Well, actually IMHO she has malingering, factitious DO & possibly even conversion disorder. ALL freakin 3!
She has faked symptoms for a identifiable & quantifiable gain (malingering), but has also faked symptoms for attention from staff & family.
I hate saying this & this may show countertransference on my part but she's like that kid in the Twilight Zone episode where that little kid can wish anyone out of existence & and destroyed the entire universe except for a few people & his hometown.
Her family, very well intentioned, gave in to her every wish because this patient was born with a rare genetic disorder that made her have special needs. This particular disorder causes mental ******ation & very short height.
& in turn--she learned to manipulate her parents by faking symptoms.
By the time she became an adult, her parents couldn't handle it anymore & put her in a group home. She attempted to burn the home down because she didn't want to be there & she wanted to get "revenge" on other people in the home who were upsetting her.
The first day I was assigned to the unit with this patient, she went up to me & asked me to diagnose her with OCD. I told her why, and what symptoms of OCD she may have had. She couldn't mention any.
She then went to another doctor in the hospital, asked for a brochure on OCD, and when this doctor asked why she wanted a brochure on it, she said "so I can know what symptoms to tell my doctor to prove to him I have OCD". That doctor wouldn't give her the brochure & alerted me to the situation.
Mind you that I've had her for > 3 months and no one in the treatment has seen any OCD symptom from her.
I told her I wouldn't diagnose her with OCD. Her diagnoise when I took her case was psychosis NOS & anxiety DO NOS, both of which I believe are complete bull. She was put on Seroquel & Lexapro to treat them.
Not that particular time, but a few weeks later, she asked that I switch her meds around (She has showed no evidence of a psychotic, mood or anxiety disorder yet) becuase she's suffering from hallucinations. She has been put on every atypical antipsychotic including Clozaril, and several atypicals in the past & claim none of them have worked. She was also recorded to show no improvement from these meds.
I had the psychologist working with me do some psychometric tests to see if her symptoms were real or fake such as the M-FAST...all of them suggested she was faking them.
I told this patient that she should focus on getting better without the use of medications--she flipped out, started screaming & told me, "I'm taking you down, and I'm going to use the court system". I told her, "ok, if that's your choice" and walked away from her while she had a hissy fit.
(& yes I did to several lit searches on her genetic disorder which shows no correlation with psychotic symptoms, though it does have a correlation with anxiety disorders--though she shows no objective symptoms of an anxiety disorder).
She at one point, for attention, claimed she was suicidal and took some laundry detergent & put it in her mouth. She started smiling & said, "now you got to help me & bring me to the hospital". The detergent was non-toxic, the IM doc told us she could just drink some milk, but really didn't need any other intervention. So we gave her a cup of milk & left her alone. She started screaming, "you're supposed to send me to the hospital!". We told her she was perfectly safe and she sat on the unit very upset.
I'm convinced at this point that she is not mentally ill in the usual sense such as a psychotic, anxiety or mood disorder. However I can't discharge her because the second someone in a group home upsets her, and they aren't punished appropriately per this patient's wishes she will try to burn the place down to "make them pay" as she had in the past. She has attempted several times to get me to punish patients who on a whim upset her. I tell her nicely that its not my job to punish patients, which just upsets her and she throws a fit.
One interesting dynamic, several of the patients on the unit don't get along with this patient, and she has just befriended a new patient who is rather large & butch. She is trying to use this large patient to bully other patients, somewhat like Master Blaster from Mad Max Beyond Thunderdome. Now that she actually has some muscle to back her up, all the patients she tried to get me to "punish", she's having the large butch patient push around on the unit.
Geez--all this from a mentally ******ed patient. Doesn't seem so mentally challenged to me.
He wanted to be admitted and I bargained him to hang out in the ER and leave in the morning... I suppose that's better than getting admitted.
wish i could say the same about myself!
