Factitious disorders

Factitious disorders are a group of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits. The namefactitious comes from a Latin word that means artificial. These disorders arenot malingering, which is defined as pretending illness when the "patient" has a clear motive, such as financial gain. Patients with factitious disordersproduce or exaggerate the symptoms of a physical or mental illness by contaminating urine samples with blood, taking hallucinogens, injecting themselves with bacteria to produce infections, and other similar behaviors. There are no reliable statistics on the frequency of factitious disorders, but they are more common in men than in women. Several conditions are sometimes classified as factitious disorders: Munchausen syndrome, Munchausen by proxy, and Ganser's syndrome. In Munchausen syndrome, which starts in early adulthood, patients dramatize and exaggerate their factitious symptoms. Many goso far as to undergo major surgery repeatedly, at several locations to avoiddetection. Many have been employed in hospitals or in health care professions. Munchausen by proxy is factitious disorders in children produced by parentsor other caregivers. The parent may falsify the child's medical history or tamper with laboratory tests in order to make the child appear sick. Occasionally, he/she may actually injure the child to assure that the child will be treated. Ganser's syndrome is an unusual reaction to extreme stress in which the patient gives absurd or silly answers to simple questions. It has sometimesbeen labeled as psychiatric malingering, but is more often classified as a factitious disorder.

Factitious disorders are attributed to many causes: personality disorders; child abuse; the wish to repeat a satisfying childhood relationship witha doctor; the desire to deceive or test authority figures; and the wish to assume the role of patient and be cared for. In many cases, the person has suffered a major personal loss. Indications of a factitious disorder include: Dramatic but inconsistent medical history, extensive knowledge of medicine and/or hospitals, negative test results followed by further symptom development,symptoms that occur only when the patient is not being observed, few visitors, arguments with hospital staff or similar acting-out behaviors, and eagerness to undergo operations and other procedures. When patients with factitious disorders are confronted, they usually deny that their symptoms are intentional. They may become angry and leave the hospital. In many cases they enter another hospital.

Diagnosis of factitious disorders is usually based on the exclusion of bona fide medical or psychiatric conditions, together with a combination of the signs listed earlier. In some cases, the diagnosis is made on the basis of records from other hospitals. Treatment is usually limited to prompt recognition of the condition and the refusal to give unnecessary medications or to performunneeded procedures. Factitious disorder patients do not usually remain in the hospital long enough for effective psychiatric treatment. Some clinicianshave tried psychotherapeutic treatment for factitious disorder patients, andthere are anecdotal reports that antidepressant or antipsychotic medications are helpful in certain cases. Some patients have only one or two episodes of factitious disorders; others develop a chronic form that may belifelong. Successful treatment of the chronic form appears to be rare.

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