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Feigned psychiatric symptoms in the emergency room
B D Yates1, C R Nordquist, R A Schultz-Ross
1Veterans Affairs Medical Center, Roseburg, Oregon 97470, USA.
Psychiatric Services (Washington, D.C.)
|September 1, 1996
Summary
Psychiatrists often suspect patients in emergency settings of malingering or seeking secondary gains. However, few patients suspected of feigning symptoms received a malingering diagnosis or were confronted by clinicians.
Area of Science:
- Psychiatry
- Emergency Medicine
- Medical Ethics
Background:
- Malingering, the intentional feigning of symptoms for external gain, presents diagnostic challenges in emergency psychiatry.
- Secondary gains, such as obtaining medication or avoiding responsibilities, can complicate the assessment of psychiatric symptoms.
Purpose of the Study:
- To investigate the frequency with which psychiatrists suspect malingering or secondary gains in emergency settings.
- To determine the rate at which patients suspected of malingering or secondary gains are confronted by clinicians.
Main Methods:
- Psychiatrists at an urban general hospital evaluated 227 patients over two months.
- Questionnaires assessed suspicions of malingering/secondary gains and whether patients were confronted.
Main Results:
- Thirteen percent of patients were suspected of feigning symptoms.
- No patients received a primary diagnosis of malingering.
- Less than half of suspected patients were confronted by their evaluating psychiatrist.
Conclusions:
- Suspicions of malingering are common in emergency psychiatry, but formal diagnoses are rare.
- Confrontation rates for suspected malingering are low, suggesting a potential gap in clinical practice.
- Common secondary gains identified include basic needs, medication, financial benefits, and avoidance of legal or social obligations.