Sapienza University of Rome, NESMOS Department (Neuroscience, Mental Health and Sensory Organs), School of Medicine and Psychology, Sant'Andrea Hospital of Rome, Rome, Italy.
Forensic Sci Int. 2012 Jun 10;219(1-3):e37-40. doi: 10.1016/j.forsciint.2012.01.011. Epub 2012 Jan 27.
We describe a case of factitious disorder with physical and psychological symptoms comorbid with bipolar I disorder in a 37-year-old woman. Since the onset of bipolar disorder, which occurred at the age of 31, she increasingly complained of physical symptoms, compulsively seeking medical and surgical interventions. She has been hospitalised several times and her Munchausen-type factitious disorder recently appeared to be developing into Munchausen by proxy, involving her 11-year-old daughter. The patient adhered poorly to stabilising and antipsychotic drug treatment and did not improve through the years. We here analyse her mood phases, which were always associated with changes in the quality of factitious symptoms, according to whether the disorder was in its depressive phase (somatic complaints and suicidal ideation prevail), or in its manic or mixed phase (medical intervention-seeking and manipulation of clinicians to obtain surgical interventions). We also briefly discuss some important forensic issues to consider in similar cases, mainly stemming from the psychotic aspects of these two co-occurring disorders. Clinicians should be aware of some patients' ability to produce signs and symptoms of physical and/or psychological illness and consult psychiatrists before giving consent to invasive diagnostic procedures or surgery.
我们描述了一例 37 岁女性同时患有躯体和心理症状的人为性疾病，伴发 I 型双相情感障碍。自 31 岁起出现双相情感障碍后，她开始频繁出现躯体症状，并不断寻求医疗和手术干预，多次住院治疗。最近，她的马氏综合征样人为性疾病似乎发展成了代理型马氏综合征，涉及到她 11 岁的女儿。该患者对稳定和抗精神病药物治疗的依从性较差，多年来病情没有改善。我们在此分析了她的情绪阶段，根据疾病是处于抑郁期（躯体主诉和自杀意念占主导地位）还是躁狂或混合期（寻求医疗干预和操纵临床医生以获得手术干预），这些阶段总是与人为性症状的质量变化相关。我们还简要讨论了类似情况下需要考虑的一些重要法律问题，这些问题主要源于这两种共存疾病的精神病学方面。临床医生应该意识到一些患者产生躯体和/或心理疾病的迹象和症状的能力，并在同意进行侵入性诊断程序或手术之前咨询精神科医生。
