The Peregrinating Psychiatric Patient in the Emergency Department

Abstract

Many emergency department (ED) psychiatric patients present after traveling. Although such travel, or peregrination, has long been associated with factitious disorder, other diagnoses are more common among travelers, including psychotic disorders, personality disorders, and substance abuse. Travelers’ intense psychopathology, disrupted social networks, lack of collateral informants, and unawareness of local resources complicate treatment. These patients can consume disproportionate time and resources from emergency providers. We review the literature on the emergency psychiatric treatment of peregrinating patients and use case examples to illustrate common presentations and treatment strategies. Difficulties in studying this population and suggestions for future research are discussed.

Early death in Munchausen syndrome: A case report

“…His approach was characterized by manipulations and lies, and his behavior was marked by frequent flights from hospitals especially when he was “discovered.” Also, his family and childhood history were characterized by the same features described in many cases in the literature: isolation, lack of adequate family support, and early institutionalization . In addition, this case presented other characteristics of factitious disorder not immediately recognized: He did not have any relatives to interview, there was no primary physician responsible for his care registered on his documents, and he was socially isolated . Although these elements could have suggested the factitious nature of his symptoms and signs, he underwent many medical treatments because his physical complaints were frequently convincing .…”

“…11 In addition, this case presented other characteristics of factitious disorder not immediately recognized: He did not have any relatives to interview, there was no primary physician responsible for his care registered on his documents, and he was socially isolated. 15 Although these elements could have suggested the factitious nature of his symptoms and signs, he underwent many medical treatments because his physical complaints were frequently convincing. 5 When the patient requested psychiatric consultation, he complained of psychiatric symptoms simulated in order to be hospitalized even if in a psychiatric ward.…”

“…14 Later, they look for another hospital or health facility for new admissions. 15,16 For this reason, epidemiological studies and clinical trials to establish therapeutic strategies for MS are difficult to conduct because patients deny suffering from a psychiatric disorder and lack cooperation regarding treatment. 10,11,17,18 In this report, we describe the case of a Caucasian male patient in his 20s, with a clinical history of repetitive hospital admissions due to factitious symptoms.…”

Síndrome De Munchausen: Um Caso De Confissão Espontânea Da Simulação De Sinais E Sintomas

“…Há uma associação histórica entre TF e peregrinação 9 , isto é, é característico de pacientes com tal transtorno viajar longas distâncias para buscar atendimentos médicos, assim como ocorre no caso descrito. Outrossim, o histórico de peregrinação associado a falta de comunicação com familiares e informantes próximos ao paciente, pode tornar o manejo do caso mais complicado 10 . Pacientes com SM podem se apresentar em qualquer especialidade e instituição de saúde 11 .…”

Bleeding Diathesis or Fabrication: Munchausen Syndrome

“…He traveled from place to place telling fantastic tales about his imaginary exploits. Munchausen syndrome is unique among other factitious disorders as it includes extreme chronicity of sick role and seeking treatment and desired attention [ 1 - 2 ]. It is characterized by consciously feigning and fabricating symptoms to adopt a sick role.…”