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11/11/2021 | 2:45 PM to 3:45 PM
WORKSHOP LIVE DISCUSSION: Cases and Controversies in Factitious Disorder: An Interactive Workshop
Click to watch the presentation recording of this session in advance of the live discussion:
https://clp21.secure-platform.com/a/solicitations/8/sessiongallery/42
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Patients with factitious disorder present unique diagnostic and treatment challenges for the C-L psychiatrist. Despite existing demographic information in the literature, there is little evidence-based consensus about strategies for management. In this case-based workshop, we will discuss four particularly challenging dilemmas pertaining to factitious disorder, and provide concrete recommendations based on our own clinical experiences and available data. We will engage the audience via real time polling and an opportunity for open discussion at the end of the presentation. Session 1: 15 minutes - “How much evidence do I need to formally diagnose Factitious Disorder?” The speaker will present two cases which highlight the pitfalls of both premature and delayed formal diagnoses with recommendations on how to navigate these extremes. The presentation will also highlight relevant legal and ethical considerations and provide clinical recommendations on when, and if, a formal diagnosis must be made. Session 2: 15 minutes - “How early in a patient’s development can factitious disorder be diagnosed?” The speaker will present a case of an adolescent with factitiously generated tic disorder in the context of family dissolution and serious childhood illness. This will include a discussion of risk factors for factitious disorder that can be identified in childhood and adolescence. Finally, the risks and benefits of diagnosis of factitious disorder in youth will be discussed. Session 3: 15 minutes - “When should involuntary psychiatric commitment be considered?” The speaker will discuss a case which illustrates possible criterion for which involuntary psychiatric commitment may be considered, with a special focus on family involvement and behavioral incentives. The presenter will review concepts of behavioral conditioning as well as the ethico-legal implications of this treatment option. Session 4: 15 minutes - “When and how should the family be engaged during therapeutic confrontation?” The speaker will continue discussion about the utility of family involvement in the case of a healthcare worker with factitious disorder. This will include a review of the paucity of evidence regarding family involvement as a treatment strategy. Methods of using family involvement as part of the supportive confrontation model will be proposed, with further exploration of legal and logistic challenges.
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Patients with factitious disorder present unique diagnostic and treatment challenges for the C-L psychiatrist. Despite existing demographic information in the literature, there is little evidence-based consensus about strategies for management. In this case-based workshop, we will discuss four particularly challenging dilemmas pertaining to factitious disorder, and provide concrete recommendations based on our own clinical experiences and available data. We will engage the audience via real time polling and an opportunity for open discussion at the end of the presentation. Session 1: 15 minutes - “How much evidence do I need to formally diagnose Factitious Disorder?” The speaker will present two cases which highlight the pitfalls of both premature and delayed formal diagnoses with recommendations on how to navigate these extremes. The presentation will also highlight relevant legal and ethical considerations and provide clinical recommendations on when, and if, a formal diagnosis must be made. Session 2: 15 minutes - “How early in a patient’s development can factitious disorder be diagnosed?” The speaker will present a case of an adolescent with factitiously generated tic disorder in the context of family dissolution and serious childhood illness. This will include a discussion of risk factors for factitious disorder that can be identified in childhood and adolescence. Finally, the risks and benefits of diagnosis of factitious disorder in youth will be discussed. Session 3: 15 minutes - “When should involuntary psychiatric commitment be considered?” The speaker will discuss a case which illustrates possible criterion for which involuntary psychiatric commitment may be considered, with a special focus on family involvement and behavioral incentives. The presenter will review concepts of behavioral conditioning as well as the ethico-legal implications of this treatment option. Session 4: 15 minutes - “When and how should the family be engaged during therapeutic confrontation?” The speaker will continue discussion about the utility of family involvement in the case of a healthcare worker with factitious disorder. This will include a review of the paucity of evidence regarding family involvement as a treatment strategy. Methods of using family involvement as part of the supportive confrontation model will be proposed, with further exploration of legal and logistic challenges.
Speakers
Shamik Mukherji
Consultation - Liaison Psychiatrist | Long Island Jewish Medical Center/Northwell Health
Shamik Mukherji is a Consultation Liaison Psychiatrist at Long Island Jewish Medical Center in Queens NY, and an Assistant Professor of Psychiatry at the Zucker School of Medicine at Hofstra University. His roles include general inpatient psychiatric consultation as well as outpatient Psycho-Oncology at Northwell Health's Monter Cancer Center. He graduated with Honors from University of California - Irvine, and completed medical school at Stony Brook University SOM. He completed his General Inpatient Psychiatry residency at Zucker Hillside Hospital - Northwell Health. Finally, he completed fellowship in Consultation Liaison Psychiatry and Psycho-Oncology at Memorial Sloan Kettering Cancer Center / Cornell - New York Presbyterian. He is double board certified in Adult Psychiatry and Consultation Liaison Psychiatry. His main areas of interest include Psycho-Oncology, Palliative Care related Psychiatry, and HIV related psychiatry.
