Symptômes dépressifs et pathomimie : comorbidité ou trouble psychiatrique factice ?

Abstract

The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders. The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement. These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.