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ianb78

Fed up of malingerers!

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I have recently moved work from a relatively affluent area to a city with socioeconomic problems and one of the most challenging aspects are the numbers of people claiming to be hearing voices or going high when they are blatantly making it up to claim benefits.

I saw one young lady the other day who had been given a diagnosis of bipolar disorder by my predecessor and started on depakote after her initial consultation. The next two appts she c/o depressive type symptoms so I added an antidepressant.

The other day I saw her and she stated that she went 'high' for 10 days and reeled off a list of sx which seemed to fit with a manic episode. She said she attempted to come and see me but that the recpetionsist said she couldn't be fitted in (very odd). This episode supposedly suddenly stopped and for the last 4 weeks she has been euthymic.

She described the episode in a very matter of fact way which I have never seen in a patient with biploar disorder. Obviously they tend to enjoy such episodes and so not disclose them readily. No-one has witnessed a manic episode.

Recently I completed her benefits form.

I'm sure that this is bullsh!t but what can you?

Are others experiencing similar issues?! It's so frustrating!

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Internet is the evil ;) they read every sign and symptoms and its really hard unless u know they patient well. With defensive practice we hv to kind of believe wot they say unless we hv seen them few times and KNOW them well.

Isnt it the case where people get admitted on the ward and later found with no mental illnesses.

So we have to bear it with a smile until enough EVIDENCE is there.

Remember after Baby P death only the medic got the sack

cheers

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I guess one has to believe them to a certain point.

Just out of interest would people have stopped her antidpressant given that she stated she went 'high' four weeks ago but was 'depressed' at the previous OPA?

Incidentally I increased her depakote.

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I have recently moved work from a relatively affluent area to a city with socioeconomic problems and one of the most challenging aspects are the numbers of people claiming to be hearing voices or going high when they are blatantly making it up to claim benefits.

I saw one young lady the other day who had been given a diagnosis of bipolar disorder by my predecessor and started on depakote after her initial consultation. The next two appts she c/o depressive type symptoms so I added an antidepressant.

The other day I saw her and she stated that she went 'high' for 10 days and reeled off a list of sx which seemed to fit with a manic episode. She said she attempted to come and see me but that the recpetionsist said she couldn't be fitted in (very odd). This episode supposedly suddenly stopped and for the last 4 weeks she has been euthymic.

She described the episode in a very matter of fact way which I have never seen in a patient with biploar disorder. Obviously they tend to enjoy such episodes and so not disclose them readily. No-one has witnessed a manic episode.

Recently I completed her benefits form.

I'm sure that this is bullsh!t but what can you?

Are others experiencing similar issues?! It's so frustrating!

This is one of the reasons ICD-10 for most mental illnesses have a diagnostic criterion of impairment of functioning.

In other words, it would be difficult to arrive at a diagnosis through symptoms alone when there is no functional impairment.

I would be very wary of diagnosing someone with Depression, if inspite of his symptoms, the person regularly plays a round of golf on week ends, goes out for bingo with his mates in the evening, is able to do his christmas shopping and is dating someone.

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I guess one has to believe them to a certain point.

Just out of interest would people have stopped her antidpressant given that she stated she went 'high' four weeks ago but was 'depressed' at the previous OPA?

Incidentally I increased her depakote.

I would have stopped the antidepressants.

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Have you considered a diagnosis of bipolar type II? That could be consistent with the symptoms she describes (unless it was florid mania she was reporting) and may account for the brevity of the episode.

A more important question is why did you fill in her benefits forms if you were not sure that you agreed with the diagnosis, or impact of her symptoms on her ability to work?

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Have you considered a diagnosis of bipolar type II? That could be consistent with the symptoms she describes (unless it was florid mania she was reporting) and may account for the brevity of the episode.

[highlight]A more important question is why did you fill in her benefits forms if you were not sure that you agreed with the diagnosis, or impact of her symptoms on her ability to work?[/highlight]

Good question.

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To maintain the therpeutic relationship.

To redistribute the nations wealth.

To reduce criminogenic behaviour - stops her from stealing, in order to pay for drugs and alcohol.

To reduce std's - stops her from prostituting herself to pay for the above.

Because it takes too much effort to question, when it so prevalent.

Because your consultant will compel you to do it in a few weeks time, after relatives, SW, CPN and various other team members complain.

