Grey's Anatomy Kalpana

In the television series Grey’s Anatomy, produced by Shonda Rhimes in 2005, a few medical interns acquire the central focus, taken place in an hospital environment. Considering the topic of Grey’s Anatomy is solely around the medical field, they receive many out of the ordinary cases. In the duration of this particular television episode, a patient that goes by the name, Kalpana Rivera, was one of the more unusual cases in the Seattle Grace Hospital. Although, Kalpana is only present for one episode out of all eleven Grey’s anatomy series, she displays a noticeable amount of obscure signs, grasping the doctors attention. Kalpana Rivera, is a female adult, from Nepal India, who I believe has met the criteria for factitious disorder. Factitious

disorder will be described later in more depth, but it is a disorder in which a patient is deceitful about medical or psychological signs or symptoms (American Psychiatric Association, 2013).There is minimum background knowledge about Kalpana, due to the fact that she is not a main character on the television series.

Although, the behavior and context in the episode was enough to adequately determine Kalpana’s disorder.
Even though Grey’s Anatomy only omits limited context about Kalpana, her conduct presented and brief circumstance overview, provides enough confirmation. Some of the behavior that Kalpana reveals as questionable throughout the episode emerges within seconds of the show’s introduction of her character. In the start of the episode, Kalpana absorbs her surrounding attention, of available medical staff, hovering over her bedside, while she proceeds to story tell. In the book, A Concise Guide for Medical Students, Residents, and Medical Practitioners, by Roberts, Layde, and Balon, they discuss how a factitious patients so called conceivable scenario’s may attract more medical attention. Roberts, Layde, and Balon state that the deceitfulness of the patient communicates “limited factual material mixed with extensive and colorful fantasies, and

