Diagnosis Of Munchausen Syndrome Research Articles

Le syndrome de Munchausen partagé chez l’adolescent : un entre deux pour un continuum du syndrome de Munchausen par procuration au syndrome de Munchausen

ObjectivesMunchausen syndrome by proxy is defined by the production of factitious disorders on an individual by a close relative, generating a medical nomadism and more or less invasive somatic treatments. The reported cases of victims range from the perinatal period to adulthood. The existence of cases in adolescents raises the question of the victim's participation, conscious or unconscious, in Munchausen syndrome by proxy. The aim of this study was to investigate the type of adolescent involvement in this syndrome. Patients and methodsWe collected a series of height cases hospitalized in the Children and Adolescents Psychiatry Department of the Pitié Salpêtrière Hospital, from 1994 to 2022. These patients were hospitalized in a context of complex clinical expressions for which the diagnosis of Munchausen syndrome by proxy was a possibility. We studied the different psychopathological aspects of these eight cases from the medical records (hospitalization reports, patient interviews, psychological and psychomotor assessments). ResultsWe described 8 cases of hospitalized children,aged between 9 and 17 years. Their functional symptoms were psychiatric and sometimes somatic. The additional benefits were, for the majority of them, to receive parental attention, with an improvement noted in all patients during the separation from the relative. We studied the patient's participation in the different cases described, and the awareness level of their own participation. DiscussionThese different clinical observations enable us to outline a systemic dimension with a system composed of the perpetrator, the “victim” patient and the doctor suggesting a participation of each member in the system. The psychopathological arguments found are the improvement at the separation from the relative, systemic dysfunctions, a family organization around the relationship of two members, most often between the child and his mother without a third person and more particularly without a paternal figure, fostering an exclusive mother-child dyadic interaction. All of the benefits secondary to the production of the disorders are mainly aimed at maintaining a “fusional” relationship with the parent, based on somatic or psychiatric symptoms. In these complex cases, we question the participation of the child, seeking to meet the expectations of his parent who sees him as a chronic patient, in this pathology initially induced by a family member. In view of the systemic arguments, we propose the term “shared” rather than “by proxy” Munchausen syndrome in cases of active or passive and partially conscious participation of the adolescent in the subterfuge. ConclusionThis series has thus led us to favor a systemic approach especially in the older adolescents and to introduce the concept of shared Munchausen syndrome. We collected cases of Munchausen syndrome “by proxy”, especially in younger patients, cases of “shared” Munchausen syndrome and cases of patients who self-inflict lesions with a conscious and active participation in the Munchausen syndrome suggesting an evolution towards a “classic” Munchausen syndrome. We can assume that the different syndromes of Munchausen “by proxy”, “shared” or “classic” present themselves as a continuum according to age and psychic maturity.

A rare case of Munchausen syndrome: foreign body ingestion

Munchausen Syndrome (MS) is characterized by mental or physical diseases intentionally induced by the patients. In this case report, we aimed to present MS and review current literature. A 36-year-old female patient was admitted to the emergency room with the complaint of abdominal pain that developed after swallowing stitch needles. Physical examination revealed minimal tenderness in the abdomen with palpation. The plain abdominal X-ray revealed more than ten needle-shaped opacities. During the anamnesis, the patient was incoherent and too determined to have a surgical intervention, which gave rise to a suspicion of MS. A psychiatrist consultation was conducted, she was diagnosed with MS and hospitalization of the patient was planned. Clinical suspicion and detailed anamnesis are the key for the diagnosis. Physicians should bring to mind the diagnosis of MS and seek psychiatric support in patients with frequent hospital admissions, incompatibility between their complaints and a history and examination findings.

Recurrent ear bleed with profound bilateral sensorineural hearing loss: A case of Munchausen syndrome

Factitious disorders and Munchausen syndromes present with history and physical symptoms to all specialties, and they are often extensively evaluated. Diagnosis of Munchausen syndrome is a challenge and patients often do not receive the correct diagnosis and appropriate care especially in settings where access to mental health professionals is difficult. We present a case of recurrent bleed from the right ear, bilateral profound hearing loss and jerky movement of limbs that was extensively evaluated and followed up for 4 years until a diagnosis of Munchausen syndrome was reached. This case reports the risk of harm to the patient and wastage of healthcare resources unless physicians begin to actively evaluate for factitious disorders.

The Incidence of Diagnosis of Munchausen Syndrome, Other Factitious Disorders, and Malingering.

