Emergency Psychiatry

Journal Article Annotations
2018, 4th Quarter

Emergency Psychiatry

Annotations by Scott Simpson, MD, MPH
January 2018

  1. Malingering in the psychiatric emergency department: prevalence, predictors, and outcomes

PUBLICATION #1 — Emergency Psychiatry
Malingering in the psychiatric emergency department: prevalence, predictors, and outcomes
Rumschik SM, Appel JM


Type of study: Cohort study

The finding: The authors asked attending psychiatrists to anonymously share their suspicion of malingering for a consecutive series of patients seen in an emergency psychiatric service. The prevalence of suspected malingering was quite high—20% of patients were strongly or definitely suspected of malingering. Admission rates for malingering patients were far lower (4%) than for non-malingering patients (48%). The most commonly malingered symptom was suicidal ideation (58%) followed by depression (39%), although about half of patients (44%) malingered multiple symptoms.

Strength and weaknesses: The investigators achieved a high response rate (94% of possible patients were captured) in a real world, heterogeneous patient sample. The correlation of suspected malingering with disposition is anecdotally sensible but has never before been published and studied. The use of anonymous surveys precluded assessment of how individual clinicians might approach the assessment and management of malingering differently. Patients might have presented multiple times to the emergency department (ED) in this study; given that malingerers are probably but not certainly more likely to re-present, the study may overestimate the prevalence of malingering.

Relevance: This simple and highly valuable study demonstrates something that many emergency psychiatrists know well from experience: malingering is very common in emergency settings. More attention should be paid to determine best practices for identifying malingering, mitigating risks associated with the condition, and establishing a standard of care. Future studies should seek to clarify longitudinal outcomes among these patients.