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  • Simulacija suicidalnosti ka...
    Kordić, Valentin; Jukić, Melita; Požgain, Ivan; Đuričić, Vanja

    Medica Jadertina, 06/2023, Volume: 53, Issue: 1
    Journal Article, Paper

    Nesklad između anamnestičkih podataka, kliničke slike i dijagnostičkih rezultata uvijek upućuje na mogućnost simulacije. Simulacija poremećaja i bolesti može dovesti do značajnih teškoća u dijagnosticiranju i liječenju, te nepotrebnog trošenja društvenih resursa. Simulacija je otežavajuća pojava u psihijatriji i drugim granama medicine, ali posebno je ozbiljna kada se radi o suicidalnosti. Sama suicidalnost predstavlja ozbiljan, složen i terapijski zahtjevan klinički fenomen s opasnošću smrtnog ishoda. Simulacija suicidalnosti posebno je dijagnostički i terapijski zahtjevna zbog brojnih nedoumica u dijagnosticiranju, pravnom postupanju, te opasnosti od mogućeg lošeg ishoda. U ovome radu prikazan je slučaj izuzetno ustrajne simulacije suicidalnosti s ciljem manipulacije sustavom zdravstva i socijalne skrbi. Nakon dulje opservacije, izuzetno opširne dijagnostičke obrade i tek drugog psihijatrijskog pregleda, posumnjalo se na mogućnost simulacije s čime je bolesnik i konfrontiran. Nakon konfrontacije bolesnik je reagirao nezrelim ponašanjem, a potom i priznanjem simulacije. Otklonjena je suicidalna opasnost, a ponašanje bolesnika je shvaćeno kao iscrpljenje prilagodbenih sposobnosti kod osobe s naglašenim histrionskim crtama ličnosti. Bolesnik je potaknut na razumijevanje i kritičnost prema vlastitim postupcima. Cilj rada je naglasiti da u slučajevima moguće suicidalnosti i očitu simulaciju moramo shvatiti kao iscrpljenje prilagodbenih sposobnosti, te teatralni poziv u pomoć. Važan je razumijevajući i suportivan pristup bolesniku, kako bismo mu pomogli u stjecanju uvida u štetnost vlastitog ponašanja, te potrebu prihvaćanje zrelih obrazaca ponašanja. The discrepancy between anamnestic data, clinical presentation, and diagnostic results always points tothe possibility of simulation. Simulation of disorders and diseases can lead to significant difficulties indiagnosis, treatment, and unnecessary consumption of social resources. Simulation is an aggravatingphenomenon in psychiatry and other branches of medicine, but it is especially serious when it comes tosuicidality. Suicidality itself represents a serious, complex, and therapeutically demanding clinicalphenomenon with the risk of death. Simulation of suicidality is particularly diagnostically andtherapeutically demanding due to numerous doubts in diagnosis, legal treatment, and the risk of a possiblebad outcome.This paper presents a case of extremely persistent simulation of suicidality to manipulate the health andsocial care system. After longer observation, extremely extensive diagnostic work-up, and only the secondpsychiatric examination, the possibility of the simulation was suspected, and the patient was confronted with this. After the confrontation, the patient reacted with immature behavior and then by admitting thesimulation. The suicidal danger was removed, and the patient's behavior was understood as the exhaustionof adaptive abilities in a person with accentuated histrionic personality traits. The patient is encouraged tounderstand and be critical of his actions.The paper aims to emphasize that in cases of possible suicidality, we must understand the obvioussimulation as exhaustion of adaptive abilities and a theatrical call for help. An understanding and supportiveapproach to the patient is important to help him gain insight into the harmfulness of his behavior and theneed to accept mature patterns of behavior.