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In reality, the lines between factitious disorder, functional disorder, and malingering are quite blurred. In factitious disorder and malingering, patients consciously and deliberately create false medical and/or psychiatric symptoms for self-gain, often approaching multiple healthcare facilities to evade detection. Although the factitious disorder is pervasive, and the literature lacks accurate and consistent information, comorbidity with nonepileptic seizure (NES, a component of functional disorder) is quite commonly documented. In our case, the patient feigned multiple symptoms including two seizures and a shoulder dislocation to gain access to opioids. The clinical picture was only significant for alcohol withdrawal, aspiration pneumonia (possibly intubation vs. NES-related), and self-induced shoulder dislocation. Generally, management of these disorders should involve multiple specialties, multiple approaches, and identifying the triggering and comorbid psychological disorders, such as abandonment issues, personality disorders, physical or emotional abuse, anxiety, depression, stress, and substance use. Blindly approaching patients with a factitious disorder or malingering will not lead to any productive outcomes. Perhaps, creating a patient database could help reduce futile efforts while providing patients with the required help. This case report describes the presentation, diagnosis, management, and outcomes related to a patient with NES, engaging the reader to decipher the most appropriate diagnosis.
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Background The persisting challenge of substance use disorder's impact on society prompts the need for insights into its mortality trends. This study examines epidemiological patterns and factors tied to mortality rates in individuals with psychoactive substance-related mental and behavioral disorders from 1999 to 2020. Methodology This study used a retrospective observational design. The study analyzed the Centers for Disease Control and Prevention's (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database information, encompassing mortality and population-based data. Data extraction focused on specific criteria such as age, sex, race/ethnicity, and geographic location. Descriptive statistics were employed to depict the study population and reveal epidemiological trends. Results The study encompassed data from 239,573 individuals who died due to psychoactive substance use-related mental and behavioral disorders between 1999 and 2020. The overall mortality rate was 3.55 per 100,000 individuals (95% confidence interval (CI) = 3.55-3.54) across the study period. Noticeable discrepancies in mortality rates emerged among various geographic regions, genders, races, and age groups. Males (5.32 per 100,000 individuals) experienced notably higher mortality rates than females (1.80 per 100,000 individuals), while the 55-64 age group faced elevated mortality risks (8.24 per 100,000 individuals) compared to the 25-34 age group (1.71 per 100,000 individuals). Significant variations in mortality rates were also evident across different racial and ethnic groups. Conclusions Between 1999 and 2020, the study explored mortality rates in individuals with psychoactive substance use-related mental and behavioral disorders. This analysis revealed variations in mortality across genders, ages (with the 55-64 age group facing higher risks compared to the 25-34 age group), and ethnicities. Notably, males exhibited higher mortality than females. Additionally, divergent rates were observed among different geographic regions. These insights can inform public health initiatives and support the development of targeted strategies to reduce mortality rates and improve the well-being of affected individuals.
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PURPOSE: The objective of this analysis was to find an association between employment status, psychological distress, and alcohol consumption. METHODS: Data from the 2020 Health Information National Trends Survey (HINTS) data was used. Patient health questionnaire-4 (PHQ-4) data and an average number of drinks per week were used to assess psychological distress and drinking status. RESULTS: Out of the 3865 people who answered the survey in the year 2020, 1890 (59.11%) were employed in one or multiple jobs during the time of the survey. The sample included 1561 men and 2204 women with an average age of 48.4 years. More than half (58.7%) of them were Non-Hispanic White followed by Hispanic and Non-Hispanic Black at 15.73% and 10.32%, respectively. Bivariate analysis showed a significant association between employment, psychological distress (p value=0.032), and alcohol drinking (p value=0.002); 60.59% of participants reporting severe distress (PHQ-4 score of 9-12) were unemployed. Alternatively, 73.1% of the employed respondents reported no stress (PHQ-4 score of 0-2). While more than half (75.97%) of those who were unemployed consumed only 1-2 drinks per week on an average, 7.27% consumed >13 drinks per week on an average. After adjusting for covariates, the regression analysis showed a highly significant association (p value< 0.001) between unemployment and psychological distress (OR=1.55; 95% CI 1.03, 2.31), and alcohol consumption (OR=0.67; 95% CI 0.48, 0.92). CONCLUSION: Unemployment is associated with outcomes like psychological distress and alcohol consumption. However, being employed was found to be more strongly associated with alcohol drinking. We do not know if the coronavirus disease 2019 (COVID-19) pandemic was a risk factor for the given outcomes.
