Patients who are faking illness

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How do you approach patients that you know our feigning illness in the mental/ behavioral health setting?  For instance, I had a patient who wasted a lot of staff time faking seizures on a very busy PICU.  On another occasion, I had a patient who pretended they had Tourette’s.  Is it best to address the behavior directly, redirect, or ignore it?

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Specializes in Mental Health.

I deal with this all the time and it can be very frustrating. I work in both inpatient and residential settings with residents who have frequent pseudo seizures or who just plain want to be sent to the hospital. The most important thing to remember is that this is usually attention-seeking behavior (in some cases drug seeking if they got some IV lorazepam from an unsuspecting provider). So naturally, a good way to minimize the occurrences is to give it the least amount of attention possible. At the facility I'm at our docs will usually write up a protocol for a patient's episodes for non-clinical staff to follow. It usually goes something like:

  1. When patient passes out/has an episode, tech should get VS and tell them to the RN
  2. If pt behaviors are distressing to others, move the other residents
  3. DO NOT CALL 911 UNLESS TOLD TO BY RN or unless the pt stops breathing/has no pulse
  4. Check-in on them every 15 minutes visually until the episode has resolved

Once staff begins basically stepping around them after they "pass out" in the hallway, the behaviors cease pretty quickly. 

I will say, the FIRST time someone pulls this we usually cover our butts and have them sent to the ER. The ER doc usually points out the lack of a postictal period, does a few scans, tells the resident that they aren't epileptic seizures and they can follow-up with our staff in the future. From there we are usually OK to just treat them as complete behavioral events.

Edit: To answer your question haha We don't really address it with the patient... they just stop getting rewarded with attention for the behavior and it tends to go away. In PACU it should be even easier since you can monitor their vitals without even approaching them.

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Specializes in Psych/Med Surg/Ortho/Tele/Peds.

I gently remind them that I pay attention in shift handoff: "I heard about your..." I set firm limits and let them know they will be monitored for certain bx.  They usually cut the ish and those bx magically disappear.

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It might help to remember that not all patients feigning illness are malingering. Some may have factitious or somatic disorder and should be treated. This is particularly true for patients "seeking attention." Some helpful info:

https://www.promisesbehavioralhealth.com/addiction-recovery-blog/what-is-the-difference-between-malingering-and-factitious-disorder/

https://www.psychologytoday.com/us/conditions/malingering

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Specializes in Private Duty Pediatrics.
10 hours ago, lilRN16 said:

I gently remind them that I pay attention in shift handoff: "I heard about your..." I set firm limits and let them know they will be monitored for certain bx.  They usually cut the ish and those bx magically disappear.

ish?

bx?

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Specializes in Emergency.
On 11/1/2021 at 4:26 PM, Kitiger said:

ish?

bx?

ish - slang for bull 

bx - I believe I've seen in notes before and is behavior(s). But I might be wrong

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Specializes in Psychiatry, Forensics, Addictions.

I have worked with many attention seeking and malingering patients.  Especially the patients who would continue to reside at our state psych facility rather than return to corrections.  In my experience, these patients are tremendously frustrating, but I tend to treat them as I would any other patient.  There may be issues that the patient is dealing with that are unknown to staff.  

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Specializes in Psychiatric nursing.

The doctor should tell you how to deal with these patients. It's not really our role to decide if they're malingering or not. That said, I just make sure I don't give them more attention than the other patients. The other patients shouldn't be neglected because someone else is faking a seizure every single shift. (Also, interestingly, just because a seizure isn't epileptic doesn't mean it's fake: psychogenic seizures are real seizures caused by psychological issues. So, it can be super hard to tell what's "real" or not.)

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Specializes in Psyche Nursing, Med/Surg, LTAC.

Taking vital signs gives the patient a few minutes of attention. Documenting them covers the nurse. I had a patient who kept yelling about her abdominal pain and telling her family she might have appendicitis. Took her vital signs every hour for 6 hours-all normal-and I could tell her family we were monitoring her closely. 

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Specializes in Psych, Addictions, SOL (Student of Life).
On 11/1/2021 at 12:00 PM, GoldilocksNP said:

It might help to remember that not all patients feigning illness are malingering. Some may have factitious or somatic disorder and should be treated. This is particularly true for patients "seeking attention." Some helpful info:

https://www.promisesbehavioralhealth.com/addiction-recovery-blog/what-is-the-difference-between-malingering-and-factitious-disorder/

https://www.psychologytoday.com/us/conditions/malingering

This!

"Nonepileptic seizures are also commonly referred to as pseudoseizures. “Pseudo” is a Latin word meaning false, however, pseudoseizures are as real as epileptic seizures. They’re also sometimes called psychogenic nonepileptic seizures (PNES)."

....... "these seizures are a physical manifestation of psychological distress, there are a lot of possible causes."

Griffith, T. (2019, March 22). Understanding pseudoseizures: Causes, diagnosis, and treatment. Healthline. Retrieved January 27, 2022, from https://www.healthline.com/health/pseudoseizures#causes

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I probably should have specified that I had a malingering adolescent.  These kids tend to get together a raise he’ll if one of them are offended.

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Specializes in Psych, Addictions, SOL (Student of Life).
34 minutes ago, Queen Tiye said:

I probably should have specified that I had a malingering adolescent.  These kids tend to get together a raise he’ll if one of them are offended.

I have worked Adolescent psych for many years and a very familiar with malingering behavior. A few years ago all our docs got together and decided that we would not be giving Ativan to adolescents. We use a different cocktail for behavioral emergencies. The worst malingering occurs with our frequent flyers who will come to the hospital then call all their friends and basically tell them to get admitted so they can all hang out for a week.  The problem is that as long as they are telling the psychiatrist that they are suicidal the docs won't risk their license with a discharge.

Hppy 

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