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Feigned psychosis revisited — a 20 year follow up of 10 patients

Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF

Alan Ogilvie, Clinical Scientist

MRC Brain Metabolism Unit, Royal Edinburgh Hospital

^* Correspondence

Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM-III-R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.