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Year: 2017

When Munchausen Becomes Malingering: Factitious Disorders That Penetrate the Legal System

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Factitious disorders are those conditions in which individuals actively create signs or symptoms of physical or psychological disease states.' Although there are numerous reports of factitious psychological disorders, there is controversy about the legitimacy of the diagnosis This paper will limit its focus to factitious physical disorders and how they may enter the legal system in civil litigation. Although most psychiatrists are familiar with factitious disorders from their medical training, many attorneys and judges have had not any exposure to such cases. As these cases appear to be developing more frequently in legal and other non-medical settings,' it is important for these non-psychiatrists to become aware of the factitious disorders in order to deal with cases appropriately. Considerable education may be necessary to inform legal staff about factitious disorders because the entity is so counter intuitive-no one expects an apparently reasonable person to actively create a...

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Factitious Disorder Imposed on Another (Munchausen by proxy)

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Practice Essentials

Factitious disorder imposed on another (formerly factitious disorder by proxy) has as its cardinal characteristic the production or feigning of physical or psychological symptoms in another person, usually a child or adult under the care of the person with the disorder. It is currently understood as including the condition commonly known as Munchausen syndrome by proxy (MSBP). Signs and symptoms

Common presentations of factitious disorder imposed on another (including MSBP) include the following:

•Bleeding •Seizures •Recurrent apparent life-threatening events •Poisoning •Apnea •Central nervous system (CNS) depression •Diarrhea and vomiting •Fever, either feigned (via falsification of chart records) or actual •Rash •Hypoglycemia •Hyperglycemia •Hematuria or guaiac-positive stools •Multiple infections with varied and often unusual organisms

Warning signs that raise the possibility of this disorder include the following:

Unexplainable, persistent, or recurrent illnesses Discrepancies among the history, clinical findings, and child’s general health

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What Is the Difference Between Malingering and Factitious Disorder?

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Factitious disorder is the term used to describe a pattern of behavior centered on the exaggeration or outright falsifications of one’s own health problems or the health problems of others. Some people with this disorder fake or exaggerate physical problems; others fake or exaggerate psychological problems or a combination of physical and psychological problems. Factitious disorder differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.

Factitious Disorder Basics

People with factitious disorder do several things that are unexpected for patients who present themselves for medical treatment, or for individuals seeking treatment for others in their care. First, they commonly exaggerate or lie about problems in their medical histories or the histories of others. They also present their doctors with symptoms that don’t legitimately ....

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Munchausen’s Syndrome and Other Factitious Disorders in Children

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Abstract

There has been increasing recognition in the pediatric literature for the past 20 years that illness falsification by caregivers must be included in the differential diagnosis of children presenting with persistent, unexplained symptoms or laboratory findings. However, there is considerably less awareness that pediatric symptoms can also be intentionally falsified by child and adolescent patients, and this unique group has remained virtually invisible. There have been reports that many children with factitious disorders also suffer from other mental disorders, particularly personality disorders. We report an unusual case of Munchausen's syndrome in a 15-year-old patient with sickle cell disease. We also review other reported pediatric factitious disorders in literature. Our purpose is to make clinicians aware of this less known disorder in children and to discuss the similarities and differences these disorders have in children compared to adults with the same disorders.

Introduction

Adult patients who present with symptoms of factitious disease are...

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Are Psychiatric Diagnoses Defamatory Statements?

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Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To evaluate evidence from randomised controlled trials (RCTs) for the efficacy of different communication strategies used by clinicians to inform patients about the diagnosis and outcome of schizophrenia, compared with treatment as usual

To compare efficacy between different communication strategies.

Background

Description of the condition

Schizophrenia, a serious mental illness, is a group of heterogeneous disorders typically characterised by the presence of delusions, hallucinations, disorganised speech, disorganised behaviour, and negative symptoms (avolition, apathy, anhedonia, alogia, affective blunting). The two major classification systems, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), have different requirements of symptoms duration for the diagnosis of schizophrenia. While the DSM requires a total duration of a minimum of six months, the ICD-10 warrants a minimum duration of one month.

