Use of Measures of Cognitive Effort and Feigned Psychiatric Symptoms with Pretrial Forensic Psychiatric Patients

This study examined the classification accuracy of measures of cognitive effort, as well as the impact of estimated IQ and psychiatric symptoms on these measures in a sample of hospitalized pretrial criminal defendants. A criterion-groups design was used to classify patients into those suspected of feigning (n=25) and those believed to be genuinely mentally ill (n=93). The Test of Memory Malingering (TOMM), Dot Counting Test (DCT), and Rey Fifteen-Item Memory Test (RMT) were roughly comparable to the SIRS-2 in classifying patient groups but the Validity Indicator Profile (VIP) Verbal subscale was not. Several measures of cognitive effort increased detection of suspected feigning over the SIRS-2 alone. However, among genuinely mentally ill psychiatric patients, level of estimated intelligence was significantly associated with scores on each of the measures of cognitive effort (rs=.38 to .65), with false positive rates in excess of 30% for patients with estimated intelligence in the Extremely Low range. Performance on measures of cognitive effort was only modestly associated with types, but not total severity of psychiatric symptoms. Implications for the assessment of feigning in clinical settings are discussed.