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精神科环境中精神病性症状的诈病:理论层面与临床考量

Malingering of Psychotic Symptoms in Psychiatric Settings: Theoretical Aspects and Clinical Considerations.

作者信息

Bellman Val, Chinthalapally Anisha, Johnston Ethan, Russell Nina, Bruce Jared, Saleem Shazia

机构信息

University of Missouri Kansas City, Department of Psychiatry, Kansas City, MO, USA.

University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.

出版信息

Psychiatry J. 2022 Apr 21;2022:3884317. doi: 10.1155/2022/3884317. eCollection 2022.

Abstract

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list malingering in its diagnostic section and therefore does not identify it as a formal mental disorder, malingering and verified mental illness commonly coexist. Some subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings. The article discusses these three theoretical concepts with their possible clinical aspects, illustrating each phenomenon by clinical case with self-reported and/or observed psychotic symptoms. We summarized relevant findings and provided a review of clinical considerations that physicians can use to aid in the evaluation of psychotic symptoms in the context of those three concepts.

摘要

诈病是指在外部诱因驱使下,故意制造虚假或严重夸大的身体或心理症状。尽管《精神疾病诊断与统计手册》(第五版)(DSM - 5)在其诊断部分未列出诈病,因此未将其认定为正式的精神障碍,但诈病与已确诊的精神疾病常同时存在。当患者报告的应激源与客观检查结果之间存在明显差异时,可能会怀疑一些伪装行为的亚型,如部分或完全诈病、掩饰和虚假归咎。本文讨论了这三个理论概念及其可能的临床情况,并通过伴有自我报告和/或观察到的精神病性症状的临床病例对每种现象进行说明。我们总结了相关发现,并对临床考量进行了综述,医生可利用这些考量,在这三个概念的背景下协助评估精神病性症状。

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