title: Factitious disorder comorbid with bipolar I disorder. A case report.
abstract: We describe a case of factitious disorder with physical and psychological symptoms comorbid with bipolar I disorder in a 37-year-old woman. Since the onset of bipolar disorder, which occurred at the age of 31, she increasingly complained of physical symptoms, compulsively seeking medical and surgical interventions. She has been hospitalised several times and her Munchausen-type factitious disorder recently appeared to be developing into Munchausen by proxy, involving her 11-year-old daughter. The patient adhered poorly to stabilising and antipsychotic drug treatment and did not improve through the years. We here analyse her mood phases, which were always associated with changes in the quality of factitious symptoms, according to whether the disorder was in its depressive phase (somatic complaints and suicidal ideation prevail), or in its manic or mixed phase (medical intervention-seeking and manipulation of clinicians to obtain surgical interventions). We also briefly discuss some important forensic issues to consider in similar cases, mainly stemming from the psychotic aspects of these two co-occurring disorders. Clinicians should be aware of some patients' ability to produce signs and symptoms of physical and/or psychological illness and consult psychiatrists before giving consent to invasive diagnostic procedures or surgery.
authors.affiliation: Sapienza University of Rome, NESMOS Department (Neuroscience, Mental Health and Sensory Organs), School of Medicine and Psychology, Sant'Andrea Hospital of Rome, Rome, Italy. antonio.delcasale@uniroma1.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.forename: Daniele
authors.initials: D
authors.lastname: Serata
authors.forename: Alessio
authors.initials: A
authors.lastname: Simonetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Caloro
authors.forename: Paolo
authors.initials: P
authors.lastname: Roma
authors.forename: Valeria
authors.initials: V
authors.lastname: Savoja
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sani
authors.forename: Roberto
authors.initials: R
authors.lastname: Tatarelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D002648:Child; D005162:Factitious Disorders / Q000523:psychology*; D005260:Female; D005555:Forensic Psychiatry; D006801:Humans; D008257:Machiavellianism; D055118:Medication Adherence; D016735:Munchausen Syndrome by Proxy / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs