Faking It

Granted Fal · Mar 9, 2003

Malingering seems to steal resources, but in all actuality the client is still trying to meet some type of need. Commonly occurring incidents are Med seeking, superficial cutting, nebulous somatic complaints, maybe even years of incessant SI etc.

Even though the end result of this type of client's problem doesn't necessarily meet the "true need" that drives this behavior, to the client and their level of functioning or coping, there may simply be no other way to meet their needs and we may choose to wind up frustrated and impatient with the recidivism.

Treating the need rather than the symptom can't be done in an ER or short term setting realistically, but just this type of realization ( client ineffectively attempting to meet some need )

- at least for me -- makes dealing with these patients easier and keeps you more professional. Besides, we all get payed the same regardless of the clients coming through the door.

Disablednurse · Mar 9, 2003

I too have seen my share of fakers in the past 25 years. But this is about a nurse that accused everyone who wanted pain med as being a faker. We had one guy that had a bad heart and had had it for so long, that he did not just toss and turn when he was having chest pain. ONe nurse told in report that he got his morphine but was not hurting, she said his telemetry did not show anything. I told her that unless he was having an actual heart attack, the telemetry probably would not show it(this was told to me by a doctor). This nurse never again told me that he was faking. That nurse left and went to work somewhere else and not long after that, this gentleman had a heart transplant. Guess he was not faking.

karbyr · Mar 10, 2003

I worked psyche for a couple of years...........a whole new perspective on faking.............and, while I agree that a lot of times the faker is trying to meet a need, giving in to a patients maladaptive ways of meeting their needs doesn't fix the problem either............. truly believe that an offer of a psych consult is best "fix", whether is drug seeking, attention seeking, whatever..... and, if by some error there truly is something seriously wrong, they are under medical supervision, so can be treated that much more quickly............True, many will get angry and leave, but always possible that you have made them seek a more appropriate method of meeting their own needs.......

l.rae · Mar 10, 2003

lt;s never safe to assume someone is faking......honestly, there is a whole package of red flags that lead to this deduction.....l feel bad for you Hellllonurse, there are nurses out there that have no compassion.....and besides, it is unsafe to assume you are correct in charging pts with faking, l believe one should get the benifit of the doubt....doesn't necessarily mean they will get the drugs they want.....but those who get beligerant at the mention of toradol, or are allergic to every low key pain reliever known to medicine, no family doc...even though they were referred the last 6 times they were in.....and on and on.....after a while it is painfully obvious....pardon the pun...

MoJoeRN,C · Mar 12, 2003

I was working at a state psychiatric facility, one of our patients had a certified Dx of Epilepsy. He was noted during his seizures to sometimes "cop a feel" on younger aids, nurses. Once while "having a seizure" after a traumatic "not getting his way" a cigarette lighter came out of his pocket and slid on the floor. No lighters were allowed on the psych unit, staff lit cigarettes. I observed him, as he was having his seizure, slowly reaching for the lighter, which I got before he did, he was really POed then. LMAO

Candalita · Jan 27, 2004

I'm doing a research paper entitled "Mental Illness: An Excuse For a Crime?" and a major aspect I'm trying to cover is on people faking mental illness'. In doing my research, I ran across this bulletin, and after reading through most of it, I was wondering if anyone had any suggestions on either: resources, or just some nursey knowledge :-)

It would be a tremendous help!!

Thanks

Dragonnurse1, ASN, RN · Jan 27, 2004

My all time favorite. MD and nurses watching pt have "seizure". Pt was doing an excellent job but then blew it when the doc said "Wonder what he takes for his seizures?" Pt. stopped seizing long enough to say "Valium" then went right back to seizing.

Toadly · Jan 30, 2004

Well,

I am not a doctor, nor a nurse, rather a patient who does have Epilepsy among other things.

I do not doubt unfortunately many of you end up with the fakers.

Why I posted.

