Factitious Disorders in Neurology: An Analysis of Reported Cases

Kanaan, Richard A A; Wessely, Simon

doi:10.1016/s0033-3182(10)70658-7

Cited by 36 publications

(5 citation statements)

References 66 publications

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“…Even though this result is in contrast to some researches in literature [3,15], it can't be excluded that this data is partly conditioned by the impossibility to obtain this information from the whole sample examined. This aspect deserves a detailed study in the future.…”

Section: Discussioncontrasting

confidence: 96%

“…These data show that clinical presentation is considerably heterogeneous, but there are some specific clusters of psychiatric, trauma and neurological signs and symptoms. Despite there are some previous researches which disclose this aspect [15,20], the psychiatric presentation has never been prevalent in previous studies [3,21]. This interesting observation emerged from this review suggests the possibility of underestimation of factitious patients who exhibit psychiatric symptoms and indicates the diagnostic and classification difficulties in patients with psychological signs or symptoms rather than physical ones.…”

Section: A Systematic Review On Factitious Disorders: Psychopathologymentioning

confidence: 63%

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A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

Caselli¹,

Poloni²,

Ceccon³

et al. 2018

Neuropsychiatry

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Factitious disorder (FD) is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clarified. The aims of this study are: to outline a demographic and clinical profile of a large sample of patients with FD, to highlight the psychopathological correlates and to study the evolution of position of FD in the DSM. A systematic search for all case reports and case series of adult patients in the databases MEDLINE, Scopus and PsycINFO was conducted. 1636 records were obtained based on key search terms, after exclusion of duplicate records. 577 articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation and factors leading to the diagnosis of FD. 64.5% of patients in the sample were females. Mean age at presentation was 33.5 y.o. A healthcare profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency and internal medicine departments. Statistical analysis has highlighted significant correlations between factitious disorders and depressive disorders and borderline personality disorder (BPD) and a significant effect of BPD and abuses in childhood on substance abuse. The survey of socio-demographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The research also allows deepening the psychopathological correlates of the disorder. The study showed that patients did not meet DSM-5 diagnostic criteria in the 11.3% of cases.

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Section: Discussioncontrasting

confidence: 96%

Section: A Systematic Review On Factitious Disorders: Psychopathologymentioning

confidence: 63%

A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

Caselli¹,

Poloni²,

Ceccon³

et al. 2018

Neuropsychiatry

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“…The adaptive use of dissimulation and deception can develop very early before explicit cognitive processes arise, which makes differential diagnosis even more complex. These difficulties probably contribute to relatively low rates of factitious disorders in neurology settings (Kanaan, 2022; Kanaan & Wessely, 2010). For this reason, it is essential to involve different specialists in the assessment of children and adolescents with neurological symptoms, given that the interaction between biological, psychological, and social factors should always be considered (Hallett et al, 2022; Onofrj et al, 2023).…”

Section: Functional Neurological Symptom Disorder Mimicsmentioning

confidence: 99%

Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report

Baglioni,

Esposito,

Bernardi

et al. 2024

Clin Child Psychol Psychiatry

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Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features. However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as “functional” solely because other conditions can be excluded.

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“…A pattern of seeking medical care, often supported by inexplicable laboratory findings and paraphernalia of tampering (syringes, hidden medications) is evidence of primary gain (Factitious Disorder), but this often requires some knowledge of the patient’s behavior over time. In Factitious Disorder involving feigned neurologic symptoms specifically, objective evidence is often absent, and most cases are determined through “detection of previous history…use of false names, false histories, and peregrination” [ 4 ]. Without this historical evidence the distinction between Factitious Disorder and FND is very difficult.…”

Section: The General Process Of Diagnosing Fndmentioning

confidence: 99%

Challenges to the Diagnosis of Functional Neurological Disorder: Feigning, Intentionality, and Responsibility

Mason

2022

Neuroethics

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The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of moral responsibility. Understanding the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND.

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Factitious Disorders in Neurology: An Analysis of Reported Cases

Cited by 36 publications

References 66 publications

A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report

Challenges to the Diagnosis of Functional Neurological Disorder: Feigning, Intentionality, and Responsibility

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