Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria.

Covert video recordings of life-threatening child abuse — lessons for child protection

OBJECTIVE
Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed.


METHODS
We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: <or=14 years, 15 to 18 years, or as an adult (>or=19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use.


RESULTS
Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use.


CONCLUSIONS
The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.

Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study

Despite affecting millions of families around the world, parental alienation has been largely unacknowledged or denied by legal and health professionals as a form of family violence. This complex form of aggression entails a parental figure engaging in the long-term use of a variety of aggressive behaviors to harm the relationship between their child and another parental figure, and/or to hurt the other parental figure directly because of their relationship with their child. Like other forms of family violence, parental alienation has serious and negative consequences for family members, yet victims are often blamed for their experience. In order to be recognized as a form of family violence and to secure protection for victims under law and social policies, a formal review and comparison of parental alienating behaviors and outcomes to child abuse and intimate partner violence has been sorely needed. The result of this review highlights how the societal denial of parental alienation has been like the historical social and political denial or other forms of abuse in many parts of the world (e.g., child abuse a century ago). Reframing parental alienating behaviors as a form of family violence also serves as a desperate call to action for social scientists to focus more theoretical and empirical attention to this topic. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Parental alienating behaviors: An unacknowledged form of family violence.

The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases

INTRODUCTION Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification They may deceive plastic surgeons into performing multiple unnecessary procedures We undertook the first systematic review of FD case reports in plastic surgery Our aims were 2-fold: (1) describe the adverse outcomes associated with these cases and (2) identify strategies for their prevention by surgeons METHODS MEDLINE, EMBASE, and SCOPUS databases were searched We included cases in which an adult with FD presented to a plastic surgeon Our search returned a total of 42 eligible cases reported from North America (43%), Europe (37%), and Asia (20%) RESULTS Seventy-six percent of patients were women, and 62% worked in health care Sixty percent had a comorbid psychiatric disorder, the most common (50%) being depression Ninety-three percent of our sample presented with self-induced lesions The average delay in diagnosis of FD was 54 months, with 46% of patients receiving multiple surgical procedures in this time, including debridement (36%) and skin grafts (39%) Surgical wounds were frequently exploited by patients to remain in, or return to, hospital: 50% contaminated or manipulated their wounds to prevent healing Thirty-six percent of cases resulted in significant long-term disability (24%) or disfigurement (12%) Ten percent of patients received an amputation Outcomes were improved when patients were confronted by surgeons, however, and 62% were willing to see a psychiatrist Surgeons were able to support recovery in 33% of cases-for example, by using occlusive wound dressings CONCLUSIONS Patients with FD who present to plastic surgeons are high risk: the majority require surgical intervention for severe self-injury, and many engage in harmful behaviors, such as "doctor-shopping" Early recognition of FD in plastic surgery is, therefore, crucial and may be achieved via careful examination of lesions for unusual morphology Medical records may reveal extensive health care service use and negative investigations Finally, plastic surgeons may play an important role in managing such patients Management strategies include direct observation by nursing staff in the postoperative period and use of strict occlusive dressings to prevent access to surgical wounds

Factitious Disorder (Munchausen Syndrome) in Plastic Surgery: A Systematic Review of 42 Cases.

Factitious disorders in medical and psychiatric practices.

Acute hypocalcaemia can be life-threatening and must be diagnosed promptly. The gold-standard investigation is ionised calcium, which is measured on most blood gas analysers. Total calcium measurements are inaccurate in severe depletion even if ‘corrected’ or ‘adjusted’ for albumin. We present an illustrative case of a woman in her 30s with symptomatic hypocalcaemia and a very low ionised calcium on VBG analysis. Emergency calcium replacement was delayed due to a falsely reassuring corrected calcium result. Our discussion includes a systematic literature review on the use of ionised calcium in emergency and acute medical settings. We suggest cognitive biases that may explain clinical over-reliance on corrected calcium, and call for the inclusion of ionised calcium values in major treatment guidelines for acute hypocalcaemia.

Gregory P. Yates

Papers

Factitious Disorder (Munchausen Syndrome) in Plastic Surgery: A Systematic Review of 42 Cases.

Factitious disorders in medical and psychiatric practices.

Ionised hypocalcaemia in emergency and acute medicine