Psychosocial Disorders 537495.A mother brings her 7-year-old daughter to the ED with a reported illness
of 3 days where the child has been weak and not eating her usual amount.
The mother also reports that she noticed her daughter’s urine to be of a reddish
color and that her stools have been smaller in caliber. She brings a specimen
of her daughter’s urine with her. She reports that her daughter has been
hospitalized multiple times before for similar reasons and dehydration. Upon
physical examination, the patient is without distress, quiet, and states that
she feels tired. Her chest is clear to auscultation, her abdomen is benign
and her neurologic examination nonfocal. A urinalysis performed fails to
show any blood or myoglobin in the child’s urine. Which of the following
should be included in the differential diagnosis of this child?
a. Malingering
b. Factitious disorder
c. Munchausen syndrome
d. Munchausen syndrome by proxy
e. Conversion disorder
496.A 62-year-old man presents to the ED after he was found talking to
himself by witnesses on a nearby street. Upon arrival, the patient appears
confused and is actively hallucinating. His initial vitals include an irregular
HR of 80 to 110 beats per minute, an RR of 14 breaths per minute, a BP of
160/80 mm Hg with an oxygen saturation of 97% on room air. An ECG
indicates atrial fibrillation. The patient can be redirected but states that he is
distracted by colorful, floating images in the room. Given this patient’s presen-
tation,what is the most likely etiology of his symptoms?
a. Acute psychotic disorder
b. Malingering
c. Conversion disorder
d. Digoxin overdose
e. Antidepressant overdose