Factitious hand disorders: review of 29 years of multidisciplinary care.

PURPOSE: To improve our understanding of factitious hand disorders with a review of our experience over 29 years in a multidisciplinary hand center. METHODS: A retrospective chart review was performed to identify workers' compensation patients treated for factitious hand disorders in the multidisciplinary hand center between January 1981 and September 2010. Multidisciplinary evaluation at this center involved evaluation by hand surgeons, occupational therapists, and psychologists. Data collected include age, sex, race, educational level, clinical presentation, number of diagnostic tests, number of surgeries, time to referral to the multidisciplinary center, direct cost of care, psychological diagnosis, Minnesota Multiphasic Personality Inventory, treatment modalities, and work status. RESULTS: We identified 174 workers' compensation patients with factitious hand disorders. Presentation was used to classify patients into 1 of 4 categories: psychopathological dystonia, factitious edema, psychopathological complex regional pain syndrome, and factitious wound creation and manipulation. There were statistically significant differences between the 4 categories in demographics, utilization of medical resources, psychopathology, treatment modalities, and return-to-work status. Patients with factitious wounds were more educated, used more medical resources, demonstrated an angry or hostile profile, and experienced a lower return-to-work rate. Patients with dystonia were less educated, used less medical resources, demonstrated a hypochondriasis or depressed profile, and experienced a higher return-to-work rate. CONCLUSIONS: Treatment of factitious hand disorders remains frustrating and costly due to failure or recurrence after traditional approaches. This review is a large-scale examination of the factitious hand disorder population that demonstrates the unique pathology involved in each of the 4 categories. There is a specific association between the category of hand disorder and the underlying pathology and prognosis. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Estimated cost of a factitious disorder with 6-year follow-up.

Long-term follow up is rarely described for patients with Factitious Disorder, mainly because of the lack of access to patient's confidential information. In addition, the financial burden of multiple uses of health care system has not been examined so far. We report a 6-year follow-up for a patient with Factitious Disorder who first reported neurological then psychiatric symptoms, and investigate the cost of his detected hospitalizations.

Factitious wound infections in an altruistic living liver donor.

We report a case of recurrent factitious wound infections in an altruistic living liver donor. Costs for the infections after donation were billed to the recipient, creating a threat to the recipient's lifetime benefits. This case illustrates the importance of obtaining previous medical records on living donors.

Factitious renal colic.

OBJECTIVES: We reviewed our experience with patients with factitious disorders who presented with renal colic to identify their common characteristics and to quantify the cost burden placed on the health care system as a result. METHODS: We retrospectively reviewed the medical records of two Philadelphia area hospitals from 1989 to 1995 to find patients with factitious disorders who presented with renal colic. A control group of patients with nephroureterolithiasis was also identified. RESULTS: We identified 12 patients who presented with renal colic and had a final diagnosis of Munchausen's syndrome or malingering. The incidence of factitious renal colic was 0.6%. Eighty-three percent of these 12 patients were men, had an average age of 32 years, and made a total of 18 hospital visits. Ninety-two percent claimed an intravenous contrast allergy, 25% claimed an allergy to a specific narcotic, and 39% of the hospital visits ended with the patient voluntarily discharged against medical advice. Thirty-three percent were treated elsewhere for similar complaints. Only the number of intravenous contrast allergies and the number of patients leaving against medical advice were statistically different from the control group. The total cost for all factitious visits was $52,452, with a mean cost per visit of $2914. The average bill of those patients who received retrograde pyelograms was $3046 greater than for those who did not. CONCLUSIONS: Factitious disorders should be considered when evaluating patients with an intravenous contrast allergy and renal colic. These patients are likely to leave against medical advice and place a significant cost burden on hospitals.

Classification system for factitious syndromes in the hand with implications for treatment.

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

Chronic factitious disorders. Helping those who hurt themselves.

A chronic factitious disorder is a complex psychiatric illness that generally manifests itself in the medical/surgical setting. The immediate need for psychiatric intervention is generally overshadowed by the need for intense medical treatment. The psychiatric liaison nurse is in a key position to manage emotional nursing care during acute hospitalization. Assisting staff to recognize behavioral manifestations can help to prevent further self-destruction and promote future psychiatric followup. The prevalence of factitious disorders is probably higher than misconceptions about the disorder. The potential to save health care cost as well as needless human misery makes this a professional nursing concern. The high incidence of factitious disorders in the nursing profession may make profession may make it a personal issue for nurses as well.