychiatric symptoms in forensic settings, but it is now used frequently on other clinical groups such as post-accident patients or war veterans, to assess malingering of non-psychiatric medical symptoms, i.e., on patient groups and on symptoms for which the M-FAST was not validated in accordance with standards of the American Psychological Association (APA). Method:The M-Fast consists only of 25 items.We undertook a systematic review of all 25 items to evaluate their content validity, i.e., congruence with the intended goal to differentiate malingerers from legitimate patients. Results: With respect to detection of malingering of psychiatric symptoms, the M-FAST items list many legitimate psychiatric symptoms that are (rather perplexingly) scored as indicators of malingering. A few examples are as follows: auditory hallucinations ("voices") associated with autonomic signs of anxiety (Item 18) or with fear of leaving the room or home during such episodes (Item 22), hallucinations lasting for days (Item 6), and olfactory hallucinations (phantosmia) (Item 17), adverse changes of mood while suspecting to be plotted against (Item 3), a belief to have special powers with respect to sensory perception (Item 13), and delusional parasitosis (Item 20). An M-FAST item refers to "feeling depressed most of the time" (Item 2) and is also scored as indicator of malingering. With respect to detection of malingering of medical symptoms in survivors of motor vehicle accidents (MVA), examples of unduly contaminated item content include: depressed feelings (Item 2), tinnitus triggered or exacerbated over the duration of stressful interview (Item 25), intense nightmares that occur concurrently with weight loss (Item 12), neurological symptom of formication (Item 20), phantosmia (Item 17), and fluctuation of symptoms as if someone is "turning them on and off …" (Item 14).Discussion and Conclusions: More than a half of M-FAST items have content that can be legitimately endorsed by psychiatric patients, or those injured in MVAs, or by injured war veterans, but in the M-FAST, these items are erroneously scored as indicators of malingering.This can lead to high rates of false positives, e.g., 33% to 63% in the 2017 study by Weiss and Rosenfeld.

Background: Oculomotor dysfunction (OMD) is observed in perhaps 10% to 30% of motorists injured in high impact car accidents.A screening tool for signs of OMD is needed to facilitate systematic evaluations of such patients for potential referral to neuro-ophthalmologists for rehabilitation. Method:A perusal of neuro-opthalmological case reports and OMD literature led to the development of a 15 item scale.This Oculomotor Scale was administered to 29 survivors of high impact motor vehicle accidents (MVAs) who complained about OMD signs and to 30 normal controls.The patients' scores were also available on the Rivermead measure of the post-concussion syndrome, the Post-MVA Neurological Symptoms (PMNS) scale, the Insomnia Severity Index, and ratings of pain, depression, and anxiety.p<.001) and to the PMNS measure of post-accident neuropsychological symptoms (r=.65, p<.001). Results: Criterion validity of the Oculomotor Scale is demonstrated by its very satisfactory capacity to differentiate the patients reporting OMD signs from the normal controls (point biserial coefficient =.87, p<.001). Convergent validity of the scale is shown by its significant and large correlations to Discussion and Conclusions:The Oculomotor Scale has not been designed for independent diagnosing of oculomotor dysfunction (OMD): it is intended only as a brief screening scale for family physicians or medical psychologists, in order to facilitate a referral for the thorough professional assessment by specialized rehabilitative neuro-ophthalmologists.Hopefully, the availability of this screening scale would increase the number of referrals of such patients with post-accident oculomotor dysfunction for beneficial specialized assessment and therapies by rehabilitative neuro-ophthalmologists.

Background: Psychologists contracted and remunerated by car insurance companies to evaluate the insurance claims of injured motorists work under the implied pressure to rule out malingering.This study evaluates their use of psychological tests. Method: 43 psychological reports were examined with respect to their use of evidently fallacious measures of malingering such as the Structured Inventory of Malingered Symptomatology (SIMS), Miller Forensic Assessment of Symptoms Test (M-FAST), Modified Somatic Perception Questionnaire (MSPQ), and also Paul Green's Medical Symptom Validity Tests (MSVTs), i.e., of tests never properly validated to assess malingering in injured motorists.Results and Discussion: About a half (48.9%) of the 43 psychological reports relied on the SIMS, M-FAST, or MSPQ.An additional 4 reports (9.3%) listed the test of malingering only generically as a Symptom Validity Test (SVT), but the descriptive paragraphs about its results strongly suggested that it was the SIMS.Unknown to the insurance psychologists, all 43 patients were carefully pre-screened by another agency via the Gutierrez questionnaire that assesses the presence of the typical polytraumatic psychological symptom pattern after vehicular accidents, i.e., persistent pain, pain-related insomnia, post-concussion syndrome, PTSD, depression, generalized anxiety, driving anxiety, and subjective psychological signs of spinal injury such as tingling, numbness, or reduced feeling in the limbs: all 43 reported symptoms in at least half of these symptom areas.The insurance contracted psychologists typically neglected to properly assess such typical post-accident symptoms, but declared about two-thirds of the patients (67.4%) as free of accident related psychological impairments.This rejection rate of patients' claims seems higher than reasonably assumed rates of malingering. Conclusions:The SIMS, M-FAST, and MSPQ were used in about a half of 43 psychological reports contracted by car insurance companies: these are fallacious tests in which legitimate psychological symptoms are scored falsely as indicators of malingering.

