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PubMedDate not supplied

Factitial cheilitis in an adolescent.

A 14-year-old adolescent girl presented with a 2-year history of an exquisitely tender, vegetating cheilitis. Because of this, she was unable to drink fluids and was repeatedly hospitalized for dehydration and pain management. Lip and skin biopsies, as well as multiple laboratory studies did not support a definitive diagnosis. After 2 years, a diagnosis of factitial cheilitis was finally established.

Adolescent↗
PubMed2002

Dermatitis artefacta of the breast: a series of case reports.

Dermatitis artefacta of the breast is a common disease process with a psychological basis. Psychiatric assessment is a useful adjunct in the management of these patients who at initial presentation seem to have a strictly surgical dermatological problem.

Adult↗
PubMed2002

[Differences in insulin secretion facilitate the differential diagnosis of insulinoma and factitious hypoglycaemia].

HISTORY: A 33-year-old female nurse (married; two children; BMI 30.9 kg/m2) had recurrent episodes of symptomatic hypoglycaemia over some months. INVESTIGATIONS: Two fasting tests were terminated after 26 hours because the patient became unconscious. Improved insulin/glucose ratio was infinity and 6.1 [mU/l]/[mg/dl] (normal value < 0.5). An hyperinsulinaemic-hypoglycaemic angle "clamp test" produced a C-peptide suppression to minimally 0.26 - 0.38 nmol/l (normal value 0.06 +/- 0.01 nmol). There was no spontaneous or paradoxical burst in insulin or C-peptide concentration after either the fasting or the "clamp test". Serum analysis of sulphonylurea on several occasions documented an increase of glibenclamide above therapeutic range. TREATMENT AND COURSE: The patient denied any intake of oral antidiabetic preparations, but there were no further hypoglycaemia attacks in subsequent months. DIAGNOSIS: The demonstration of sulphonylurea in serum confirmed the diagnosis of factitious hypoglycaemia. CONCLUSION: With regard to insulin or C-peptide suppression, the results of the fasting and clamp tests are the same in factitious hypoglycaemia and insulinoma. However, under the influence of sulphonylurea drugs there are no insulin or C-peptide bursts so typical of insulinoma. In case of doubt, detection of sulphonylurea preparations in serum or urine is the only reliable way of diagnosing factitious hypoglaema due to the ingestion of sulphonylurea.

Adult↗
PubMed1997

[Phenomenology of hysterical pseudopsychoses].

Clinical observation shows that hysteria can produce states that are difficult to differentiate from all forms of endogenous psychoses. Using phenomenological methodology, the elements and qualities of these hysterical states are analysed and described. It is demonstrated that the phenomena are properties of hysterical personalities, intensified and pronounced, but nevertheless intra- and extrapsychically targeted as "useful", i.e. serving a purpose. Phenomena that would be characteristic of real psychoses, are never seen. There is no "deprivation" of ego poser, and structural deformations are always absent. Considering the phenomenologico-psychopathological definitions of "psychosis", these hysterical states must be considered as pseudopsychoses.

Diagnosis, Differential↗
PubMed1988

[Self-inflicted necroses (mastitis factitia) as an unusual course of non-puerperal mastitis].

The present paper reports of a long lasting necrotising mastitis which, regarding the psychiatric aspect of the patient as well, has to be interpreted as artefactual mastitis. The uncommon localisation, the unusual history and histology as well as the hardly accessible personality may be indicative of a self inflicted injury with subsequent inflammation. Additional to the local therapy, these patients need a psychological guidance, avoiding direct confrontation with the suspected pathogenesis.

Abscess↗
PubMed1989

[Factitious diarrhea in the differential diagnosis of chronic diarrhea. Observations on 7 patients].

Over the last seven years self-inflicted diarrhoea was diagnosed in seven patients with chronic diarrhoea which was deliberately induced by the secret intake of laxatives. Six of the patients were female, four of them in paramedical occupations. All also had loss of weight and hypokalaemia between 2.1 and 2.9 mmol/l. All had accepted extensive and interventional procedures during a mean of five hospital admissions, with minimal pathological findings and no aetiological diagnosis. They had undergone numerous therapeutic measures, in one instance even several operations and parenteral feedings. Making the correct diagnosis was decisively impeded and delayed by the patients' seeming cooperativeness. In four patients the diagnosis was finally made by demonstrating laxatives in the urine, in two others by finding hidden tablets in the room, in one by demonstrating melanosis of the colon. A factitious cause of chronic diarrhoea should be excluded if no other cause can be established.

Adult↗
PubMed1988

[Bradycardia factitia].

Repeated intake of 240-400 mg non-retard verapamil by a 26-year-old male nurse brought about interference dissociation resulting from extreme sinus bradycardia, passive AV nodal rhythm and hypotension. Because of a history of myocarditis a recurrence was suspected and an organic cause of the arrhythmia assumed at first, until its self-inflicted origin was discovered. The case demonstrates the need to consider self-medication, even if at first denied, in the differential diagnosis of arrhythmias even in the absence initially of any clear-cut pointers towards it.

Adult↗
PubMed1987

[Factitious hypoglycemia caused by taking a sulfonylurea drug].

Three cases of factitious (self-induced) hypoglycaemia, brought about by regular intake of sulphonylurea preparations, seen in the span of three years are reported. The clinical picture was similar to that caused by an insulinoma. One patient was a 31-year-old male nurse, another a 17-year-old girl whose mother was a diabetic, the third a 60-year-old female diabetic. The correct diagnosis of factitious hypoglycemia was made only after demonstrating glibenclamide in serum and urine. Factitious hypoglycemia can be differentiated from fasting hypoglycemia caused by hyperinsulinaemia by a lowered C-peptide level after injection of insulin. When sulphonylurea preparations are taken, the only way of distinguishing factitious hypoglycemia from insulinoma is by determining the drug in serum and urine. The cases reported in the literature are almost all in medical personnel, diabetics or members of their family.

Adolescent↗
PubMed1988

Factitious AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Ganser symptoms in a case of frontal-temporal lobe dementia: is there a common neural substrate?

Neuropsychological testing was completed in a patient who showed cognitive decline of mental functions, unusual answers to questions, and other characteristics of what has typically been described in the literature as the "Ganser Syndrome." Clear evidence of malingering on a memory test seemed to confirm that this patient was exaggerating deficits for psychiatric reasons or secondary gain, yet the patient showed evidence of mild organic impairment on MRI and continued to deteriorate in cognitive functions and basic self-care. Although an initial SPECT scan had suggested a pattern inconsistent with dementia, a second scan showed frontal-temporal perfusion deficits. Based on this scan and the clinical picture of progressive deterioration, a diagnosis of frontal-temporal lobe dementia was made. This case illustrates that the seemingly deliberate selection of incorrect responses may occur in the early stages of an organic dementia, and that a diagnosis of frontal-temporal lobe dementia should be considered in cases where symptoms appear to be psychiatric or nonorganic. The case further raises the question of whether the reported symptoms of Ganser Syndrome may be accounted for by frontal-temporal lobe dysfunction, since there appears to be some overlap between symptoms of Ganser Syndrome and frontal-temporal lobe dementia. It is also important to note that many reported cases of Ganser Syndrome had a history of head injury.

Dementia↗