Med. Pro Praxi 2008; 5(3): 128-132

Předstírané poruchy a simulace

doc. MUDr. Ján Praško CSc, MUDr. Dagmar Seifertová CSc
Psychiatrické centrum Praha, 3. LF UK, Praha

U předstírané (faktitivní) poruchy i u simulace pacient své příznaky z různých důvodu předstírá a dělá to vědomě. U faktitivních poruch je cílem získání zdravotní péče a zájmu zdravotníků. Důležité je včasné rozpoznání poruchy, aby se předešlo nepotřebným vyšetřením, nákladné terapii či iatrogenním komplikacím. Citlivý psychoterapeutický přístup může postiženému pomoci. Přímá konfrontace zpravidla smysl nemá. Doporučovány jsou postupy dialekticko-behaviorální terapie podobně jako u hraniční poruchy osobnosti. U simulací pacient příznaky nemoci předstírá z vědomě zištných důvodů jako jsou ekonomické výhody (finanční náhrada, invalidní důchod) nebo vyhýbání se něčemu nepříjemnému (zodpovědnosti, práci, trestu apod.). Simulovat je možné příznaky tělesné či psychické nemoci, traumatické zážitky v minulosti, dopad či důsledky nemoci. Simulace se může projevit v různých formách – od čisté simulace, při které jedinec falšuje všechny příznaky, k parciální simulaci – agravaci – kdy jsou příznaky zveličovány nebo jejich vliv na denní fungování je prezentován nadměrně. Lékař má v každém případě potlačit svojí negativní afektivní reakci na zjištění simulace, udělat rozbor celé situace a zkusit pochopit, co pacienta k tomuto chování přimělo. Simulující nebo agravující by měl být v klidu se zjištěním simulace i jejich důvodů konfrontován, bez moralizování, hněvu či triumfování a ubezpečen, že svého cíle touto cestou nedosáhne.

Keywords: předstírané poruchy, simulace, sekundární zisky, klinické vedení, psychoterapie

Published: May 21, 2008  Show citation

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Praško J, Seifertová D. Předstírané poruchy a simulace. Med. praxi. 2008;5(3):128-132.
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