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Different Communication Strategies For Disclosing A Diagnosis Of Schizophrenia And Related Disorders

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Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To evaluate evidence from randomised controlled trials (RCTs) for the efficacy of different communication strategies used by clinicians to inform patients about the diagnosis and outcome of schizophrenia, compared with treatment as usual

To compare efficacy between different communication strategies.

Background

Description of the condition

Schizophrenia, a serious mental illness, is a group of heterogeneous disorders typically characterised by the presence of delusions, hallucinations, disorganised speech, disorganised behaviour, and negative symptoms (avolition, apathy, anhedonia, alogia, affective blunting). The two major classification systems, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), have different requirements of symptoms duration for the diagnosis of schizophrenia. While the DSM requires a total duration of a minimum of six months, the ICD-10 warrants a minimum duration of one month. The DSM-IV has a requirement for...

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Lies in the Doctor-Patient Relationship

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Have you ever lied to your patients or been surprised to learn that one of your patients lied to you? Have you considered it important to learn why lies emerge in the treatment relationship? Have you wondered whether (or how) you should confront such untruths? If you have, then the following discussion should provide the forum for answers to these and other questions related to the exploration, detection, and management of lies in the medical arena.

Clinicians realize that making an accurate diagnosis relies on the provision of reliable information by patients and their family members and that timely, astute, and compassionate care depends on effective bidirectional communications (between the patient and the physician). Unfortunately, both patients and physicians are often challenged by complicated communications; each group withholds, distorts, obfuscates, fabricates, or lies about information that is crucial to the doctor-patient relationship and to effective treatment....

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Niacin Skin Flush Test: A Research Tool for Studying Schizophrenia.

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Abstract

BACKGROUND:

A body of biochemical evidence suggests that abnormal phospholipid metabolism may play a role in the etiology of schizophrenia, and possibly, other psychiatric and neurological diseases. Niacin, a B-complex vitamin, induces prostaglandin synthesis, vasodilatation, and skin flushing when applied as a solution on the skin or taken orally. In schizophrenia, diminished or absent skin response to niacin represents a robust finding.

RESULTS:

Attenuated niacin skin-flush response has been analysed as a potential biochemical marker of impaired prostaglandin signaling in schizophrenia. Diminished skin redness after topical application of niacin might be caused by a reduced level of the precursor arachidonic acid in the peripheral membranes, increased activity of the enzyme phospholipase A2, abnormal expression of niacin or prostaglandin receptors, or poor vasomotor activity of cutaneous capillary walls. Heritability estimates established in several studies support niacin skin flush response as a vulnerability...

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About Schizophrenia and Psychosis

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About one in a hundred people have schizophrenia and can have a variety of ‘positive’ symptoms, such as hallucinations, delusions or disordered speech/behaviour, and ‘negative’ symptoms such as problems with fluency of language and thoughts or with expression of emotions.

As is the case with most mental illness, the cause of schizophrenia is not known. The conventional treatment for schizophrenia is usually long-term treatment with antipsychotic medication. A nutritional approach works alongside conventional treatment and may improve both positive and negative symptoms, and also reduce the side-effects of medication.

Below is an outline of nutrition approaches that may be relevant:

• Correcting blood sugar problems made worse by excess stimulant and drug use • Addressing essential fat imbalances • Increasing antioxidants; niacin (Vitamin B3) therapy • Addressing methylation problems helped by B12 and folic acid • Investigating pyroluria and the need for zinc and identifying any food allergies

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What-If Analysis

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Definition

In order to be able to evaluate beforehand the impact of a strategic or tactical move so as to plan optimal strategies to reach their goals, decision makers need reliable predictive systems. What-if analysis is a data-intensive simulation whose goal is to inspect the behavior of a complex system, such as the corporate business or a part of it, under some given hypotheses called scenarios. In particular, what-if analysis measures how changes in a set of independent variables impact a set of dependent variables with reference to a given simulation model such a model is a simplified representation of the business, tuned according to the historical corporate data. In practice, formulating a scenario enables the building of a hypothetical world that the analyst can then query and navigate.

Historical Background

Though what-if analysis can be considered as a relatively recent discipline, its background is rooted at the confluence... ..

