Mental Health Malingering and the Fraudulent Motor Insurance Claimant

Malingering is the intentional production of false or grossly exaggerated symptoms in order to obtain an advantage. Although it has been estimated that over 800,000 claims for personal injury in Road Traffic Accidents (RTA) were filed in the UK in 2012, no approximation exists forhow many involved malingering. This study attempts to understand what influences a psychiatrist to conclude that a claimant’s symptoms are not caused by an RTA and thus suggests the claimant is malingering. This article describes a study of Personality Assessment Inventory scores alongside collateral forms of evidence for 100 RTA claimants; all individuals seeking compensation for damages to their mental health. The results suggest that up to 40% of these claims could be cate-gorised as not being the result of the RTA. Significant differences emerged between those claimants diagnosed as having a mental disorder as a result of the RTA and those claimants who were classified as not having a mental disorder as a result of the RTA in regards to: employment status, level of injuries and scores on the paranoia scales of the PAI.The study emphasises how the assessment process is idiosyncratic and in need of further researc

Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies

BACKGROUND: Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005. METHODS: The results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission. RESULTS: Out of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6-35.5] and 15.1% [95% CI: 8.6-25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0-46.7] for SP and 18.3% [95% CI: 11.6-28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4-32.7] for SP monotherapy. CONCLUSION: The finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country

Identification and characterisation of mutations associated with von Willebrand disease in a Turkish patient cohort

Several cohort studies have investigated the molecular basis of von Willebrand disease (VWD); however, these have mostly focused on European and North American populations. This study aimed to investigate mutation spectrum in 26 index cases (IC) from Turkey diagnosed with all three VWD types, the majority (73%) with parents who were knowingly related. IC were screened for mutations using multiplex ligation-dependent probe amplification and analysis of all von Willebrand factor gene (VWF) exons and exon/intron boundaries. Selected missense mutations were expressed in vitro. Candidate VWF mutations were identified in 25 of 26 IC and included propeptide missense mutations in four IC (two resulting in type 1 and two in recessive 2A), all influencing VWF expression in vitro. Four missense mutations, a nonsense mutation and a small in-frame insertion resulting in type 2A were also identified. Of 15 type 3 VWD IC, 13 were homozygous and two compound heterozygous for 14 candidate mutations predicted to result in lack of expression and two propeptide missense changes. Identification of intronic breakpoints of an exon 17–18 deletion suggested that the mutation resulted from non-homologous end joining. This study provides further insight into the pathogenesis of VWD in a population with a high degree of consanguineous partnerships

Characterization of large in-frame von Willebrand factor deletions highlights differing pathogenic mechanisms

Copy number variation (CNV) is known to cause all von Willebrand disease (VWD) types, although the associated pathogenic mechanisms involved have not been extensively studied. Notably, in-frame CNV provides a unique opportunity to investigate how specific von Willebrand factor (VWF) domains influence the processing and packaging of the protein. Using multiplex ligation-dependent probe amplification, this study determined the extent to which CNV contributed to VWD in the Molecular and Clinical Markers for the Diagnosis and Management of Type 1 von Willebrand Disease cohort, highlighting in-frame deletions of exons 3, 4-5, 32-34, and 33-34. Heterozygous in vitro recombinant VWF expression demonstrated that, although deletion of exons 3, 32-34, and 33-34 all resulted in significant reductions in total VWF (P < .0001, P < .001, and P < .01, respectively), only deletion of exons 3 and 32-34 had a significant impact on VWF secretion (P < .0001). High-resolution microscopy of heterozygous and homozygous deletions confirmed these observations, indicating that deletion of exons 3 and 32-34 severely impaired pseudo-Weibel-Palade body (WPB) formation, whereas deletion of exons 33-34 did not, with this variant still exhibiting pseudo-WPB formation similar to wild-type VWF. In-frame deletions in VWD, therefore, contribute to pathogenesis via moderate or severe defects in VWF biosynthesis and secretion

Mission impossible? Assessing the veracity of a mental health problem as result of a road traffic accident: a preliminary review of UK experts’ practices

The number of people claiming for personal injury after being involved in a road traffic accident (RTA) in the UK continues to soar. In April 2015, the UK Government intervened to implement measures aimed at reducing the prevalence of fraud within such personal injury claims. However, these reforms did not include claims for mental disorder that arise because of a RTA despite being responsible for substantially larger payouts in comparison with claims for whiplash. The present study examines the assessment practice for detecting fraudulent claims of this nature using a mixed methods survey analysing UK medico-legal professionals’ assessment methodologies (N = 37). The findings suggest comprehensively that assessment practices in this field are idiosyncratic. The findings evidence limitations in all aspects of the assessment process from medico-legal assessors being asked to undertake examinations without the presence of medical records to 44% of examiners being unaware of the three types of malingering. The article concludes with recommendations for improving both assessments and the assessment process for assessing RTA claimants in the UK

Cognitive and emotional stressors of child homicide investigations on UK and Danish police investigators

In a previous paper, key differences in the form and manifestation of cognitive and emotional stress experienced by investigators of adult and child homicide were identified, along with a cursory look at how investigators commonly deal or cope with these effects. In this paper, the findings from eleven interviews with UK and Danish police officers with experience of investigating both adult and child homicides, suggest that child homicide investigations can have a profoundly different effect on police investigators that can vary between officers. The effects experienced and coping strategies employed were similar among officers in Denmark and the UK, and these included becoming more emotionally closed and engaging in regular sport and exercise. The findings hold important implications for police training and for the welfare of current and future police homicide investigators particularly where the victim is a child

Dealing with the Unthinkable: A Study of the Cognitive and Emotional Effects of Adult and Child Homicide Cases on Police Investigators.

Although the death of a child is without doubt one of the most distressing events imaginable, when it occurs in suspicious circumstances, such as at the hand of a parent or close family member, its effects are often more acute and incomprehensible. This paper presents an exploratory study comparing the cognitive and emotional stressors experienced by police when investigating child and adult homicides. The results of an online survey questionnaire with 99 experienced UK police investigators are presented, with key differences found in the cognitive and emotional stress experienced depending on whether the victim is a child or an adult, key differences and similarities identified in the ways investigators deal and cope with adult and child homicide cases, with a tentative discussion of the implications for the well-being and training of police investigators provided

Creating and curating an archive: Bury St Edmunds and its Anglo-Saxon past

This contribution explores the mechanisms by which the Benedictine foundation of Bury St Edmunds sought to legitimise and preserve their spurious pre-Conquest privileges and holdings throughout the Middle Ages. The archive is extraordinary in terms of the large number of surviving registers and cartularies which contain copies of Anglo-Saxon charters, many of which are wholly or partly in Old English. The essay charts the changing use to which these ancient documents were put in response to threats to the foundation's continued enjoyment of its liberties. The focus throughout the essay is to demonstrate how pragmatic considerations at every stage affects the development of the archive and the ways in which these linguistically challenging texts were presented, re-presented, and represented during the Abbey’s history