Factitious disorder and malingering — structured clinical viva

Interpretation

Viva stations

Station A — Nosology (4 min)

Expected: Define FDIS, FDIA, malingering (not a mental disorder), FND as involuntary. Intentionality + incentive type. Munchausen as historical severe stereotype, not a detention criterion.[1][2]

Station B — Differential and formulation (4 min)

Expected: Working differentials — malingering with external incentive; FND; mixed exaggeration of genuine functional symptoms; factitious if sick-role deception dominates without external reward. Note coexistence possible.[1][2][7]

Station C — Assessment tools (4 min)

Expected: Multidisciplinary plan; collateral and workplace/claim records within law; serial observation; consider symptom/performance validity and structured interviews (SIRS family) in high-stakes contexts; Slick-style neurocognitive malingering framework if cognition claimed; base-rate awareness (Mittenberg).[3][4][5][7]

Station D — Ethics, law, management (5 min)

Expected: Not automatic Mental Health Act detention for "Munchausen". Capacity decision-specific. No false certificates. Non-collusion and planned communication. Treat genuine needs. Limited psychotherapy evidence for factitious; malingering disposition often administrative/forensic reporting within role.[1][6][7]

Pass / fail cues

Pass: intentionality axis clear; refuses punitive detention-as-punishment; cites base rates and collateral; documents facts.
Fail: equates all functional symptoms with faking; invents section criteria; colludes with claim; no risk or medical safety thinking.[1][2][3]