Psychosocial Disorders Answers 545or treatments. In contrast to those with a factitious disorder (b), these patients
prefer to counterfeit mental illness given the difficulty in objectively verifying or
disproving the etiology of the patient’s reported symptoms. Amnesia, paranoia,
depression, and suicidal ideation are commonly seen. The idea of an external
gain motivates these individuals to fabricate medical symptoms. Conversely,
factitious disorders are characterized by symptoms or signs that are inten-
tionally produced or feigned by the patient in the absence of external incentives.
Munchausen syndrome (c)is one of the most dramatic of the factitious
disorders. Its name is derived from a Baron Karl F. von Munchausen who
amusedhis friends with fantastic and incredible tales about his personal
life. Conversion disorder (e)is a rare disorder that is characterized by the
abrupt, dramatic onset of a single symptom. It typically presents as some
nonpainful neurologic disorder for which there is no objective data for.
496.The answer is d.(Rosen, pp 1549-1583.) This patient is experiencing
avisual hallucination,most typical of a medical rather than psychiatric
etiology. Digoxinis a common precipitant of these symptoms and may
begin with yellow-blue changes in vision, known as van Gogh vision. Digoxin
directly binds the Na-K ATPase which increases sodium and calciumlevels,
increasing the contractility of the heart. Hallucinations are often an early
symptom of digoxin overdose. Treatment for this includes a protein fragment
that binds this medication.
(a)Auditory hallucinations are usually seen in psychiatric illness or an
acute psychotic episode. Antidepressants (e)typically do not produce changes
in vision or hallucinations. His symptoms are also not typical of malingering
(b),given that he was not brought in of his own accord without secondary
gain, or of conversion disorder (c).
497.The answer is c.(Rosen, pp 1549-1583.)In the psychiatric literature,
there exists a “SADPERSONS” scale that enumerates risk factors. Two points are
given for factors that are considered higher risk. These include depression or
hopelessness,rational thinking loss, organized or serious attempt, and stated
future intent. Lower risk factors, given one point, are male sex, age <19 years or
45 years, previous attempts or psychiatric care, excessive alcohol or drug use,
separation, divorce or widowed status, and no social supports. Firearms in the
household, family violence, abuse, and chronic illness also increase risk.
Sex (male) 1
Age (<19 or >45 years) 1
Depression or hopelessness 2