Flashcards in Munchausen Syndrome Deck (18)
Extreme example case of Munchausen pt?
pt comes in and presents with hx of:
- pt unhappy with childhood
- sexually abused and neglected
- at age 16 had her appendix out - finally happy
- admitted herself into more than 600 hospitals
- had over 42 unnecessary surgeries
3 types of munchausen syndromes?
- munchausen's syndrome by proxy (MSBP)
Definition of factitious disorder?
- a persons exaggerates or creates sxs of illnesses in themselves to gain investigation, tx, attention, sympathy, and comfort from medical personnel
Malingering vs factitious disorder?
- malingering: feigning illness has an external incentive (avoiding work, obtaining money)
- factitious disorder: has no other incentive than to be a pt and experience the sick role
Munchausen vs hypochodriacs?
- munchausen: pts know they are not sick
- hypochondriacs: believe they actually have the disease
Etiology of munchausen syndrome?
- theories suggest that a hx of abuse or neglect as a child, or a hx of frequent illness requring hospitalization
- 4:1 females
Sxs of munchausen sydrome?
- dramatic but inconsistent/discrepant medical hx
- unclear sxs that are not controllable and that become more severe or change once tx has begun
- predictable relapses following
- extensive knowledge of hospitals and/or medical terminology as well as textbook descriptions of illnesses
- mult. surgical scars
- new or additional sxs following negative test results
- presence of sxs only when the pt is alone or not being observed
Typical characteristics of munchausen's pts?
- dramatic, but inconsistnet medical hx
- unclear sxs that are not controllable and that become more severe once tx has begun
- predictable relapses following improvement in condition
- extensive knowledge of hospitals and or medical terminology
- presence of mult surgical scars
- appearance of new or additional sxs following negative test resuls
- presence of sxs only when pt is being observed by others
- willingness or eagerness to have medical tests, operatios, or other procedures
- hx of seeking tx at numerous hospitals
- reluctance by pt to meet with family or prior doctors
Examples of common illnesses that munchausen pts show up with?
- self induced infections: wounds, bacteremia, sepsis, fever
- surreptitious ingestion of meds, vitamins, minterals: diarrhea, vomiting, hypokalemia (laxatives, diuretics), renal failure
- self-induced injury: unhealed wounds, bruises, deformities, reflex sympathetic dystrophy
- phlebotomy (self or animal): anemia, melena, hematochezia, hematemesis, hematuria
- thermometer manipulation or substitution of thermometerL fever
- stimulation of clinical manifestations of specific diseases or syndromes - sometimes using falsified medical records or contamination of body fluids - cancer, AIDS, CF, pancreatitis
What is munchausen by proxy?
- this is medical child abuse
- fabricating or inducing illness in a child by parent or primary caregiver in order to get attention, that results in persistent medical eval
- the illness doesn't occur when the child and caregiver are separated
- elusive, potentially lethal and frequently misunderstood form of child abuse
Signs and sxs of MSBP?
- most common:
bleeding from various sites
central nervous system depression
Common presentation of MSBP of child and perpetrator?
- an illness that is unexpected, unusual, prolonged and is recalcitrant to tx
- problem only originates in presence of perpetrator and resolves when the child and perpetrator are separated
- the perp seems less concerned about the child's illness than the clinicians who are providing care
Characteristics of perp in MSBP?
- biological mother
- usually 20-30
- seem to be loving and caring when around medical staff
- all have some sort of marital conflict
- 50% with medical training in the past
- show little emotion when their child is in distress or pain
Common presentations of MSBP signs and sxs?
- GI bleed or UTI: put blood in stool or urine sample
- vomiting or reflux: admin. ipeacac or other drugs
- diarrhea: administering prunes or laxatives
- Apnea (may lead to SIDS) - suffocate child
- hypoglycemia: administer insulin or withold food
Dx munchausen syndrome by proxy?
- most impt step is recognition
- some of the more common presentations:
- A complete HX is a must!
Management of Munchausen syndrome by proxy?
- est the dx of munchausen by proxy reqrs multidisciplinary approach that includes the medical care team (physicians, nurses, social workers), hospital security, and hospital risk managemnt
- whenever possible, a multidisciplanry child protection team that includes a child abuse expertise should be consulted.
- hospitalization is typically necessary
- must first ensure safety of child and requires the involvement of law enforcement and children's protective and social services when suspected or confirmed
What is cybermunch?
- join support groups on internet and then falsify stories about themselves so that others will show sympathy towards them and talk to them about their misfortunes
- people make up ridiculous sob stories to get attention