Bordes G, Schuster J-P, Limosin F
Service universitaire de psychiatrie, hôpital Corentin-Celton, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France.
Encephale. 2011 Apr;37(2):133-7. doi: 10.1016/j.encep.2010.04.010. Epub 2010 Jul 1.
The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character.
Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders.
The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement.
These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.
诈病，更常见的称呼是病理性模拟，主要表现为患者主动诱发的躯体症状。与装病不同，患有这些障碍的患者并非寻求立即获得继发性利益。他们向医生发起挑战，有时通过自我伤害或置身于生命危险之中。他们的目的是引起医学界的关注并调动其积极性。在诈病的虚假性质被揭露之前，患者会与医护人员建立密切关系，在技术层面以及情感层面都是如此。在某些情况下，诈病是指一个人通过故意表现出精神症状，好像自己患有精神障碍。最常描述的是诈病性急性精神病性障碍、诈病性哀伤、情感障碍和创伤后应激障碍。精神性诈病难以诊断，但它们与其他病理性模拟有共同的诊断标准。这些患者可能因出现其他精神症状而患有病理性模拟，如病态人格、适应障碍、酒精或其他物质滥用和/或依赖，或抑郁障碍。本文描述了三例病理性模拟的临床病例，这些病例是在因抑郁症状入住精神科病房后被诊断出来的，与其诈病或真实性质相关。
三例病例报告，描述了因抑郁障碍入住精神科的病理性模拟患者。
第一例是一名57岁男性，被认为患有双相情感障碍，因抑郁综合征住院。所描述和报告的症状属于诈病。患者要求出院，中断了医疗护理。第二例是一名年轻女性，在自杀未遂后住院。她有多种躯体和精神性诈病病史。入院时她有抑郁症状，更可能与病态人格有关，而非重度抑郁发作。第三例表现为孟乔森综合征。他因抑郁症状住院。他合并有重度抑郁发作。抗抑郁药的使用导致了显著的临床改善。
这三例病例表明，患有病理性模拟的患者可能会出现真正的抑郁综合征。因此，进行中立且全面的精神评估是必要的，以免剥夺这些患者接受适当治疗的机会。
