Factitious Disorder Research Articles

Dermatitis artefacta and artefactual skin disease: the need for a psychodermatology multidisciplinary team to treat a difficult condition

Dermatitis artefacta (DA) is a factitious skin disorder caused by the deliberate production of skin lesions by patients with a history of underlying psychological problems. The patient may not be fully aware of this, and the true extent of this disorder, especially in children, is currently unknown. Management of these patients is challenging as many fail to engage effectively with their dermatologist. To explore the various clinical presentations and strategies employed to treat DA in our local population, and note outcomes in order to evaluate effectiveness of our management. A retrospective case note review was conducted of 28 patients attending the regional psychodermatology clinic at the Royal London Hospital from January 2003 to December 2011. Out of 28 patients identified with DA, the majority of patients were female, and the most frequent sites for skin lesions were the face and upper body. Anxiety, depression and personality disorders were common underlying psychiatric diagnoses. Ninety-three per cent of patients were successfully managed (i.e. the DA resolved or was in remission at the time of writing) in our combined psychodermatology clinic by a multidisciplinary psychocutaneous medicine team. Thirty-two per cent of our cases were children (aged < 16 years) and one of these was referred to local child protection services; 46% of patients had a concomitant mental health disease at the time of presentation with DA. A multidisciplinary psychocutaneous team is important in this condition particularly as the patient is likely to require psychological intervention (to facilitate the resolution of the precipitant), in addition to dermatological (to make the diagnosis and, importantly, to exclude organic disease) and psychiatric (to manage concomitant psychiatric disease) input. Our findings indicate that our model of a psychodermatology multidisciplinary team will achieve greater successful treatment of patients with DA and we are the first to describe this important service in the U.K.

Factitious Hand Disorders: Review of 29 Years of Multidisciplinary Care

To improve our understanding of factitious hand disorders with a review of our experience over 29 years in a multidisciplinary hand center. A retrospective chart review was performed to identify workers' compensation patients treated for factitious hand disorders in the multidisciplinary hand center between January 1981 and September 2010. Multidisciplinary evaluation at this center involved evaluation by hand surgeons, occupational therapists, and psychologists. Data collected include age, sex, race, educational level, clinical presentation, number of diagnostic tests, number of surgeries, time to referral to the multidisciplinary center, direct cost of care, psychological diagnosis, Minnesota Multiphasic Personality Inventory, treatment modalities, and work status. We identified 174 workers' compensation patients with factitious hand disorders. Presentation was used to classify patients into 1 of 4 categories: psychopathological dystonia, factitious edema, psychopathological complex regional pain syndrome, and factitious wound creation and manipulation. There were statistically significant differences between the 4 categories in demographics, utilization of medical resources, psychopathology, treatment modalities, and return-to-work status. Patients with factitious wounds were more educated, used more medical resources, demonstrated an angry or hostile profile, and experienced a lower return-to-work rate. Patients with dystonia were less educated, used less medical resources, demonstrated a hypochondriasis or depressed profile, and experienced a higher return-to-work rate. Treatment of factitious hand disorders remains frustrating and costly due to failure or recurrence after traditional approaches. This review is a large-scale examination of the factitious hand disorder population that demonstrates the unique pathology involved in each of the 4 categories. There is a specific association between the category of hand disorder and the underlying pathology and prognosis. Prognostic IV.

Identification and Management of Factitious Disorder by Proxy

This paper presents a literature review of current research on factitious disorder by proxy (FDP). It identifies common symptoms and management techniques of both the child and caregiver in hopes of aiding primary care practitioners to better recognize the diagnosis and implement treatment. FDP is a subtle and dangerous form of child abuse that can cause significant morbidity and mortality. Knowledge of common symptoms displayed by the child and caregiver can assist in immediate legal and medical intercession, as well as initiation of treatment for all parties involved.

Prolonged Vertigo Associated with Nystagmus: an Organic or a Psychiatric Disorder? – Discussing a Case Report

Background:&#x0D; It is mostly organic diseases that are considered when a neurological sign or symptom is present in the history of a patient; however, there may be psychiatric problems also present which could be missed. We report a case to discuss the possibility of the presence of an organic or psychiatric underlying disorder when facing neurological problems.&#x0D; Case Presentation:&#x0D; We report a case of chronic headache accompanied by vertigo and multiple medical problems including nystagmus and abdominal pain without any significant findings on physical exam that was diagnosed to have a somatization disorder (Not Otherwise Specified or NOS).&#x0D; Conclusion:&#x0D; We did not find any documents regarding the presence of true nystagmus as a functional, factitious or psychosomatic disorder; however, voluntary nystagmus has been reported in some cases with a series of fast (saccadic) back-to-back eye movements, without any interval or slow phase. It is recommended that psychiatrists and neurologists search for a psychiatric disorder as well; even if the problem is supposed to have an organic nature like nystagmus or vertigo, especially when associated with a prolonged, resistant, or unusual course.