Because we have no objective way of testing her veracity.

Becuase it has gone on, it will continue to go on, be part of the system or the sytem will engulf you eventually, whatever your level of attritition.

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agree completely

malingering is hugely on the increase.

sometimes they come in saying that their friends (also on benefits)told them they had mood disorder so they bugged the gp enough to get a OPA.

i think speaking to gp can help, also asking patients to keep a mood diary- really should weed out the people who are sincerely concerned about their moods etc from that increasingly large number of lazy spongers.

Born and brought up in UK- great NHS ideals, great welfare state but scum who abuse it so blatantly are one of the huge reasons for this country's downfall.

Also, 'voices'--checking carefully for pseudohallucinations can usually root out some cheaters. Also a genuine patient should be devastated or at least concerned with such a diagnosis, so anyone 'seeking it' or demanding it, should be held with a degree of suspicion.

I do also see the flip side, where our over-cynicism may lead to missing genuinely needy, so we must be careful.

But seriously-----these SCUM ripping off the whole country while they sit in lovely house, never worked, full SKY tv package, latest mobile phone,IPod etc etc etc .....

Rant over

Better take a Lorazepam quickly.....

;)

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agree completely

[highlight]

But seriously-----these SCUM ripping off the whole country while they sit in lovely house, never worked, full SKY tv package, latest mobile phone,IPod etc etc etc .....[/highlight]

Rant over

Better take a Lorazepam quickly.....

;)

I'm a great believer in not medicalising everything but let us apply EBM principles to the highlighted statement.

The evidence is that the amount spent on the benefit system is a fraction of that given to big business as handouts (through various 'incentives' and tax benefits and even straightforward bailouts). Also - think of the money squandered in the NHS each day.

Society has a lot to answer for in terms of creating the 'malingerers'. Is malingering even worthy as a diagnosis? A very very wise consultant told me she never cared to find out if someone's child abuse was real or not - the fact that they would say they were abused was enough for her. It represented pathology and the veracity of it was never a question for her.

Psychiatrists should at least give patients the benefit of the doubt. Try not to lose your hope too quickly - in psychiatry and your fellow humans. There's a difference between being an optimist and being naive.

F_S

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agree completely

[highlight]

But seriously-----these SCUM ripping off the whole country while they sit in lovely house, never worked, full SKY tv package, latest mobile phone,IPod etc etc etc .....[/highlight]

Rant over

Better take a Lorazepam quickly.....

;)

I'm a great believer in not medicalising everything but let us apply EBM principles to the highlighted statement.

The evidence is that the amount spent on the benefit system is a fraction of that given to big business as handouts (through various 'incentives' and tax benefits and even straightforward bailouts). Also - think of the money squandered in the NHS each day.

Society has a lot to answer for in terms of creating the 'malingerers'. Is malingering even worthy as a diagnosis? A very very wise consultant told me she never cared to find out if someone's child abuse was real or not - the fact that they would say they were abused was enough for her. It represented pathology and the veracity of it was never a question for her.

Psychiatrists should at least give patients the benefit of the doubt. Try not to lose your hope too quickly - in psychiatry and your fellow humans. [highlight]There's a difference between being an optimist and being naive.[/highlight]

F_S

Yeah but the middle ground is difficult to achieve and needs a lot of negative experience. :D

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No Flak.

My point was that we should be optimists - not naive.

Inflammatory headlines belong in the Daily Wail. Despite MTAS and everything else we lead very privileged lives. I think we forget sometimes about human suffering.For someone to rely on faking mental illness as a survival strategy - well, that's just such a sorry state of affairs.

First do no harm.

F_S

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Interesting comments.

I personally feel that alot of the patients are not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

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Interesting comments.

I personally feel that alot of the patients are [highlight]not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.[/highlight]

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

What's malingering then?

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Interesting comments.

I personally feel that alot of the patients are [highlight]not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.[/highlight]

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

[highlight]What's malingering then?[/highlight]

I think Frontier means thinking outside the malingering vs factitious box.

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Interesting comments.

I personally feel that alot of the patients are [highlight]not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.[/highlight]

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

[highlight]What's malingering then?[/highlight]

I think Frontier means thinking outside the malingering vs factitious box.

I'm sorry, living upto something in an unconscious sense? Doesnt jell up in my mind at least!

