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Yıl:2015; Cilt: 5; Sayı: 3>> Özet
Psikiyatride Güncel; 2015;5(3):223-232
Hastalık benzetimiyle hekimi yanıltıcı davranıș (simülasyon)
H Soysal
Hekimi yanıltıcı davranış hekime başvuran ya da gönderilen kişinin, bir kazanç sağlamak, bir yükümlülük veya sorumluluktan kurtulmak, ceza almasını engellemek gibi çıkar amaçlı ve bilinçli bir şekilde hasta olmadığı halde kendisini hasta olarak göstermesi veya var olan hastalık belirtilerini abartmasıdır. Yalandan psikiyatrik hastalık taklit etme, kliniklerin özelliklerine göre %1 ile %20 arasında değişmektedir. En çok asker hastaneleriyle adli psikiyatri gözlem ortamlarında görülür. Muayene edilen kişinin hasta olduğunun saptanması halinde bir yarar elde edeceği veya bir sorumluluktan kurtulacağı durumlarda saptamak daha kolayken tanı konulduğunda bunun daha sonra dolaylı yollarla kullanıldığı hallerde hekimin yanılma olasılığı artmaktadır. Benzetimi yapılan psikiyatrik durumlar sıklık sırasıyla; zekâ geriliği, demans ve amnestik durumlar, psikozlar ile travma sonrası stres bozukluğudur. Psikiyatrlar benzetimleri yapay bozukluklar, konversiyon bozuklukları ve atipik belirtilerle seyreden psikozlarla en sık karıştırırlar. Benzetimin saptanmasında kişinin tanı konulduğunda yarar elde edecek olması, antisosyal kişilik bozukluğunun varlığı, belirtilerle klinik gözlemin ve adli dosya, sosyal çalışmacı raporları, psikolojik testler ve özgeçmişin örtüşmemesi başat ipuçlarıdır. MMPI ve Rey Test yararlanılabilecek psikolojik testlerdir. Hekimin deneyimleri ve uyanıklığı yanıltıcı davranışın yakalanmasında önemli olsa da çok deneyimli hekimlerin de tanıyı atlaması veya hastaya yanıltıcı davranış tanısı koyması olasıdır. İlgili yazında, taklitçiliği saptanan kişiyle çoğunlukla yüzleşilmesi önerilmektedir. Ayrım yapmak için bir stratejinin parçası veya kişinin inadını kırmak ya da bilgilendirmek için yalan yaptığına inanıldığı bildirilebilir. Ancak hakaret amacı veya tavrı içermemelidir. Ancak yüzleştirmenin işlevi olmayacaksa, bunu yaparak yalan yapanın öfkesini hatta saldırganlığını ortaya çıkarma olasılığı yüksekse, yüzleştirmeden sakınmak daha doğrudur.
Malingering (Simulation)
Malingering (Simulation) Malingering is a misleading behavior of a patient who seeks medical help or who is referred to a physician ant it includes consciously pretending to be sick when actually he/she is not or exaggerating the symptoms of illness for secondary gain, to avoid a duty, responsibility, or punishment. Cases of simulation of psychiatric illness are seen between 1% and 20% of all patients, depending on the type of health facility. This condition is most commonly encountered in military hospitals and forensic psychiatry observation wards. While it is easier to detect malingering in conditions where the person will gain a benefit for being sick or will avoid a responsibility by being found ill, the probability of the physician making a misdiagnosis increases as malingering is done in indirect ways. The psychiatric conditions that are most frequently simulated include mental retardation, psychosis, dementia, amnestic disorders and post-traumatic stress disorder (in descending order of frequency). Psychiatrists most frequently confuse artificial disorders with conversion disorder and psychosis with atypical symptoms. The most prominent clues in favor of simulation include secondary gain of the person with this diagnosis, presence of antisocial personality disorder, absence of concordance between the symptoms and clinical observation, forensic file, reports of the social workers, psychological tests and personal history. MMPI and Rey Test are among psychological tests that may prove beneficial. Although the experience and alertness of the physician are important factors in detecting the misleading behavior, very experienced physicians may fail to diagnose this condition or misdiagnose a really ill person as being a malingerer. In the medical literature, confrontation with the malingerer is recommended. In an attempt on differentiation, he/she may be informed that he/she is believed to be malingering, with an aim to break his/her stubbornness. But this should not contain an aim or attitude of insult. On the other hand, if the confrontation will not be functional, and if there is a high probability that such an approach may trigger anger or even hostility of the malingerer, avoiding a direct confrontation may be better.

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