"The best tool for fighting ignorance is education"

Please if for no other reason than to know the difference, look up the definitions for different types of seizures and not from ten years ago or even three; today's.

Your assessments may very well have been fully correct, some of your examples however were those of seizures and some reasons for having excluded the possibility of seizures were as well.

Originally psoted by: l.rae

"1 do not make eye contact"

2 do hit your self in the face with your arm when it is dropped on your face.

3. do not tear up when the amonia cap is broken

4 do piss yourself

5. puking is always effective

From this site: http://epilepsyontario.org/client/EO/EOWeb.nsf/web/sim-part

"Simple partial seizures result from epileptic activity which is localized in one part of the brain, usually the cortex or limbic system.

Consciousness is not impaired: people experiencing a simple partial seizure can talk and answer questions. They will remember what went on during the seizure."

In my opinion and those of many published MD's qualified specifically in neurology, many of your assessments are founded though possibly correct, on incorrect reasoning.

Originally posted by TX Guy:

"Wow thats scary. You could hurt someone or yourself just trying to help these people"

Very true. As well sadly the fakers have made those who are not faking less likely to receive the care needed; this is not even close to simply my own opinion.

Originally posted by Nurse Ratched:

"Told a patient who was faking a seizure that I couldn't roll her over and she needed to lie on her side so she wouldn't choke, in case she vomited. She rolled over with no assistance."

For this I repeat first posted example.

Originally posted by l.rae:

"l can understand why ppl w/ valid illnesses can raise eyebrows at topics like these....."

thank you for that.

"but you first must understand...#1, we attempt to treat these ppl regardless of our inclinations...they ARE given the benefit of the doubt...."

I believe many share your stance, I also believe many make the assumption prior to any testing as I know many who went down that road.

"#2 there is rarely any documented medical history of anything r/t sx's."

So true, though I would ask why this is the case knowing it stems from the "look" many get of "disbelief" being labeled a "fake" when not; "but you look fine".

"#3 these ppl ALWAYS get worse with an audience..especially the family/friends they are attempting to manipulate....."

Family and friends add stress, stress is a trigger... I can add.

"#4these ppl NEVER look ill or truley distressed....let me give you 2 examples..."

From:

"A Remarkable Position to Be In"

Dr. Anthony Ritaccio

NYU Comprehensive Epilepsy Center, New York

"...To such a patient, seizures are not an abstraction but an old foe, hated yet all too familiar."

While living with this everyday should we put on a special "show" to make it more believable? Again remember stress factor, we learn to slow our pace to reduce triggers.

"1. young girl 16yo arrives via emt "unresponsive" with sz-like activity....brought from a high school football game....friends state she only had a coke which they wittnessed her open the can herself.....except for the fact she won't respond, she looks great....(parents can especially appreciate this cause you know kids look like crap when they are sick). Eyes open and close, limbs jerking....much worse when juvenile tearful friends in the room. MD comes in room, holds open her eyelid and BINGO....eye contact....MD turns around, rolls eyes, and orders all obligatory tests....drug screen clean, ct neg.......funny thing though, when she first came in l told another nurse in room my bets were on FWB syndrome..(Fight With Boyfriend).....long story short......l was right."

From this site:

http://epilepsyontario.org/client/EO/EOWeb.nsf/web/sim-part

"Emotional and Other - Simple partial seizures which arise in or near the temporal lobes often take the form of an odd experience..."

"...An absence seizure begins abruptly and without warning, consists of a period of unconsciousness with a blank stare, and ends abruptly. There is no confusion after the seizure, and the person can usually resume full activity immediately. An absence seizure may be accompanied by chewing movements, rapid breathing, or rhythmic blinking..."

And from this site:

http://www.epilepsyfoundation.org/answerplace/Medical/seizures/types/partialSeizures/

"In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which consciousness is retained); and complex partial seizures (in which consciousness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized."

You are aware that caffeine can be and often is a trigger for seizures?

