You Done Messed Up
You have tactlessly told your patient with factitious disorder “you are wasting my time and hospital resources”. They will be quite likely to do this:
What is “sign out AMA/seek care elsewhere/return at a later date”?
Before suspecting anorexia in young patient with recent onset of amenorrhea, you should check the results of this test first.
What is a urine hCG?
A patient comes to the ED complaining of nausea and abdominal pain. Your resident informs him that he will be waiting for a CT scan for quite some time and states that he will be providing the patient with a note for missing work in the morning. Twenty minutes after this conversation the patient is seen eating Taco Bell that he had delivered to the hospital waiting room. You are highly suspicious that the patient is exhibiting this behavior pattern.
What is malingering?
This is a major difference between factitious disorder and malingering.
What are external rewards?
This eating disorder has the highest rate of remission.
What is binge-eating disorder?
You tell your patient with illness anxiety disorder “all the tests were negative, it’s all in your head”. You have lost trust and rapport with this patient because you failed to provide this important part of patient communication.
What is validation?
Patients with one of these two disorders should only see a single primary care physician.
What is illness anxiety disorder or somatic symptom disorder?
Your patient states “I’m able to walk, but I can’t feel my feet”. His gait is good on both tiptoe and heel walking. While completing your neurological exam he has absent soft touch and pinprick from the knee down bilaterally and 1/5 strength on plantarflexion. He states that the symptoms began while he was arguing with his wife this morning. You suspect that he is suffering from this disorder.
What is conversion disorder?
This is a major difference between a patient suffering from anorexia and a patient suffering from bulimia.
What is “patients with bulimia maintain a ‘normal’ weight”?
This disorder has been associated with personality disorders and healthcare workers.
What is factitious disorder?
The Abdomen CT for your headache patient just came back negative. While in the patient’s chart you notice a negative Abdomen CT from last night, as well as two more negative scans from the last week. The four residents that saw this patient have broken this rule for caring for patients with somatic symptom disorder.
What is “check recent charts carefully and minimize unnecessary workup”?
You should be most concerned that a patient with this disorder will commit suicide in their lifetime.
What is anorexia?
Your resident is closely inspecting a patient’s hand during the physical exam. Later, she explains that she was looking for this suggestion of purging behavior.
What is Russell’s Sign?
This is the difference between anorexia and avoidant/restrictive food intake disorder.
What is a fear of ‘getting fat’ or ‘viewing their body in a negative way’?
Risk factors for this disorder include older age, fewer years of education, lower socioeconomic status, unemployment, and history of childhood sexual abuse.
What is somatic symptom disorder?
Your patient with bulimia begins seizing while you are giving her discharge instructions. You accidentally may have started her on this medication.
What is Bupropion (Wellbutrin)?
Upon physical exam, you notice that your patient’s arms are covered in thin, soft hair. This is the name of a sign of malnourishment seen in patients with anorexia or bulimia.
What is lanugo?
Your patient’s brother tells you that his sister seems to cover her mouth with her napkin and cough many times during family dinner. You are suspicious that the patient may suffer from this eating disorder.
What is rumination disorder?
This is a sure sign that your patient has somatic symptom disorder and not illness anxiety disorder.
What is “the patient has specific symptoms that are bothering him”?
Women are 10x more likely than men to suffer from this eating disorder than men.
What is bulimia?
Your patient with anorexia develops delirium, fluid retention, and the cardiac rhythm shown. You neglected to check her labs during the morning rounds, and she developed this complication from her treatment.
What is refeeding syndrome?
You begin treating a patient suffering from depression and anorexia with Fluoxetine. She states that she wants to read up on the medication when she gets home. Three months later she returns with worsening depression. This is a reason she may not be taking the medication you prescribed, which has led to the lack of improvement in symptoms.
What is possible weight gain (associated with SSRIs)?
You glance at your resident’s desk and see this EKG. You suspect your patient may have one of these two eating disorders.
What is anorexia or bulimia?
These are two signs that your patient has conversion disorder and not somatic symptom disorder.
What is acute onset of symptoms and lack of concern for those symptoms?
This is the only somatic symptom-related disorder that does not affect women at a higher rate than men.
What is Illness Anxiety Disorder?