# Blurring Fact and Fiction: A Complex Case of Recurrent Emergency Presentations, Polypharmacy, and Psychiatric Conflict

## TL;DR

A young patient with complex psychiatric and medical issues repeatedly presented to the emergency department with severe symptoms linked to concealed medications, raising concerns about factitious disorder.

## Contribution

This case study presents a rare and complex interplay of factitious disorder, psychiatric comorbidities, and polypharmacy misuse in a medically unstable patient.

## Key findings

- The patient's clinical deterioration was temporally linked to concealed medications like antihypertensives and semaglutide.
- The case illustrates the challenges of managing patients with overlapping psychiatric and somatic presentations.
- Repeated interventions may reinforce maladaptive behaviors, highlighting the need for multidisciplinary and ethical approaches.

## Abstract

A patient in their early 20s with a complex psychiatric and medical history presented with severe electrolyte imbalance, dehydration, and progressive functional decline. After initial stabilisation, the patient developed recurrent episodes of hypotension, hypoglycaemia, and seizure-like activity despite normal neuroimaging and an established diagnosis of non-epileptic attack disorder. Repeated nursing safety checks revealed concealed medications, including antihypertensives, anticoagulants, semaglutide, and central nervous system depressants, all temporally associated with clinical deterioration and emergency responses. The patient’s presentation raised concern for factitious disorder, compounded by comorbid anorexia nervosa, emotionally unstable personality disorder, and complex PTSD.

This case highlights the diagnostic and ethical challenges of managing medically unstable patients whose presentations blur the boundaries between psychiatric and somatic illness. It illustrates the risks of reinforcing maladaptive behaviour through repeated interventions and prolonged hospitalisation, emphasising the importance of multidisciplinary collaboration, cautious escalation of care, and early involvement of psychological and ethical support.