Background Systematic studies on factitious disorders and malingering in large populations are rare. To address this issue, we performed a nationwide epidemiological study in Norway on the incidence of these diagnoses in an unselected patient population. In particular, we tried to confirm the diagnoses and to estimate the contribution of Munchausen syndrome to the spectrum of factitious disorders. Methods We analyzed data obtained from the Norwegian Patient Registry (NPR), which provided a deidentified list of all patients from 2008 to 2016 who had received the ICD-10 diagnosis of F68.1 or the diagnosis code Z76.5. Results Altogether, 237 patients (99 females; 138 males) received a diagnosis of F68.1. Code Z76.5 was applied to 52 patients (12 females; 40 males), all diagnosed within health institutions. Three of 1700 specialists (somatic specialist, psychologist, or psychiatrist) in private practice had diagnosed a factitious disorder in altogether 87 patients. After contacting these specialists, we could identify no true case of F68.1. For 24 of 146 patients who were equally distributed by gender within health institutions, we managed to identify the diagnosing healthcare providers. Of these 24 patients, only 11 correctly qualified for code F68.1. Only two female patients qualified for a Munchausen syndrome diagnosis. Conclusions There is a male predominance for the diagnosis of malingering. An earlier suspicion of a female predominance for Munchausen syndrome is upheld. There is significant underdiagnosing and misdiagnosing for both conditions and for factitious disorders in general. To separate the most serious form of factitious disorders from milder forms and to facilitate more systematic research, we recommend a specific ICD diagnosis for Munchausen syndrome.

Recurrent Renal Colic in a Patient with Munchausen Syndrome

Background: In most of the cases regarding children, factitious disorders (FDs) are intentionally produced by parents. Less attention is paid to FDs in which a child or adolescent intentionally induces or falsifies the disease to attain a patient’s role. Case presentation: A 13-year-old immigrated and adopted boy previously underwent an operation for renal joint syndrome and was affected by recurrent episodes of renal colic. The boy was admitted reporting acute left flank pain with scars on the mucous face of his prepuce and had a recent previous hospitalization for the same reason. Laboratory tests and radiological findings did not reveal any morphological or functional alterations. Self-induced FD was suspected, and a psychiatric consultation was performed. After psychiatric consultation and remission of the symptoms with a placebo, a diagnosis of Munchausen syndrome was suspected. The patient’s uncle was not initially convinced of the diagnosis. Some videos clearly showed that the boy was handling his prepuce to excrete stones, explaining the scars. A therapeutic plan with psychiatrist support was later accepted with a positive outcome. No further signs and symptoms of renal colic were reported. Conclusions: It is recommended that paediatricians include FD in the differential diagnosis of a persistent and unexplained medical condition. If suspicion arises, confirmation and long-term therapy by a group of qualified specialists, including psychiatrists, should be planned.

Pitfalls in the Recognition and Diagnosis of Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MSBP) is a type of child abuse in which the perpetrator intentionally causes illness in an offspring. It remains a challenge to determine the actual medical course in MSBP. Here, we report two cases of MSBP. The pediatric patients were diagnosed with chronic organic diseases at other hospitals. Their symptoms persisted and were eventually referred to our hospital. The patients were not considered as MSBP at the time of admission. However, a series of evaluation by an interdisciplinary team led to the detection of the incompatibilities of the medical courses in the earlier period with the patients’ condition. The patients were diagnosed with MSBP. Careful evaluation of patient’s history is important in the diagnosis of MSBP

Munchausen syndrome presenting with recurrent abdominal pain and coagulation disorder

Munchausen syndrome is a serious psychiatric factitious disorder, or mental illness, wherein sufferers feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. In this attention-seeking syndrome associated with severe emotional difficulties, affected person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. The atypical manifestations of Munchausen syndrome represent a broad spectrum of clinical findings and features. It may be very difficult, labor intensive, expensive and time consuming to establish the accurate diagnosis. Herein, we report of a 28-year-old patient with coagulation disorder caused by self-inflicted warfarin use admitting repeatedly to many different hospitals with abdominal pain. Thorough psychiatric assessment and workup to shed light on the challenging clinical situation revealed the diagnosis of Munchausen syndrome for this patient.

