Management of Factitious Disorders: A Systematic Review

Abstract

Background: The literature regarding the management of factitious disorder (FD) is diverse and generally of case reports or case series. To date there has been no systematic review of the effectiveness of management techniques. Methods: Systematic review of all evidence reporting the management and subsequent outcome in FD. Data were extracted and outcomes were assessed using an adaptation of the Global Improvement Scale. Results were analysed by parametric statistical tests; a meta-analysis was not possible. Results: Thirty-two case reports and 13 case series were eligible for inclusion. Analysis of the case reports found no significant difference in outcomes between confrontational and non-confrontational approaches [t(29) = 0.72, p = 0.48], between treatment with psychotherapy compared to no psychotherapy [t(30) = 0.69, p = 0.48], and when psychiatric medication had been prescribed compared with not [t(30) = 0.35, p = 0.73]. A trend was observed that a longer length of treatment lead to better outcomes, but this was not significant [F(5, 26) = 1.17, p = 0.35]. The consecutive case series demonstrated that many FD sufferers were not engaged in treatment and were lost to follow-up but did not provide any strong evidence regarding the effectiveness of different management approaches. Conclusions: There is an absence of sufficient robust research to determine the effectiveness of any management technique for FD. The establishment of a central reporting register to facilitate the development of evidence-based guidelines is recommended.

A Systematic Review on Factitious Disorders: Psychopathology and Diagnostic Classification

“…This data support the hypothesis of several case reports [9] and reviews [3,10] that FD occur mainly in women. However other studies published in literature show a clear prevalence in male gender.…”

Factitious disorder with self inflicted injuries

“…But results of a systematic review found no significant difference between outcomes of confrontational and non-confrontational approaches. 7 An early diagnosis of the factitious disorder can be obtained by clinical clues, incompatible findings especially discordant laboratory results and new sophisticated laboratory assays. 8 Though in this case, there was a little role of laboratory test in general, laboratory can play a key role in the detection and diagnosis.…”

Artifizielle Störungen

“…Empfehlungen zur allgemeinen Gestaltung der Arzt-Patienten-Beziehung hinsichtlich Kontaktaufnahme, Konfrontation oder Nichtkonfrontation sowie Motivation zu weiterführenden Therapiemaßnahmen sind möglich. Sie gründen derzeit aber noch wesentlich auf Expertenmeinung [55]. Allgemein vorteilhaft erweist sich ein interdisziplinäres Vorgehen mit einem stützenden Vertreter des Pflegeteams, dem behandelnden Arzt und dem hinzugeholten Konsiliarpsychiater [7].…”