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Factitious disorder

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Has anyone any experience of the above illness aka Munchausen's. Had a patient with a likely diagnosis of this find his way onto a psychiatric ward. He was pretty crap at it but managed to convince me upon my first meeting with him that he had displaced his patella. It was perhaps the funniest but equally most embarassing moment of my career when the orthopaedic SHO called me to confirm he'd 'just been holding his leg at a funny angle'. B@stard.

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lol. .but i never had the privilege to work with one of those..

the really obvious fakers, were so bad that we cud see thru them right away and the liaison staff sent them home pronto.. :P

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Has anyone any experience of the above illness aka Munchausen's. Had a patient with a likely diagnosis of this find his way onto a psychiatric ward. He was pretty crap at it but managed to convince me upon my first meeting with him that he had displaced his patella. It was perhaps the funniest but equally most embarassing moment of my career when the orthopaedic SHO called me to confirm he'd 'just been holding his leg at a funny angle'. B@stard.

I would rule out depression and hypochondriacal delusions..

Unless the patient actually admits that he was faking symptoms to get attention at the hospital, with no other secondary gain (including monetary.... which is very very rare...) and it is really difficult to prove that there is no secondary gain like monetary benefits etc...

I would be aware of diagnosing a factitious... (or the patient shud have multiple hospital admission etc etc etc... even then it is difficult to differentiate from hypochondriasis and somatization disorder)

If there is evidence of a secondary gain other than gaining admission into hospital, it would be malingering...

Malingering and factitious are quite different... both are DSM diagnoses...

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Indeed Dorian. You raise important questions to answer in such cases. In this patient there was undeniably falsification of symptoms and during the short admission they also claimed they were NIDDM with hypoglycaemia! This was also objectively falsified by the contradictory ward reading of the BM, as opposed to our pts reading from a machine in his bag!!

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a couple of years ago as an spr i was asked to see someone by the surgeons who thought that the guy had munchausen's. they asked me to see him after they took a bit of his bowel out just to be sure. he apparantly had very little bowel left as many other hospitals had done the same. he told me he had only spent 3 nights (or something like that, i can't remember exactly) out of hospital in the last 2 years and had had ops performed all over the world - the one previous to this being in iceland to release adhesions. he said he got lots of abdominal pain and travelled around to see if anyone could cure it.

i found it interesting that the surgeon's on admission felt that the diagnosis was munchausen's, yet still opened him up and on opening up decided to take a piece of bowel out just in case before referring to us saying we think he's got manchausen's and that the bit of bowel they took out was entierley normal as they had expected it would be.

pretty much as soon as i introduced myself he told me he knew he had a problem and that it was psychological in nature. he asked if i would admit him for treatment. i said no. he asked if he could get outpatient treatment. i told him that if he was to get housed in the area and register with a gp i'd refer him for psychotherapy, then after approx 18 months he might get to see one. he said that he'd had enough of his travelling lifestyle and had decided that settling down and having psychotherapy would be a good idea.

he got as far as registering homeless, being found a hostel place and then dissappeared - presumably to a nearby hospital.

i've no idea if his 3 nights in two years thing was true - i doubted it on the grounds of the cost of travel from place to place, i suppose hitchhiking would have been a possibility...

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Intresting J.

Hope he doesn't turn up homeless in our area.

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Awesome story J. Saddens me to think my chap is heading that way. Funny how he tried to get admitted again by you.

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asked to see someone by the surgeons who thought that the guy had munchausen's.  

he had only spent 3 nights (or something like that, i can't remember exactly) out of hospital in the last 2 years and had had ops performed all over the world - the one previous to this being in iceland to release adhesions.  

he said he got lots of abdominal pain and travelled around to see if anyone could cure it.

bit of bowel they took out was entierley normal as they had expected it would be.

pretty much as soon as i introduced myself he told me he knew he had a problem and that it was psychological in nature.  

he got as far as registering homeless, being found a hostel place and then dissappeared - presumably to a nearby hospital.

