The dissimulating disorders: a single diagnostic entity?
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Conversion Disorder↗
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Results for “Factitious Disorders”
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The symptom pattern variations of unipolar depression during life span: a cross-sectional study.
The psychopathological syndromes are analyzed for 436 patients suffering from a unipolar affective psychosis, depressed type, without any further psychiatric or somatic diagnosis, separately for the second to eighth decade of life. The intensity of the depressive syndrome, as well as the apathy syndrome according to the Manual for the Assessment and Documentation of Psychopathology (AMDP) system, does not decrease. The autonomic syndrome increases for the group in the involutional age, and the psycho-organic syndrome for the group in the old age. The analysis of special symptom patterns, as for the agitated behavior or symptoms of the psycho-organic syndrome, is presented.
Adult↗
Munchausen's syndrome and substance abuse.
The syndrome of factitious disorders with physical symptoms was named "Munchausen's syndrome" by Richard Asher (1951). The present article contains an interesting case report of a patient who has a history of Munchausen's syndrome, substance abuse, and genuine physical illness. A review of the literature supports a strong association of substance abuse in patients with Munchausen's syndrome. Also important for clinicians to remember is that patients with Munchausen's syndrome often have true physical illnesses which need appropriate treatment. The patient described here has successfully begun treatment with methadone maintenance, but further study will be needed regarding methadone maintenance's role in the management of Munchausen's syndrome.
Adult↗
Diagnostic, expanatory, and detection models of Munchausen by proxy: extrapolations from malingering and deception.
OBJECTIVE: The overriding objective is a critical examination of Munchausen syndrome by proxy (MSBP) and its closely-related alternative, factitious disorder by proxy (FDBP). Beyond issues of diagnostic validity, assessment methods and potential detection strategies are explored. METHODS: A painstaking analysis was conducted of the MSBP and FDBP literature as it relates diagnostic and assessment issues. Given the limitations of this literature, extrapolations were provided from the extensive theory and research on malingering as a related response style. RESULTS: Diagnostic formulations for both MSBP and FDBP de-emphasize the clinical characteristics of the perpetrator. In the case of FDBP, inferential judgments about motivation (e.g., adoption of a sick role) are challenging on conceptual and clinical grounds. When explanatory models from malingering are applied, most research has focused pathogenic models, often allied with psychodynamic thought. Finally, clinical methods for the assessment of MSBP and FDBP are not well developed. CONCLUSIONS: Refinements in the conceptualization of MSBP and FDBP can be provided through prototypical analysis. Drawing from malingering research, explanatory models should be expanded to include adaptational and criminological models. Finally, detection strategies for MSBP and FDBP must be formally operationalized and rigorously validated.
Adult↗
Self-inflicted pneumothoraces.
Self-inflicted pneumothoraces are rare manifestations of psychiatric illness. Two patients with self-inflicted pneumothoraces are reported, and the typical clinical features of factitious disorders are described. If thoracic surgeons are aware of these conditions, inappropriate surgery- and poor outcomes-can be avoided.
Adult↗
Pseudoseizures, families, and unspeakable dilemmas.
Fourteen videotaped family interviews of patients with diagnosed pseudoseizures were studied to determine the relationship of the symptoms to unspeakable dilemmas as forced choices imposed by family or social circumstances under conditions that also require the ensuing distress to be hidden. An unspeakable dilemma was evident in 13 of 14 interviews, with the patient the most silent family member in 13 interviews. In six cases, there was revealed a realistic threat of physical or sexual assault to a person involved in the problem, although not always the patient. These findings point to an important role for family therapy skills in the evaluation and treatment of pseudoseizures.
Adolescent↗
The deceit continues: an updated literature review of Munchausen Syndrome by Proxy.
OBJECTIVE: This article presents an updated review of the literature of Munchausen Syndrome by Proxy (Factitious Disorder by Proxy, MBP). METHOD: Four hundred fifty-one cases of MBP were analyzed from 154 medical and psychosocial journal articles. RESULTS: Typical victims may be either males or females, usually 4 years of age or under. Victims averaged 21.8 months from onset of symptoms to diagnosis. Six percent of victims were dead, and 7.3% were judged to have suffered long-term or permanent injury. Twenty-five percent of victims' known siblings are dead, and 61.3% of siblings had illnesses similar to those of the victim or which raised suspicions of MBP. Mothers were perpetrators in 76.5% of cases, but as knowledge of MBP grows a wider range of perpetrators is identified. In a small number of cases, MBP was found to co-exist with secondary gain or other inflicted injury. CONCLUSION: Although published cases form a non-random sample, they add to knowledge about MBP and validate claims that it occurs. More knowledge about non-medical aspects of MBP, and more pooling of data, is desirable.
