Wang Andy Y, Rehman Urrooj H
Department of Psychiatry, BayRidge Hospital, Beth Israel Lahey Health, Lynn, MA, USA.
Case Rep Psychiatry. 2021 Nov 29;2021:1860757. doi: 10.1155/2021/1860757. eCollection 2021.
Malingering involves the intentional production of physical or psychological behaviors due to motivation from external incentives, posing unique challenges to healthcare. Although malingering as an entity has been well studied, the current literature does not explore the intentional production of catatonia-like behavior or how to differentiate malingering from catatonia. Here, we describe a 45-year-old female who was admitted to an acute psychiatric hospital with a complex presentation of catatonia-like signs that was ultimately thought to be volitional behavior, resulting in a diagnosis of malingering. We highlight the important factors considered in her presentation, the differences between her behaviors and true catatonia, and other important differential diagnoses to consider. Although a diagnosis of malingering is difficult to make, we underscore the importance of reaching this conclusion in order to avoid unnecessary and potentially harmful medical interventions. We stress the importance of shifting focus from medical management to more appropriate patient goals such as providing social services and treatment of other underlying psychiatric illnesses.
诈病涉及因外部诱因的驱使而故意产生身体或心理行为，这给医疗保健带来了独特的挑战。尽管诈病作为一个实体已经得到了充分研究，但当前文献并未探讨类紧张症行为的故意产生，也未涉及如何区分诈病和紧张症。在此，我们描述一名45岁女性，她因复杂的类紧张症体征表现入住一家急性精神病医院，最终被认为是故意行为，从而诊断为诈病。我们强调了在她的表现中所考虑的重要因素、她的行为与真性紧张症之间的差异以及其他需要考虑的重要鉴别诊断。尽管诈病的诊断很难做出，但我们强调得出这一结论的重要性，以避免不必要的、可能有害的医疗干预。我们强调将重点从医疗管理转向更合适的患者目标的重要性，比如提供社会服务和治疗其他潜在的精神疾病。
