Descripción de pacientes colombianos con simulación/magnificación de enfermedad mental, un problema frecuente en psiquiatría laboral

Abstract

Introduction

Occupational psychiatry evaluates the relationship of manifestations of mental problems with work. The Colombian occupational insurance model provides financial and work-related benefits due to occupational disease, and simulation can therefore become a challenge for the psychiatrist.

Methods

We evaluated 76 patients in a mental health medical board, applying simulation tests (SIMS, TOMM and the Rey 15-item test) and cognitive performance and personality tests. We analysed the results with measures of central tendency and dispersion, Pearson's correlation index, the χ²test, Student's t test and the Mann Whitney U test. We carried out a binary logistic regression model of magnification behaviours using independent clinical, neuropsychological and personality variables.

Results

71% had suffered work accidents; 84.2% had a psychiatric diagnosis pre-meeting and 27.6% post-meeting; clinical inconsistencies and magnification and simulation of symptoms were demonstrated; 64.5% reported chronic pain and 50% were disabled. All simulation tests positively correlated with each other and the F-K index (MMPI-2), positively correlated with SIMS and schooling. Medical disability and chronic pain increased the risk of magnifying behaviours.

Conclusions

The mental health medical board enables effective identification of illness, simulation and magnification in difficult cases. The simulation and magnification behaviours are associated with medical disability and chronic pain. Our results demonstrate the importance of an adequate diagnosis and early detection of simulation and magnification behaviours.