Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy

Abstract

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.

Neuropathic Pain Syndrome Displayed by Malingerers

“…Conversely, rejecting the potential deliberate psychogenic nature of CRPS I/RSD is equally biased, and challenged by previous reports (Rodriguez-Moreno, 1990; Chevalier et al, 1996; Kurlan et al, 1997; Mendelson and Mendelson, 2004; Verdugo et al, 2004; Taskaynatan et al, 2005) and by the present series of malingerers. Recently Mailis et al (2008) report patients displaying the non-specific profile of CRPS I, plus self-inflicted cutaneous stigmata, implying a gross personality disorder.…”

Neurogenic Edema from Complex Regional Pain Syndrome Resulting in Fulminant Infection Necessitating Below Elbow Amputation

“…This has been previously reported in patients carrying a chronic diagnosis of CRPS-1. 17 Though certainly a possibility, we found nothing in our patient's history such as previous psychiatric diagnoses or behavior patterns to suggest that this was the cause. Additionally, the patient had a long history of bilateral upper extremity symptoms with the left as presented being profoundly more involved than the right.…”

Proposing a Scoring System for the Research Criteria of Complex Regional Pain Syndrome

“…The BRC has been expected to be equally important in the context of sample selection for outcome studies due to its specificity (10), but a doubtful point is that the patients who are selected by the BRC, could represent the CRPS group clearly without considering correlation between signs from distinct categories as shown in the present study. Therefore it is necessary that the BRC should be more sophisticated to represent the characteristics of CRPS including all objective signs, although these objective signs could be fabricated by patients like factitious disorder (15). …”

“…Signs such as sensory, decreased range of motion (ROM) or motor dysfunction could be fabricated intentionally even though motor signs are considerable to distinguish between CRPS and acute trauma (12), and sensory deficit and motor dysfunction are clinically prognostic factor of CRPS after stroke (13). Since the detailed information on the symptoms and signs of CRPS are easy to access via Internet or media by patients these days, aforementioned fabrication of symptoms may be increased, especially in a claim for compensation (14) and in an uneasy environment (15). Consequently, if the patients are selected by the BRC, the systematic error such as a publication bias may occur and then the features of CRPS tend to be deviated in the event.…”