Pt faking seizure

[VFlutter]

We had a patient obnoxiously fake a sezuire when I was doing ER clinical. He would open his one eye to see what we were doing then try to act unresponsive. The Dr pulled the classic foley line and said "Let's get the student to put a catheter in his penis. He needs the practice. Now don't forget the lube like last time". We all get a good laugh about that one.

 

[Achilles]

Is it considered assault if you do the hand drop test?

 

[Shishkabob]

Is it considered assault if you do the hand drop test?

Nope.


But on the same token, put your hand between their hand and their face... I once had a nurse try the test and, just as I told her, the patient was not faking, but got a hand to the face anyhow.

 

[leoemt]

Actually, faking seizures isn't a medical problem. Psychogenic seizures are. Big difference. And they are related to psychiatric problems, not psychotic.

It is only proper to say possible pseudoseizures if the pt has already been diagnosed with them. Otherwise the proper way to document it is to write something like "seizure like activity". If you want to get more specific you can further describe the situation like "Non rhythmic seizure like activity without neurological impairment"

Psychogenic seizures are also called Pseudo Seizures which is a medical problem. Pseudo Seizures can also be called fake seizures. The underlying cause can be a myriad of reasons including diagnosed or undiagnosed mental problems.

In our system we don't "diagnose". We make our best guess based on information available to us but we don't diagnose that falls to an MD. Our doctors want to know as much as possible even if we believe the patient to be faking. Hence, in the A part of our report "Possible Pseudo Seizure."

I can usually tell based on Signs, Symptoms and History as to the type of seizure a patient is having. If I can't well that is what the "S" of my report is for.

I don't need a prior diagnosis of Pseudo Seizures to call something a Pseudo Seizure. Hence why we use the term "possible".

 

[VFlutter]

Psychogenic seizures are also called Pseudo Seizures which is a medical problem. Pseudo Seizures can also be called fake seizures. The underlying cause can be a myriad of reasons including diagnosed or undiagnosed mental problems.

In our system we don't "diagnose". We make our best guess based on information available to us but we don't diagnose that falls to an MD. Our doctors want to know as much as possible even if we believe the patient to be faking. Hence, in the A part of our report "Possible Pseudo Seizure."

I can usually tell based on Signs, Symptoms and History as to the type of seizure a patient is having. If I can't well that is what the "S" of my report is for.

I don't need a prior diagnosis of Pseudo Seizures to call something a Pseudo Seizure. Hence why we use the term "possible".

I think you missed the point of Aidey's post. There is a difference between faking seizures and pseudo/psychogenic seizures which are not fake seizures. I guess you can call it I medical problem but I would consider it more psychological, most commonly a conversion disorder. Why even bother saying "possible pseudo seizure"? Just describe what you see. You are walking a fine line of trying to diagnosis a very complex condition that you honestly have no clue about (not an insult). Also true psychogeic seizures are quite rare.

 

[Aidey]

Psychogenic seizures are also called Pseudo Seizures which is a medical problem. Pseudo Seizures can also be called fake seizures. The underlying cause can be a myriad of reasons including diagnosed or undiagnosed mental problems.

In our system we don't "diagnose". We make our best guess based on information available to us but we don't diagnose that falls to an MD. Our doctors want to know as much as possible even if we believe the patient to be faking. Hence, in the A part of our report "Possible Pseudo Seizure."

I can usually tell based on Signs, Symptoms and History as to the type of seizure a patient is having. If I can't well that is what the "S" of my report is for.

I don't need a prior diagnosis of Pseudo Seizures to call something a Pseudo Seizure. Hence why we use the term "possible".

I'm sorry, but you're wrong. You are using a diagnostic term inappropriately and justifying it with semantics. As has been detailed above, there are several other things you can write under the "A" section and still describe the situation without misusing the term pseudoseizure.

To look at it another way, you are called for a child who suddenly has shortness of breath during PE. She has a low SpO2 and is wheezing on expiration, but she has no history of lung problems. Are you going to write "Asthma attack" under assessment or "Acute onset SOB with wheezing"?. It is the same exact principle. If they have a history of asthma it is appropriate to document that as your assessment. If they do not, then you are giving them a new diagnosis without the necessary diagnostic tests.

 

[Veneficus]

Could somebody tell me what the "A" part of a report is?

As well as the "S" part?

 

[VFlutter]

Could somebody tell me what the "A" part of a report is?

As well as the "S" part?

I am guessing A= Assessment and S= Subjective

 

[Veneficus]

I am guessing A= Assessment and S= Subjective

Thanks.

