DSM-IV-TR A. Intentional production or feigning o physical or psychological s&s B. Motivation for behavior is to assume d sick role C.

External incentives for behavior r absent E:g o behavior : Economic gain Avoiding legal responsibility Improving physical well being Code based on type : Wif predominantly psychological s&s : If psychological s&s predominate in clinical presentation Wif predominantly physical s&s : If physical s&s predominate in clinical presentation With combined psychological & physical s&s : If both psychological & physical s&s r present but neither predominates in clinical presentation

FD wif predominantly psychological s&s Presentation: Bereavement Eating disorder Hypersomnia Depression Amnesia Transexualism Posttraumatic stress dz Substance related dz Paraphilias Pain dz Psychosis Bipolar I dz Dissociative identity dz Symptoms: Depression Bizarre behavior Hallucination Dissociative & conversion sympt Pseudologia fantastica : Limited factual material is mixed w extensive & colourful fantasies Imposture : Lying , Px assume d identity o prestigious person Wif predominantly physical s&s AKA Munchausen syndrome Predisposing factors : True physical disorder during childhood xtensive medical tx Grudge 2ward medical profession Employment as medical paraprofessional Important r/ship w a physician in past Able to present with physical symptoms Clinical presentation : myriad dizziness Fever Hematoma N&V Hypoglycaemia haemoptysis Abd pain Lupus like syndrome

Fa ctitious disor der

Intentional production o physical pathology or feigning o physical or psychological symptoms with apparent aim o being dz as ill

Factitious disorder not otherwise specified Px with factitious s&s do not meet DSM criteria for specific FD Most notable dz is FACTITIOUS DISORDER BY PROXY A person INTENTIONALLY prod physical s&s in ANOTHER person who is under 1st person care DSM-IV-TR RESEARCH CRITERIA for FD by Proxy A. Intentional production or feigning of physical or psychological s&s in another person who is under individual s care B. D motivation for d perpetrators behavior is to assume d sick role by proxy C. External incentives for behavior (such as economic gain) r absent D. D behavior x better accounted by another mental disorder
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Mx Major goals : 1. risk of morbidity & mortality 2. Address d underlying emotional needs or psychiatric dx underlying factitious illness behavior 3. To be mindful of legal ethical issue Guidelines of mx & tx Active pursuit or prompt dx can minimize d risk of morbidity & mortality Minimize harm avoid unnessary test or procedures especially invasivetreat according to clinical jugdement, keeping in mind that subjective complaint might be deceptive Regular interdisciplinary meeting to conflict & spliiting among staff mx staff countertranference. Consider facilitating healing by using double-bind technique or facesaving behavior strategies such as self-hypnosis or biofeedback Steer px toward psychiatric tx in empathic, nonconfrontational, facesavingmanner. Avoid aggressive direct confrontation. Tx underlying psychiatric disturbance such as Axis I dz & Axis II dz. In psychoitherapy, address coping strategies & emotional confict Appoint a primary care provider as a gatekeeper for all medical & psychiatric tx Consider involving risk mx professional & bioethics from early point Consider appointing a guardian for medical & psychiatric decisions Consider presecution for fraud as behavioural disincentive

DDX

Malingering

Somatoform disorder

Hv obvious, recognized environmental goal in producing s& s Seek hospitalization to : Secure financial compensation Evade police Avoid work Can stop s&s when they r no longer considered profitable or when risk too great Px x usually conversant with medical terminology & hospital routine

Personality disorder Schizophrenia Substance abuse Gansers syndrome

a/w prison inmate respond to simple question w incorrect answer to avoid punishment or responsibility for their actions

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