Factitious disorder vs malingering — assessment, ethics and non-collusive management (MEQ)

(i) Definitions and differentials (≈5 marks)

FDIS: intentional falsification or induction of illness associated with identified deception; behaviour occurs even without obvious external rewards; not better explained by another mental disorder.[1][5]

Malingering: intentional false/exaggerated symptoms for external incentives (money, drugs, duty avoidance, legal); not a mental disorder.[1][5] Here litigation is absent; sick-role and procedure-seeking with self-induction pattern favours factitious over pure malingering, though mixed motives can occur.

FND: involuntary functional neurological symptoms — not intentional deception; different alliance and rehab tasks.[6]

SSD: distressing somatic symptoms with disproportionate thoughts/feelings/behaviours; symptoms not intentionally produced.[5]

Stem features supporting FDIS working formulation: polymicrobial gut organisms, isolation-linked fevers, multi-hospital procedures, demand for lines, healthcare knowledge access.[3][4]

(ii) Assessment (≈4 marks)

Medical stabilisation concurrent with psychiatry. Multidisciplinary meeting before confrontation.[1] Collateral: prior hospitals, GP, pharmacy, workplace occupational health if lawful. Timeline of admissions and procedures. Risk: ongoing self-induction, iatrogenic harm from further lines, suicide risk given PHQ-9 16, flight risk. Capacity decision-specific for proposed interventions. Document facts and sources, not pejorative slogans.[1][4]

(iii) Management (≈5 marks)

Acute: treat bacteraemia; remove unnecessary devices; supervised care environment as needed; pause non-essential invasive tests.[1]

Definitive non-collusion: single named team and GP plan; do not certify false diagnoses or continue procedures that only maintain deception; planned non-punitive discussion of inconsistencies; offer psychiatric follow-up without requiring confession.[1][2] Evidence for specific psychotherapies is limited (Eastwood systematic review) — say so.[2] Treat comorbid depression with standard antidepressant pathway and monitoring; medication does not “cure” factitious behaviour.[2]

(iv) Ethics and law (≈3 marks)

Non-maleficence (stop iatrogenic harm), beneficence (treat real infection and depression), justice (resource use), honesty (no false certificates). Confidentiality has limits for protecting the patient and preventing multi-hospital harm — share on lawful basis under local privacy rules.[1] Capacity: deception ≠ automatic incapacity. Avoid solo shaming confrontation.[1][2]

(v) Prognosis and disposition (≈3 marks)

Published series suggest chronic courses are common; multi-hospital migration and untreated comorbidity worsen outlook.[3][4] Better if engaged with single team, reduced procedures, treated depression. Disposition: C-L shared plan, outpatient psychiatry, clear re-presentation pathway that does not reward fabrication, safety-net for mood/suicide risk.[1][2]