 

[Veneficus]

In our system we don't "diagnose". We make our best guess based on information available to us but we don't diagnose that falls to an MD. Our doctors want to know as much as possible even if we believe the patient to be faking. Hence, in the A part of our report "Possible Pseudo Seizure."

Now that I understand you are attempting to use a SOAP format... (Thanks Chase)

I feel a burning compulsion to tell you that you cannot possible document you assessment, which is what you think is wrong with the patient without offering a Dx.

It may be a differential dx, an incomplete differential dx, maybe even a presumptive dx. BUt it is still a dx.

Please do not try to hide behind "not making a dx." It is something amateurs do and you are better than that.

 

[VFlutter]

Now that I understand you are attempting to use a SOAP format... (Thanks Chase)

I feel a burning compulsion to tell you that you cannot possible document you assessment, which is what you think is wrong with the patient without offering a Dx.

It may be a differential dx, an incomplete differential dx, maybe even a presumptive dx. BUt it is still a dx.

Please do not try to hide behind "not making a dx." It is something amateurs do and you are better than that.

I understand your point and agree to a certain degree but in this situation what does adding a presumptive ddx like "Pseudoseizure" add to the report? I do not see a reason to throw in that dx instead of just documenting seizure like activity.

 

[Veneficus]

I understand your point and agree to a certain degree but in this situation what does adding a presumptive ddx like "Pseudoseizure" add to the report? I do not see a reason to throw in that dx instead of just documenting seizure like activity.

I do not think adding a presumptive rare diagnosis helps at all. Actually I think it is rather pointless.

A differential or simply unknown is a much better idea.

 

[Milla3P]

"Pt stated that she had seizures when not administered fentenyl IV rapid push. Walked to truck, entered and sat on stretcher under her own power with unhindered gait. After being secured to stretcher and transport initiated pt displayed significant tonic-clonic seizure-like activity. After completion of seizure-like activity, pt returned to a&ox4 stating that she had a seizure and would have another without the administration of IV fentenyl."

Something like that?

 

[mycrofft]

Acute dystonia? Dispatchers have to pick something, and if it involves abnormal movement, they usually pick seizures.

People dialing in 911 (or inmates "hitting the button") call EVERYTHING "a seizure".

 

[leoemt]

Now that I understand you are attempting to use a SOAP format... (Thanks Chase)

I feel a burning compulsion to tell you that you cannot possible document you assessment, which is what you think is wrong with the patient without offering a Dx.

It may be a differential dx, an incomplete differential dx, maybe even a presumptive dx. BUt it is still a dx.

Please do not try to hide behind "not making a dx." It is something amateurs do and you are better than that.

We don't make a dx. Now that I said what the legal eagles want me to say you are correct though I would lean more to a presumptive dx.

Pseudoseizures have been lumped under psycogenic seizures. However the definition of Pseudo is pretend or fake. As taken from dictionary.com:

pseu·do [soo-doh] Show IPA
adjective
1.
not actually but having the appearance of; pretended; false or spurious; sham.
2.
almost, approaching, or trying to be.
Origin:
1940–45; independent use of pseudo-

Therefore a Pseudo Seizure is a pretend, or false seizure. People who fake seizures have underlying causes often psychological. I don't ever call anything "fake."

I document what I see. Since a person who fakes a seizure won't be postictal I can't really call it a Tonic - Clonic. My documentation will support what I observe and the "A". It is understood, at least around here, that the 'A' is not a diagnosis and is only a "best guess." I also don't ever accuse anyone of faking anything. However, I am blunt in my assessment and will tell them out right that I don't feel they were having actual seizure activity.

I transported a patient from the local ER to a SNF. In the Hospital paper work was the diagnosis of Pseudo seizures and in parentheses was Fake Seizures. It was followed up by a detailed psych exam which explained why the patient faked their seizures.

I have had patients admit to me that they were faking their seizures. It doesn't make them any less of a patient but it does change their treatment as treatment will likely focus on the psychological rather than the neurological. It is important for me to relay to the hospital if I suspect the patient is faking their seizures.

It will be up to the hospital to determine why the patient is faking their seizure.

 

[mycrofft]

Now that I understand you are attempting to use a SOAP format... (Thanks Chase)

I feel a burning compulsion to tell you that you cannot possible document you assessment, which is what you think is wrong with the patient without offering a Dx.

It may be a differential dx, an incomplete differential dx, maybe even a presumptive dx. BUt it is still a dx.

Please do not try to hide behind "not making a dx." It is something amateurs do and you are better than that.