the listener’s interest pleases the patient and thus reinforces the symptom.”(___)Once the doctors start inquiry regarding her health care, Kalpana begins to state her medical background, similar to a justifiable manor. Kalpana proceeded to inform the doctors of an almost near death experience,due to what she recalled as the rheumatic fever. When she was (asked) about) her most recent arrival to the emergency room, Kalpana expressed her medical symptoms around ventricular arrhythmia. Subsequent to the doctors first visit, Kalpana was targeted by an of duty doctor for taking undocumented medication. Promptly after Kalpana was accused of her sneaky behavior, she fainted in front of two argumentative doctors. Her contentious actions continued, while she discussing her episode occurrence from losing consciousness. Kalpana urgently asked her two assigned doctors why she wouldn’t be receiving more than one medical test or pace maker. The last skeptical red flag the doctors recognized was her abnormality in urine color. On the account that these events only transpired in a concise period of time, there were other diagnoses, I contemplated along with factitious disorder.
When trying to distinguish if Kalpana possessed a comorbid diagnosis, I pondered the idea of panic disorder. One of my other original thoughts for a diagnosis included panic disorder, because of Kalpan’s fainting episode. A panic disorder is described as consistently having worries but specifically due to the panic attacks themselves and their reoccurrence( Craske M.G, 2010). When considering if Kalpana qualified for panic disorder, specific signs were brought to my attention. Before she had lost consciousness, her symptoms appeared to resemble a Panic attack and were present in her physical presentation. Kalpana’s breathing appeared to be irregular, her facial expression drastically changed; meanwhile she had been accused of an act that could have essentially blown her cover. Stated in the DSM-5 by the American Psychiatric Association, some of the diagnostic criteria for panic disorder includes “a sense of shortness in breath and feelings of faintness(pg. 208,American Psychiatric Association, 2013).” Diagnostic Criteria in the DSM-5 for Panic Disorder also encompassed consistent fear, concern, and worrying surrounding having future panic attacks from occurring. (pg. 208,American Psychiatric Association, 2013) Another requirement present in Panic Disorder is a disruption, change, or avoidance in a patients daily behavior to dodge environments or people that may trigger a panic attack( 208, American Psychiatric Association, 2013). This disruption of fear of upcoming panic attacks did not seem relevant in her life based off of the limited background informations and daily scenes displayed. It was not apparent, during any time in the show that Kalpana showed any signs of intense worrying either by displaying physical signs or simply in her speech pattern. Although, the television series does not bring us through her typical day, based on the information given in the episode and her behavior in the hospital, I came to the conclusion this was not a severe issue. Based off of the previously stated specifications, there is not a sufficient amount of evidence in this episode of Grey’s Anatomy, to appropriately diagnosis Kalpana with Panic Disorder.
Furthermore, it was pronounced that Kalpana qualified for the diagnosis of factitious disorder based, on the information provided from the Grey’s Anatomy episode and the criterion in the DSM-5. Before moving forward, factitious disorder falls within the diagnostic category of Somatic Symptom and Related Disorders. The type of disorder that Kalpana suffered is a conscious display of physical symptoms in search of extra medical care. In factitious disorder, there is no real known medical problem, and the patient intentionally presents themselves as ill in order to receive external benefits (Austrian, Sonia G., 2005). The blatant benchmarks for factitious disorder that Kalpana obtains in the DSM-5 include the falsification of her physical and psychological signs or symptoms, and the induction of disease, relating to her identified deception (American Psychiatric Association, 2013). Kalpana expresses this behavior when guilefully proceeding to take an unauthorized medication that induced her illness. The second qualification in the DSM-5. that is applicable to Kalpana’s diagnosis is,when she presents herself as being ill with ventricular arrhythmia. Next is the fact that her visit in the hospital was not related to any medical concern, and has no better explanation then a mental or psychiatric disorder. An instance where Kalpana unveiled this criterion is when the doctors eventually figured out her urine was discolored from the self-induced medication. Although I couldn’t be certain of all five diagnostic requirements, four were evidently met from the disposition that Kalpana exhibits through her stay in the emergency room.
In addition to the DSM standard for factitious disorder, Kalpana was only shown having one episode. Although, further specifications assured me that factitious disorder was the appropriate diagnosis, due to the fact that Kalpana’s exploration in the emergency room. One requirement in the DSM-5 is having at least one occurrence of falsifying behavior, which Kalpana demonstrated. Another supporting factor would be recurrent episodes of deceitful illness or injury inflicted on ones self.(American Psychiatric Association, 2013). Despite not having the knowledge of Kalpana’s background story, I believe there is enough evidence to conclude this was not her first episode. Provided in the introduction of the episode, Kalpana informs the doctors of her past medical history that included rheumatic fever that she claims to have almost killed her. Not to mention Kalpana exhibits red flags when presented with interactions, she suspects as the doctors condemning her. Kalpana is conveniently proficient when it comes to medical information. Kalpana professes her accomplishment of receiving a PH.D in pharmacology, allowing her to cunningly slide by the doctors radar originally. The duration of Kalpana’s episode exhibited conspicuous signs and symptoms in addition to the DSM criteria for factitious disorder.
The etiology for factitious disorder is restricted on the account of the majority of patients restraining from treatment.

Some known contributing factors to this disorder consist of child abuse, a medical complication as a child, working in the medical field, or someone who obtains neuroticism or a poor sense of self. Individuals who suffer from factitious disorder face complicating circumstances and obstacles each day. An individual with factitious disorder can have disruption in their daily routine, put themselves at high risk for injury and self harm, suicide attempts, and death rates. Additionally, people with the disorder can experience consequences with interpersonal relationships and job stability. Typical treatment for a patient that posses factitious disorder may encompass a consistent medical provider, cognitive behavior therapy, psychotherapy, and in some cases family therapy. The approach I would execute would be a combination of all of these suggested treatments. My main focus would concentrate on psychotherapy by intertwining cognitive behavioral therapy. I would aim to promote a positive thinking process, reduce anxiety, and improve self destructive thinking and misbeliefs. I believe having one medical provider for a factitious patient would beneficial for not only the individual but surrounding people as well. This medical provider can generate all communication with other team members, monitor visits, and keep track of reported symptoms. Lastly, it was

mentioned in the Grey’s Anatomy episode that Kalpana’s parent’s traveled leaving her to feel neglected. In Kalpana’s instance I would try to acquire family therapy sessions with her loved ones. Not only will this make them more aware of her disorder, but Kalpan’s loved ones can hopefully form as a support system for her.