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Czech Factors Related to Reproductive Coercion and Pregnancy Avoidance Among Women Experiencing Intimate Partner Violence

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Approximately 5% of US women have experienced reproductive coercion – an intimate partner trying to get them pregnant when they did not want to be (Black et al., 2011). Reported prevalence is higher (14-74%) in smaller community samples of women receiving services (Miller et al., 2010; Moore, Frohwirth, & Miller, 2010; Raphael, 2005). Associations with physical/sexual violence have been mixed (Messing & Thaller, 2012; Miller et al., 2010), though reproductive coercion was related to unintended pregnancy when physical violence was present (Miller et al., 2010). Reproductive coercion has also been associated with compromised sexual health decision-making (fear of refusing sex or asking a partner to use a condom; Messing & Thaller, 2012). There is need to investigate other factors associated with reproductive coercion and pregnancy avoidance among women experiencing intimate partner violence (IPV) to inform development of screening tools and targeted interventions....

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Technology Arms Peeping Toms with a New and Dangerous Arsenal: A Compelling Need for States to Adopt New Legislation, 17 J. Marshall J. Computer & Info. L. 1167 (1999)

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I. INTRODUCTION

The act of voyeurism is becoming an increasingly prevalent and unsettling threat to human dignity and the right to privacy. The "peeping Tom" of yesterday is now armed with a new arsenal that threatens more than just the unsuspecting victim standing by an open window. With the development and advancement of surveillance technology, voyeurism has evolved into something an increasing number of people suspect and fear. The accessibility of small video cameras and other viewing or recording methods eases the barriers for perverts to observe others engaged in otherwise personal activities. The story of Susan and Gary Wilson, recent victims of video voyeurism, illustrates what these peeping perverts can do with the aid of a video camera. In 1996, the couple went looking for a home and at the suggestion of a friend and fellow church member, Steve Glover,...

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Voyeurism And Exhibitionism: How Common Are They?

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Do you enjoy R-rated movies with steamy sex scenes? Most people do. There’s a little bit of voyeur in all of us.

Do you ever wear tight, form-fitting, or revealing clothing to show off some aspect of your body? Many people do from time to time at the beach, the gym, or socially. There’s a little bit of exhibitionist in most of us, too.

But how many people are really deeply into watching sex or exposing themselves in public? That’s been a mystery but a Swedish study has investigated the issue, providing what, as far as I know, are the only real data on the subject.

Researchers at the Karolinska Institute (the university that awards Nobel Prizes) surveyed a random sample of 2,450 Swedes age 18 to 60. Seventy-six (3.1 percent) reported at least one incident of feeling sexually aroused by exposing their genitals...

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The Misuse Of Input Information In Judgments Of Outcomes

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Abstract

In this paper we identify an input bias, the systematic misuse of input information in judgments of outcome quality. In many settings irrelevant input measures, such as the amount of time an employee spends in the office, influence outcome assessments, such as performance reviews. Across four studies we find that input values subtly, but significantly distort judgments of outcome quality.Irrelevant input information predictably influences outcome assessments even when people recognize that input measures should not matter and believe that input information did not matter. We examine the mechanics of the input bias, and suggest that because input measures are often easy to manipulate or misrepresent, the input bias is likely to have broad implications for managerial judgment and decision making.

2003 Published by Elsevier Science (USA)

1. Introduction

Judgments of quality are essential prerequisites for many decision making tasks. For example, prior to making a hiring decision a manager needs to assess thequality of...

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Why Thought Stopping Doesn’t Work

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Some therapists still recommend a technique called "thought stopping". This is quite unfortunate since thought-stopping leads to thought rebounding. The research by Wegner at Harvard on "white bears and other unwanted thoughts" shows that trying not to think of a thought leads to the thought persisting later. In a recent review of strategies that people use, Yale psychologists Ameli Aldao and Susan Nolen-Hoeksema found that suppression strategies for thoughts and emotions are associated with greater anxiety and depression, whereas other strategies (such as problem-solving, acceptance and cognitive restructuring) are associated with less anxiety.

"Thought-stopping,"is a now discarded behavioral technique that involves getting rid of negative or unwanted thoughts by suppressing them. Thus, whenever you have the worry that you will lose all your money in the stock market, you are encouraged to force yourself to stop having these thoughts by snapping a rubber band on your...

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