Okay, maybe in this case you are right and she was putting on a show though that is not my point; what if she were not? Take the stress factors with the boyfriend, the game (confusion auditory and visual also can be triggers), the caffeine,,, guess I would have thought about that one again though possibly I would have been wrong and possibly even if right she may not have another ever; no kindling with luck.

Originally posted by yannadey:

"the other night had a seizure faker I gave her the call light & told her call when it was over, she took the button asked me if I'm going to call the doctor told her no the doctor will be coming in the morning she wanted to know what time then she said "I guess I'll wait till then to have my seizure all I could say was yep that would be the perfect time of course I did give the doctor & on coming nurse a heads up on what to expect. I was told the following night about the oscar worthy performance they received"

I truly wish I could site something I felt would address this properly, however I cannot find it. Suffice to say it has been suggested by MD's published that with some types of seizures the ability to "put them off" is plausible: Reminiscent of dealing with stressful situation when you have the time.

Originally posted by l.rae:

"I disagree somewhat with this statement....Many really DO intentionally arrive at ER with just this purpose.....sometimes they want to get at someone who has been perceived to have done them some kind of injustice or some may be Munchausen's....some want the ativan and valium......all different kinds of reasons......there is an element of your thoughts that l agree with though.....they are sick and there are some who truely believe they are having sz(few though).....you just have to be there though...."

Unfortunately I agree with you; ulterior motives far too often. As well I believe there are many who are turned away who should not have been, not always due to epileptic in nature seizures though as well with.

Originally posted by rdhdnrs:

"We had a pregnant girl who faked blindness!!! I guess she thought we'd deliver her for it. When her mom came, she was miraculously cured.

Have had many pseudoseizure pts... when they're pregnant you have to really take it seriously...I guess they are mag addicts??"

again this site:

http://www.epilepsyfoundation.org/answerplace/Medical/seizures/types/partialSeizures/

"Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations."

Originally posted by 3rdShiftGuy:

"The unit I just left had continuous video eeg monitors and we would get patients on a direct admit basis. People who have thought they've had seizures for many years. Whom even "fooled " ERs and doctors, being on anitseizure meds. (Because you don't have to flipflop and piss on yourself to have a seizure) (Sometimes, it's very obvious that a person isn't having a true seizure.) The monitors tell the truth. They are then sent for proper help, not sent on their way chastised for being "fakers", just for drugs and attention."

The following is from:

"A Remarkable Position to Be In"

Dr. Anthony Ritaccio

NYU Comprehensive Epilepsy Center, New York

..."Faced with such overwhelming personal transformations in our patients in the absence of EEG tracings on which to hang our hats, we neurologists are brought back uncomfortably to the pre-EEG days during which epilepsy was an impenetrable enigma..."

The follosing is from:

Clinical and electroencephalographic features of simple partial seizures.

Devinsky O, Kelley K, Porter RJ, Theodore WH.

Medical Neurology Branch, NINCDS, Bethesda, MD 20892.

"Overall, among the 87 simple partial seizures, only 18 (21%) revealed ictal EEG changes. Thus, a normal EEG is common during simple partial seizures and does not exclude the diagnosis."

Following is from:

Fujimoto S, Mizuno K, Takasaka Y, Shibata H, Kanayama M, Ishikawa T.

Department of Central Clinical Laboratories, Nagoya City University Hospital.

"We analyzed the ictal electroencephalographies (EEGs) in 75 seizures of 73 patients...

...Because half of the patients with pseudoseizures also had epilepsy, their ictal EEG examinations were very useful."

Following is from:

"Electroencephalographic studies of simple partial seizures with subdural electrode recordings."

Devinsky O, Sato S, Kufta CV, Ito B, Rose DF, Theodore WH, Porter RJ.

Division of Intramural Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892.

