Malingered psychosis

Abstract

When forensic psychiatry was developed in the nineteenth century, the detection of malingered psychosis was a central concern. A number of clinical methods were established to facilitate this. However, during the twentieth century interest in the topic waned, apparently due to the erroneous assumption that malingerers fake symptoms to ward off impending psychosis. In the UK, the subject has remained largely ignored. However, in the 1980s there was a resurgence of interest in malingering in the USA among forensic psychiatrists, with the development of instruments that systematised the clinical observations first made during the preceding century. A parallel development in the USA was the development of specific tests designed to elicit evidence of feigned cognitive impairment, first used in head injury cases involving civil litigation. Despite the recognition in the nineteenth century that individuals who feigned psychosis also malingered cognitive impairment, few modern research studies have investigated the incidence of feigned cognitive impairment in those who malinger psychosis, or have applied the instruments designed to detect feigned cognitive deficits to research in this area. Although prevalence data are limited, the available studies indicate that malingered psychosis is not a rare condition, particularly in forensic populations. The authors suggest that the assessment of malingering in forensic settings should always be based on a range of recently developed instruments that evaluate cognitive as well as psychiatric symptoms.

Keywords:

• forensic
• malingering
• psychosis
• cognitive impairment