主动脉夹层法医学伤病关系35例案例回顾分析

目的 通过案例分析不同原因导致的主动脉夹层(aortic dissection, AD)特征，为AD的法医学鉴定案例提供鉴定思路。方法 收集35例AD的法医学鉴定案例(包括32例死亡鉴定，3例法医临床鉴定),对被鉴定人的外伤史、年龄、性别、发病经过、医疗过程、尸体解剖、病理检验等进行分类分析。结果 35例AD案件中患者平均年龄为47岁，男性居多(32例);涉及外伤的案件13例，其中交通事故最多(8例);被鉴定人首发症状主要为胸痛或呼吸困难(18例),余依次为腹痛或呕吐(8例)、头晕或头痛(3例)、意识丧失(4例)、腰痛或下肢不适(2例);97%(31例)的被鉴定人在急性期死亡；27例合并高血压或心脏肥大，24例合并动脉粥样硬化症。结论 法医鉴定创伤性AD案件时应进行伤病关系分析，先检查被鉴定人的自身基础疾病，再评估外伤的作用力，最后考虑医疗等中介因素对死亡或损伤的影响。     

精神医学鉴定中社会能力评估的意义与方法

在精神医学鉴定中,经常涉及到对被鉴定人的能力损伤及其程度的评估问题.社会能力是反映个体能力水平高低的重要因素之一.各种原因所导致的智力损伤可能没有达到智力缺陷的程度,但社会功能却有明显受损.因此,在评估能力损伤时不仅要评定个体的智力商数,还应该评估其社会能力,并对个体损伤前后的智力和社会能力进行对比分析.目前,我国尚无公认的能客观反映损伤前后社会能力的评估工具.本文复习了社会能力的概念、内涵、评估的意义和现有的方法,并提出了社会能力评估中尚存在的困难和研究趋势.     

68例精神损伤司法精神病学鉴定分析

目的调查司法精神病学鉴定中精神损伤赔偿案例的特点，并对与其相关的医疗终结期、精神障碍的伤残等级等问题进行探讨。方法调查近四年半内鉴定的案例中精神损伤赔偿的案例，依鉴定报告内容逐项进行调查。结果精神损伤赔偿案例占全部调喳案例的-18．28％（68／372）；男：女=1：4．67；文化程度在初中（含初中）以下者占76．47％（52／68）；诊断分类中以癔症居首位，占58．82％（40／68）；诱发因素中以殴打居多，占70．59％（48／68）；直接要求鉴定医疗终结期、精神障碍程度或伤残等级者共12例（占17．65％）。结论精神损伤的评定工作较复杂，尚需制定统一的行业评定标准。     

患精神病后,还有工作能力吗?

近年来,我国市场经济劳动制度不断完善,精神卫生知识逐渐普及,在用人单位和劳动者之间发生劳动争议案例中,涉及对疑似精神异常的当事人作精神疾病司法鉴定的情况逐年增多。这类情况比较特殊,它关系到精神病人作为劳动争议当事人的合法权益。2002年4月5日,我国劳动和社会保障部制定了《职工非因工伤残或因病丧失劳动能力程度鉴定标准(试行)》,其中包括精神病人劳动能力方面的内容。     

损伤导致精神损伤程度评定标准研究

损伤可致躯体伤残 ,也可致精神的伤残 [1 ]。损伤导致精神障碍损伤程度即精神损伤程度的评定结果 ,不仅涉及到损伤赔偿问题 ,有的还涉及到刑事责任 [1 ] 。颅脑损伤的严重程度与所致精神损伤的程度密切相关。严重的颅脑外伤 ,不管易感素质如何 ,均可引起昏迷或意识障碍 ,但颅脑外伤后的后遗症状 ,以及后遗症状持续时间的长短 ,却与个体素质有关[2 ,3 ] 。在评定精神损伤严重程度时 ,应当把颅脑损伤严重程度与社会功能和精神活动能力下降的程度结合起来 ,作为评定精神损伤程度的依据。鉴于目前尚无严谨的适用于我国法律的心理测验方法 ,为了…     

常德地区精神与智力残疾鉴定情况分析

目的了解精神残疾和智力残疾情况.方法对近3年的所有精神与智力残疾鉴定病例进行调查分析.结果与遗传有关的残疾占90.1%.精神发育迟滞和精神分裂症是致残的主要原因,占80.3%.结论遗传病问题在精神与智力残疾中尤其突出,其预防更为重要.     

