Abstract
Context and purpose: suffering from mental disorders is considered as a factor for mitigating punishment in many judicial systems. Therefore, the forensic psychiatrist has a key role in the diagnosis of dementia. However, there is little information about the most common symptoms that are imitated by patients. This study was conducted in order to evaluate these symptoms among patients in Iranian society. Methodology: In this study, people who were referred to the Forensic Psychiatry Center in Tehran with a judicial order to evaluate their mental status were evaluated based on the DSM-IV criteria for mental disorders. 41 cases that were identified as patients were interviewed again. Findings: In this study, behavioral disorder symptoms were imitated by clients more than other symptoms, so that these symptoms were seen in 75.6% (95% confidence limits: 62.5-88.8). After that, mood and emotional symptoms (65.9%), cognitive disorder symptoms (56.1%), thought disorder symptoms (46.3%), perception disorder symptoms (34.1%) and thought content disorder symptoms (19.5%) were seen in order of prevalence. In the examination of these symptoms according to age, gender, occupation and reason for referral for psychiatric examination, no significant difference was seen between different groups. Only symptoms of thought disorder increased significantly with the level of education of clients (p=0.045). Conclusion: Mental illness symptoms are more common in the low economic and social levels of Iranian society, and most people try to imitate simple symptoms such as behavioral disorders and mood and emotional symptoms. Although conducting an interview by a forensic psychiatrist can be helpful in distinguishing real patients from psychopaths, it is necessary to carry out studies on the validation of psychiatric evaluation tests in the country. A forensic psychologist therefore has a key role in the discovery of malingering. Our knowledge to what symptoms are further possible to emulate by malingerers is very little yet. Here, we proposed to evaluate these symptoms among Iranian malingerers. Methods: Here, perpetrators were evaluated with a judicial order to assess mental status at the Tehran center for forensic psychiatry during one year period. Members were assessed using the American Psychiatric Association's Diagnostic and Statistical Manual 4th Edition (DSM-IV) standards for mental disorders. Forty one cases identified as malingerers and were evaluated in another specific conversation. Results: in this study, behavioral symptoms were more likely to be imitated by participants, so in 75.6% (95% confidence interval: 62.5-88.8) such symptoms were observed. Mood and affect symptoms (65.9%), cognitive function symptoms (56.1%), thought process symptoms (46.3%), perceptual disorder symptoms (34.1%) and thought content symptoms (19.5%) were observed respectively. According to age, sex, occupation, birthplace, and the context of denoting for psychiatric evaluation, there was no statistically significant difference between diverse groups. Only thought process symptoms were significantly increased based on the educational level (p=0.045). Conclusions: in Iranian population, simulation to the symptoms of mental illness more likely to be observed in low socioeconomic estates and many will attempt to mimic simple symptoms of behavioral as well as mood and affect disorders. Although the interviews conducted by forensic psychiatrists can be helpful to identify malingerers and genuine patients, it is necessary to validate malingering diagnostic tests in Iran.
Chapter 1- Introduction
One ??of the most important topics investigated in forensic psychiatry is the issue of malingering and deception (1).
Since the article 51 Islamic Penal Code considers insanity while committing a crime as a criminal liability, many criminals try to use this legal article and by imitating the symptoms of disorders.
Since Article 51 of the Islamic Penal Code considers insanity during the commission of a crime as a criminal liability, many criminals try to avoid punishment by using this legal article and by imitating the symptoms of mental disorders. Another group of people also try to obtain compensation or disability by mimicking the symptoms of mental disorders following brief traumatic events that did not cause serious damage or lasting defects in them (2,3,4). In any case, the remarkable thing about patients is that there is always an external motivation to intentionally and consciously create false physical and mental symptoms (5). Wiley explained in 1998 that based on the criteria of DSM-IV, symptoms should be considered as disorders in psychiatry that are extremely and excessively unusual and strange (6). If these people describe the symptoms of a disease, they usually state that the symptoms sometimes exist and sometimes disappear, and they do not show a desire to be hospitalized and treated (7).
In the following, some behavioral signs of depression are mentioned:
1- The person with depression is confused at the beginning of the interview and more comfortable at the end of the interview.
2- The way he enters the interview session, the way he sits, his grooming and clothing may be strange and unusual.
3- Non-psychotic behaviors are more obvious when he is not in the center of attention, and psychotic behaviors are more obvious when others are paying attention.
4- Criminal behavior usually occurs with non-psychotic motivation.
5- The person with mental illness takes a gesture of attack and anger during the interview (1).
Given the importance of diagnosing mental illness in forensic psychiatric examinations on the one hand, or considering the limited number of studies published in this field in our country on the other hand (Appendix 1) and as far as possible in different societies according to cultural and social conditions. There are obvious differences in the signs and symptoms of mental retardation, in this study we tried to evaluate the prevalence and background of these symptoms in the Iranian society by examining the frequency of imitative behaviors and symptoms in the clients of Tehran Forensic Psychiatry Center. rtl;">The appearance and general physical condition of the patient in the opinion of the interviewer is taken into consideration in this part, according to the state and condition of the body, balance, clothing and grooming, personal hygiene, unusual physical characteristics such as physical disabilities. This behavior is interpreted in relation to the cultural context and social situation. Other important areas include facial expressions, eye contact, activity level, degree of cooperation, physical attractiveness, attentiveness, and attentiveness.
The motor behavior disorder is related to the quantitative and qualitative aspects of the patient's motor behavior. These characteristics include: idiosyncrasies, tics, expressive movements, muscle twitches, stereotyped behavior, behavioral echoes, hyperactivity, agitation, belligerence, flexibility, gait, restlessness, and other physical manifestations.
Mood & Affect Symptoms
Mood is a distinct emotional state that the client expresses during the interview. The client may be sad, tense, depressed, anxious, depressed, fearful, hostile, happy, euphoric, or emotionless.
Emotion refers to a range of emotions and the source of feeling is related to an opinion. The type of emotion can be judged in terms of variables such as depth, intensity, continuity and proportion
Perceptual disorder symptoms
Different users perceive themselves and the world around them in different and numerous ways. In this part, it is important to pay attention to the perception of the reviewer. The presence of auditory hallucinations is the most common characteristic of schizophrenics, while overt visual hallucinations are generally expressed by people with dementia or brain syndromes.