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Factitious Disorder with Psychological Symptoms

Factitious Illness with Psychological Symptoms


Presentation

  • Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.[ncbi.nlm.nih.gov]
  • Patient B presented with physical and psychological symptoms. Patient C presented with mainly psychological symptoms.[primarypsychiatry.com]
  • Commonly presented clinical problems include hallucinations, depression, suicidal ideation, dissociative symptoms, and amnesia. Factitious disorders can cause serious morbidity and mortality.[scopemed.org]
  • The distinction between material and psychological incentives is an important one for "care behaviour" (Henderson 1974) in others is an important incentive, always present in such cases.[priory.com]
Anorexia
  • The patient also freely reported a psychiatric history with multiple diagnoses, including bipolar disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, a history of anorexia nervosa, and Asperger’s syndrome[primarypsychiatry.com]
  • Ann Intern Med 48: 1328–1341 Google Scholar Burge CK, Lacey JH (1993) A case of Munchausen’s syndrome in anorexia nervosa. Int J Eat Disord 14: 379–381 PubMed CrossRef Google Scholar Burman D, Stevens D (1979) Munchausen familiy.[link.springer.com]
Nightmare
  • Case reports Case 1 A 46 years old, single, unemployed man, presented to the hospital complaining of sleeping disturbances (insomnia, nightmares), loss of appetite and recurrent depressive thoughts which began two months before, soon after his mother's[priory.com]
Weight Loss
  • Physical examination revealed: left index amputation, a surgical scar in the thyroidal region, a global aspect suggesting acromegaly (salient face bones, large extremities) but no signs of weight loss.[priory.com]
Loss of Appetite
  • Case reports Case 1 A 46 years old, single, unemployed man, presented to the hospital complaining of sleeping disturbances (insomnia, nightmares), loss of appetite and recurrent depressive thoughts which began two months before, soon after his mother's[priory.com]
Blood in Stool
  • Drugs or chemicals are found in the child's urine, blood, or stool. Exams and Tests To diagnose Munchausen syndrome by proxy, providers have to see the clues.[mountsinai.org]
Bruxism
  • Agoraphobia 184 Models of Fear Reduction 192 Anxiety 201 Epidemiology 205 Summary and Conclusions 218 Multiple Personality 231 Atypical Dissociative Disorder 238 Summary and Conclusion 246 Classification 253 Theories 260 Research 271 Motor Disorders 279 Bruxism[books.google.com]
Fear
  • Acquisition 174 Treatment of Agoraphobia 184 Models of Fear Reduction 192 Anxiety 201 Epidemiology 205 Summary and Conclusions 218 Multiple Personality 231 Atypical Dissociative Disorder 238 Summary and Conclusion 246 Classification 253 Theories 260[books.google.com]
  • Factitious disorder patients are fearful of abandonment and highly sensitive to rejection. 16 They usually have comorbid Axis I and II diagnoses.[primarypsychiatry.com]
  • […] one has serious disease; fear must persist for at least 6 months; often have depression and anxiety Hypochondriasis - course and prognosis exacerbations and remissions; 30-50% eventually have significant improvement; good prognosic indicators - increased[quizlet.com]
  • […] borderline personality disorder – where a person struggles to control their feelings and often swings between positive and negative views of others narcissistic personality disorder – where a person often swings between seeing themselves as special and fearing[nhs.uk]
  • Even faked illnesses and injuries can be dangerous, and might be monitored for fear that unnecessary surgery may subsequently be performed. Prognosis [ edit ] Some individuals experience only a few outbreaks of the disorder.[en.wikipedia.org]
Denial
  • However, even in situations where patients are caught “red-handed,” there may be an impressive level of denial with patients going so far as to assert that events never actually took place.[primarypsychiatry.com]
  • Such denials are sometimes contradicted by surgical scars, by other evidence from the physical examination, or by laboratory, radiologic, or other test findings that suggest a significant medical or surgical history (eg, the presence of benign surgical[emedicine.medscape.com]
  • This form of treatment can be unsuccessful if the family is uncooperative or displays signs of denial and/or antisocial disorder. Psychotherapy is another method used to treat the disorder.[en.wikipedia.org]
  • However, as no clear structured methods are available to diagnose the FD and no clear guidelines are available to confront, precautionary methods need to be taken to avoid untoward outcomes like absconding and denial for follow-up.[ijpm.info]
Denial
  • However, even in situations where patients are caught “red-handed,” there may be an impressive level of denial with patients going so far as to assert that events never actually took place.[primarypsychiatry.com]
