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One out of every twenty emergency department (ED) visits in the United States is due to a psychiatric issue. Providing a gateway between the community and the mental health system, psychiatry emergency clinicians are responsible for assessing and managing a wide array of clinical presentations and conditions. Among emergency mental health-related visits, substance-related disorders, mood disorders, anxiety disorders, psychosis, and suicide attempts are among the most prevalent presentations. Although urgent conditions are common, increasing numbers of patients who present to the emergency department seek treatment for routine or non-acute psychiatric symptoms. Some patients self-refer to the emergency department, while others may be referred by family, friends, outpatient treatment providers, public agencies, or representatives of the law enforcement system.
The cause of factitious disorder is a matter of speculation. Risk factors are thought to include histories of child abuse, childhood hospitalizations that may have been attempts to escape abusive and chaotic families and households, and parental rejection or over-reaction to illness. Patients with factitious disorder can self-induce illness in ways that result in severe disfigurement or death, often from unnecessary medical interventions. Presentations of factitious disorder and its most severe variant, often called Munchausen's syndrome, can range from completely fabricating a medical (or psychiatric) illness, to aggravating or exaggerating symptoms, to simulating an illness, such as by mimicking a generalized seizure episode or by inducing one. Most authors do not discuss treatment for malingering because it is not considered a mental illness. However, some authors emphasize the importance of letting the malingerer save face while giving up the sick role. Recovery, not confession, is often the most realistic goal.
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