Factitious Disorder Follow-up

  • Author: Todd S Elwyn, MD; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Aug 23, 2011
 

Further Inpatient Care

Further inpatient care may be required if patients relapse. This includes the treatment of any medical or surgical conditions as well as psychiatric hospitalization when necessary.

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Further Outpatient Care

Close psychiatric follow-up care and monitoring in the outpatient setting is indicated to prevent relapse. Close medical follow-up care may also be necessary, depending on the condition.

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Transfer

Transfer from the medical floor to an inpatient psychiatric department is indicated if patients agree to treatment. In rare cases, involuntary hospitalization may be possible if the patient's health is jeopardized severely by continued production of factitious illness (eg, the patient has already lost a kidney because of factitious disorder and is in danger of losing another).

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Deterrence/Prevention

Deterrence and prevention involve clear documentation of patients with a known history of factitious disorder, although it does not involve blacklisting.

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Complications

Complications may arise from the induction of factitious illness or arise iatrogenically from the workup or treatment for the condition, in addition to producing high health care costs.

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Prognosis

  • Chronic factitious disorder appears to follow an unremitting course. Treatment may transiently ameliorate symptoms but does not appear to last.
  • Patients with simple factitious disorder follow a more variable course. Case reports in the literature suggest that some patients who seek treatment for factitious disorder may be able to overcome their illness. Even without treatment, simple factitious disorder appears to sometimes remit in the fourth decade of life.
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Patient Education

  • The patient confronted with staff suspicions that the illness is factitious may be unreceptive to attempts at patient education. Still, education should be attempted in the same gentle and supportive manner with which the patient is confronted. If the patient gives permission, educating family members about the patient's condition may also be helpful. Education as to risks of noncompliance with treatment recommendations is also important, ethically and legally, because the patient may wish to sign out against medical advice.
    • Convey empathy for the patient's distress that has led to the feigning or intentional production of illness.
    • Inform the patient that his or her distress may improve with treatment.
    • Point out that without treatment, the condition is unlikely to improve and he or she may again seek hospitalization.
    • Emphasize that each episode of producing or feigning illness can result in significant morbidity or even mortality for the patient through the production of illness or the undergoing of unnecessary tests or treatments.
  • If the patient is receptive to psychiatric treatment, patient education may be an important component of psychotherapy. Information from this article or other sources may be used to help the patient understand more about his or her illness, including the presumed origins of factitious behavior and the importance of regular follow-up care with the psychiatrist. Some useful Internet sites include the following:
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Contributor Information and Disclosures
Author

Todd S Elwyn, MD  Staff Psychiatrist, Tripler Army Medical Center, Schofield Barracks Soldier Assistance Center

Todd S Elwyn, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American College of Legal Medicine, and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Sarah C Aronson, MD  Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland

Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

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