Three cases of cutaneous Munchausen&amp;apos;s syndrome

Munchausen's syndrome is a rare chronic factitious disorder characterized by pathological lying, the intentional production ofphysical symptoms, and a restless wandering from hospital to hospital in order to obtain hospitalization or extensiveinterventions. Clinically, a variety of cutaneous presentations of Munchausen's syndrome may include dermatitis artefacta. Herein,we describe three cases of cutaneous Munchausen's syndrome with clinically intractable courses.

Syndrome des grosses mains et troubles factices : une association exceptionnelle de mauvais pronostic

The authors report an original clinical presentation of factitious disorders of the upper extremity in an ex-drug-addict patient with puffy hand syndrome. Chronic self-inflicted ulcerations appeared with sequential manner. The patient confessed deliberate self-harm and transfer of anxiety on his hands, the aspect of which had become intolerable. Association of puffy hand syndrome with comorbid psychosis and major depression explained immediate recurrence of ulcerations despite fitted medication and long-term psychotherapy.

Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis

The term Munchausen syndrome is used to describe the patient who chronically fabricates or induces illness with the sole intention of assuming the patient role. Such persons often have a close association with the medical profession and thus use their knowledge to falsify symptoms and laboratory specimens to mimic disease. Cases of factitious disease have appeared in the literature originating from all medical specialties, and include such rare disorders as phaeochromocytoma and Bartter's syndrome. The laboratory can play a key role in the detection and diagnosis of factitious disorders. Indeed discrepant biochemistry results may provide the first clue to the diagnosis. Laboratory staff should be particularly aware of highly variable test results and extreme abnormalities that are not consistent with the wider biochemical profile, suggesting sample tampering. Factitious disorder should also be included in the clinician's differential diagnosis when disease presentation is unusual or an underlying cause cannot be found. Investigation to exclude or confirm factitious disorder at an early stage can prevent unnecessary testing in the search for increasingly rare diseases. Appropriate analyses may include screening tests for the detection of surreptitious drug administration or replication of a fabricated sample to confirm the method used. In all cases close communication between the clinician and laboratory is essential. This will ensure that appropriate tests are conducted particularly with regard to time critical and repeat tests.

Wires in the Body: A Case of Factitious Disorder

Factitious disorder can present with a wide variety of symptomatology. We present a case of a young girl presenting with spontaneous extrusion of wires from her limbs. These metallic wires were present in both her upper and lower limbs in the muscle bulk and were visible on X-ray. She sought repeated surgical removal of these wires, but the wires would invariably reappear. The patient could not be engaged in a therapeutic relationship and the family took premature discharge against medical advice, as they believed in supernatural causation for the phenomenon and were afraid that medical intervention might bring further ill fortune. The case highlights the importance of belief systems of family members as a barrier in managing such cases.

Factitious Disorder as a Cause of Gastrointestinal Bleeding: Use of a Gastroenterologist's “ Secondary Survey ”

Factitious Disorder as a Cause of Gastrointestinal Bleeding: Use of a Gastroenterologist's “ Secondary Survey ”

Factitious disorders and Münchausen syndrome

This population-based study evaluates the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy in a clinical setting. All children referred to the Pediatric Unit of the Department of Pediatrics of the Catholic University Medical School (Agostino Gemelli Hospital) in Rome were recruited between November 2007 and March 2010. An experienced interdisciplinary team of medical professionals analyzed all suspected cases. A total of 751 patients were hospitalized. Factitious disorders were diagnosed in 14/751 patients, resulting in a prevalence of 1.8%. Three of 14 (21.4%) patients fulfilled the criteria for Münchausen syndrome. Münchausen syndrome by proxy was identified in four of 751 patients, resulting in a prevalence of 0.53%. The perpetrator was the mother in three of four of these cases. The epidemiological data obtained in this population-based study indicate that the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy is higher than previously observed. Moreover, early detection was possible thanks to the awareness of an expert interdisciplinary team. We suggest that physicians must consider the possibility of these diagnoses whenever there are discrepancies in a child's illness presentation.