The fantastic thing about Factitious disorder is that none of the above qualifies for a diagnosis of factitious...

unless it can be proved that he did not suffer from pain... (unfortunately we dont have a meter to measure pain)

and he was intentionally feigning his symptoms...

and his sole motivation was to assume sick role...

But I guess it is difficult to prove.... and we take proxy measures of diagnosing, like repeated presentations, and inability to fing anything medically etc etc etc...

Most difficult is when people feign mental illness...

I suspect an axis I factitious / malingering (very difficult to differntiate) in a lot of patients who present to out patients clinics/ some people in the wards who pick up symptoms form other patients...  who present with psychological symptoms like seeing things and hearing voices/ feeling depressed (none of which can be measured again)....

very difficult to prove...

We have a couple of patients whose names and description has been circulated around the casualties in the area, where they have definite management plans for the patients...

The worst thing is, from a mental health point of view, we dont do anything for these patients (if we can call them)... other than offer them psychologist referral with never ending waiting lists.... only to be rejected saying they are not suitable for psychotherapy...

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Recently we had an 18 year old girl admitted to hospital with thoughts of self harm, h/o numerous overdoses in the past, multiple substance misuse and borderline personality traits. Another interesting aspect was her presentation and admissions to different hospitals over last few years mainly gynae and surgery departments becasue of severe abdominal pain which was not even relieved by strong opioids. On every admission she was thoroughly investigated and no cause was found. She would complain of urinary retention without any obvious cause and had to be catheterised on many occasions. During this admission, very first complaint was urinary retention. On abdominal exam, I was not able to palpate a full bladder though she said she had retention for 12 hours. At that point we did not have sufficent information regarding past history so urology opinion was obtained and she was catheterised in the ward by a urology nurse. Catheter was removed after few hours and there was no further retention. Next day she complained of severe abdominal pain and it was shocking to watch her. She was extremely agitated, crying, twisting and turning on the floor. Examination was difficult but I had no reason to suspect an acute abdomen. I refused her request for the transfer to acute hospital and twas amazed to see that she was settled in 2 minutes with no further pain. Then after few hours she collapsed while in her bedroom with the mother. I found her on the floor with no response to verbal or painful stimuli including sternal pressure (which I thought was quite painful stimulus). A, B and C were fine. Except for checking the obs, we did not do anything (though I was bit unsure of that) and again she recovered within 5 minutes and was fully alert and oriented. There is no h/o epilepsy and previous ECGs have been fine. Mother later told me that she thought it was feigned and that this behaviour has bene pretty consistent since early teens. Even as a child she would poke pens and pencils in her forearms. The girl's life style has always been extremely chaotic and at times she had travelled even 200 miles to present to a different hospital with abdominal pain. Would we be right in diagnosing her as Munchausen syndrome? Only gain I can see is sick role. Obviously she also has borderline personality traits and substance misuse problems.

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Reading this is setting all of my sexual abuse alarms off!

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What about a conversion disorder, Neurotic spectrum? Abuse could be one reason but so could bad parenting with overinvolvement and overindulgence.

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Saw two in 6 months on the couth coast.

Was admitted to psych ward for assesment initally, he was very advanced, had his own insulin pen, threw himself around in very convincing seizures.

eventually found out he had prev sex offender history, and had been working his ticket around various hospitals.

Another, i was called to see in ae, he had claimed to have leukemia, got himself iv cyclizine and morphine, made a hca in tears over his heart rendering story of his treatment in London.

then was challenged by ae reg, then admitted to them he was faking it.

ae reg made me assess, whilst he called the police, pt was charged in the end with obstruction or some such nonsense.

this guy had been around the whole country- he told me he had a circuit, which allowed him geographically to cover the most hospitals.

I spoke to a clooeague working in chester who had also seen him - same presentation, same features, different name

perhaps a dtaabase would be useful/ ethical?

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working his ticket

One of my favourite expressions!

I think a database is a good idea, could potentially be a cure; even if not there's going to be less harm and less wasted resources. Criteria to get on the register would have to be very strict.

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