Deception in Clinical Setting lectures summary

the exam exists of :



-
-30 MC
3 openquestions
questions
,
,




each
each awarded with 1

awarded with 10 points
point (so30 points total)
(so 30 points total)
Zsodo points in total

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Lecture 1 (Introduction) -




Looking at validity of problems
Idifference in deceptions and how we can detect them


Deception is fundamental to survival in the animal kingdom
↳ of death to avoid
think of feigning predators
very common




Clinicians are trained to believe that the patient is honest
This leads to often not being aware of the chance of deception
However some clients are
deliberately producing false
(benefits)
or over
exaggerated symptoms
↳ for ex .
to
gain external incentives (malingering) or

to assume the sick roll (factitions disorder)

Some syndromes associated with deception :



-Substance abuse -denial & other forms of deception in order
to minimize consequences of use


-Eating disordersI patient use various deceptive practices ,
like
lying
about weight or intake , hiding food ,
use of laxatives etc.
-

Paraphilias >
illegal (think of pedophilia or frotteurism)
they are dishonest because it is


personality disorder difficulties impulse control including exaggeration/lying
with ,




factitious disorder = a
psychiatric condition in which an individual presents with an illness (internal motivation)
(
for the purpose of
deliberately produced/falsified
disorder)
the sick roll
mental
that is
=




assuming

Malingering= the intentional production of false or
grossly exaggerated physical or
psychological symptoms
(not an official disorder) motivated by external incentives such as ,
financial compensation


How can we differentiate between factitious disorder/malingering and a real medical or mental condition ?


illness anxiety disorder preoccupation with fears of Crelieved they aren't sick)
:
having a serious illness when it turns out


disorder without any
conversion
Sensory motor symptoms physiological cause (they don't do intentionally
:
or it




If a
pill looks a certain
way ,
then that will
heighten the placebo effect causing the medication to work better
,




There are multiple explanations for why people would malinger ,




these are some of the
explanatory models :
over
-Adaptational model cost-benefit analysis results in feigning impairment for the benefits vraag
leguitwumsubstaneen
open
:

kan een
-Dathogenic model a disorder causes the
malingered symptomatology >
- komen bijv :
-Criminological model malingering is :
a
sign of antisocial behaviour commited by antisocial people malingering adaptationa
- > PSM relies this
abuse volgens thouroughly
on one
explain

, Lecture 2- (factitious disorders)

factitious disorder psychiatric disorder in which an individual presents
= with an illness that is


↳ in the 1900s
deliberately produced
it was
or falsified
called 'doctor addiction'
,
for the purpose of assuming a sick roll




Pseudologia Fantastica = a
compulsive form of
pathological lying
- these are
repetitive ,
semi
compulsive ,
often ridiculous lies with no clear external goal orientation

they appear to do it to bolster self-esteem and to promote admination
by others

Beginning of the modern factitious disorder started when Asher studied case reports
of patients : -
who go from hospital to hospital
-

seeking admission through feigned symptoms
-
while embellishing their personal history
Everfraaien)


this is called Munchausen
syndrome
=
subset of patients who have a chronic variant of factitious disorder
with predominantly physical signs and symptoms

& Munchausen by is imposed by another upon you
proxy

The sole diagnosis of factitious disorder is vare
Often together with comorbid disorders like childhood trauma PTSD depression substance , , ,
abuse ED ,
,
mood disorders etc.



It's hard to estimate how often it occurs



Four features syndrome that increase morbidity/mortality risks
of FD is Munchausen :




. Dangerous manipulations of patient's own body
1

. Patients with FD frequently provide incomplete/false
2
medical
history info (like withholding allergy info)
. Medical staff may delay or withholding necessary treatment
3
of factitious medical complains (they don't take the patient
because patient has
history a
seriouslyI
Engaging in deception can cause medical care providers to start
4
.

using exotic non-proven treatments/risky diagnostics
,




The risk factors for FD are still
largely unclear developing
-
> but could be other mental/medical conditions presence that
resulted in extensive medical attention in the past

-grudge against the medical profession
-


presence of personality disorder (especially : borderline ,
narcism or antisocial)

Warning signs that might point to factitious disorder are :




-Dramatic
atypical presentation
or


-fluctuating (mostly seeking attention from important doctors/media)
clinical course

-indifferent acceptance of the discomfort and risk of diagnostic procedures/surgeries (not questioning if
something that risky is really needed)
-controlling hostile angry disruptive
. ,
attention-seeking behavior during hospitalization
,
or


mood
may be better than what would be expected of somebody in that medical condition
they have long medical record with
a multiple admissions at various hospitals in different cities
-




-appearance may include physical findings (likescars)
and inconsistent details
vague
-




-


knowledge of textbook description of illnesses
(they come too prepared
-





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