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诊断和管理对他人施加的人为性障碍(FDIA)中的法医学和伦理挑战:一例报告

Medicolegal and Ethical Challenges in Diagnosing and Managing Factitious Disorder Imposed on Another (FDIA): A Case Report.

作者信息

Fatade Olumuyiwa, Ajibade Omotola K

机构信息

Department of Psychiatry and Behavioral Sciences, Hackensack Meridian Ocean University Medical Center, Brick, USA.

出版信息

Cureus. 2022 Nov 14;14(11):e31513. doi: 10.7759/cureus.31513. eCollection 2022 Nov.

Abstract

Factitious disorder (FD) is a condition in which patients fabricate evidence and produce false stories that often subject them to needless medical interventions with no clear benefits. In some instances, it can be imposed on a secondary victim often as a form of abuse. Most often, victims of a factitious disorder imposed on another (FDIA) are children or the elderly. Despite a mortality rate between 6 and 10% among victims, FDIA still remains underdiagnosed. Research on it often fails to address healthcare management initiatives, as well as the legal and ethical challenges physicians must navigate when managing it. In this report, we present a rare case of FDIA in an adult patient with a history of diabetes, substance use disorder, and schizoaffective disorder. This case highlights the importance of appropriate communication and detailed documentation when signs of FDIA are suspected. It also identifies the benefits of implementing a multidisciplinary approach when appropriate to minimize harm and improve outcomes.

摘要

诈病(FD)是一种患者伪造证据并编造虚假故事的病症,这常常使他们遭受不必要的医疗干预且无明显益处。在某些情况下,它可能施加于二级受害者,通常作为一种虐待形式。最常见的是,被施加诈病(FDIA)的受害者是儿童或老年人。尽管受害者的死亡率在6%至10%之间,但FDIA仍未得到充分诊断。对此的研究往往未能涉及医疗管理举措,以及医生在处理时必须应对的法律和伦理挑战。在本报告中,我们呈现了一例患有糖尿病、物质使用障碍和精神分裂症谱系障碍病史的成年患者发生FDIA的罕见病例。该病例突出了在怀疑有FDIA迹象时进行适当沟通和详细记录的重要性。它还确定了在适当情况下采用多学科方法以尽量减少伤害并改善结果的益处。

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本文引用的文献

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Factitious hypoglycemia in children and adolescents with diabetes.儿童和青少年糖尿病患者的人为性低血糖。
Pediatr Diabetes. 2018 Jun;19(4):823-831. doi: 10.1111/pedi.12650. Epub 2018 Feb 21.
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