Factitious torsion dystonia in rehabilitation: A singular new case and literature review

We report a case of a 29-year-old woman suffering from chronic factitious disorder (FD) with torsion dystonia. For nearly five years, she traveled widely over the country, going from one hospital to another, taking serious medical risk in order to prolong her illness. After several admissions to Rehabilitation Units and multiple explorations, we find convincing evidence for factitious origin and the diagnosis of Munchausen syndrome was evoked. Such a clinical presentation is infrequent in Munchausen's syndrome. Indeed, most often the clinical picture is characterized by acute abdominal pain, fainting, hemoptysis, precordialgia, hematemesis or dermatological lesions. Physicians should be aware of this rare and potentially critical form of FD. Awareness in identifying these patients may lead to prevent unnecessary medical and/or surgical interventions.

Munchausen syndrome in the emergency department mostly difficult, sometimes easy to diagnose: a case report and review of the literature

Munchausen syndrome is a rare psychiatric disorder in which patients inflict on themselves an illness or injury for the primary purpose of assuming the sick role. Because these patients can present with many different complaints and clinical symptoms, diagnosis is often made at a later stage of hospitalisation. In contrast we report a case of a 40-year old woman very easy to diagnose with Munchausen syndrome.This trained nurse presented at our emergency department (ED) complaining of abdominal pain. Interviewed by the medical trainee, she immediately confessed having put a knitting needle into her urethra four days earlier. She was not able to remove it anymore because it was beyond her reach. Abdominal X-ray confirmed the presence of the needle and a median laparotomy was performed to remove it. The diagnosis of Munchausen syndrome seemed immediately obvious in this case.

Savonarola at the Stake: The Rise and Fall of Roy Meadow

The aim of this paper is to describe the role of prominent paediatrician Professor Sir Roy Meadow in the controversy surrounding the diagnosis of Munchausen Syndrome by Proxy (MSBP) in mothers accused of murdering their children. The MSBP saga is a further chapter of an era of moral panic that started several decades ago with repressed memory therapy, satanic ritual abuse and multiple personalities. The fall of medieval sage Savonarola is an apt analogy for the fate of Roy Meadow. The history of medicine is rife with figures who become their own authority and rule by force of personality.

Clear otorrhea: a case of Munchausen syndrome in a pediatric patient

This paper reports a case of Munchausen syndrome in a pediatric patient. An 11-year-old girl presented with the complaint of clear fluid otorrhea. She underwent numerous investigations with deception of the physicians. The literature with respect to Munchausen syndrome in the pediatric patient is reviewed. Diagnosis of Munchausen syndrome is difficult especially during the initial assessment, although suspicion might be aroused by inconsistencies in the patient’s history and discrepancies between signs and symptoms.

Munchausen syndrome with foreign-body granuloma mimicking rheumatic diseases

A 37-year-old man was admitted to our hospital because of fever, polyarthralgia, and subcutaneous tumors. There was swelling of the bilateral wrists and ankles, and subcutaneous tumors over the bilateral elbow joints. Despite his complaints of multiple symptoms, clinical investigations failed to reveal any abnormality. Although laboratory parameters improved rapidly after steroid therapy, the symptoms remained unchanged, and there was an enormous discrepancy between the laboratory data and his symptoms. A biopsy specimen from one of the subcutaneous tumors revealed foreign-body granuloma associated with a foreign body fragment. Because the nursing staff later discovered that the patient had been carrying out self-injection, a diagnosis of Munchausen syndrome was made. Munchausen syndrome should be included in the differential diagnosis of rheumatic diseases.

A case of intractable recurrent corneal erosion caused by Munchausen syndrome

Object: We report a case of intractable recurrent corneal erosion that was unresponsive to any medication, but was cured by psychiatric care after diagnosis of Munchausen syndrome. Case: The patient, a 35-year-old female who developed pain in her left eye in July, 20 XX, was diagnosed with epidemic keratoconjunctivitis at the hospital where she worked as a nurse. Despite medication, the eye condition gradually worsened. After undergoing examination at many medical institutions, she came to our hospital on October 6, 20 XX. Her left eye manifested superficial punctate keratitis, then exhibited recurring corneal erosion. The eye condition was intractable, total corneal epithelial defect ultimately occurring on December 30. Subsequently, a bottle of hydrochloric acid oxybuprocaine eye drops was found under her pillow. We therefore suspected that the corneal erosion was due to self-inflicted injury. She consulted a psychiatrist, and was diagnosed with Munchausen syndrome. After about 2 months of therapy in which she was prevented from touching the eye (eye patch etc.), her eye condition improved. Conclusion: This case was not diagnosed as Munchausen syndrome for 5 months. In cases of intractable corneal erosion, the possibility of self-inflicted injury should be considered. Nippon Ganka Gakkai Zasshi

Ethical issues in the use of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: the Atlanta study--an ethical challenge for medicine.

