Noon conference 2 caballero

1. Noon Conference
Meghan Caballero
05/06/2019

2. © 2016 Virginia Mason Medical Center
https://create.kahoot.it/share/persona
lity-disorders/d18fa055-1981-4301-
a1b5-b488509847b5
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3. © 2016 Virginia Mason Medical Center 3
Objectives
Factitious Disorder
• Review definitions, epidemiology, and
pathogenesis
• Present clinical features
• Discuss diagnosis and treatment options

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Definition
• Factitious disorder imposed on self: patients
deceptively misrepresent, simulate, or cause
symptoms of an illness and/or injury in
themselves, even in the absence of obvious
external rewards such as financial gain, housing,
or medications
• Factitious disorder imposed on others: as above,
involving a child or older adult, for example
• AKA Munchausen Syndrome
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Epidemiology
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• In clinical settings, estimated incidence of
1%
• First presentation usually in 3rd or 4th
decade of life
• Onset usually follows hospitalization;
develops gradually
• Risk factors:
• Females
• Unmarried individuals
• Healthcare workers

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Pathogenesis
• Psychosocial:
– Early losses via death, sickness, or abandonment
– Disrupted attachments to others 2/2 neglect, abuse, institutionalization, or other
trauma
– Gratifying experiences related to sick role
– Desire for attention
• Neurocognition:
– Dysfunction in the right hemisphere
• Neuroimaging:
– MRI in 1 patient detected bilaterally disseminated white matter lesions
– CT head in 1 patient showed cerebellar & bilateral frontotemporal cortical atrophy
– SPECT scan in 1 patient showed hyperperfusion of right thalamus
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Clinical Features
• Majority of patients present with somatic complaints and the stated belief that they have a
general medical illness
• Deception is a key feature
• Patients may feign symptoms and illness by:
– Exaggerating or fabricating their symptoms and/or medical history
– Exacerbating or inducing signs, physiologic disturbances, or illness
– Aggravating genuine, existing illness by not adhering to medical recommendations
– Presenting benign physical findings as pathological
– Tampering with medical instruments, tests, or lab specimens
– Forging medical records
– Coaching others to provide false information to clinicians related to medical history or
symptoms
• Patients may behaving in such a way as to “split” the treatment team
• Frequently comorbid with depressive disorders, substance abuse disorders, and personality
disorders

8. © 2016 Virginia Mason Medical Center
Diagnosis
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• DSM-5 Criteria:
• Falsification of physical or psychological signs
or symptoms, or induction of injury or disease,
associated with identified deception
• The individual presents him/herself to others as
ill, impaired, or injured
• The deceptive behavior is evident even in the
absence of obvious external reward
• The behavior is not better explained by another
mental disorder, such as delusional disorder or
another psychotic disorder

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Treatment
• Psychotherapy is standard treatment
• However, studies have shown that
more than 60% of patients either
refused or did not follow up with
psychiatric treatment
• Medications have not been found to
be beneficial unless another
underlying psychiatric disorder is
present
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10. © 2016 Virginia Mason Medical Center
Malingering
• Definition: illness falsification to
obtain obvious external benefits
such as money, medications (eg,
opioids or benzodiazepines), time off
work, child custody, or avoiding
criminal prosecution
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11. © 2016 Virginia Mason Medical Center
Patient Relations
• Patient relations can be a great resource
to utilize when treating patients with
these types of disorders
Patient Relations Department
Virginia Mason Medical Center
P.O. Box 900
Mail Stop: C1-PTR
Seattle, WA 98111-0900
Phone: (206) 223-6616
Fax: (206) 223-6394
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12. © 2016 Virginia Mason Medical Center
Acknowledgements
• Team A!
• Katherine Adler
• Peter Whooley
• Cheyenne Enevold
• PROG nursing staff
• Patient relations
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13. © 2016 Virginia Mason Medical Center
Resources
• UpToDate
• https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1484524/
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