From Big Medical Encyclopedia

SIMULATION (simulatio pretense) — creation by the person of false representation about nonexistent at it actually a disease; in court. - medical practice refer to simulation also imitation of pregnancy, the former childbirth or abortion. The page should be distinguished from mutilations (see) and artificial diseases (see), at to-rykh drawing to itself damages or calling of symptoms of this or that disease takes place.

Distinguish true S., at a cut consciously, more often with the mercenary purposes (evasion from labor duties, military service, obtaining any material benefits) represent obviously not existing disease, and pathological S. — not understood, arising unintentionally at mentally sick. At true S. the subject bears full responsibility for the actions, at pathological S. his responsibility is defined by character and weight of a basic disease.

Simulate both various somatic and mental diseases, and their separate symptoms. As a rule, it the diseases which are characterized by hl. obr. the subjective symptoms which are difficult giving in to objective diagnosis, or a disease with hron. current and periodic aggravations. Most often in S.'s cases show complaints to such manifestations of somatopathies as periodically arising hypertensia, tachycardia, heartaches, unconscious conditions, disorders of breath, cough, a pneumorrhagia, a nocturia, a hamaturia, deafness, decrease in sight, restriction of mobility in joints, symptoms nevrol. diseases, etc.

S. can be just pretense, but more often pretense is combined using any receptions and means (chemical, biological, medicinal) for imitation of these or those displays of a disease. So, e.g., by simple pretense simulate contractures of joints, deafness, stutter, epileptic seizures, a nocturia, etc. In other cases, napr, at S. of a peptic ulcer, for bigger plausibility of complaints add the fresh or dried-up blood to kcal, before a fence of a gastric juice accept inside ascorbic to - that, before rentgenol. a research swallow small X-ray contrast objects, to-rye can imitate, e.g., polyps of a stomach. For S. of disturbances of cordial activity apply the exciting substances (strong tea, coffee, tincture of tobacco, etc.) causing temporary tachycardia, arrhythmia and an asthma. In S.'s cases of diseases of lungs of blackout in them imitate by rubbing of skin mercury ointment or administrations of radiopaque substances under skin before rentgenol. a research, and pulmonary bleeding — by exhaustion of blood from gums or intentional injury of a mucous membrane of a nose, an oral cavity or a throat.

At S. with criminal intents or at the arisen suspicion that the person under investigation (defendant) simulates, judicial investigating authorities appoint court. - medical examination, on permission a cut set a task of objective establishment of existence or lack of those signs of disease state, to-rye osvidetel-stvuyemy shows as the proof of the disease which is allegedly available for it, signs of pregnancy, recent childbirth or abortion. Court. - medical examination provides obligatory stationary inspection osvidetelstvuyemy, at Krom on the basis of original medical documents specify earlier postponed diseases, compare the complaints shown osvidetelstvuyemy, dynamics of a disease or its symptoms with the reasons, with to-rymi osvidetelstvuyemy connects their emergence. Each of the shown complaints shall be checked by means of objective methods of a research and, along with it, the functional condition of all bodies and systems of an organism is investigated. At the same time approach to inspection shall be objective, impartial. Absence of a disease will not be proved yet, the conclusion about With cannot be drawn, especially as nek-ry diseases, especially at the beginning of the development, proceed latentno and can not be followed by objective symptomatology.

During the carrying out stationary inspection osvidetelstvuyemy is under constant observation of medical staff. This already in itself sometimes allows to determine the fact C. since the simulator, as a rule, cannot reproduce all symptom complex of a disease in dynamics and therefore represents not a disease, but its separate symptoms. At the same time usually simulate the brightest, but symptoms, not obligatory for the simulated disease, while other symptoms, the most characteristic of this disease, no. The behavior of the simulator is very typical. He is persuasive, constantly speaks to all about the disease, tries to attract attention, complains about unsuccessful treatment; complaints are stereotypic, repeat in the same expressions. If, in his opinion, complaints make an insufficient impression, he begins either to exaggerate them, or to show new, persistently convincing the doctor of the disease. Symptoms of a disease at the same time are always exaggerated. On a metkokhma to old expression, the simulator «worse sees, than the blind person, hears worse, than the deaf, shivers stronger, than a parkinsonik». Pay attention also on unusual a wedge. a current at S. of the diseases which do not have characteristic recurrence. As a rule, at long hron. diseases remissions are observed, to-rykh there is in S. Podozriteln's cases no constant identical intensity and localization of various painful feelings. Can point to S. also sudden recovery at change of conditions in the party, favorable for the simulator. In S.'s diagnosis sudden after-hour medical examinations and a lab have essential value. researches, material for to-rykh take unexpectedly for inspected at presence and under control of the medic.

Page of pregnancy, the former childbirth and abortions establish by an exception of the signs characterizing these states (see. Sexual states disputable ).

Final ethane of clinical, tool and laboratory researches is carrying out commission court. - medical examinations (see. Examination, medicolegal ), resolving an issue of the true state of health osvidetelstvuyemy, absence or existence at it these or those symptoms or diseases.