Ethical issues in the use of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: the Atlanta study--an ethical challenge for medicine.

Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases

In 1993, Children's Healthcare of Atlanta at Scottish Rite (formery Scottish Rite Children's Medical Center, Atlanta, GA) added facilities to perform inpatient covert video surveillance (CVS) of suspected cases of Munchausen syndrome by proxy (MSBP). Forty-one patients were monitored from 1993 to 1997. This study was performed to review our experience with these cases. How useful was video surveillance in making the diagnosis? What were the characteristics of families with children who were victims of MSBP? Medical, social work, security, and administrative records of all children who underwent covert video monitoring at Children's Healthcare of Atlanta at Scottish Rite from 1993 through 1997 were reviewed retrospectively by a team of physicians, risk managers, and social workers. A diagnosis of MSBP was made in 23 of 41 patients monitored. CVS was required to make the diagnosis in 13 (56.1%) of these 23, and supportive of the diagnosis in 5 (21.7%) cases. In 4 patients, this surveillance was instrumental in establishing innocence of the parents. MSBP was more common in Caucasian patients than in other ethnic groups seen at our hospital. Fifty-five percent of mothers gave a history of health care work or study, and another 25% had previously worked in day care. Although many of caretakers fit the profile of MSBP, such as excessive familiarity with medical staff, eagerness for invasive medical testing, and history of health care work, these characteristics were not sensitive indicators of MSBP in our study. Even when present, they were not sufficiently compelling to make the diagnosis. CVS is required to make a definitive and timely diagnosis in most cases of MSBP. Without this medical diagnostic tool, many cases will go undetected, placing children at risk. All tertiary care children's hospitals should develop facilities to perform CVS in suspected cases.

Lithiase urinaire et syndrome de Münchhausen

Unlike the so-called Munchausen syndrome by proxy, which is a form of child abuse, Munchausen syndrome is seldom reported in pediatric literature. Anthony, an 8.5-year-old child, was referred because he passed several urinary stones. Although biological findings and urinary tract ultrasonography were normal, intravenous pyelogram showed a round area of decreased density in front of the anterior urethra, which disappeared from postmicturation X-ray. For a 1 month period, the child passed 20 stones without intense pain. After undergoing an appendectomy, he was readmitted for left lumbar pain which disappeared after passage of a stone. He spent the following 10 months without any complaint. On later re-admission with similar symptoms, Munchausen syndrome was suspected because of the discrepancy arising from the emission of stones on one hand and the absence of nephritic colic, of hematuria and of urinary tract dilatation on the other hand. Diagnosis of Munchausen syndrome was confirmed by chemical analysis which reported that samples were in fact ordinary pebbles and by child's confession, during interrogation without his parents, to having introduced the pebbles into his urinary tracts. When unusual clinical features are present in children, it is necessary to evoke the Munchausen syndrome which can be likened to a distress signal revealing the presence of psychological disorders.

Urinary obstruction caused by factitious urethral stones: An amazing manifestation of Munchausen syndrome by proxy

The diagnosis of Munchausen syndrome by proxy is frequently difficult to document and often delayed. A unique presentation of a case of Munchausen syndrome by proxy involving insertion of factitious stones in the lower urinary tract is reported.

Social Work's Role with Patients with Munchausen Syndrome

Social Work's Role with Patients with Munchausen Syndrome Get access Katharine Moore Katharine Moore Katherine Moore, MSSA, ACSW, LCSW, is retired director, Department of Social Services, Beverly Hospital Claremont, CA 91711. Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Work, Volume 40, Issue 6, November 1995, Pages 823–825, https://doi.org/10.1093/sw/40.6.823 Published: 01 November 1995 Article history Accepted: 25 January 1995 Published: 01 November 1995

Practical concerns about the diagnosis of Munchausen syndrome by proxy.

Practical concerns about the diagnosis of Munchausen syndrome by proxy.

Munchausen syndrome by proxy: an experience from Nigeria

We report here on a child who over a period of 8 years was admitted several times to hospitals in different states of Nigeria based on fictitious illnesses described by his mother. The child had various unnecessary, expensive and invasive investigations followed by treatment with harmful drugs. The evolution of this case of Munchausen syndrome by proxy is described in order to alert paediatricians in developing countries to a problem which is described frequently in more affluent societies. We believe this is the first such case to be recorded in West Africa.