[Phenomenology of malingering, dissimulation and aspiration].

Malingering is a voluntary production and presentation of false or grossly exaggerated physical or psychological symptoms in an attempt to achieve secondary gain which otherwise is difficult to reach. Dissimulation means concealment of genuine psychiatric or other medical symptoms in an attempt to present a picture of psychiatric or organic health. Secondary gain is prominent, yet, primary gain exists as well. Aspiration is a higher degree of dissimulation, whereby the person not only denies having symptoms but pretends to be much healthier than he actually is and even more than all the healthy people surrounding him. Aspiration is mostly driven by primary gain. Secondary gain strengthens the primary one by the positive feedback the individual receives in considering him to be healthy and strong, deserving appropriate social, professional and financial attitudes. The article discusses these three phenomenological concepts with their possible medico-legal aspects, illustrating each by clinical vignettes.

[Non-urgent compulsory hospitalization].

The Israel Mental Health Law of 1991 gave authority to the regional psychiatrist to give orders of compulsory hospitalization - urgent and non-urgent. The non-urgent Hospitalization Order applies to conditions of non-immediate danger, in which potential for significant damage or harm to the patient or others is expected. Authority is granted to the District Psychiatric Committee as a body of appeal (before the Hospitalization Order is carried out) and as a tribunal to decide upon continuation after the first two weeks of hospitalization. This article aims to stress the main problems encountered by psychiatrists regarding management and treatment under the Non-Urgent Compulsory Hospitalization Order: 1) Postponing hospitalization or releasing a patient for 24 hours, in order to launch an appeal before receiving any treatment, may facilitate clinical deterioration. The ambiguous waiting period could enhance anxiety, acting out and dangerousness. 2) The article discusses clinical and legal aspects of compulsory hospitalization - both urgent and non-urgent. The diverse problematic issues will be elaborated through three clinical cases, and, when clinically indicated, proposals raised for possible solutions in converting an urgent compulsory order to a non-urgent compulsory order.