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Barking dogs seldom bite? a case of diagnostic overshadowing in emergency department

Published online by Cambridge University Press:  13 August 2021

J. Gonçalves Cerejeira ,
C. Burón ,
I. Santos Carrasco ,
C. Capella Meseguer ,
E. Rodríguez Vázquez ,
M. Queipo De Llano De La Viuda ,
A. Gonzaga Ramírez  and
G. Guerra Valera
J. Gonçalves Cerejeira*
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. Burón
Affiliation:
Psychiatry, Hospital Clínico Valladolid, Valladolid, Spain
I. Santos Carrasco
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. Capella Meseguer
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
E. Rodríguez Vázquez
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. Queipo De Llano De La Viuda
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
A. Gonzaga Ramírez
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
G. Guerra Valera
Affiliation:
Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
*
*Corresponding author.

Abstract

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Introduction

Diagnostic overshadowing is one of the main consequences of stigma involving patients diagnosed with a psychiatric disorder. Some studies show that in emergency departments, being diagnosed with a psychiatric illness can lead to a poor evaluation of organic symptoms, delaying the diagnosis and putting the patient’s life at risk.

Objectives

- To present the case of a patient diagnosed with factitious disorder who was misdiagnosed after attending the emergency department due to the stigma related to his psychiatric diagnosis. - To provide a reflection on stigma in mental health.

Methods

We will present a case report and a literature review.

Results

We report a case of a 57-year-old man diagnosed with a factitious disorder. He attended the emergency department of our tertiary care center with confused speech, desorientation and disruptive behavior at home. Although the clinical picture was compatible with a confusional state, he was ordered to be admitted to the psychiatric service. No blood test was previously requested. Three hours after being admitted, he suffered an episode of seizures. A blood test was requested and severe hypomagnesemia (0.2 mg / dl) was found. Because of this episode the patient was admitted to the Intensive Care Unit for three days.

Conclusions

Factitious disorder is a serious mental disorder with a significant stigmatizing burden. Giving a patient this diagnostic label should be the subject of careful thought in order to protect him from future diagnostic neglect.

Disclosure

No significant relationships.

Keywords

StigmaDiagnostic overshadowingfactitious disorder
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S654
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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