Factitious disorders, Psych II Sec B

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Psych II, Sec B Finals

Psych II, Sec B Finals

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  • 1. Hyacinth C. Manood, MD, FPPA
  • 2.
    • A condition in which patient fake illness to the point of inflicting painful, deforming, or even life-threatening injury on themselves or those under their care with the primary goal of gaining the emotional care and attention that comes with playing the role of the patient
    • Approximately 0.8 to 1.0 percent of psychiatry consultation patients
  • 3.
    • Intentional production or feigning of physical or psychological signs or symptoms.
    • The motivation for the behavior is to assume the sick role.
    • External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in malingering) are absent.
  • 4.
    •   With predominantly psychological signs and symptoms
    • With predominantly physical signs and symptoms (Munchausen Syndrome)
    •    With combined psychological and physical signs and symptoms
  • 5.
    • Factitious Disorder Not Otherwise Specified
      • Factitious disorder by proxy - a person intentionally produces physical signs or symptoms in another person who is under the first person's care.
        • for the caretaker to indirectly assume the sick role;
        • to be relieved of the caretaking role by having the child hospitalized
  • 6.
    • Munchausen syndrome
      • a syndrome in which patients embellish their personal history, chronically fabricate symptoms to gain hospital admission, and move from hospital to hospital.
      • Approx. 2/3 are male
      • white, middle-aged, unemployed, unmarried, and without significant social or family attachments
      • essential feature of patients with the disorder is their ability to present physical symptoms so well that they can gain admission to, and stay in, a hospital
  • 7.
    • Factitious disorders with physical signs and symptoms
      • are mostly women who outnumber men 3 to 1.
      • usually 20 to 40 years of age with a history of employment or education in nursing or a health care occupation
  • 8.
    • Factitious disorder by proxy
      • most commonly perpetrated by mothers against infants or young children
      • less than 0.04 percent
  • 9.
    • The symptoms and pattern of illness are extremely unusual, or inexplicable physiologically.
    • Repeated hospitalizations and workups by numerous caregivers fail to reveal a conclusive diagnosis or cause.
    • Physiological parameters are consistent with induced illness; e.g., apnea monitor tracings disclose massive muscle artifact prior to respiratory arrest, suggesting that the child has been struggling against an obstruction to the airways.
  • 10.
    • The patient fails to respond to appropriate treatments.
    • The vitality of the patient is inconsistent with the laboratory findings.
    • The signs and symptoms abate when the mother has not had access to the child.
    • The mother is the only witness to the onset of signs and symptoms
    • Unexplained illnesses have occurred in the mother or her other children.
  • 11.
    • The mother has had medical or nursing education, or exposure to models of the illnesses afflicting the child (e.g., a parent with sleep apnea).
    • The mother welcomes even invasive and painful tests.
    • The mother grows anxious if the child improves.
    • Maternal lying is proved.
    • Medical observations yield information that is inconsistent with parental reports.
  • 12.
    • many of the patients suffered childhood abuse or deprivation, resulting in frequent hospitalizations during early development
      • inpatient stay may have been regarded as an escape from a traumatic home situation, and the patient may have found a series of caretakers to be loving and caring.
  • 13.
    • The usual history reveals that the patient perceives one or both parents as rejecting figures who are unable to form close relationships.
      • The facsimile of genuine illness, therefore, is used to recreate the desired positive parent -child bond
  • 14.
    • basic conflict of needing and seeking acceptance and love while expecting that they will not be forthcoming
    • patient transforms the physicians and staff members into rejecting parents.
    • seek out painful procedures, such as surgical operations and invasive diagnostic tests, may have a masochistic personality makeup in which pain serves as punishment for past sins, imagined or real
  • 15.
    • Patients who feign psychiatric illness may have had a relative who was hospitalized with the illness they are simulating.
    • Through identification, patients hope to reunite with the relative in a magical way.
    • no genetic patterns have been established, and electroencephalographic (EEG) studies noted no specific abnormalities in patients with factitious disorders
  • 16.  
  • 17.
    • Somatoform Disorders
      • voluntary production of factitious symptoms
      • the extreme course of multiple hospitalizations
      • seeming willingness of patients with a factitious disorder to undergo an extraordinary number of mutilating procedures
  • 18.
    • Personality Disorders
      • Antisocial PD
      • Histrionic PD
      • Borderline PD
    • Schizophrenia
    • Malingering
    • Substance Abuse
    • Ganser’s Syndrome
  • 19.
    • begin in early adulthood
    • onset of the disorder or of discrete episodes of seeking treatment may follow real illness, loss, rejection, or abandonment
    • long pattern of successive hospitalizations
    • patient becomes knowledgeable about medicine and hospitals
    • prognosis in most cases is poor
  • 20.
    • a few of them probably die as a result of needless medication, instrumentation, or surgery
  • 21.
    • 3 Major Goals of Treatment:
      • To reduce the risk of morbidity and mortality
      • to address the underlying emotional needs or psychiatric diagnosis underlying factitious illness behavior
      • to be mindful of legal and ethical issues