Psychotic patients who are victims of catfishing scams

[Lexanoob]

I’m taking care of a patient who is manic but also seems to be a victim of a catfishing scam, where she believes that she is going to be marrying Johnny Depp, and has been hacked and has been homeless for many years in financial stress. This patient has suffered enormous loss, and her psychotic level of denial is a defense to addess this. I’m curious more generally though, as apparently and unfortunately, this seems to be a very common scam among many vulnerable individuals.

Delusions are hard to treat with antipsychotics, and this patient is psychotic in other ways outside of this sole aspect, but it appears that the rigidity behind this belief is somehow perversely reality based/ it is suggestible for those who are vulnerable. Has anyone else encountered this vulnerability to being scammed/ suggested delusions and rigidity in the belief for romance scams? I’m surprised that I haven’t been able to find anything about it!

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[bashir]

I've seen this story several times. I haven't looked into the literature to see what's been written about it, so I hope others who are more knowledgeable may chime in. I would think that once the mania is under control CBTp would be worth trying, if that's available. Because as you note this delusion seems to be acting as a defense against recognizing all she has lost, it may be more effective to defer working on treating the delusion for a while. An effective therapist might help her rebuild her life to the point that the delusion starts to be less necessary and becomes a little less closely held and easier to work with.

 

[Celexa]

This is a really interesting question. With chronically delusional patients, I have found it helpful for my own formulation to think through my treatment plan from a harm reduction point of view. This has helped me reduce the inherent feeling of helplessness that comes with working with truly delusional patients with poor insight. I agree these delusions (of multiple types) often come out of a aggressive psychologic defense against trauma, loss, and failure. It's an area where I find the DSM to not be particualrly useful.

 

[smalltownpsych]

During one year of my training, I was at a day treatment program (a very good program by the way) and during group the patients talked about all of the scams they had fallen for. Back then the Nigerian princess scam seemed popular. They were trying to help a fellow patient who was in the middle of one to challenge the delusional belief with little effect. There are a lot of things that are connected to or related to chronic mental illness that don’t seem to get much study and as a society we continue to act as though chronic mental illness isn’t really a thing.

 

[whopper]

I've had a few patients fall for scams. One lost over $500,000.

You could make this person get a financial guardian, but yes delusions without other psychosis are hard to treat.

 

[comp1]

They need a payee/fiduciary. This can/should have a much, much lower bar than a full conservator who can decide where they live. You should be able to contact Social Security with a request for an investigation. IANAL, but this would appear to fall under a concern for serious harm exception to HIPAA.

 

[whopper]

I'm sometimes stuck into a hate triangle with such a patient, they don't listen to my advice and recommendations and then their family intrusively keeps calling me asking why I haven't fixed the situation despite that it's out of my hands. E.g. a patient refuses to take a med, doesn't get better, then the family's all ticked off that the patient doesn't get better. Add to this if the patient doesn't sign a release you can't talk to the family, but no they don't stop calling and bugging the heck out of you.

This family could try to seek to harm you in some way despite that you did nothing wrong. E.g. they might launch a complaint against you with the state medical board, seek legal action against you, and yes you will win if you did sound practice, but at a cost of dozens of wasted hours, possibly hiring a lawyer, and your insurance premiums going up for years. This is what I'd be worried about.

In such cases if it goes to an extreme I terminate the patient. I also create milestones such as I talked to the patient over 3x about said issue and the termination is due to noncompliance which is a valid reason to terminate. This is for the ethical and legal issue of avoiding abandonment and and having a justifiable way to look at this case and say to myself I didn't terminate because it was just the easier but not right thing to do.

I've never had the scam-victim patient's family bother me, but such patients have fallen into the family calling me daily demanding to know what's going on category with no HIPAA release, but they still continue to call. In one of the few times this situation happened, I was on the verge of having a lawyer send a cease and desist letter to the family, but the patient, (THANK GOD) fired me as a doctor.