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There has been great debate concerning the existence and meaning of compensation neurosis. It is included in the International Classification of Diseases (ICD)-9 and -10 but not listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). On the eve of publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), we re-examine the history and concept of compensation neurosis and conceptually update the condition to reflect current psychiatric thought. We consider its utility as a diagnostic entity for forensic evaluations and its components as they relate to exaggeration in injury claims. We also discuss how compensation neurosis differs from malingering and factitious disorder.

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On November 2, 2010, the US Supreme Court heard arguments in the case of Schwarzenegger v Entertainment Merchants Association, with a ruling expected in 2011. This case addressed whether states have the right to restrict freedom of speech by limiting the sale of violent video games to minors. To date, 8 states have tried to pass legislation to this effect, with all attempts being found unconstitutional by lower courts. In large part, the Supreme Court's decision will be determined by its review and interpretation of the medical and social science literature addressing the effects of violent video games on children. Those on both sides of the violent video game debate claim that the scientific literature supports their opinions. Some involved in the debate have proclaimed that the debate is scientifically settled and that only people holding personal interests and biases oppose these "established truths." We review the historical similarities found in the 1950s comic book debate and studies identified from a PubMed search of the term violent video games showing both the harmful and beneficial effects of these video games. We define factors that physicians need to consider when reading and stating opinions about this literature. Opinions from past court rulings are discussed to provide insight into how judges may approach the application of these social science studies to the current legal issue. Although on the surface the case of Schwarzenegger v Entertainment Merchants Association pertains only to the restriction of violent video games, it may establish principles about how medical and public health testimony can affect fundamental constitutional rights and how much and on what basis the courts will defer to legislators' reliance on unsettled science.

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OBJECTIVE: This article looks at lessons learned from the 1995 Kikwit Ebola outbreak and suggests how modern hospitals should apply these lessons to the next lethal viral epidemic that occurs. METHOD: The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo (formally Zaire) is one of the most well studied epidemics to have occurred to date. Many of the lessons learned from identifying, containing and treating that epidemic are applicable to future viral outbreaks, natural disasters and bioterrorist attacks. This is due to Ebola's highly contagious nature and high mortality rate. RESULTS: When an outbreak occurs, it often produces fear in the community and causes the basic practice of medicine to be altered. Changes seen at Kikwit included limited physical examinations, hesitance to give intravenous medications and closure of supporting hospital facilities. The Kikwit Ebola outbreak also provided beneficial psychological insight into how patients, staff and the general community respond to a biological crisis and how this will affect physicians working in an epidemic. CONCLUSIONS: General lessons from the outbreak include the importance of having simple, well-defined triage procedures; staff who are flexible and able to adapt to situations with unknowns; and the need to protect staff physically and emotionally to ensure a sustained effort to provide care.

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Pedophilia has become a topic of increased interest, awareness, and concern for both the medical community and the public at large. Increased media exposure, new sexual offender disclosure laws, Web sites that list the names and addresses of convicted sexual offenders, politicians taking a 'get tough' stance on sexual offenders, and increased investigations of sexual acts with children have increased public awareness about pedophilia. Because of this increased awareness, it is important for physicians to understand pedophilia, its rate of occurrence, and the characteristics of pedophiles and sexually abused children. In this article, we address research that defines the various types and categories of pedophilia, review available federal data on child molestation and pornography, and briefly discuss the theories on what makes an individual develop a sexual orientation toward children. This article also examines how researchers determine if someone is a pedophile, potential treatments for pedophiles and sexually abused children, the risk of additional sexual offenses, the effect of mandatory reporting laws on both physicians and pedophiles, and limitations of the current pedophilic literature.

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Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.

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The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo is one of the first Ebola outbreaks to be treated in a hospital setting and is one of the most well-studied Ebola epidemics to have occurred to date. Many of the lessons learned from identifying, containing, and treating the epidemic are applicable to future viral outbreaks. This article looks at the characteristics of the Ebola virus and health system issues, which affected the healthcare providers' ability to contain and treat the virus. It specifically examines factors such as the disease characteristics, surge capacity, supply issues, press involvement, and the involvement of voluntary organizations.

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OBJECTIVE: This paper aims to study the detection of individuals malingering posttraumatic stress disorder (PTSD) in criminal and civil situations. METHOD: A brief history of PTSD and its rise to prominence in legal circles are discussed. The characteristics of individuals who malinger and particularly those who fake PTSD are discussed. Diagnostic dilemmas inherent to the condition, such as the definition of a traumatic exposure, what constitutes a PTSD flashback and the potential for normal symptom exaggeration, are explored. RESULTS: The typical presentation of malingered symptoms is presented to help clinicians detect commonly seen malingering patterns. Suggestions for interview techniques, Minnesota Multiphasic Personality Inventory test values and sources of collateral information to help detect malingering are reviewed. CONCLUSION: The paper concludes with a review of the typical presentations of malingered PTSD symptoms and a reminder that physicians need to distinguish legitimate symptoms from faked or embellished presentations.

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Bombing is the preferred method of terrorist attack. Unfortunately, the frequency and prevalence of this form of terrorism/criminal act/means of extortion are increasing in the United States. These attacks result in specific physical and psychiatric trauma, and produce both acute and long-term psychiatric sequelae. It will become increasingly important for trauma surgeons, emergency physicians and psychiatrists to be familiar with the special needs and treatment of these patients. This paper reviews the physical and psychiatric consequences of high explosive and radiological (dirty) bombs, and makes recommendations for the psychiatric management of bombing victims.

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The authors review the literature from human and animal studies on the neurochemical and pathological psychiatric effects of supraphysiological doses of anabolic-androgenic steroids (AAS) and discuss the AAS use and abuse patterns, additional drug use patterns, and personality and behavioral characteristics of AAS abusers.

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The following article is a literature review of supraphysiologic doses of anabolic-androgenic steroids (AAS). This article contains a brief review of the history of AAS, the chemistry of the varying forms of AAS, and proposed mechanisms of action. The article then focuses on how AAS are used in an illicit manner by the general population. Terms such as "stacking" and "pyramiding" are discussed. The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers.

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Injuries from blows to the head often are manifested only as subjective complaints. Postconcussional syndrome thus can be feigned for financial or psychological gain. The authors review the pathology of brain trauma, symptoms of postconcussional syndrome, and criteria for diagnosis. In addition to somatic deficits, psychological and cognitive problems are common. The likelihood and severity of postconcussional syndrome are greater for women. Malingering may be suspected in cases involving litigation, and tests to detect it are available. Treatment for postconcussional syndrome depends on the specific symptoms. Pharmacotherapies may be helpful, but care should be used in prescribing drugs that could produce deleterious CNS effects.

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A 79-year-old nursing home resident who was taking olanzapine presented to multiple hospitals with fevers of unknown origin. After an extensive workup to rule out infection, the patient was diagnosed as having neuroleptic malignant syndrome (NMS). This patient's presentation was atypical because of the lack of rigidity or tremor at the time of admission. This case highlights the importance of including NMS in the differential diagnosis of fever of unknown origin in medical patients. A review of the medical literature is taken, focusing on diagnoses, prevalence, predisposing factors, pathophysiology, and current treatment approaches for NMS.

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