Malingering in general psychiatry.

This is a case report of a woman with a long history of schizophrenia. She suddenly "confessed" that she had been feigning symptoms all along. Taken at face value, this statement caused a delay in antipsychotic treatment followed by a serious deterioration of the patient's mental state. It became clear over time that several components of the patient's experience of lying were delusional in nature. The diagnosis of schizophrenia was once again validated and antipsychotic treatment resumed. Doctors are advised to be very careful when basing clinical decisions upon suspicion of malingering.

Do we know the mind of others? Suspicion of malingering in emergency psychiatry.

INTRODUCTION: Malingering can be divided into simulation and exaggeration of symptoms. Malingering has traditionally been considered rare in general psychiatry. In contrast to earlier estimates, more recent studies report that doctors suspect malingering frequently in psychiatric emergency departments. The aim of this study is to survey how often doctors in psychiatric emergency units in a public, free-of-charge, mental health service suspect that patients are malingering, and which diagnoses, symptom complaints and suspected reasons for malingering doctors ascribe to their patients. METHODS: Questionnaires were distributed in three psychiatric emergency departments in Denmark. Suspected simulation and exaggeration were rated with a 5-point scale. Doctors were encouraged to write down the symptoms and perceived causes for suspected malingering. RESULTS: 362 questionnaires were filled in. 25% of all patients were suspected of simulating to some degree. 8% of patients were highly suspected or definitely believed to be simulating. Patients complaining of suicidal ideation were most frequently suspected of malingering. 'Attention seeking' was the most common suspected reason for malingering. Patients with diagnoses of substance use and personality disorder were the most suspected of malingering. CONCLUSION: This is the first study to investigate doctors' suspicions of psychiatric malingering in a European setting. Patients with established personality and substance use disorder are at higher risk of being suspected of malingering, which potentially affects the course of treatment significantly. The rise in suspected malingering is conspicuous and requires further investigation. Doctors are encouraged to act conservatively upon suspicion of malingering in emergency psychiatry.

Challenges of concurrent ADHD and schizophrenia.

ADHD-related symptoms are common in schizophrenia. Many patients will be troubled by cognitive disturbances such as attention deficit and concentration difficulties. The treatment for these patients is often difficult, as ADHD medicine and antipsychotics have opposed effects on synaptic dopamine concentration. It is possible that some patients with schizophrenia may benefit from treatment with central stimulant drugs. However, there is not sufficient evidence to develop clinical guidelines. In this review we emphasize, that such treatment should be conducted by specialists during admission, and caution is recommended.