  • Such denials are sometimes contradicted by surgical scars, by other evidence from the physical examination, or by laboratory, radiologic, or other test findings that suggest a significant medical or surgical history (eg, the presence of benign surgical[emedicine.medscape.com]
  • This form of treatment can be unsuccessful if the family is uncooperative or displays signs of denial and/or antisocial disorder. Psychotherapy is another method used to treat the disorder.[en.wikipedia.org]
  • However, as no clear structured methods are available to diagnose the FD and no clear guidelines are available to confront, precautionary methods need to be taken to avoid untoward outcomes like absconding and denial for follow-up.[ijpm.info]
Suicidal Ideation
  • Commonly presented clinical problems include hallucinations, depression, suicidal ideation, dissociative symptoms, and amnesia. Factitious disorders can cause serious morbidity and mortality.[scopemed.org]
  • ideation with a plan to walk into traffic.[primarypsychiatry.com]
  • Bethany had been seen once by a psychologist in early adolescence for suicidal ideation, but could not remember any specific mental health diagnosis.[ahcmedia.com]
Histrionic Personality Disorder
  • Malingerers also frequently exhibit signs of another personality-related condition, called histrionic personality disorder.[elementsbehavioralhealth.com]
  • The treatment team noticed that the patient had traits of antisocial, narcissistic, borderline, and histrionic personality disorders.[primarypsychiatry.com]
  • Personality problems were diagnosed in three patients, of whom two had anxious avoidant personality traits and another patient had histrionic personality disorder.[ijpm.info]
Sexual Dysfunction
  • Dysfunctions 725 The Sexual Response System 736 Classification of Sexual Problems 752 Etiology of Sexual Dysfunction 759 Treatment of Sexual Problems 765 Sexual Deviations 777 References 804 Methodological Strategies 814 References 834 Behavioral Disorders[books.google.com]
  • One of the most common sexual dysfunctions in men is premature ejaculation .[open.lib.umn.edu]
  • dysfunction, not due to a substance or known physiological condition ( F52.- ) thumb-sucking ( F98.8 ) tic disorders (in childhood and adolescence) ( F95.- ) Tourette's syndrome ( F95.2 ) trichotillomania ( F63.3 ) ICD-10-CM Codes Adjacent To F68.1 F65.8[icd10data.com]
Amnesia
  • Commonly presented clinical problems include hallucinations, depression, suicidal ideation, dissociative symptoms, and amnesia. Factitious disorders can cause serious morbidity and mortality.[scopemed.org]
  • Other simulated psychological disorders include various forms of dementia, amnesia, or fugue; multiple personality disorder; and more rarely, schizophrenia.[mhmedical.com]
  • […] disorder Borderline Personality Disorder – distorted behavior, self image and personality, mood disorder, dissociation Dissociative Identity Disorder – multiple distinct personalities/identities, alter egos, memory loss, depression, de-realization, amnesia[ietherapy.com]
Excitement
  • Just as there was excitement in the anatomic advances that took place a hundred years ago when Emil Kraepelin and his collaborators took on the enormous task of classification of psychiatric disorders based on rational scientific thinking, new advances[books.google.com]
  • […] phase Male orgasmic disorder Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity Premature ejaculation Persistent or recurrent ejaculation with minimal sexual stimulation before, on[open.lib.umn.edu]
  • The production of "psychotic symptoms" was induced by the parents’ allegations of hallucinations and encouragement of heteroaggressive episodes that occurred during periods of family excitement.[omicsonline.org]
Sleep Disturbance
  • Disturbances 683 The Sleep Disorders e e s e e e e e e e e e e 688 Conclusion 716 The Sexual Dysfunctions 725 The Sexual Response System 736 Classification of Sexual Problems 752 Etiology of Sexual Dysfunction 759 Treatment of Sexual Problems 765 Sexual[books.google.com]
  • Case reports Case 1 A 46 years old, single, unemployed man, presented to the hospital complaining of sleeping disturbances (insomnia, nightmares), loss of appetite and recurrent depressive thoughts which began two months before, soon after his mother's[priory.com]
Insomnia
  • Case 2 A 36 years old, married, unemployed man, walked in the hospital complaining of auditory and visual hallucinations, insomnia and inability to control his excessive alcohol intake.[priory.com]
Speech Disorders
  • No objective signs (blocking, insomnia, speech disorders) were noted. During hospitalisation we noted frequent changes in symptomatology unrelated to medication. Once again, medical records were very informative.[priory.com]

