The therapeutic discharge: An approach to dealing with deceptive patients

Gen Hosp Psychiatry. 2017 May:46:74-78. doi: 10.1016/j.genhosppsych.2017.03.010. Epub 2017 Mar 29.


Objective: Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these patients and keep further harm, iatrogenic or otherwise, from being inflicted.

Method: Once an indication has been identified, the therapeutic discharge can be carried out in a stepwise fashion, resulting in a safe discharge. We outlined how to prepare for, and execute, the therapeutic discharge, along with preemptive consideration of complications that may arise.

Results: Consequences for the patient, physicians, and larger healthcare system are considered.

Conclusion: The therapeutic discharge is a safe and effective procedure for patients with deception syndromes in acute care settings. Carrying it out is a necessary element of psychiatric residency and psychosomatic medicine fellowship training.

Keywords: Consultation psychiatry; Deception; Factitious disorder; Malingering; Therapeutic discharge.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Deception*
  • Factitious Disorders / diagnosis*
  • Humans
  • Malingering / diagnosis*
  • Patient Discharge / standards*
  • Psychosomatic Medicine / education
  • Risk Assessment