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Essentially I don't think that alot of the people 'trying it on' consciously produce the symptoms.

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Essentially I don't think that alot of the people 'trying it on' consciously produce the symptoms.

Thats what I didnt understand. What do you mean? 'Trying it on' would seem to mean you try something, how can you do it unconsciously?

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Instead of labelling them as 'malingerers' as I did initally maybe they unconsciously produce symptoms.

So in that sense I guess they aren't 'trying it on'

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Instead of labelling them as 'malingerers' as I did initally maybe they unconsciously produce symptoms.

So in that sense I guess they aren't 'trying it on'

If you are talking abt conversion disorder like symptoms yes then agreed.

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Interesting comments.

I personally feel that alot of the patients are not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

FP - it sounds like you're describing factitious disorder to me - the [highlight]concious[/highlight] feigning of symptoms to enter the sick role - and all the benefits of being in the sick role (though the concept is more about psychological benefits such as not having to work than material ones AFAIK).

The unconcious development of symptoms to please the doctor? I think that would deserve a new classification : dependent factitious personality!

F_S

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Interesting comments.

I personally feel that alot of the patients are not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

FP - it sounds like you're describing factitious disorder to me - the [highlight]concious[/highlight] feigning of symptoms to enter the sick role - and all the benefits of being in the sick role (though the concept is more about psychological benefits such as not having to work than material ones AFAIK).

The unconcious development of symptoms to please the doctor? I think that would deserve a new classification : [highlight]dependent factitious personality![/highlight]

F_S

:lol: :lol: :lol: :lol: :lol:

Admire your sarcastic sense of humour, F_S! ;)

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Interesting comments.

I personally feel that alot of the patients are not malingerers in the true sense of the word but that they unconsciously produce the symptoms or live up to the expectations of the doctor in order to receieve secondary gain.

Someone of sound mental health and leading a productive lifestyle would not do this. By this logic they are in need of help of some kind. The question is what kind of help should be offered. Prescribing powerful psychotropic drugs for people that do not truly suffer from formal mental illness is obviously counterproductive and a waste of resources.

FP - it sounds like you're describing factitious disorder to me - the [highlight]concious[/highlight] feigning of symptoms to enter the sick role - and all the benefits of being in the sick role (though the concept is more about psychological benefits such as not having to work than material ones AFAIK).

The unconcious development of symptoms to please the doctor? I think that would deserve a new classification : [highlight]dependent factitious personality![/highlight]

F_S

:lol: :lol: :lol: :lol: :lol:

Admire your sarcastic sense of humour, F_S! ;)

Agree, that's what i have been trying to point out to him. I think it should be INdependent or UN dependent F Disorder as it is 'unconscious' ;)

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I'm not being sarcastic Usain - these categories we use are subject to revision and it's always good to tweak and refine.

I thought FP was having a rant about malingerers - I happen to think the term is not particularly helpful. It sounds too much like 'malignant' and it taints people who are probably not functioning well in society anyway.

At the same time I'm not suggesting a new term - just some temperence. People get so worked up about 'benefits' but very few actually know how little of their tax money goes on the welfare system and how in debt many on welfare actually are.

A light read on that very topic can be found here - especially Chapter 6 (Big welfare Mamas).

I can't imagine the pressures of practicing GA psychiatry in a large city. In psychiatry I still feel the medics need to have some hope for their patients - that's all.

F_S

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I'm not being sarcastic Usain - these categories we use are subject to revision and it's always good to tweak and refine.

I thought FP was having a rant about malingerers - I happen to think the term is not particularly helpful. It sounds too much like 'malignant' and it taints people who are probably not functioning well in society anyway.

At the same time I'm not suggesting a new term - just some temperence. People get so worked up about 'benefits' but very few actually know how little of their tax money goes on the welfare system and how in debt many on welfare actually are.

A light read on that very topic can be found here - especially Chapter 6 (Big welfare Mamas).

I can't imagine the pressures of practicing GA psychiatry in a large city. In psychiatry I still feel the medics need to have some hope for [highlight]their patients [/highlight]- that's all.

F_S

I practice GA in a large city. I have hope for my patients, sympathy for those who are not and npt doing well in society, but only advice to get real for malingerers. I dont see whats wrong with the term. We have to stop being to PC.

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