Consultation-Liaison Case Conference: A Case of Factitious Disorder Imposed on Self.

We present the case of a young woman with an extensive medical history that most notably includes over 60 emergency-room visits for unfounded respiratory distress that often prompted intubations. Each presentation displays elements of deceitfulness or inappropriate demands that align with factitious disorder imposed on self. Top experts in the Consultation-Liaison field provide guidance for this commonly encountered clinical case based on their experience and review of available literature. Key teaching topics include a review of risk factors for development of deceptive syndromes, distinguishing factitious disorder from malingering and conversion disorder, and the role of a consulting psychiatrist in such cases. Patients with factitious disorder often show signs of pathologic lying, obstinance, and erratic behavior. Such attributes frequently arouse negative countertransference in providers, causing frustration and dread with continuing care, rendering psychiatric involvement. We address the unique challenges in managing factitious disorder and how to effectively collaborate with an interdisciplinary inpatient team with these cases.

Understanding and co-managing medication treatment options for opioid use disorder.

The number of patients with opioid use disorder (OUD) has increased dramatically. Substance use disorders in general are thought to occur in one in five patients in primary care. However, despite this prevalence, there is a dearth of training in undergraduate and continuing medical education to manage OUDs, and internal medicine doctors need to have an understanding of the basic physiology and treatment options for this illness. Expanding knowledge of OUD treatments will allow internists to use their skills and strong patient-doctor relationships to ensure the trust of their patients with OUD, leading to better outcomes and increased chances of recovery. It will also allow clinicians to appropriately refer their patients for lifesaving specialized care and help them prevent dangerous medical complications often seen as a result of addiction. There are three FDA-approved medications to treat OUD disorder, known collectively as medication-assisted treatment (MAT). In this paper, the three medications-methadone, naltrexone, and buprenorphine-are presented, compared, contrasted, and clinically reviewed.

Guidelines for the assessment and management of addiction in the hospitalized patient with opioid use disorder: a twenty-first century update.

While there have been many articles published on managing the medical sequelae of opioid use disorder in specific patient populations or settings, there is a dearth of literature on assessing and managing opioid use disorder in the acute hospital setting. In 1975, Fultz and Senay published proposed guidelines on the management of what they called the "hospitalized narcotic addict" Fultz and Senay (Ann Intern Med 82(6):815-818, 1975). Since then, many new developments in the treatment of opioid use disorder have occurred. In our experience, services in the acute inpatient hospital turn to psychiatric consultation teams for recommendations on how to manage these complicated and, sometimes, difficult patients. This article serves to provide the internal medicine physician a foundation of understanding how to address the main issues in hospitalized patients with opioid use disorder on a general medical or surgical floor.

Altered Mental Status: A Case Report of Toxic Leukoencephalopathy Following Heroin Exposure.

: Toxic leukoencephalopathy is a rare illness that causes diffuse white matter destruction, and as a result may mimic psychiatric disorders. Multiple causes have been identified including nerve related injury from exposure to a toxin. When symptoms present, they typically improve after the offending agent is eliminated. However, the clinical presentation in this report is unique in that the syndrome got worse several weeks after the toxin was removed. Research indicates that supportive supplements and vitamins can be used to facilitate neurological recovery. This report outlines a case of toxic leukoencephalopathy following heroin overdose that was treated with vitamin supplementation.