Anna Dickerman
Chief, Consultation-Liaison Psychiatry Service | New York-Presbyterian Hospital/Weill Cornell Medicine
Dr. Anna Dickerman is Chief of the Psychiatric Consultation-Liaison Service at New York-Presbyterian Hospital/Weill Cornell Medicine, and Associate Professor of Clinical Psychiatry at Weill Cornell Medicine. Dr. Dickerman attended Harvard College, where she graduated magna cum laude with highest honors. Following her undergraduate studies, she received her M.D. degree at The New York University School of Medicine, where she was elected toAlpha Omega Alpha. She completed her residency in Adult Psychiatry at New York Presbyterian Hospital/Weil Cornell Medical Center, where she received the Payne Whitney Faculty Council Award for Excellence in Teaching and the Consultation-Liaison Psychiatry Department Trainee Award. Following her residency, Dr. Dickerman completed a fellowship in Psychosomatic Medicine at New York-Presbyterian Hospital/Columbia University Medical Center. She also completed psychoanalytic fellowships at the Columbia University Center for Psychoanalytic Training and Research, and the American Psychoanalytic Association. She is a recipient of the William L. Webb Fellowship Award from the Academy of Consultation-Liaison Psychiatry, and is a Fellow of both the American Psychiatric Association and the Academy of Consultation-Liaison Psychiatry. Dr. Dickerman has written and published on a broad variety of topics in C-L psychiatry, and has also co-edited multiple study guides from American Psychiatric Publishing. From 2015-2018, she served on the Scientific Program Committee of the American Psychiatric Association. She is also a board member of the Society for Liaison Psychiatry.
Xavier Jimenez
Director, Consultation-Liaison Psychiatry | Long Island Jewish Medical Center/Northwell
Xavier Jimenez MD, FACLP is Director of Consultation-Liaison Psychiatry at Long Island Jewish Medical Center/Northwell in NY. He completed psychiatry residency training at the University of Pittsburgh Medical Center while also completing a 2-year psychodynamic psychotherapy training course at the Pittsburgh Psychoanalytic Institute. He thereafter completed a Psychosomatic Medicine fellowship at the Massachusetts General Hospital in Boston, and later also became board-certified in both Addiction Medicine and Pain Medicine. He worked at the Cleveland Clinic for over 7 years in the Consultation-Liaison Psychiatry, Bioethics, and Pain Medicine departments, and formerly directed the Chronic Pain Rehabilitation Program. He has conducted research, presented, and taught on a variety of topics, including chronic pain, medically-unexplained symptoms, clinical ethics, addiction medicine, and more.
Megan Gilman
Assistant Attending | Memorial Sloan Kettering Cancer Center
Dr. Megan Gilman completed General Psychiatry residency training at Temple University Hospital and a fellowship in Consult-Liaison Psychiatry and Psycho-Oncology at Memorial Sloan Kettering Cancer Center before returning to MSK as an Assistant Attending with a focus in Adolescent/Young Adult Psycho-Oncology. She is double board certified in General Psychiatry and Consult Liaison Psychiatry. Dr. Gilman is a core member of AYA@MSK, a program dedicated to the whole-person care of and advancement of research into Adolescent and Young Adult cancer patients, established in January 2020. In addition to inpatient and outpatient care and clinical research, most recently focused on antiracism and AYA patient engagement, she is involved in didactic and clinical education of CL Psychiatry fellows and, as an Assistant Professor of Psychiatry at Weil-Cornell Medical College, provides didactic teaching and wellness support to WCMC Pediatric residents during their Oncology rotations.
J Michael Bostwick
Professor of Psychiatry, Mayo Clinic College of Medicine | J. Michael Bostwick, Mayo Clinic, Rochester, MN
J. Michael Bostwick, MD, is Professor of Psychiatry in the Mayo Clinic College of Medicine and Senior Associate Dean for Admissions at Mayo Medical School in Rochester, MN. He has more than 125 publications on suicide epidemiology and prevention, medical marijuana, and numerous psychosomatic topics, and serves on editorial boards for three medical journals. He is an avid teacher at all levels of Mayo's medical school and psychiatry residency, and frequently collaborates with trainees on research and writing projects. He holds undergraduate degrees from Yale University and the University of Hawaii in Art History and Zoology respectively. He attended Brown University for medical school, and did residency and fellowship training in pediatrics, adult psychiatry, and consultation liaison psychiatry at Harvard University at Massachusetts General Hospital, Cambridge Hospital, and Brigham and Women's Hospital respectively. He is currently working on a Masters of Fine Arts degree in non-fiction from Bennington College, his focus being a memoir of suicide, exploring how the deaths of family, friends, and patients have shaped the psychiatrist he has become.
Dara Wilensky
Assistant Professor of Psychiatry | Boston University School of Medicine
Dara Wilensky is an Assistant Professor of Psychiatry at the Boston University School of Medicine. She completed her medical training at the Mount Sinai School of Medicine in New York City. She is a 2018 graduate of the Harvard Longwood Psychiatry Residency Training Program, and a 2019 graduate of the Consultation Liaison Psychiatry fellowship at Boston University Medical Center.
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Speakers
Presentations:
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