Workup

  • Preliminary workups reveal that there is no cyst or obstruction, no infection, and no apparent reason for the pain. The young woman demands surgery to remove her appendix.[luxury.rehabs.com]
  • […] angry, disruptive, or attention-seeking behavior during hospitalization Evidence of pathologic lying in areas other than the presenting symptoms Fluctuating clinical course, including rapid development of complications or a new pathology if the initial workup[emedicine.medscape.com]
  • […] biological and neuropsychological factors important (impaired hemispheric communication); pre-existing psychiatric illness, depressive disorders, anxiety disorders, schizophrenia, somatization disorder Conversion Disorder - management thorough medical workup[quizlet.com]
  • […] complications of Factitious Disorder Imposed on Self (FDIOS) / Factitious Disorder Imposed on Another (FDIOA) include: The artificial production of illness can lead to emotional distress in the individual (or victim) and their family members Multiple workups[dovemed.com]

Treatment

  • Invention of psychological symptoms never felt before by the patient and deliberate intervention in the psychiatric treatment to modify the evolution of the illness were less frequent.[ncbi.nlm.nih.gov]
  • 133 Models for the Description of Abnormal Behavior 141 MMPI Models 147 Conclusion 157 Phobic Disorders 163 Theoretical Models of Fear Acquisition 174 Treatment of Agoraphobia 184 Models of Fear Reduction 192 Anxiety 201 Epidemiology 205 Summary and[books.google.com]
  • These unnecessary treatments could lead to severe adverse reactions. Improving diagnosis is important for both clinics and research. From clinical point of view, it permits a better management or at least avoids unnecessary treatments.[priory.com]

Prognosis

  • Indeed, the limited outcome studies that have been described suggest that a factitious psychological disorder has a worse prognosis than most other Axis I disorders.[health.am]
  • The prognosis is quite severe; in the previously cited article Pope shows that it is worse that the prognosis of schizophrenia.[priory.com]
  • Pain Disorder - course and prognosis varies; can be chronic and disabling; prognosis worse when: patient has characterological (personality) traits, is involved in litigation, is receiving financial compensation, using addictive substances Pain Disorder[quizlet.com]
  • Prognosis The prognosis of factitious disorder varies by subcategory. Males diagnosed with the psychological subtype of FD are generally considered to have the worst prognosis. Self-mutilation and suicide attempts are common in these individuals.[minddisorders.com]
  • However, every effort should be taken to protect them from doing further damage to themselves (or victims) The prognosis varies from fair to poor depending on the severity and chronicity (prolonged period).[dovemed.com]

Etiology

  • Clayton Springer Science & Business Media, ١٥‏/٠٥‏/٢٠٠٨ - 799 من الصفحات Psychiatry has emerged as a burgeoning scientific field with major advances in etiology and treatment of several disorders.[books.google.com]
  • Identification of factitious psychological disorders also may be more difficult than identification of factitious physical disorders because verification of the etiology rests primarily with the patient.[health.am]
  • Dementia A true Dementia frequently has a demonstrable organic etiology or pathophysiological process.[dsm.wikia.com]
  • The treating physician should also seek consultations from specialists in other fields to exclude a medical etiology for the patient’s signs and symptoms.[primarypsychiatry.com]

Epidemiology

  • Disorders e e e e e s e a e 332 Malingering 340 The Affective Disorders 349 Biological Considerations 369 Biological 375 Delusions a s e e 383 Theories of Delusional Thinking 399 Delusions as Rational Systematic Explanations 402 The Schizophrenias 411 Epidemiology[books.google.com]
  • Standard epidemiological techniques are constrained by the fact that Factitious Disorder always involves deception… » » In Factitious Disorder With Predominantly Psychological Signs and Symptoms, the intentional giving of approximate answers may occur[recurrentdepression.com]
  • The dearth of information available on factitious disorder and the difficulty in obtaining epidemiologic and diagnostic information should not preclude the possibility of more accurate diagnosis and better management.[primarypsychiatry.com]
  • Epidemiology The exact incidence of Münchhausen's syndrome is not known but it is rare. A survey of 106 hospital doctors in Germany estimated an incidence of factitious disorder of 1.3%.[patient.info]
  • […] intentionally produced with sole objective to assume the role of patient; facitious disorder with predominantly physical signs and symptoms - Munchausen's syndrome; factitious disorder with predominantly psychological signs and symptoms Factious Disorder - epidemiology[quizlet.com]
Sex distribution
Age distribution

Pathophysiology

  • Dementia A true Dementia frequently has a demonstrable organic etiology or pathophysiological process.[dsm.wikia.com]
  • Definition and Classification Somatization has been defined as the occurrence of one or more physical complaints for which appropriate medical evaluation reveals no explanatory physical pathology or pathophysiologic mechanism.[pedsinreview.aappublications.org]
  • Response of an individual and his/her family to symptoms pathophysiological process and documentable lesions attention patients give to and how they interpret their bodily symptoms, and what action they take about their symptoms Abnormal Illness Behavior[quizlet.com]

Prevention

  • Prevention There are no current guidelines to prevent factitious disorder. An overview of factitious disorders. Cleveland Clinic website. Available at: . Accessed October 4, 2017. Factitious disorder. EBSCO DynaMed Plus website. Available at: .[wmhs.com]
  • Because the cause of factitious disorder is unknown, there's currently no known way to prevent it.[mayoclinic.org]
  • Prevention Recognition of Munchausen syndrome by proxy in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing. References Dubowitz H, Lane WG. Abused and neglected children.[mountsinai.org]
  • Prevention There are no current guidelines to prevent factitious disorder. References: An overview of factitious disorders. Cleveland Clinic website. Available at: . Accessed October 4, 2017. Huffman JC, Stern TA.[cancercarewny.com]

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