Factitious disorder as a differential diagnosis for organic hallucinations

A factitious disorder (FD) is a condition in which someone acts by deliberately producing or feigning symptoms. People with a factitious disorder mainly produce somatic symptoms, whereas psychological symptoms less frequently. Hallucinations may be caused by the side effects of medication, the effect of substance abuse, physical illness like epilepsy or metabolic diseases (more properly defined hallucinosis), or they can be symptoms of a psychotic disorders. This paper describes the case of a 42-years woman who came to clinical attention for an emotional distress characterized by anxiety and insomnia, and hallucinosis not responsive to drugs. On suspicion of organic etiology, the patient underwent routine blood test, thyroid function test, B12, folate and ammonium assays, HBV, HCV, syphilis and Lyme borreliosis tests, brain CT and brain MRI, resulted all clear. Rorschach and Minnesota Multiphasic Personality Inventory-2 (MMP-2) tests showed results consistent with depressive personality traits, no signs of psychotic disorders and high values in the subscales of amplification of symptoms. Hallucinosis have been not modified neither by treatments addressed to hypothetic organic causes nor by antipsychotics treatments. Moreover, the willing to accept psychiatric hospitalization, the accentuation of psychological symptoms when the patient was observed or next to discharge were also recognized in literature as factors suggesting the diagnosis of FD with psychological symptoms. Thus, the paper aimed to provide a prompt analysis of the differential diagnostic process of an apparent organic symptom to reach a diagnosis of FD with psychological symptoms.