肌电图在司法鉴定中的应用(续) 第七章 鉴别和对付诈伤的方法及案例

正在众多的待鉴定的被检者中,不可否认有相当一部分被检者为了减轻法律责任,或加大对方的法律责任,或者因为经济利益的驱使,想通过司法程序得到更多的经济赔偿或减免法律的处罚,这类人经常有诈伤现象发生。司法鉴定肌电图的检查分析中对伤残的真实性要准确地报告,科学、严谨地检查,同时要加以甄别是否有诈伤现象,以求对当事的双方客观、公正,也是维护法律的尊严。这就要求检查的医生某种程度上不仅当一名诊断的医生,还要当一     

不该发生的凶杀案

抑郁症是以显著而持久的情绪低落为主要特征的、伴有相应认知和行为改变的精神障碍,间歇期精神状态基本正常,往往有复发倾向,预后一般较好。但是通过长期追踪发现自杀死亡者占抑郁症患者的15％左右,构成所有自杀者中的1/2—2/3。而且抑郁症患者实施攻击、伤人甚至杀人行为的案例,在司法精神鉴定工作中也不少见。由于这类患者“不打不闹”,常常不引起周围人的重视,或被看作神经衰弱。直到案件发生,人们才后悔莫及。     

脑外伤后伤残鉴定患者二项必选数字记忆测验应用结果分析

目的 :研究二项必选数字记忆测验 (二项测验 )鉴别伪装智力低下的实证效度。方法 :用二项测验对一年内脑外伤伤残鉴定的患者进行测查 ,并与经验性评定结果、瑞文标准推理测验成绩以及最终评残等级进行比较。全部病例均在深圳市医务劳动鉴定委员会鉴定终结后予以回访。结果 :(1)二项测验总分判定伪装率为 78.1% ,与经验性评定的伪装率 (43.8% )相比 ,提高伪装识别率 34.3%。 (2 )经验性评定的“有伪装”、“无伪装”和“不确定”的三组人数比率差异无显著性 ,其中 ,16例“不确定”者 ,均被二项测验判定为“有伪装” ,占 2 5 % (16 / 6 4 )。 (3)回访 6 4例智力评残者中 ,仅 1例 (1.6 % )被鉴定委员提出异议。结论 :二项必选数字记忆测验是鉴别伪装智力低下的有效评定工具 ,尤其对经验性评定难以定论的伪装有良好的识别作用     

7例正常妇女被强奸后精神障碍分析

妇女被强奸因精神障碍而提请司法精神医学鉴定有两种情况,一是原患有精神疾病妇女,因丧失性防卫能力遭强奸、国内对这类案例报告颇多;二是精神正常妇女被强奸后出现精神障碍,对此报告甚少。本文对7例第二类案例与被奸后未发生精神障碍的     

The effects of coaching on the sensitivity and specificity of malingering measures.

This study sought to identify patterns of performance indicative of malingering on the Auditory Verbal Learning Test (AVLT). Participants were randomly assigned to perform normally, simulate head injury, or simulate head injury with warning that there might be attempts to detect malingering. Participants completed an expanded AVLT and a forced-choice task, in addition to several other memory tests. The warned simulators performed worse than normals on the forced-choice task, but better than those simulating head injury without a warning, suggesting that the warned subjects recognized forced choice as a malingering test. A combination of AVLT indices was able to predict group status for both nai;ve and warned malingerers (73.6% for nai;ve malingerers, 84.8% for warned, no false positives). The forced-choice measure detected only 31.6% of the nai;ve malingerers when specificity was maximized, and detected only 6.5% of the warned malingerers, a significant drop in detection rate. Findings suggest that pattern of performance indices are useful in detecting malingering, even when subjects are aware of attempts to detect malingering.     

Malingering and Defensiveness in the Neuropsychological Assessment of Mild Traumatic Brain Injury

A balanced approach to the detection of malingering and defensiveness in the neuropsychological assessment of mild traumatic brain injury (MTBI) is suggested, while genuine neurobehavioral and psychopathological sequelae are documented. The absence of neuroradio-loglcal evidence and heavy reliance on patient report and neuropsychological test data make malingering and defensiveness issues that are critical in forensic contexts and for the credibility of neuropsychology. Deficiencies in interview data collection and the relative strengths and weaknesses of the MMPI (Minnesota Muttiphasic Personality Inventory) are reviewed. The potential independence of malingering and defensiveness and of MMPI and neuropsychological data are noted. The equivocal research on malingering is reviewed, with particular emphasis on assessment of memory deficits as one of the most common complaints in MTBI. Arguably, malingering is more similar to than different from other diagnoses, but it has not been so treated in clinical practice. The need for developing sophisticated malingering probes is acknowledged, but the quest for a single malingering test is criticized and preference given to approaches that rely on evaluating data patterns indicating malingering.     

Detection and diagnosis of malingering in electrical injury.

This paper sought to demonstrate that diagnosable malingering does occur in Electrical Injury (EI) and examine the relationship of malingering to potential indicators of the presence and severity of neurological injury. Eleven consecutive EI patients seen for neuropsychological evaluation were presented. Over half the patients met the Slick et al. (1999) criteria for at least Probable MND. Most of the MND patients lacked evidence of a biologically meaningful exposure to electrical current. These findings highlight the importance of considering biological markers of neurological injury and of non-neurological factors, including effort/malingering, in the study of the neurocognitive consequences of EI.     

Cross-validation of indicators of malingering: a comparison of nine neuropsychological tests, four tests of malingering, and behavioral observations.