Background: Analog validation of malingering tests was evoked by Smith and Burger in 1997 as a method they used to "validate" their Structured Inventory of Malingered Symptomatology (SIMS). Their procedure consists in comparing students instructed to respond honestly with those instructed to feign medical symptoms. The procedure was adopted by others, notably by Holly Miller for the development of her Miller Forensic Assessment of Symptoms Test (M-FAST). Since both the SIMS and M-FAST consist of legitimate medical symptoms incorrectly scored as indicators of malingering, the analog validation could also be used on other known lists of legitimate medical symptoms, such as the Beck Depression Inventory-II (BDI-2).Method: 20 adults (mean age 47.9 years, SD=16.5) were instructed to respond twice to the BDI-2, at first by responding honestly and then while feigning or simulating "very severe depression." Results:The mean score was 6.5 (SD=7.6)for the honest responses and 52.2 (SD=6.2) for feigned or simulated depression.There was no overlap in the distribution of these two sets of scores.In our sample, any cutoff from 30 to 40 points would result in statistics of 100% sensitivity, 100% specificity, and 100% efficiency.The cutoff of 14 or more points (Beck's lower end of the category of mild depression) would result in 100% sensitivity, 85% specificity, and 92.5% efficiency. Discussion and Conclusion:Our easily replicable study demonstrates methodological shortcomings of analog validations.Malingering tests validated in such a fatally flawed manner, in particular the SIMS and the M-FAST, may adequately differentiate reporters from non-reporters of medical symptoms, but not legitimate patients from malingerers.

Although the incidence of tardive dyskinesia is expected to decline with increasing use of atypical antipsychotic drugs, the risk in susceptible patients, the continued use of older conventional antipsychotics, and the legacy of thousands of patients who previously acquired dyskinesias, underscore the relevance of this potentially irreversible adverse drug reaction. Considerable evidence has accumulated concerning the epidemiology, clinical presentation, pathogenesis and management of tardive dyskinesia. Better understanding of the condition is important not only for clinical practice, but also in elucidating the interaction between antipsychotic drugs and dyskinetic vulnerability associated with schizophrenia and ageing.

Background and Objective:The Structured Inventory of Malingered Symptomatology (SIMS) is used widely to "detect malingering" of medical symptoms, even though there is no convincing evidence that it does differentiate malingerers from patients with legitimate symptoms.This study focuses on the Affective Disorder (AF) subscale of the SIMS. Method:In Study 1, ten raters (3 psychologists and 7 psychiatrists), each with more than 35 years of clinical experience, evaluated whether the AF items have any capacity to differentiate malingerers from legitimate patients.Study 2 evaluated responses to AF items by 16 survivors of high impact car accidents (6 men and 10 women; mean age 36.6 years, SD=12.3).Study 3 compared responses of these 16 patients to SIMS responses of 30 instructed malingerers and also to 47 medical patients who sustained only relatively minor injuries in car accidents (data from a 2014 study led by Capilla Ramírez with González Ordi).Results: All ten raters agreed that none of the AF items would be endorsed only by malingerers: on the contrary, all AF items list only legitimate symptoms of depression.The most frequently endorsed items by our 16 postaccident patients were those dealing with lack of energy (100% of the patients) and sleep problems (93.8%).87.5% of these 16 patients who survived high impact car collisions would be falsely classified by the AF as "malingering an affective disorder."These 16 patients obtained significantly higher AF scores and higher total SIMS score than the 47 Spanish patients who sustained only relatively minor injuries in their car accidents (t-tests, p<.001).The 16 patients did not differ significantly in their AF and total SIMS scores from the instructed malingerers recruited in the Spanish study (p>.05). Discussion and Conclusions:The AF subscale of the SIMS contains no items with reasonable capacity to differentiate malingerers from legitimate patients.The SIMS is a fallacious test: its use on real patients is iatrogenic.