Detecting Deception on the Part of Patients

Article excerpt

The tragic death of actor Heath Ledger from an apparent overdose of drugs known to be dangerous in combination raises the question of how he obtained them.

Details are still unfolding, and there is much that we might never know. We must be careful about speculating on the role of Mr. Ledger or that of his physician(s), if any, in what happened. Regardless of the specifics, this case serves as a reminder that patients sometimes deceive physicians to obtain drugs. Even those of us who are forensic psychiatrists know that our ability to recognize lies is limited.

Despite knowing that the desire to obtain drugs motivates many patients to lie, we want to trust our patients and must devote our limited time and resources to diagnosis and treatment--rather than to determining whether the patient is being honest. Still, we serve our patients better if we can uncover efforts at deception with some strategies that might contribute to better care.

The possibility of attempted deception to obtain drugs should be considered when the patient does any of the following:

* Remembers suddenly, near the end of the evaluation, a hypnotic that he or she has been taking and wants continued.

* Reports adverse reactions to all nonaddictive drugs for a given indication.

* Tells you that only one drug works, and that drug turns out to be a benzodiazepine.

* Tells you atomoxetine and bupropion were ineffective for attention-deficit hyperactivity disorder, or that methylphenidate works better when snorted.

* Reports that he needs higher than usual doses of a benzodiazepine or psychostimulant.

* Objects to a trial of a nonaddictive alternative.

Even when you do not suspect drug seeking, obtaining information from other sources can help you provide better care. Include family or friends in part, but not necessarily all, of the evaluation.

Patients might not want to tell you the whole story in front of family, but sometimes only a family member will provide critical information. …