The therapeutic discharge: An approach to dealing with deceptive patients

Abstract

Objective: Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these patients and keep further harm, iatrogenic or otherwise, from being inflicted.

Method: Once an indication has been identified, the therapeutic discharge can be carried out in a stepwise fashion, resulting in a safe discharge. We outlined how to prepare for, and execute, the therapeutic discharge, along with preemptive consideration of complications that may arise.

Results: Consequences for the patient, physicians, and larger healthcare system are considered.

Conclusion: The therapeutic discharge is a safe and effective procedure for patients with deception syndromes in acute care settings. Carrying it out is a necessary element of psychiatric residency and psychosomatic medicine fellowship training.

Keywords: Consultation psychiatry; Deception; Factitious disorder; Malingering; Therapeutic discharge.