ALEEM AND AJARIM (1995): Overutilisation

Question 1

when was the Aleem and Ajarim study conducted?

Answer 1

• 1995

Question 2

Aleem and Ajarim (aim)

Answer 2

• To present a case of the (attempted) diagnosis, and treatment
• Of a patient with Munchausen’s syndrome
• Within a hospital setting

Question 3

Describe the sample

Answer 3

• 22 y/o
• Saudi Arabian
• University Student
• Initially suspected for suffering from immune deficiency.
• Seen by dr’s at 17 for “amenorrhea” and was prescribed medication

Amenorrhea-missing one or more menstrual periods

Question 4

Case Details: Name all of the illnesses the patient supposedly had before doctors were suspicious.

Answer 4

1. Vein Thrombosis
2. Groin Swelling
3. Breast swelling/ Abcess
4. Breast Lumps

Question 5

Describe the patients ailmemts:
1. Vein thrombosis
2. Groin swelling

Answer 5

1. Vein thrombosis: Over the following months, she developed recurring deep vein thrombosis.
   TREATMENT:Blood thinners.
2. Groin swelling: Began complaining of painful swellings in both sides of the groin, along with leg weaknesses.
   TREATMENT: Several investigative methods, surgery, medication change.

Vein thrombosis- Blood clots forming in veins

Question 6

Describe the patients ailements:
3. (Right) Breast swellings + Abcess begun developing

Answer 6

• (Right) BREAST SWELLING: Complained of painful swelling above her right breast/ with several similar swelling in her abdomen.

TREATMENT: 20 surgeries, hospitalisation + surgical drainage was requires as an abcess had developed

Question 7

Describe the patients aliments: 5. Breast lumps

Answer 7

• (4 days layer) A similar lump appeared in her left breast. TREATMENT: Surgically drained.
• Further tests had shown the lumps contained a range of organisims that couldn’t be explained which led to suspictions of Munchausen’s

Question 8

Treatment: How was the patient treated?

Answer 8

• Psychiatric consultation was made.
• The patient was: Very defensive, rationalising, stressed (during the consulation)
• TREATMENT: Suggested the patient should undergo (long-term) psychotherapy.

Question 9

Results

Answer 9

• A nurse found needles + syinges filled with faecal matter under the patients bed (after being tipped of by another patient who shared a room with her)
• When the patient found out she became very angry and left the hospital against medical advice (and was lost to follow up)