Department of Occupational Health, Dudley and Walsall NHS Trust, Health Centre, Cross Street, Dudley DY1 1RN, UK.
Occup Med (Lond). 2010 Mar;60(2):127-32. doi: 10.1093/occmed/kqp170. Epub 2009 Dec 22.
Illness deception (ID) may be difficult to detect. Objective techniques that improve a doctor's skills of detection will have benefits for the health economy.
To ascertain the incidence of ID in a general occupational medicine clinic, to give examples by way of case vignettes how it may manifest and to compare the variability of maximal grip strength measurements of patients with suspected simulated weakness of grip with controls.
Four hundred consecutive new patient referrals were examined by the author and those who met Diagnostic and Statistical Manual-IV criteria for factitious disorder (FD) or malingering identified. Those with suspected simulated weakness of grip were asked to perform three consecutive maximal grips with a Jamar hand dynamometer. One hundred normal subjects and 100 patients with rheumatoid arthritis (RA) of the hands were similarly tested.
Thirty-two of 400 (8%) patients exhibited behaviour in keeping with ID (29 malingering and 3 FD). Cases included simulated hand-arm vibration syndrome, occupational asthma, deafness and weakness of a limb. The median and 90th percentile for coefficient of variation (CV) of three consecutive maximal grip strengths for normal subjects and patients with RA were 5.2, 10.5%; 5.4, 14.5% right and 4.5, 10.2%; 6.0, 14.4% left hand, respectively. The CV of the six patients who simulated weakness of grip was from 17.3 to 37.8%.
ID is relatively common in occupational medical practice and multiform in its manifestations. Simulated weakness of grip should be suspected when consecutive declared maximal grip strengths are inexplicably submaximal for age and sex and highly variable in force.
疾病性诈病（ID）可能难以察觉。提高医生检测技能的客观技术将有益于医疗经济。
确定普通职业医学诊所中 ID 的发生率，通过病例示例说明其可能的表现形式，并比较可疑握力模拟减弱的患者与对照组的最大握力测量值的变异性。
作者对 400 名连续的新患者转诊进行了检查，并确定了符合伪造障碍（FD）或诈病诊断标准的患者。对那些疑似握力模拟减弱的患者，要求他们使用 Jamar 握力计进行三次连续最大握力。100 名正常受试者和 100 名手部类风湿关节炎（RA）患者也进行了类似的测试。
400 名患者中有 32 名（8%）表现出与 ID 相符的行为（29 名诈病和 3 名 FD）。病例包括模拟手臂振动综合征、职业性哮喘、耳聋和肢体无力。正常受试者和 RA 患者连续三次最大握力的变异系数（CV）中位数和 90 百分位数分别为 5.2%、10.5%；5.4%、14.5%右和 4.5%、10.2%；6.0%、14.4%左。模拟握力减弱的 6 名患者的 CV 值从 17.3%到 37.8%不等。
在职业医学实践中，ID 相对常见，表现形式多样。当连续申报的最大握力明显低于年龄和性别预期且力量高度变化时，应怀疑存在模拟握力减弱。