Simulation of mental disorders — reproduction with various degree of reliance of the symptoms of a mental disease which are absent actually. The page of mental disorders meets usually in forensic-psychiatric practice and at examination of working capacity, is much more rare in the conditions of usual mental health facilities. It can proceed for a long time, is usually more long at true S.

Istinnaya S. always has intentional and purposeful character. Its manifestations are rather various since they are defined by a large number of factors: the ideas of the reasons and symptoms occurring in society mental diseases (see), awareness in the field of the psychiatric knowledge obtained from special literature or a purposeful talk on psychiatric subjects with relatives or acquaintances, personal experience, behavior and statements surrounding mentally sick, separate remarks of medical staff, etc. Are important here and characterologic properties of the personality — imagination, ability to imitation and transformation, endurance, suggestibility, commitment, etc.

True S. is more often carried out during medical observation by simulation of the mental status. Usually productive psikhopatol imitate that. symptoms, to-rye do not demand big expense of physical and mental efforts and stereotipizirutsya at the same time easily. The mutism, unavailability, failure from food, slovenliness, slackness and uniform behavior, separate hallucinatory disturbances (statements

about visions and voices) and the crazy ideas belong to such frustration («look», «want to do much harm», «intimidate»). Simulate the positive symptoms demanding big physical and mental tension less often: conditions of speech and motive excitement, struporous states (see), disorders of thinking, the expressed affective disturbances. The statements («everything indifferently», «is not present attachments», etc.) characteristic of emotional impoverishment, decrease in energy potential, dysmnesias most often occur among the simulated negative symptoms. The page of mental disorders differs in bigger variability of manifestations in the beginning, to-rye further grow poor and stereotipizirutsya.

In some cases at true S. falsification of the anamnesis for creation of visibility of developing of mental disorders in the past is observed. Sometimes, aiming at establishment of the dummy diagnosis, resort to hospitalization in a psychiatric hospital or address in psikhonevrol. clinic. In some cases with the purpose C. of mental disorders use various pharmaceuticals — so-called simulation by means of medicines. At true S. simulation of the anamnesis and simulation of a mental state during observation can be observed at the same time.

Pathological S. is observed at the persons suffering from anomalies of character (see. Psychopathies ), oligophrenia (see), various mental diseases — schizophrenia (see), epilepsy (see), mental disorders at organic diseases of c. N of page, etc. Unlike true S., at a cut the feigned behavior is always realized and purposefully, at patol. Pages these properties are often expressed vaguely and in a varying degree are manifestation patol. motivations of behavior of the patient.

Allocate the following forms of pathological S.: metasimulation and syursimulyation. Metasimulation (extension of a disease) — S. of the mental disorders which were available in the past, but now absent. Most often metasimulation of symptoms meets reactive psychosis (see) or acute alcoholic psychoses in the form of a delirium and hallucinosis (see. Alcoholic psychoses ). Syursimulyation — S. of the mental disorders not inherent to a mental disease, the Crimea suffers this person. At the same time by sick schizophrenia, e.g., claims that it has epileptic seizures. Pathological S. very often reflects features of a basic disease and can serve, to a certain extent, one of its diagnostic criteria.

In forensic-psychiatric practice S. for the purpose of evasion from criminal liability often meets. At the same time allocate three forms C.: preliminary (preventive) S., edges it is carried out during the period preceding commission of socially dangerous act; Page during commission of socially dangerous act; the subsequent S. observed after commission of socially dangerous act (meets more often other forms).

The main method of recognition of S. of mental disorders is clinical, including, in addition to psychiatric inspection, experimental and psychological, elektroentsefalografichesky (at suspicion on S. of paroxysmal frustration or organic changes of mentality) and somatoneurologic researches. The persons suspected of S. of mental disorders should be sent to a hospital for forensic-psychiatric examination. At a research of a mental condition of the person suspected of S. of mental disorders it is necessary to be guided by a number of general provisions: 1) simulate, as a rule, only separate symptoms, but not a disease in general; 2) usually there is no complete picture of some individual mental disease; 3) coexistence of the symptoms which are found at various nozol is quite often observed. forms; 4) The page of separate symptoms has, as a rule, static character, and there are no all painful frustration developing in dynamics. At S.'s establishment mental disorders data of both the subjective, and objective anamnesis are important. The conclusion about S. of mental disorders is based also on data of overseeing by behavior of the studied person.

See also Aggravation , Dissimulation , Survey .

Bibliography: Govseev of A. A. Simul tion of sincere diseases and pathological pretense, Kharkiv, 1894, bibliogr.; Krasnushkin E. K. Chosen works, page 73, M., 1960; A. N. O Moloch of simulation of psychoses, Neuropath, and psikhiat., t. 6, century 8, page 43, 1937, bibliogr.; Morozov G. V., Lunts D. R. and Felinskaya N. I. Main stages of development of domestic judicial psychiatry, M., 1976; Manuel alphabetique de psychiatrie clinique et therapeutique, publ. par A. Porot, P., 1969.

Century of H. Kryukov; G.V. Morozov (psikhiat.).