Factitious disorders, Psych II Sec B


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Psych II, Sec B Finals

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Factitious disorders, Psych II Sec B

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