[A case report. Factitious disorder with psychological symptoms. Is confrontation useful?]. / Trastorno facticio con síntomas psicológicos. Diagnóstico y tratamiento. ¿Es útil la confrontacion?

Factitious disorder is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the patient role. It is frequently difficult to adequately diagnose this disorder, above all, when the faked symptoms are those of a psychological or a psychiatric disorder. In these cases, there is often high comorbidity with other mental disorders, thus making it difficult to differentiate between real and factitious symptoms. Moreover, the lack of clear objective markers makes assessing the diagnosis even more difficult. In this article, we have aimed to clarify how a correct diagnosis of factitious disorder with psychological symptoms can be reached, to observe the different therapeutic strategies described in the literature and to analyze the utility of each one of them in a given case report.

Prevalencia de trastornos facticios con síntomas psicológicos en pacientes hospitalizados / Prevalence of factitious disorder with psychological symptoms in hospitalized patients

El trastorno facticio se caracteriza por la invención, producción o falsificación de síntomas físicos o psicológicos que simulan una enfermedad física o mental. Entre los pacientes psiquiátricos tanto ingresados como ambulatorios no es infrecuente observar síntomas que se sospecha que son facticios aunque nunca se llegue a confirmar esta sospecha. Tras establecer unos criterios de sospecha de trastorno facticio con síntomas psicológicos se observó que el 8% de los pacientes ingresados en una unidad de hospitalización psiquiátrica presentaban síntomas facticios. Los pacientes con este diagnóstico eran fundamentalmente mujeres y su media de edad fue de 36,2 años. Los síntomas de sospecha que más se observan son la respuesta poco congruente al tratamiento, el empeoramiento de los síntomas ante la perspectiva del alta, la desaparición de los síntomas rápidamente tras el ingreso y el establecimiento de relaciones intensas con otros pacientes o con el personal durante el ingreso. Aunque no es posible determinar con total exactitud el método utilizado en la producción facticia de los síntomas psicológicos, la estrecha observación de los pacientes permite deducir que el 75% de los pacientes exageran síntomas psicológicos presentes en la actualidad o en el pasado y por tanto experimentados en algún momento de la vida. La invención de síntomas psicológicos aparentemente no experimentados nunca por el paciente y la intervención deliberada con el tratamiento psiquiátrico para afectar la evolución de la enfermedad se observaron con menos frecuencia. El 25% de los pacientes con criterios de sospecha de trastorno facticio con síntomas psicológicos presentaron también síntomas somáticos considerados facticios durante el ingreso. El 62,5% de los pacientes con síntomas facticios establecieron relaciones intensas con otros pacientes (AU)

Factitious disorder is characterized by the invention, production or falsification of physical and psychological symptoms that feign a physical or mental illness. Although it is not rare to find symptoms that seem to be factitious among psychiatric patients (both outpatients and inpatients), we have never been able to confirm this suspicion. Once we had established the suspicion criteria for factitious disorder with psychological symptoms, we discovered that 8% of the patients admitted to an inpatient psychiatric unit had factitious symptoms. The patients were mostly women with a mean age of 36.2 years. The most frequent symptoms were non-consistent response to treatment, worsening of the symptoms when faced with the perspective of a discharge plan, disappearance of the symptoms just after being admitted and intense relationship with other patients or staff during the hospitalization. Although it is not possible to determine the method used in the factitious production of the psychological systems accurately, close observation of the patients helps to infer that 75 % of the patients exaggerate the psychological symptoms currently present or those occurring in the past and thus experienced at some time during their lifespan. Invention of psychological symptoms never felt before by the patient and deliberate intervention in the psychiatric treatment to modify the evolution of the illness were less frequent. A total of 25% of the patients with suspicion criteria for factitious disorder with psychological symptoms also had physical symptoms considered to be factitious during the hospitalization and 62% of patients with factitious symptoms developed intense relationships with other patients (AU)

Prevalence of factitious disorder with psychological symptoms in hospitalized patients.

Factitious disorder is characterized by the invention, production or falsification of physical and psychological symptoms that feign a physical or mental illness. Although it is not rare to find symptoms that seem to be factitious among psychiatric patients (both outpatients and inpatients), we have never been able to confirm this suspicion. Once we had established the suspicion criteria for factitious disorder with psychological symptoms, we discovered that 8% of the patients admitted to an inpatient psychiatric unit had factitious symptoms. The patients were mostly women with a mean age of 36.2 years. The most frequent symptoms were non-consistent response to treatment, worsening of the symptoms when faced with the perspective of a discharge plan, disappearance of the symptoms just after being admitted and intense relationship with other patients or staff during the hospitalization. Although it is not possible to determine the method used in the factitious production of the psychological systems accurately, close observation of the patients helps to infer that 75% of the patients exaggerate the psychological symptoms currently present or those occurring in the past and thus experienced at some time during their lifespan. Invention of psychological symptoms never felt before by the patient and deliberate intervention in the psychiatric treatment to modify the evolution of the illness were less frequent. A total of 25% of the patients with suspicion criteria for factitious disorder with psychological symptoms also had physical symptoms considered to be factitious during the hospitalization and 62% of patients with factitious symptoms developed intense relationships with other patients.

Schizophrenic syndromes and clozapine response in treatment-resistant schizophrenia.

Relationships between symptom profile and clozapine response were studied. Symptom scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms were subjected to principal component analysis (PCA) in a group of 66 treatment-resistant schizophrenic patients, 49 of whom were treated with clozapine. Factor scores were compared among responders, non-responders and partial responders. The PCA yielded a four-factor solution, with positive symptoms, negative symptoms, cognitive disorganization and behavioral disorganization components. Cognitive and behavioral disorganization syndrome scores showed significant differences across groups. Cognitive disorganization was higher in non-responders, while behavioral disorganization was higher in partial responders. The results support the possibility of using clinical profiles to predict therapeutic response to clozapine.