Adult↗
Brain single photon emission computed tomography findings in depressive pseudodementia patients.
BACKGROUND: Recently, there have been studies suggesting that depressive pseudodementia would include early-stage dementing disorder. Through the comparison of the 99mTc-HMPAO single photon emission computed tomography (SPECT) image of depressive pseudodementia subjects, healthy comparison subjects, depressed subjects free of cognitive impairment, and dementia of Alzheimer's type (DAT) subjects, we aimed to see part of pathophysiology of the depressive pseudodementia of elderly patients. METHODS: Study subjects consisted of seven patients with depressive pseudodementia, seven healthy comparison subjects, seven patients with depression free of cognitive impairment, and eleven patients with DAT. Depression patients were diagnosed according to DSM-III-R. DAT patients were diagnosed by DSM III-R and NINCDS-ADRDA criteria of DAT. Other measures for assessment include Hamilton Rating Scale for Depression and Mini Mental State Exam. All underwent 99mTc-HMPAO SPECT scan. The images of each group were analyzed using statistical parametric mapping of Friston, which compares the images on voxel-by-voxel basis. RESULTS: The results were as follows (1) The DAT group showed significant decreases of cerebral blood flow (CBF) in the right frontal, right temporal region, and both parietal regions as compared with control group (P < 0.05). (2) The depression group showed a significant decrease of CBF in the left frontal region as compared with control group (P < 0.05). (3) The depressive pseudodementia group showed significant decreases of CBF in both parietal regions as compared with control group (P < 0.05). (4) The depressive pseudodementia group showed significant decreases of CBF in the right temporal region and both parietal regions as compared with depression group (P < 0.05). (5) The DAT group showed significant decreases of CBF in the right temporal region, both frontal regions, and both parietal regions as compared with depressive pseudodementia group (P < 0.05). LIMITATIONS: The small number of subjects may make it difficult to generalize from our results. Because decreased CBF in depressive pseudodementia is found while the subjects were depressed, we cannot tell whether it is a state marker or a trait marker. CONCLUSIONS: The depressive pseudodementia group showed decreased CBF in the temporo-parietal region, similar to that of the DAT group and different from that of the depression group.
Aged↗
Two cases of Munchausen's syndrome presenting as acute respiratory distress.
We present two cases of factitious disorder that presented as acute respiratory distress. The presentation was extreme to the point that the patients were intubated. Both patients were employed in an ancillary health care profession.
Adult↗
Forensic Neuropsychology: are we there yet?
Forensic Neuropsychology is a new and rapidly evolving subspecialty of clinical neuropsychology that applies neuropsychological principles and practices to matters that pertain to legal decision-making. Forensic neuropsychologists provide the trier of fact with specialized information regarding brain-behavior relationships. The primary responsibility of the forensic neuropsychologist is to provide information based on scientifically-validated neuropsychological principles and clinical methodology that is pertinent to the Forensic Question at hand-which is not just whether the patient has dysfunction, but whether the dysfunction results from the event under consideration. To best answer the Forensic Question, the neuropsychologist must use a methodology that has been scientifically-validated on brain-impaired individuals, and can distinguish various brain conditions from each other as well as from normal variation. The methodology must be able to determine whether any dysfunction found is, in fact, the result of a neurological condition as opposed to non-neurological, psychological, or even factitious disorders. This paper discusses neuropsychological methodology in the context of forensic application and the requirements of the legal process and illustrates these issues with case examples.
Decision Making↗
Functional visual loss: II. Psychiatric aspects in 42 patients followed for 4 years.
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Adolescent↗
Cognitive complaints in elderly depressed and pseudodemented patients.
The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.
Aged↗
Dermatological symptoms and sexual abuse: a review and case reports.
