factitious disorders, psych ii sec b
DESCRIPTION
Psych II, Sec B FinalsTRANSCRIPT
Hyacinth C. Manood, MD, FPPA
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
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.
With predominantly psychological signs and symptoms
With predominantly physical signs and symptoms (Munchausen Syndrome)
With combined psychological and physical signs and symptoms
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
Munchausen syndromea 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 malewhite, 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
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
Factitious disorder by proxy
most commonly perpetrated by mothers against infants or young children
less than 0.04 percent
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.
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.
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.
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.
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
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
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
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
Personality DisordersAntisocial PDHistrionic PDBorderline PD
Schizophrenia Malingering Substance Abuse Ganser’s Syndrome
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
a few of them probably die as a result of needless medication, instrumentation, or surgery
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