Malingered psychosis leading to involuntary psychiatric hospitalization

Abstract

It is important to consider malingering as a differential diagnosis in patients who present with atypical features and have clear external incentives for their behaviour. With improved health literacy and access to health information, individuals who are marginalized in society and have limited social and occupational opportunities may malinger symptoms for obvious personal gain. Inconsistency between reported symptoms and clinical observations, as well as contradictory collateral information from multiple sources, are helpful tools in diagnosing malingering. It is important for clinicians to identify malingerers early and limit unnecessary admissions.

Malingering Psychosis: Guidelines for Assessment and Management

“…• Promoting a safe and supportive relationship to assist in eliciting possible underlying motivations (Harris, 2003;Murdach, 2006) • Explore the client's knowledge of psychosis and symptoms of psychotic illnesses (Resnick & Knoll, 2005;Waite & Geddes, 2006) • Determine the nature of the secondary gain that is being sought (Waite & Geddes, 2006) • "Accept the deceiver but not the deception" (Murdach, 2006, p. 157) • Provide clear explanation of possible realistic options for services (Garriga, 2007) • Follow the "ABCs" to presenting to the patient the findings of malingering as documented by LeBourgeois (2007). "Avoid accusations of lying, beware of countertransference, clarify not confront, security measures" (p. 3)…”

“…While a specific amount of time varies among clinicians and facilities, what is important is to allow time to ask the same question in varying contexts. Finally, the clinician should always consider any collateral information that is available (Resnick & Knoll, ; Waite & Geddes, ). Sources of information might include family and friends presenting with the patient, other medical records, case workers, or other evaluations that may have occurred for social benefits.…”

“…Management techniques at a practice level: Clear documentation and access to consultation for psychometric testing (LeBourgeois, ; Murdach, ) Obtaining comprehensive psychological testing using reliable and valid instruments whenever possible (Chesterman et al., ; LeBourgeois, ; LoPiccolo, Goodkin, & Baldewicz, ; Resnick & Knoll, ) Have a mechanism for obtaining collateral information if available (Harris, ; LeBourgeois, ; LoPiccolo et al., ) Management techniques while with the patient: Promoting a safe and supportive relationship to assist in eliciting possible underlying motivations (Harris, ; Murdach, ) Explore the client's knowledge of psychosis and symptoms of psychotic illnesses (Resnick & Knoll, ; Waite & Geddes, ) Determine the nature of the secondary gain that is being sought (Waite & Geddes, ) “Accept the deceiver but not the deception” (Murdach, , p. 157) Provide clear explanation of possible realistic options for services (Garriga, ) Follow the “ABCs” to presenting to the patient the findings of malingering as documented by LeBourgeois (). “Avoid accusations of lying, beware of countertransference, clarify not confront, security measures” (p. 3) Give patients an out by gently presenting inconsistencies to real diagnostic features.…”