Dermatological symptoms in cases of sexual abuse can be very diverse. To establish a causal relationship between skin diseases and sexual abuse is particularly difficult. In dermatology, three main areas of presentation can be identified. ACUTE CONSEQUENCES: Direct injuries found on the genitalia and body. Behaviour and psychological changes seen. Sexually transmitted diseases (STD) may be identified, after an appropriate incubation period. LONG-TERM CONSEQUENCES: In the long term, even decades later, patients may manifest with a wide spectrum of psychosomatic manifestations of skin diseases, particularly factitious disorders. IMITATIONS: A group whose skin manifestations may mimic and be mistaken for sexual abuse. The initial suspicion of sexual abuse and the need for specific questioning and investigations can lead to a disturbance in the doctor-patient relationship.
Adult↗
Differing approaches to the identification of Munchausen by Proxy Syndrome (MBPS): a case of professional training or role of experiental exposure.
Much recent research recognises that a multidisciplinary team approach is best to manage Munchausen by Proxy Syndrome (MBPS), an extreme manifestation of factitious disorder by proxy (FDBP). Generally described as fabricating illness symptoms in a child to serve the adult caretaker's attention seeking needs, identification of the disorder remains problematic. Various relevant professionals differ in their emphasis and vary in their knowledge of the condition which in turn can inhibit collaborative investigation and intervention. Reasons for these difficulties are described together with a rationale for better interagency co-operation, not least because the outcome in some cases is the death of the child. The present paper discusses the implications of professional training in identification of MBPS and the value of previous exposure to cases in increasing likelihood of detection. An empirical study is described that presents working models used by different professionals to identify cases of MBPS (n=12). Analysis of qualitative interview material by means of a multidimensional scaling procedure revealed no clear grouping in terms of occupational specialism, rather commonalities of approach appeared related to previous experience with MBPS. The range of salient factors elicited was used to devise a parsimonious screening checklist intended for use by different professional groups. Finally, future research in terms of investigating psychometric profiles of MBPS child abusers and demonstrating the utility of the checklist for use by multidisciplinary teams in early detection and subsequent management of MBPS is discussed.
Journal Article↗
[Neuropsychological assessment of malingering].
Current problems and neuropsychological assessment strategies of malingering detection (assessment of negative response bias or non-optimal test behaviour) are reviewed. First, the paper discusses major conceptual problems inherent in the definition of malingering, factitious disorders, and somatoform disorders. Traditional and modern test approaches and diagnostic procedures are reviewed. Two case vignettes illustrate the application of particular strategies for malingering assessment. In German speaking countries, malingering research has not yet aroused profound interest comparable to that in English speaking countries. Diagnostic standards and instruments still have to be refined.
Humans↗
[Factitious skin lesions as an expression of a family crisis].
The factitious disorder is a deliberately induced, hidden self-mutilation based on a psychic conflict. We present a previously healthy nine-year old girl with initially obscure symmetric skin lesions. Family history, psychological exploration, special tests like pictural expression and scenial exhibition revealed the child's fear of a divorce of her parents and her own identity problem. These examinations aroused the suspicion that the girl could only express her conflict of ambivalence by self-injury behavior in the meaning of artificial disease. Guided by this impression, an intensive conversation with both parents was undertaken, focussing the familiar crisis. Afterwards, the skin lesions disappeared the girl admitted the self-mutilation. A family therapy was initiated.
Child↗
Head injury, dissociation and the Ganser syndrome.
OBJECTIVE: To describe the clinical characteristics and psychiatric correlates of the Ganser syndrome following mild traumatic brain injury (TBI). METHOD: A retrospective chart review of patients with mild TBI assessed in a tertiary care outpatient clinic. RESULTS: Of 513 patients reviewed in a 1 year period, four subjects with a diagnosis of Ganser syndrome, with the hallmark syndrome of approximate answers ('vorbeigehen') were identified. In three of these patients, symptoms of Acute Stress Disorder (ASD) and/or Post-traumatic Stress Disorder (PTSD) were found. Only one patient was pursuing litigation. CONCLUSIONS: While no epidemiologic conclusions can be drawn from the data, clinicians should, nevertheless, be alert to the possibility of patients presenting with Ganser syndrome following TBI. The findings are discussed in the light of data linking the syndrome to dissociative and post-traumatic stress related disorders.
Adult↗
Ganser syndrome after solitary confinement in prison: a short review and a case report.
A short review of the Ganser syndrome is given. The condition is a rare, probably dissociative, disorder with transient Vorbeireden as the central symptom. The case of a middle-aged man developing a transient Ganser syndrome after long-term solitary confinement in a remand prison is presented. Systematic investigation of 268 remand prisoners confirms the rarity of the syndrome, as only the case subject had this disorder.
Attention↗