Miller L
NeuroRehabilitation. 2001;16(2):109-22.
When patients present with syndromes we mistrust or misunderstand, clinician are often quick to make a determination of malingering. However, the use of malingering as a default diagnosis neglects a variety of clinical possibilities that may be relevant for treatment and forensic disposition. In neuropsychology, the growing use of a malingering diagnosis has recently been fueled by the increasingly adversarial nature of forensic brain injury litigation in which the goal is often less to provide an objective evaluation of cognition and personality as to brand all personal injury claimants as manipulative frauds. Less maliciously, but still disturbing, neuropsychologists whose knowledge base and clinical experience involves mainly the administration and scoring of psychometric tests may ignorantly, if innocently, overlook alternative diagnoses and syndromes that their education and training have ill-prepared them to recognize. And some patients do indeed malinger, and it is important to identify them, if only to spare legitimately injured claimants from being tarred with the same brush. This paper describes some of the syndromes that may present in clinical and forensic practice with brain-injured patients. It is to be considered a first step toward a practice model of neuropsychology that encourages the role of knowledge and clinical judgement in guiding the meaningful clinical interpretation of tests and measures.
当患者表现出我们不信任或误解的综合征时，临床医生往往会迅速判定为诈病。然而，将诈病作为默认诊断忽视了各种可能与治疗及法医处置相关的临床可能性。在神经心理学领域，法医脑损伤诉讼日益对抗性的性质推动了诈病诊断的更多使用，在这类诉讼中，目标往往并非对认知和人格进行客观评估，而是将所有个人伤害索赔者都打上操纵欺诈者的烙印。虽恶意较小但仍令人不安的是，一些知识基础和临床经验主要涉及心理测量测试的施测和评分的神经心理学家，可能会无知地（如果是无心的话）忽略他们的教育和培训使他们难以识别的其他诊断和综合征。而且有些患者确实在诈病，识别出他们很重要，这样做至少能避免让真正受伤的索赔者受到牵连。本文描述了一些在临床和法医实践中脑损伤患者可能出现的综合征。这应被视为迈向神经心理学实践模式的第一步，该模式鼓励知识和临床判断在指导对测试和测量进行有意义的临床解释中发挥作用。
