Raffard Stéphane, Capdevielle Delphine, Boulenger Jean-Philippe, Gely-Nargeot Marie-Christine, Bayard Sophie
a Laboratory Epsylon , University Montpellier 3 , EA 4425, Boulevard Henri IV, Montpellier , France.
Cogn Neuropsychiatry. 2014;19(5):414-26. doi: 10.1080/13546805.2014.896251. Epub 2014 Mar 21.
Neuropsychological tests are increasingly applied in research studies and clinical practice in psychiatry. In this context, the detection of poor effort is crucial to adequately interpret data. We measured schizophrenia patients' performance on a memory test designed to detect excessive malingering (the "21-Item Test"), before examining whether a second group of schizophrenia patients would excessively malinger on this test when given an incentive to feign memory impairment.
Two independent studies including respectively 49 schizophrenia patients and 100 controls (study 1) and 25 schizophrenia patients and 25 controls (study 2) were conducted. In study 1, participants were asked to complete the 21-Item Test to the best of their ability. In study 2, participants were given a hypothetical scenario in which having a memory impairment would be financially advantageous for them, before completing the 21-Item Test.
In study 1, no participant scored at levels indicative of excessive malingering. In study 2, 84% of controls but only 36% of patients scored at excessive levels of malingering, and these patients had higher executive functioning than patients who did not excessively malinger, although it should be noted that a significantly greater proportion of patients excessively malingered in study 2 compared to study 1.
These results indicate that schizophrenia patients do not normally feign excessive memory impairment during psychological testing. Furthermore, they are less able and/or less inclined to excessively malinger than controls in situations where a memory impairment would be advantageous, perhaps indicating a better ability to malinger without detection. Potential clinical implications are discussed.
神经心理学测试在精神病学的研究和临床实践中应用越来越广泛。在此背景下，检测测试时不够投入对于准确解释数据至关重要。我们测量了精神分裂症患者在一项旨在检测过度伪装（“21项测试”）的记忆测试中的表现，然后考察另一组精神分裂症患者在被给予伪装记忆损害的诱因时是否会在该测试中过度伪装。
进行了两项独立研究，第一项研究包括49名精神分裂症患者和100名对照者（研究1），第二项研究包括25名精神分裂症患者和25名对照者（研究2）。在研究1中，要求参与者尽其所能完成21项测试。在研究2中，在完成21项测试之前，给参与者一个假设情景，即记忆损害对他们在经济上有利。
在研究1中，没有参与者的得分达到表明过度伪装的水平。在研究2中，84%的对照者但只有36%的患者得分达到过度伪装的水平，并且这些患者的执行功能高于未过度伪装的患者，不过应该注意的是，与研究1相比，研究2中过度伪装的患者比例显著更高。
这些结果表明，精神分裂症患者在心理测试中通常不会伪装过度记忆损害。此外，在记忆损害有利的情况下，他们比对照者更没有能力和/或更不愿意过度伪装，这可能表明他们有更好的伪装而不被发现的能力。文中讨论了潜在的临床意义。
