JUNE 2008
CLINICAL
PSYCHIATRIC TIMES
67
www.psychiatrictimes.com
Pathological Lying: Symptom or Disease? Lying With No Apparent Motive or Benefit by Charles C. Dike, MD, MPH, MRCPsych athological lying (PL) is a controversial topic. There is, as yet, no consensus in the psychiatric community on its definition, although there is general agreement on its core elements. PL is characterized by a long history (maybe lifelong) of frequent and repeated lying for which no apparent psychological motive or external benefit can be discerned. While ordinary lies are goal-directed and are told to obtain external benefit or to avoid punishment, pathological lies often appear purposeless. In some cases, they might be self-incriminating or damaging, which makes the behavior even more incomprehensible.
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He had lied repeatedly to his colleagues, telling them that he had an incurable disease and was receiving palliative treat-
ment. Initially, his coworkers treated him with sensitivity and concern, but as the weeks wore on, the scrutiny of his col-
leagues became increasingly pointed. He had to tell more and more outrageous lies (Please see Pathological Lying, page 68)
SEROQUEL stabilizes mood in bipolar disorder and is the only atypical proven effective in both acute mania AND bipolar depression1,2
CHECK POINTS
Pathological lying (PL) is noted
for the chronicity and frequency of the lies and the apparent lack of benefit derived from them.
Pathological liars believe their lies to the extent that the belief may be delusional.
Lying behaviors that mimic PL
have been described in certain personality disorders and in factitious disorder.
Conditions that could be
confused with PL include malingering, Ganser syndrome, and confabulation.
Important Safety Information Despite its relative obscurity, PL has been recognized and written about in the psychiatric literature for more than a century. The German physician, Anton Delbruck,1 is credited with being the first to describe the concept of PL. He observed that some of his patients told lies that were so abnormal and out of proportion that they deserved a special category. He subsequently described the lies as “pseudologia phantastica.”
CASE VIGNETTE Mr A was desperate. He was about to lose yet another job,not because he was at risk for being fired, but because his lying behavior had finally boxed him into a corner.
• SEROQUEL is indicated for the treatment of depressive episodes in bipolar disorder; acute manic episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex; and schizophrenia. Patients should be periodically reassessed to determine the need for treatment beyond the acute response • Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk (1.6 to 1.7 times) of death, compared to placebo (4.5% vs 2.6%, respectively). SEROQUEL is not approved for the treatment of patients with dementia-related psychosis (see Boxed Warning) • Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder and other psychiatric disorders. Patients of all ages started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. SEROQUEL is not approved for use in patients under the age of 18 years (see Boxed Warning)
Please see additional Important Safety Information on following pages, and Brief Summary of Prescribing Information, including Boxed Warnings, at the end of this ad.
25 mg, 50 mg, 100 mg, 200 mg, 300 mg & 400 mg tablets