Few studies to date have cross-validated indicators of malingering that have been suggested on various neuropsychological tests. This study presents data cross-validating several indicators of malingering on neuropsychological tests, as well as on tests of malingering and via behavioral observations. It incorporates methodological recommendations by Rogers [Researching dissimulation. In: R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 309-327). New York: Guilford Press.] resulting in an ecologically valid design utilizing college students with a history of mild head injury as analog malingerers. Results indicated that the Letter Memory Test (LMT) and the Digit Memory Test (DMT) attained the highest hit rates for the detection of malingering, while the sensitivity of many other measures declined on cross-validation.     

Exploration of malingering indices in the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span subtest

Prior research shows that Digit Span is a useful embedded measure of malingering. However, the Wechsler Adult Intelligence Scale-IV (Wechsler, 2008) altered Digit Span in meaningful ways, necessitating another look at Digit Span as an embedded measure of malingering. Using a simulated malingerer design, we examined the predictive accuracy of existing Digit Span validity indices and explored whether patterns of performance utilizing the new version would provide additional evidence for malingering. Undergraduates with a history of mild head injury performed with best effort or simulated impaired cognition and were also compared with a large sample of non-head-injured controls. Previously established cutoffs for the age-corrected scaled score and Reliable Digit Span (RDS) performed similarly in the present samples. Patterns of RDS length using all three subscales of the new scale were different in malingerers when compared with both head-injured and non-head-injured controls. Two potential alternative RDS scores were introduced, which showed better sensitivity than the traditional RDS, while retaining specificity to malingering.     

Discriminating between simulated malingering and closed head injury on the Wechsler memory scale-revised

We tested the hypothesis that malingering is distinguished by poorer performance on recognition relative to recall tasks by evaluating the ability of discriminant functions to distinguish between 89 subjects simulating malingering and 44 subjects with a history of closed head injury (CHI) on the Wechsler Memory Scale - Revised (WMS-R). Functions with good accuracy in discriminating between simulated malingerers and controls in prior studies did not have adequate specificity when applied to the CHI group. A newly derived discriminant function achieved overall classification accuracy of 79% for the malingering versus CHI groups on cross-validation, with 79% sensitivity (true positives for malingering) and 80% specificity (true negatives for closed head injured). A complex performance pattern on seven WMS-R subtests distinguished malingering subjects from those with CHI, but did not support the recognition versus recall hypothesis. The malingering pattern involved: (a) power performance on two relatively (but inconspicuously) easy tasks dependent on immediate recall (Visual Reproduction I and Visual Memory Span); (b) better performance on two relatively (but inconspicuously) easy tasks dependent on immediate recall (Visual Paired Associates I and Digit Span); (c) poorer performance on two relatively difficult delayed tasks (Logical Memory II and Visual Paired Associates II); and (d) better performance on another difficult task involving delayed recall (Visual Reproduction II).     

认知伪装甄别测验的编制和信效度分析

目的：编制一套甄别认知伪装的心理测验，并检验它的信效度。方法：按照Rogers提出的伪装甄别策略，编制了两个迫选式再认分测验一数字迫选测验和图符迫选测验，每个分测验含30个条目。264名正常人、33名脑损害病人和125名可疑伪装的鉴定者完成认知伪装甄别测验．其中303名被试接受华文认知能力量表测试、297名被试接受多维记忆评估量表测试。结果：数字迫选测验和阿符迫选测验的重测相关系数分别为0．603和0．571。数字迫选测验的信度系数在0．749—0．888之间，图符迫选测验的信度系数在0．753—0．872之间，全量表的信度系数为0．843—0．936。认知伪装甄别测验成绩与华文认知能力量表和多维记忆评估量表各分测验分数有显著性相关，相关值在0．308—0．608之间。正常人不同年龄组的测验成绩有明显的差异，正常组、脑损害病人组和鉴定组的测验成绩和成绩曲线有明显的不同。结论：认知伪装甄别测验具有较好的信度和效度．可以作为认知伪装的甄别工具。     

Detecting neuropsychological malingering: effects of coaching and information.

Concerns that patients presenting for neuropsychological assessment may not be putting forth maximum effort during testing has prompted the development of measures designed to detect malingering and incomplete effort. Two of these measures are the Computerized Assessment of Response Bias-97 (CARB-97) and Word Memory Test (WMT). Despite widespread use of these instruments, no study has been published determining the vulnerability of neuropsychological malingering measures to explicit coaching or brain injury information. The present study, using analog participants, found that the CARB-97 and WMT differentiate "normal" from "malingered" instructional sets, and show little difference between nai;ve and coached malingering efforts. There was also little difference between providing brain injury information and a no-information condition, but when effects were present, the information group generally scored worse. Further, it was found that response times (RTs), in addition to items correct, may also be effective in detecting those who are not giving their full effort.     

Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample.

The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.     

Intraindividual variability as an indicator of malingering in head injury.

The utility of various measures of malingering was evaluated using an analog design in which half the participants (composed of three groups: naive healthy people, professionals working with head-injured people, individuals who suffered a head injury but not currently in litigation) were asked to try their best and the remainder was asked to feign believable injury. Participants were assessed with the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT) on three separate occasions in order to determine whether repeat administration of tests improves prediction. The results indicated that regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering.