Malingered Psychosis Leading to Involuntary Psychiatric Hospitalization

Abstract

Objective: To describe a patient with feigned psychosis who was admitted to an acute psychiatric unit under the Mental Health Act, and to discuss the clinical features of malingering in this treatment setting. Method: Case report. Results: A 40-year-old man with no known past psychiatric history was brought by police to the Emergency Department. He gave a history of paranoia, hallucinations and bizarre behaviour and was admitted to a secure ward. Treatment with parenteral medication was required due to hostile and aggressive behaviour. Collateral history was inconsistent with his reported symptoms and, when confronted with this information, he acknowledged fabricating his symptoms in order to obtain a disability pension. Conclusions: It is important to consider malingering as a differential diagnosis in patients who present with atypical features and have clear external incentives for their behaviour. With improved health literacy and access to health information, individuals who are marginalized in society and have limited social and occupational opportunities may malinger symptoms for obvious personal gain. Inconsistency between reported symptoms and clinical observations, as well as contradictory collateral information from multiple sources, are helpful tools in diagnosing malingering. It is important for clinicians to identify malingerers early and limit unnecessary admissions.