"We used subdural electrodes to study the EEG features of simple partial seizures in 7 patients. We detected epileptiform discharges in 61 of 68 subdurally recorded simple partial seizures compared with 6 of 55 simple partial seizures recorded with scalp electrodes (p less than 0.0001). ..."

originally posted by brefni:

"I work on a neurosurg/neurology unit and the most common faker we see is seizure, with paralysis coming in second."

Would that be anything along the lines of Todd's Paralysis?:

From this site:

http://www.ninds.nih.gov/health_and_medical/disorders/toddsparalysis.htm

"Todd's paralysis is a neurological condition characterized by a brief period of transient (temporary) paralysis following a seizure."

navynurse29,

Wishing you 2 be sz free

By your name you also have my admiration and unending thanks.

If I missed any others I blame my sprained brain.

Originally posted by MoJoeRN,C:

"I was working at a state psychiatric facility, one of our patients had a certified Dx of Epilepsy. He was noted during his seizures to sometimes "cop a feel" on younger aids, nurses."

From this site:

http://epilepsyontario.org/client/EO/EOWeb.nsf/web/sim-part

"Autonomic Seizures... sometimes been referred to as abdominal epilepsy...A few people may experience sexual arousal, penile erection, and orgasm."

http://www.epilepsyfoundation.org/answerplace/statistics.cfm

"Epilepsy and Seizure Statistics

Health condition statistics are typically expressed in terms of incidence and prevalence in a particular population within a specific period of time.

Incidence is a measure of the number of new cases of a medical condition that occur in the population during a measured amount of time, usually one year.

Prevalence is defined as the total number of existing cases of a disease in a specific population at a stated point in time. In any one day, at a certain time, there are a specific number of people with a certain disorder.

There is no central registry of cases of epilepsy or seizures in the United States. Epidemiologists base their estimates on peer-reviewed studies of medical records at specific institutions or in defined local communities. Surveys of physicians and patients, self reporting, and studies in matched populations or segments of populations overseas may also be taken into account.

From this mixture of sources, leading experts in the field have arrived at the following estimates of the incidence and prevalence of seizures and epilepsy in the United States:

Incidence -- Seizures:

300,000 people have a first convulsion each year.

120,000 of them are under the age of 18.

Between 75,000 and 100,000 of them are children under the age of 5 who have experienced a febrile (fever-caused) seizure.

Incidence -- Epilepy:

181,000 new cases of epilepsy are diagnosed each year.

Incidence is highest under the age of 2 and over 65.

Males are slightly more likely to develop epilepsy than females.

Incidence is greater in African American and socially disadvantaged populations.

Trend shows decreased incidence in children; increased incidence in the elderly.

In 70 percent of new cases, no cause is apparent.

50 percent of people with new cases of epilepsy will have generalized onset seizures.

Generalized seizures are more common in children under the age of 10; afterwards more than half of all new cases of epilepsy will have partial seizures.

Prevalence -- Epilepsy:

Prevalence of active epilepsy (history of the disorder plus a seizure or use of antiepileptic medicine within the past 5 years) is estimated as approximately 2.5 million in the United States.

Prevalence tends to increase with age.

45,000 children under the age of 15 develop epilepsy each year.

15,000 school children through age 14 have epilepsy.

600,000 persons over the age of 65 have epilepsy.

Higher among racial minorities than among Caucasians.

Cumulative incidence (risk of developing epilepsy):

By 20 years of age, one percent of the population can be expected to have developed epilepsy.

By 75 years of age, three percent of the population can be expected to have been diagnosed with epilepsy, and ten percent will have experienced some type of seizure.

Epilepsy risk in special populations:

The basic, underlying risk of developing epilepsy is about one percent. Individuals in certain populations are at higher risk. For example, it is estimated that epilepsy can be expected to develop in:

10 percent of children with mental retardation

10 percent of children with cerebral palsy

50 percent of children with both disabilities

10 percent of Alzheimer patients

22 percent of stroke patients

8.7 percent of children of mothers with epilepsy

2.4 percent of children of fathers with epilepsy

33 percent of people who have had a single, unprovoked seizure

Remission

70 percent of people with epilepsy can be expected to enter remission, defined as 5 or more years seizure free on medication.