Behavioural and psychological management of somatic symptom disorders: An overview

The number of patients who seek help at primary and secondary care for somatic symptoms which cannot be explained by any known medical condition is enormous. It has been proposed to rename ‘somatoform disorders’ in DSM-IV as ‘somatic symptom disorders’ in DSM-5. This is supposed to include disorders such as somatization disorder, hypochondriasis, undifferentiated somatoform disorder, pain disorder and factitious disorder. The reason for the renaming and grouping is that all these disorders involve presentation of physical symptoms and/or concern about medical illness. In the literature, there is considerable variation adopted with respect to diagnosis and in the approaches adopted for intervention. However, the common feature of these disorders is the chronicity, social dysfunction, occupational difficulties and the increased healthcare use and high level of dissatisfaction for both the clinician and the patient. A number of behavioural and psychological interventions for somatic symptoms have been carried out at primary, secondary and tertiary care settings and recently there have been more attempts to involve the primary care physicians in the psychological interventions. This review aims at giving an overview of the components of the behavioural and other psychological interventions available for addressing medically unexplained somatic symptoms and to present their efficacy.

Commentary on ‘Recovery from chronic factitious disorders (Munchausne's syndrome): A personal account’ by Bass and Taylor, 2012

Commentary on ‘Recovery from chronic factitious disorders (Munchausne's syndrome): A personal account’ by Bass and Taylor, 2012

Recovery from chronic factitious disorder (Munchausen's syndrome): a personal account

This case report provides an account by a patient (with permission) of chronic factitious disorder and the factors that led to recovery. Such accounts are extremely rare in the literature. This account also throws into sharp focus current controversies in the classification of factitious disorders.

Prevalence and Characteristics of Military Malingering

The authors' principle objective was determining the prevalence and characteristics of medical malingering in the military. The authors accessed an electronic database used by the Department of Defense to monitor and manage military health care activities worldwide. The authors searched the database from 2006 to 2011 in the Northern Regional Medical Command for all instances where a health care provider, consequent to an outpatient medical visit, diagnosed malingering, factitious disorder with psychological symptoms, or factitious disorder with physical symptoms. During the time period studied, the Northern Regional Medical Command reported 28,065,568 health care visits. During the same time period, clinicians diagnosed 1,074 individuals with malingering, factitious disorder with predominantly psychological signs and symptoms, or factitious disorder with predominantly physical signs and symptoms. The typical subject diagnosed with one of these disorders was young, male, nonmarried, and enlisted. Although most diagnoses came from a mental health clinic, other medical specialties also contributed to the total tally. These diagnoses are extremely rare based on the findings from this study of outpatient medical care visits.

1996 – Facticious disorder with hallucinations - a case report

Factitious disorder (FD) is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the patient role. It's frequently difficult to adequately diagnose this disorder when the faked symptoms are those of a psychological or a psychiatric disorder. In these cases, there is often high comorbidity with other mental disorders, thus making it difficult to differentiate between real and factitious symptoms. To present a case-report of FD with hallucinations and a review study regarding the theme available in Medline . Brief literature review. A case report is presented and literature of this theme shortly reviewed. The case involves a 23-year-old female, a psychology student, born in destructured family. She had attempted suicide many times since she was 16 years old, one of them with high lethality. One month before her admission to our inpatient clinic in order to allow a clear diagnosis to be made, she began active auditory hallucinations, persecutory delusional ideation with disorganized behavior and consequent social isolation. A suitable dose of atypical antipsychotic drug was administered but Psychotic disorder was ruled out and she was dignosed with FD. After the factitious symptoms that prevented any type of therapeutic approach disappeared, the real symptoms of the patient were those characteristic of a borderline personality disorder. This case emphasizes the need for the careful observation of these patients in order to establish the diagnosis and to improve a specific management strategy for them.

Self-Inflicted Lesions in Dermatology: Terminology and Classification – A Position Paper from the European Society for Dermatology and Psychiatry (ESDaP)

The terminology, classification, diagnosis and treatment of self-inflicted dermatological lesions are subjects of open debate. The present study is the result of various meetings of a task force of dermatologists, psychiatrists and psychologists, all active in the field of psychodermatology, aimed at clarifying the terminology related to these disorders. A flow chart and glossary of terms and definitions are presented to facilitate the classification and management of self-inflicted skin lesions. Several terms are critically discussed, including: malingering; factitious disorders; Münchausen's syndrome; simulation; pathomimicry; skin picking syndrome and related skin damaging disorders; compulsive and impulsive skin picking; impulse control disorders; obsessive compulsive spectrum disorders; trichotillomania; dermatitis artefacta; factitial dermatitis; acne excoriée; and neurotic and psychogenic excoriations. Self-inflicted skin lesions are often correlated with mental disorders and/or patho-logical behaviours, thus it is important for dermatologists to become as familiar as possible with the psychiatric and psychological aspects underlying these lesions.

