Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

suspected factitious disorder

1st line – multi-disciplinary team management

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ACUTE
|
suspected factitious disorder
1st line – 

multi-disciplinary team management

Although it is best to identify one person as the primary provider to the patient, a multi-disciplinary team should be involved. This should include consulting ethics and legal services early.[25] Psychiatric evaluation is warranted in most cases to assess for comorbid psychiatric illness and evaluate suicide risk.

Plus – treatment of objective findings

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ACUTE
|
suspected factitious disorder
Plus – 

treatment of objective findings

Treatment recommended for ALL patients in selected patient group

Objective findings induced by the patient, such as infection or hypoglycaemia, must be treated as medically indicated. To prevent a patient from sabotaging treatment, supervising the patient may be necessary during this initial therapy.

Risky interventions or diagnostic procedures, such as surgeries, should be avoided unless absolutely necessary. To the extent possible, treatments should be based on objective data rather than exclusively on patient report.

Consider – psychological therapy

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ACUTE
|
suspected factitious disorder
Consider – 

psychological therapy

Additional treatment recommended for SOME patients in selected patient group

Psychiatric evaluation is warranted in most cases to assess for comorbid psychiatric illness and evaluate suicide risk.

When addressing concerns about a diagnosis of factitious disorder with the patient, the discussion should be non-punitive and supportive, respecting the dignity of the patient. Many will leave the hospital against medical advice and will not be amenable to follow-up treatment.

For those who either admit to feigning illness or are open to treatment, the long-term strategy aims towards changing behaviour so that it does not recur.

Follow-up treatment with psychotherapy has been discussed in multiple case series and case reports but has not been studied prospectively.[25] Approaches have included psychoanalytic psychotherapy, cognitive behavioural therapy, and supportive therapy in both inpatient and outpatient settings, sometimes augmented with medications. Although case reports have documented some treatment success with therapy, most patients are unlikely to engage in treatment. Some authors have suggested the establishment of centralised reporting registries to aid in the development of evidence-based treatments.[25]

This approach must be balanced with respect for protected health information and relevant laws.

Plus – safety measures + report to appropriate authorities

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ACUTE
|
suspected factitious disorder
|
imposed on another (previously factitious disorder by proxy)
Plus – 

safety measures + report to appropriate authorities

Treatment recommended for ALL patients in selected patient group

It is essential to remember that these cases are instances of abuse and must be reported to the appropriate authorities, such as child protective services, adult protective services, or the police.[26] The institution's risk-management department or attorney should be consulted to help guide reporting and documentation.

The main concern is the safety of the people involved.[26]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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