Factitious disorders Flashcards
What is the key characteristic that distinguishes a factitious disorder from malingering in the context of hand pathology?
Factitious disorders - intentionally produced or feigned symptoms without obvious external rewards
Malingering - deliberate symptom production for external benefits (compensation, medication, etc.).
This distinction is crucial for treatment approach, as factitious disorders require psychiatric intervention alongside surgical management.
In a patient with a psychoflexed hand, what is the typical digital posture?
A psychoflexed hand typically presents with all digits severely flexed and contracted, often causing maceration in the palm.
The hand often assumes a characteristic U-shape configuration where the wrist may be totally bent over the forearm, reflecting the underlying psychogenic mechanism.
What is the anatomical location characteristic of Secretan’s syndrome?
Secretan’s syndrome is characterized by recurrent or persistent hard swelling and hyperplasia on the dorsal aspect of the hand with peritendinous fibrosis around the extensor tendons, not the palm.
What is the typical temporal relationship between pain/swelling and rest in factitious disorders of the hand?
In factitious disorders of the hand, there is no characteristic temporal relationship between symptoms and rest periods. These patients typically present with dramatic, persistent symptoms that are inconsistent with observed pathology and disproportionate to physical findings, regardless of activity level or rest.
What is the SHAFT syndrome and how does it relate to factitious disorders?
SHAFT syndrome is an acronym for
Sad,
Hostile,
Anxious,
Frustrating, and
Tenacious
characteristics commonly seen in patients with factitious disorders. These patients typically seek multiple medical opinions and undergo numerous procedures, reflecting their persistent need to maintain the sick role and receive continued medical attention.
What diagnostic approach is essential before establishing a diagnosis of a factitious disorder of the hand?
Exclusion of all relevant recognized medical conditions through appropriate clinical, radiological, and laboratory investigations.
What pattern of healthcare utilization is typical in patients with factitious disorders affecting the hand?
Patients with factitious disorders typically seek multiple medical opinions and actively pursue numerous investigations and procedures. This pattern of ‘physician shopping’ and willingness to undergo extensive and often invasive procedures stems from their psychological need to maintain the sick role and receive continued medical attention.
In the evaluation of a patient with suspected factitious hand disorder, what psychological factors should be considered?
Secondary psychological issues including depression, anger, and frustration are common, especially when dealing with medical personnel.
How does a pain questionnaire and anatomic pain diagram aid in diagnosing factitious disorders of the hand?
Pain questionnaires and anatomic pain diagrams can reveal inconsistencies between reported symptoms and known anatomical patterns, helping identify non-organic pain distributions.
They also provide insight into unspoken issues and psychological factors that may be gleaned from a patient’s written responses, serving as valuable diagnostic tools.
What physical findings suggest a psychoflexed hand versus an organically contracted hand?
A psychoflexed hand typically shows severe flexion of all digits with maceration in the palm, often in a U-shaped configuration.
Unlike organic contractures, psychoflexed hands typically demonstrate inconsistent resistance to passive extension, variable resistance with distraction, and lack of corresponding muscle wasting or trophic changes that would be expected in long-standing organic contractures.
What is the role of electrodiagnostic studies in factitious disorders of the hand?
Although electrodiagnostic studies are typically normal in factitious disorders (specifically in electrically negative TOS), they remain recommended as part of the initial work-up to rule out distal nerve compression syndromes such as carpal tunnel or cubital tunnel, which may contribute to symptoms or complicate the clinical picture.
What imaging findings are characteristic of Secretan’s syndrome on MRI?
Secretan’s syndrome appears as an ill-defined infiltrative mass-like lesion on the back of the hand, visualized on MRI as homogenous dark signal intensity on T1 and T2-weighted images in the dorsal subcutaneous layer, confirming peritendinous fibrosis around the extensor tendons rather than palmar involvement.
What is the most important factor in the treatment of factitious disorders of the hand?
The most important factor is not defining the correct diagnosis but recognizing that it is the patient who is causing the disease, either consciously or subconsciously.
This recognition should guide a multidisciplinary treatment approach addressing both the physical manifestations and underlying psychological issues.
In what ways does a factitious hand disorder typically manifest differently in women versus men?
Factitious disorders of the hand are diagnosed 3.5-4 times more frequently in women than men. Women more commonly present with dramatic pain symptoms and are more likely to have a downward-sloped first rib that may contribute to neurovascular compression. Additionally, occupational risk factors differ, with women more commonly affected in careers requiring static upper extremity positioning.
How does the concept of ‘one wound, one scar’ as described by Peacock relate to mangling injuries of the hand?
Peacock’s ‘one wound, one scar’ concept describes how scar from a mangling injury forms from the skin down through bone, compromising the function of all structures involved and the extremity overall. This unified scarring process affects multiple tissue layers and critical interdependent systems simultaneously, explaining why functional outcomes can be poor despite technically successful repair of individual structures.