35 percent of people with mental retardation, cerebral palsy, or other neurological condition will enter remission.

75 percent of people who are seizure free on medication for 2-5 years can be successfully withdrawn from medication.

10 percent of new patients fail to gain control of seizures despite optimal medical management.

>

So I pose this problem: a result from those who fake is that those who are not faking are less likely to be correctly diagnosed if the symptoms are not prevalent; multitude of reasons, fault lies with the fakers with premeditated façade.

Do I make sense?

If I did then try this on for size; bends the mind seizures dew.

Sum of substance

Slipping in my aura, with an eerie ease,

Happening without having done so,

The taste of which I know so well,

While not knowing at all--

Creeps in a closed door, past my guard,

Climbs my spine and grabs my mind.

Having no recourse for this remorse--

Synapse held down systematically.

Loss in proportional relationship,

Infinite empirical dimensionality.

Stumbling turmoil in what may come to be

Between an existence without linear time,

Singularity of thought splits endlessly.

Falling from an unknown height

Of an unknown place,

Heightened awareness of what is not thought to be, till it is,

Clamber distinguish ability,

Mincing thoughts in action,

Action lacking motion,

Emotion born and conceived without my leave.

Abstracted callously,

Deterministically infinitely aware,

Worry or care not conceptual.

Whilst curiously no despair,

I simply was not there.

Todd

all my best to all

PunxyPhil · Feb 2, 2004

That was a well thought out, intelligent response consisting of good info that we can all benefit from.

I for one learned quite a bit.

Thank you Toadly :)

stevierae · Feb 2, 2004

I appreciated the insight and resources Toadly shared--and the poem was great-- but...in all fairness--should he even be accessing this site?

I thought it was called "allnurses" for a reason--Todd, nurses are known for their "black humor--" sometimes used as a coping mechanism for the things we encounter on a daily basis that only fellow nurses would begin to understand----and this is a place where we can feel comfortable venting among each other in what "outsiders" would consider a very irreverent way--I, for one, feel somewhat uncomfortable to know that there are non-health care professionals lurking or posting on these boards--makes me feel that we really have to be careful of what we say and how we say it, lest a non-nursing professional be on the board, and take offense....

Anyone having similar thoughts?

PunxyPhil · Feb 3, 2004

stevie,

I hear where you're coming from, totally understand.

I think maybe Toadly was concerned about sharing information in a friendly way. Whether or not T is a HCP, the simple fact exists that there is a stigma and lack of education surrounding epilepsy.

Blowing off steam is a good thing, but being able to empathise and possibly even learn from the very ppl who are the bread and butter of this business...stellar.

P

Toadly · Feb 3, 2004

PunxyPhil and Stevierae,

Thank you.

Without a humorous outlet or coping tools the duties of a nurse would likely overwhelm. I faced something's not to dissimilar while a mortician though more morbid, preferred that to crash scene work of any type; however this does not make me a nurse.

originally posted by stevierae:
I, for one, feel somewhat uncomfortable to know that there are non-health care professionals lurking or posting on these boards--makes me feel that we really have to be careful of what we say and how we say it, lest a non-nursing professional be on the board, and take offense....

Then please except my sincere apologies as that was not my intent at all.

I was hesitant to post here at all, though please note my posting was not born from taking any offense, still none taken.

...sometimes used as a coping mechanism for the things we encounter on a daily basis that only fellow nurses would begin to understand...

What I posted only was done after conferring with PHD (s) more qualified to correctly address prior to posting though now see upon reflection if it is taken in this fashion its purpose may never come to be as intended.

Parts of what I study passionately; neuroscience, neuropsychology. One day I may finish degree...

For now I leave you in peace, all my best.

Assumed last post

todd