If I didn't have the diagnostic equipment or there were conflicting findings/history, I'd weasel out by assessing as "R/O Somethingorother" or "dignuslike dermatitis" (not those exact terms, but the principle that I honestly indicated my trend of thinking ands was not comfortable with my assessment's trend). I'd call the MD when it seemed to need more of his attention sooner than later. He or she would call me if they wanted more than I was ready to commit to paper.

 

[VFlutter]

We don't make a dx. Now that I said what the legal eagles want me to say you are correct though I would lean more to a presumptive dx.

Pseudoseizures have been lumped under psycogenic seizures. However the definition of Pseudo is pretend or fake. As taken from dictionary.com:

pseu·do [soo-doh] Show IPA
adjective
1.
not actually but having the appearance of; pretended; false or spurious; sham.
2.
almost, approaching, or trying to be.
Origin:
1940–45; independent use of pseudo-

Therefore a Pseudo Seizure is a pretend, or false seizure. People who fake seizures have underlying causes often psychological. I don't ever call anything "fake."


I transported a patient from the local ER to a SNF. In the Hospital paper work was the diagnosis of Pseudo seizures and in parentheses was Fake Seizures. It was followed up by a detailed psych exam which explained why the patient faked their seizures.

Yes that is the dictionary definition of pseudo. The "not actually but having an appearance of" is what pseudo usually refers to in medical usage not false or pretend. A pseudo-aneurysm has an appearance like that of a true aneurysm, it is not faking or pretending to be an aneurysm. A psychogenic seizure is NOT a pretend or false seizure.

A quote from the Wiki link you posted, which is under the heading Psychogenic Non-epileptic seizures (The correct term)

"The use of older terms including pseudoseizures and hysterical seizures are discouraged.[4] While it is correct that a non-epileptic seizure may resemble an epileptic seizure, pseudo can also connote "false, fraudulent, or pretending to be something that it is not." Non-epileptic seizures are not false, fraudulent, or produced under any sort of pretense.

The condition may also be referred to as non-epileptic attack disorder, functional seizures, or psychogenic non-epileptic seizures. Within DSM IV the attacks are classified as a somatoform disorder, whilst in ICD 10 the term dissociative convulsions, is used, classed as a conversion disorder.[1]"

I do not know what that was written in the hospital report but that does not make sense to me. A person purposely faking a seizure is not a pseudo seizure. I agree people with psychological disorders may fake seizures but that is not what psychogenic seizures are. I would suggest researching somatoform disorders and getting a better understanding of psychological disorders.

Edit: To be fair, the actual medical combining form pseudo is false or appearing to be.

 

[Veneficus]

We don't make a dx. Now that I said what the legal eagles want me to say you are correct though I would lean more to a presumptive dx.

It is not legal eagles that say you do not dx, it is morons.

Pseudoseizures have been lumped under psycogenic seizures. However the definition of Pseudo is pretend or fake. As taken from dictionary.com:

pseu·do [soo-doh] Show IPA
adjective
1.
not actually but having the appearance of; pretended; false or spurious; sham.
2.
almost, approaching, or trying to be.
Origin:
1940–45; independent use of pseudo-

Therefore a Pseudo Seizure is a pretend, or false seizure. People who fake seizures have underlying causes often psychological. I don't ever call anything "fake."

I don't think you understand.

While you are correct in your wordsmithing, there is an actual, specific,medical condition which shares the name. In order to avoid confusion, it would help if you didn't use the term.

Just so you know, the bolded statements conflict.

the "A". It is understood, at least around here, that the 'A' is not a diagnosis and is only a "best guess."

It is always a best guess. But it is still a dx. The only people who commonly reach a final definitive dx are pathologists. There are many types of dx. What you are describing is a working dx.

People who tell you you do not dx are simply misinformed, though they may believe what they say.

I transported a patient from the local ER to a SNF. In the Hospital paper work was the diagnosis of Pseudo seizures and in parentheses was Fake Seizures. It was followed up by a detailed psych exam which explained why the patient faked their seizures.

I don't doubt it, but without the qualifier of (fake seizure) it can cause confusion. Write it if you are so compelled to, I am just trying to help you.

I have had patients admit to me that they were faking their seizures. It doesn't make them any less of a patient but it does change their treatment as treatment will likely focus on the psychological rather than the neurological. It is important for me to relay to the hospital if I suspect the patient is faking their seizures.

I don't think anyone disputes that.

 

[Aidey]

Y

Edit: To be fair, the actual medical combining form pseudo is false or appearing to be.

Hence why they renamed them.


As we've all pointed out though, the term pseudoseizure and psychogenic seizure are still interchangeable and pseudoseizure is a diagnosis, not a fast way to describe a fake seizure.

 

[mycrofft]

Factitious seizureform activity: lying with body language