Abdominal panniculitis as a presentation of Munchausen Syndrome

Factitious disorders including Munchausen’s syn drome are encountered by all clinicians. A considerable number of cases of Munchausen’s syndrome are under-diagnosed in clinical practice. We present a 34-year-old man who was admitted with symptoms of epigastric pain, vomiting and peri-umbilical ecchymosis. Physical examination showed signs of inflammation in the abdominal wall with tenderness and guarding in the upper abdomen. However, various blood tests were unremarkable. Computed Tomography and demonstrated anterior abdominal wall panniculitis. After many investigations looking into various aetiological factors that could lead to fat necrosis, a diagnosis of Munchausen’s syndrome was made and the patient was discharged to the care of the local general doctor practice following psychiatric input.

Somatoform, Factitious, and Related Diagnoses in the National Hospital Discharge Survey: Addressing the Proposed DSM-5 Revision

The DSM-5 working group on the somatoform (SFD) and factitious (FD) disorders has recommended substantial revisions of these categories. The recommendations are based, in part, on anecdotal evidence that the diagnoses are infrequently used. To assess the assignment rates for SFD, FD, and related diagnoses among general medical inpatients. The National Hospital Discharge Survey was queried for instances of SFD and FD, along with related diagnoses identifying medical cases in which psychological factors play a role. Diagnoses of major depression and generalized anxiety disorder were queried for comparison purposes. The target diagnoses were assigned far less frequently than published prevalence and recognition rates suggest. Nearly half of the assigned target diagnoses were generic diagnoses (esp. physiological malfunction due to psychological factors) other than SFD or FD. However, the apparent degree of underassignment of the target diagnoses was not dramatically greater than the underassignment observed for major depression and generalized anxiety disorder. The results provide empirical support for the impression that physicians do not assign SFD and FD diagnoses in recognized cases, but do not strongly support the assertion that these diagnoses are uniquely problematic.

Manifestations cutanées révélant une cryofibrinogénémie associée à une gammapathie monoclonale

Cryofibrinogenaemia is an under-recognized cutaneous thrombotic vasculopathy that may be revealed by purpura or chronic necrotic ulcerations. We report two original cases characterized by their severity, their association with a monoclonal gammopathy and their excellent response to treatment. A 38-year-old woman was admitted for large necrotic leg ulcers appearing 1 year earlier and already investigated. Non-specific signs were seen on a previous skin biopsy and the diagnosis of a factitious disorder was considered at that time. Further investigations revealed circulating cryofibrinogen associated with IgG kappa monoclonal gammopathy without cryoglobulinaemia. Plasmapheresis followed by bortezomid-dexamethasone to treat the monoclonal gammopathy resulted in rapid and complete healing of the ulcers, militating in favour of its involvement in cryofibrinogen formation. The second patient, a 91-year-old woman, was referred to our department for acute necrotic purpura of the legs. Skin biopsy revealed leukocytoclastic vasculitis. Glomerular nephropathy with acute renal failure and multiple arterial thromboses were associated with the skin condition. The cryofibrinogen assay was positive without cryoglobulinaemia and other causes of vasculitis were ruled out. The main component was monoclonal IgG lambda. Prednisone-cyclophosphamide treatment led to complete healing of the skin lesions and to recovery from the systemic consequences of cryofibrinogen without sequelae. Routine screening for cryofibrinogen in plasma should be performed to explore cutaneous symptoms of unexplained thrombotic vasculopathy, even in the presence of a non-specific skin biopsy. Specific treatment of cryofibrinogenaemia associated monoclonal gammopathy appears to be highly effective against manifestations of cryofibrinogenaemia.

Pure gait disturbance displayed by malingerers: Case report of two patients

Although not considered as a mental illness, malingering is efined among ‘code V’ in the fourth edition of the Diagnostic nd Statistical Manual of Mental Disorders (DSM-IV) as one of he “Other Conditions” that require medical attention [1]. The ssential feature of the malingering is the intentional production f false or grossly exaggerated physical or psychological sympoms, motivated by external incentives such as avoiding military uty, avoiding work, obtaining financial compensation, evading riminal prosecution, or obtaining drugs. Malingering is not conidered as a form of psychopathology, but could also emerge in the ontext of mental or personality disorders. The differential diagnois of malingering from conversion disorders, factitious disorder, ypochondriasis and somatoform disorders requires careful examnation by an experienced psychiatrist. Phenomenologically, they could mimic the full spectrum f almost any kind of organic disorders, including movement isorders. Abnormal gait disorders of psychogenic origin are charcterized by exaggerated effort, slowness, unusual uneconomic ostures, knee buckling, and near falling [2,3]. Psychogenic gait disrders (PGD) account for 1.5% to 4.5% of all patients admitted to a ovement disorder clinics [4–7]. Psychogenic disorders are classied as the somatoform disorders, where it is assumed that patients re not intentionally or consciously producing their symptoms or igns. In contrast, other conditions such as factitious disorder and