MALINGERING

1. MALINGERING Dr. Zakarias Poerba, MSi STIK-PTIK

2. Malingering • An individual fakes an incapacity in order to avoid a responsibility. • Malingering is diagnosed when the conversion like symptoms are under voluntary control (Davison, et al., 2004) Kepalsuan atau rekayasa yang dibuat individu yang bertujuan untuk menghindari tanggung jawab. Malingerer di diagnosa sebagai hasil gejala yang sengaja di kontrol/dikuasai oleh si pelaku

3. Malingering • Is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. Adanya rekaan dan rekayasa palsu dan berlebihan terhadap gejala fisik maupun psikis, di dorong oleh insentif ekternal (seperti dapatkan uang), menghindari pekerjaan, memperoleh kompensasi keuangan (keringanan akan beban pengeluaran), mengurangi masa tahanan atau untuk mendapatkan OBAT (bagi drug abuser)

4. 3 Types • The Pathogenic • The Criminological • The Adaptational

5. The Pathogenic • People who motivated by underlying pathology • Genuinely disturbed • The voluntary production of bogus symptoms will eventually erode and be replaced by a genuine disorder • Memang sudah menjadi patologis atau GANGGUAN • Seseorang yang dimotivasi karena (juga) sudah ada patologi

6. The Criminological • People with an antisocial / oppositional motivation • Feign mental disorders to obtain outcomes they do not deserve • Dilakukan oleh pelaku kriminal , berperilaku seakan2 mengalami GANGGUAN MENTAL • Biasa individu memiliki kecenderungan perilaku ANTI-SOSIAL (MELANGGAR HUKUM)  PSIKOPAT untuk menghindari hukuman-hukuman

7. The Adaptational • The person who makes “a constructive attempt, at least from the feigner’s perspective, to succeed in highly adversarial circumstances” Disesuaikan dengan situasi dan merancang  belum tentu masuk jadi gangguan (seperti Pathogenic), jadi bersifat SITUASIONAL

8. Variety of Claims • Claims of Amnesia • Claims of Injuries & disabilities • Psychosis & Deception

9. Malingering & Criminal Justice System • Competency to stand trial (CST) assessments: 60,000 referrals in US / year • Base rates of malingering estimated from 8% to 17.4% • Surveys of psychiatrists / psychologists working in forensic settings: report malingering in 16-18% patient population Cornell DG, Hawk GL: Law & Human Behavior (1989) Rogers R, et al: Law & Human Behavior (1998) Rogers R: Clinical Assessment of Malingering & Deception (2nd Ed. 1997)

10. Psychosis & Deception • Targets of Faked Psychosis • Targets Examples • 1. Behavior Bizarre motor behavior • Audible self-talk • 2. Somatic Internal body changes • Physical disease processes • 3. Sensation Vivid hallucinations • Strange illusions • 4. Imagery Terrifying nightmares • Uncontrollable flashbacks • 5. Affect Immobilizing fear • Suicidal depression • 6. Cognition Delusions of persecution, • grandiosity; looseness of thought • 7. Interpersonal Inability to respond: mutism • Sexually inappropriate questions

11. Malingering should be strongly suspected if any combination of the following is noted: • Medicolegal context of presentation (e.g the person is referred by an attorney to the clinician for examination) • Marked discrepancy between the person’s claimed stress or disability and the objective findings • Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen • The presence of Anti social Personality Disorder • Individu yang dapatdideteksijika: • Adanyacatatanmedis yang dirujukolehpengacaranyasendiri • Periksakesenjangan/diskrepansiantarastres yang diKELUHkandengantemuandilapangan (dapatbertanyapadasaksi/org2 sekitar) • Kurangnyakoordinasiselamaevaluasidiagnosa, apakahadabedaantarakeluhan, diagnosadan treatment yang disarankan • Munculnyakepribadian Anti sosial (orang2 yang cenderungmelawan, melangggar)  ceklagipada Type Criminological

12. malingering • In contrast, malingering are likely to be more guarded and cautious, perhaps because they consider interviews a challenge or threat to the success of lie. • Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. • Malingerer cenderung lebih berhati-hati karena mereka mengetahui bahwa mereka dinilai saat di wawancara atau bahkan di tes • Sering memunculkan rekayasa gangguan fisik dan psikis secara berlebihan

13. Malingering & Jail Inmates • Potential motives for malingering in jail population may include: • Avoid or delay legal proceedings with a “mental defense” (insanity, incompetent to stand trial) • Obtain(memperoleh) a preferred housing change (i.e. psych ward, hospital unit) • Evidence to obtain SSI benefits after release • Obtain psychotropic medications (sedation=pemberian obat/drugs)

14. Malingering • Individuals may be stimulated to fake mental illness at several points in the criminal justice process, including determining competency to stand trial, pleading not guilty by reason of insanity, and attempting to influence the sentence (Wrightsman & Fulero, 2005) Strategi Malingerer supaya dapat simpati publik. Mengkreasi sejumlah statement sehingga memengaruhi emosi publik.

15. Detecting Malingering • Healthcare providing • the medical records contain evidence of over-treatment for minor problems. • Malingerers are usually not willing to undergo extensive painful diagnostic testing, treatment or surgery. • Deteksi : • Fasilitas kesehatan yang dirujuk langsung • Simak atau baca baik2 rekam medis nya, gangguannya sedikit tapi minta treatment/pelayanan yang berlebihan • Biasanya Malingerer tidak mau untuk tes, operasi

16. Malingering: Assessment Resnick PJ. Psychiatr Clin North Am (1999) • Collateral behavioral observations (nursing, custody) • Clinical interview, malingered “voices”: • Continuous rather than intermittent • Vague, inaudible • Not associated with delusions or thought disorder • No strategies to cope with “voices” • Claim that all instructions are obeyed Intermittent  sebentar-sebentarVague - samar-samar, tidak jelas Inaudible  tidak terdengar jelas No 4  tidak bisa didiagnosa kl ternyata calon tersangka memiliki gangguan wicara/pendengaran No 5  protes kl harus turuti perintah terus2an Kl bicara sering terus menerus, kurang jelas makna nya

17. Malingering Assessment:Miller Forensic Assessment of Symptoms (M-FAST) • “The times when you can’t go to sleep, do you often smell strange odors that are not really there?” • “When I hear voices, my hands begin to sweat” • “Often, I get the strange feeling that I am from another planet” • “On many days I feel so bad that I can’t even remember my full name”

18. MalingeringSummary • There should be strong suspicion for malingering in forensic settings • Malingering for psychotropic medications is a growing problem for jails • Assessment of malingering should involve collateral(tambahan) observations and records • Consider the adjunctuse of validated screens (M-FAST) and tests (SIRS) • Need better exchange of clinical information between forensic settings (i.e., jails and state hospitals)

19. “Trans-Institutionalization”(Criminalization of the Mentally Ill) Source: US Dept. of Health Human Services & Dept of Justice statistics

20. Malingering Assessment:Structured Interview of Reported Symptoms (SIRS): Sample questions: • “Do you become fearful of soft household objects for no real reasons?”

21. Most NGRI Patients are Schizophrenic(Rogers & Shuman, 2000)