October 30th 2015
Reporting of symptoms that are beyond available medical evidence is a central feature of malingering and related conditions, making the clinical differentiation of these disorders a challenge.
August 28th 2014
Why do you need to know about Munchausen by Proxy? Answers here.
May 22nd 2013
A panel of experts at the APA Annual Meeting discussed how changes in DSM-5 may affect clinical practice. Highlights here.
August 21st 2012
The primary difference between malingering and factitious disorder is the question of motivation.
May 2nd 2012
Staying empathic and keeping the conflict within the patient instead of between the patient and health care provider, is a key to successful management.
4 Warning Signs of Illness Falsification
Medical, psychiatric, and/or developmental disorders can be falsified in a variety of ways. Know the warning signs often missed by clinicians.
Mini-quiz: Munchausen Syndrome
What do you include in your differential diagnosis if you suspect Munchausen syndrome? Take the quiz and learn more.
Quiz on Vicarious Trauma, Working With Other Physicians, and More
Should malingering be considered more likely than factitious disorder when a patient exhibits pseudologia fantastica? What condition persists for longer than 3 months, accompanies a disease process, and is associated with a bodily injury that has not resolved over time? These questions and more in this interactive quiz.
Psychiatry and Chronic Pain
Although acute pain typically resolves on its own with little need for intervention, for some persons pain persists past the point where it is considered an adaptive reaction to injury.
Watch Out for “Loud” Symptoms
The doctor’s role is to go beyond the obvious and to detect subtle determinants. Good diagnosticians have been trained to look beneath the loud symptom and consider underlying factors.
November/December 2009 Special Report: Forensic Psychiatry
The Case of Factitious Disorder Versus Malingering
Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions.
Readers React to “Abortion Trauma Syndrome”
Respecting the article “Abortion Trauma Syndrome” by Arline Kaplan, I would note the irony of the claim that this syndrome is “conceived by anti-abortion activists to advance their cause,” given the obvious pro-abortion attitude of everyone associated with Kaplan’s article.
Because numerous diseases- infectious, endocrinological, metabolic, and neurological, as well as connective-tissue disease-can induce psychiatric and/or behavioral symptoms, clinicians need to distinguish these neuropsychiatric masquerades from primary psychiatric disorders, warned José Maldonado, MD, the director of Stanford University’s Psychosomatic Medicine Service.
Pathological Lying: Symptom or Disease?
Mr A was desperate. He was about to lose yet another job, not because he was at risk for being fired, but because his lying behavior had finally boxed him into a corner. He had lied repeatedly to his colleagues, telling them that he had an incurable disease and was receiving palliative treatment. . .
Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60-64.
The Joker and the Thief: Persistent Malingering as a Specific Type of Therapeutic Impasse
"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
Managing Malingering in the Emergency Setting
The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.
Factitious Disorder: Detection, Diagnosis, and Forensic Implications
Few phenomena in medicine aremore confounding than the diagnosesinvolving deception:malingering, Munchausen syndrome,Munchausen by proxy (MBP), and factitiousdisorder.
On Skepticism and Tolerance in Psychiatry and Forensic Psychiatry
Recent discoveries in neuroscience have ramifications for all aspects of clinical and forensic practice, including diagnosis, treatment, and testimony in civil and criminal justice cases.
Malingering: Key Points in Assessment
The assessment of malingering presents a significant challenge for mental health clinicians.
Clinical Pearls on Best Approaches to Psychogenic Movement Disorders
Five words that are guaranteed to annoy your patientwith a diagnosis of psychogenic movementdisorder (PMD) are It's all in your head.It's the worst thing you can say, said Katie Kompoliti,MD, associate professor of neurological sciencesat Rush University Medical Center in Chicago.
CRPS Type I and Mental Illness
Dr Steven King provided an interesting summary of complex regional pain syndrome (CRPS) in Psychiatric Times (Complex Regional Pain Syndrome, June 2006, page 9). We felt it would be useful to provide some additional observations on the relationship between CRPS type I and psychological causes of pain.
Differentiating Epileptic Seizures From Other Spells
It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with convulsive, clonic movements may, in fact, be experiencing psychogenic events.
Mothers Thinking of Murder: Considerations for Prevention
While many parents fear that strangers might kill their children, a parent is actually more likely to be the perpetrator. This column focuses on preventing the tragedy of maternal filicide.
Agitation in the Elderly
While dementia is marked by such cognitive deficits as disorientation, memory loss and changes in intellectual functioning, these are not the symptoms that cause the most distress to caregivers.
Neurotechnology's New Wave, Part II: Value, Acceptance, and Clinical Applications
Neurotechnologic devices are proving themselves in clinical medicine. Many of these devices offer several distinct advantages over traditional pharmaceutical-based therapies: their effects are reversible, they are often cheaper than pharmaceuticals, and they solve therapy adherence issues. "If a problem occurs, you can turn off the device; or if the disease evolves over time, you can dynamically adjust the device," explained Ali R. Rezai, MD, chairman of the Center for Neurological Restoration at the Cleveland Clinic.
Somatization in the Primary Care Setting
Somatoform disorders (disorders that are not fully explained by a medical condition or mental disorder) may require psychiatrists to consult with physicians.
Essential Issues in Pediatric Psychosomatic Medicine
Pediatric psychosomatic research shows that emotional, behavioral, and psychiatric symptoms are found more often in children and adolescents with chronic illnesses than in healthy children.
Should Psychiatrists Perform Physical Examinations?
Psychiatrists specialize in mental phenomena, but this special expertise does not confer license to ignore the additional information that can be gathered from physical signs.
The Diagnosis of Psychogenic Nonepileptic Seizures
About 25% of patients seen in epilepsy clinics and monitoring units who do not respond to antiepileptic drugs (AEDs) have received a misdiagnosis.1-3 The eventual diagnosis for most of these patients will be psychogenic nonepileptic seizure (PNES)1,4-a somatoform conversion disorder. It is treatable, but diagnosis, delivery of the diagnosis, and management present significant challenges. A major barrier to care has been the stigma associated with the label "psychogenic."
Clinical Reflections: Making Difficult Choices
Psychiatrists can play a vital role in determining whether or not a patient will be a good candidate for an organ transplant. Using a case vignette, Dr. Garton explains how she helps a transplant team make the best possible decision.
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