Factitious renal colic

OBJECTIVES

We reviewed our experience with patients with factitious disorders who presented with renal colic to identify their common characteristics and to quantify the cost burden placed on the health care system as a result.

METHODS

We retrospectively reviewed the medical records of two Philadelphia area hospitals from 1989 to 1995 to find patients with factitious disorders who presented with renal colic. A control group of patients with nephroureterolithiasis was also identified.

RESULTS

We identified 12 patients who presented with renal colic and had a final diagnosis of Munchausen's syndrome or malingering. The incidence of factitious renal colic was 0.6%. Eighty-three percent of these 12 patients were men, had an average age of 32 years, and made a total of 18 hospital visits. Ninety-two percent claimed an intravenous contrast allergy, 25% claimed an allergy to a specific narcotic, and 39% of the hospital visits ended with the patient voluntarily discharged against medical advice. Thirty-three percent were treated elsewhere for similar complaints. Only the number of intravenous contrast allergies and the number of patients leaving against medical advice were statistically different from the control group. The total cost for all factitious visits was $52,452, with a mean cost per visit of $2914. The average bill of those patients who received retrograde pyelograms was $3046 greater than for those who did not.

CONCLUSIONS

Factitious disorders should be considered when evaluating patients with an intravenous contrast allergy and renal colic. These patients are likely to leave against medical advice and place a significant cost burden on hospitals.

Classification system for factitious syndromes in the hand with implications for treatment

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

CHRONIC FACTITIOUS DISORDERS: Helping Those Who Hurt Themselves

A chronic factitious disorder is a complex psychiatric illness that generally manifests itself in the medical/surgical setting. The immediate need for psychiatric intervention is generally overshadowed by the need for intense medical treatment. The psychiatric liaison nurse is in a key position to manage emotional nursing care during acute hospitalization. Assisting staff to recognize behavioral manifestations can help to prevent further self-destruction and promote future psychiatric followup. The prevalence of factitious disorders is probably higher than misconceptions about the disorder. The potential to save health care cost as well as needless human misery makes this a professional nursing concern. The high incidence of factitious disorders in the nursing profession may make profession may make it a personal issue for nurses as well.