Munchausen's syndrome

Question 1

Munchausen’s

3 types?

Answer 1

Munchausen’s Syndrome

Munchausen’s Syndrome by Proxy (MSBP)

Munchausen’s Syndrome by Internet (CyberMunch)

Question 2

Munchausen’s definition?

Answer 2

Factitious disorder
-A person exaggerates or creates symptoms of illnesses in themselves to gain investigation, treatment, attention, sympathy, and comfort from medical personnel.

Question 3

Describe the difference in Malingering vs Factitious Disorder?

Answer 3

Malingering
-Feigning illness has an external incentive (avoiding work, obtaining money)

Factitious disorder
-Has no other incentive than to be a patient and experience the sick role

Question 4

Describe the difference in Münchausen vs. Hypochodriasis?

Answer 4

Münchausen
-Patients know they are not sick

Hypochodriacs
-Believe they actually have the disease

Question 5

Münchausen

1. Theories on etiology?
2. More common in what gender?

Answer 5

1. Theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses requiring hospitalization
2. Women 4:1

Question 6

Münchausen
Symptoms?
7

Answer 6

1. Dramatic but inconsistent/discrepant medical history
2. Unclear symptoms that are not controllable and that become more severe or change once treatment has begun
3. Predictable relapses following
4. Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses
5. Multiple surgical scars
6. New or additional symptoms following negative test results
7. Presence of symptoms only when the patient is alone or not being observed

Question 7

Common presentation
of Münchausen?
3

Answer 7

1. an illness that is unexplained, unusual, prolonged, and is recalcitrant to treatment
2. the problem only originates in the presence of the perpetrator and resolves when the child and perpetrator are separated
3. the perpetrator seems less concerned about the child’s illness than the clinicians who are providing care.

Question 8

Münchausen
Signs and symptoms
The most common presentations:
4

Answer 8

1. Bleeding from various sites
2. Seizures
3. Central nervous system depression
4. Apnea

Question 9

Typical characteristics of Munchausen’s Patients

10

Answer 9

1. Dramatic, but inconsistent medical history
2. Unclear symptoms that are not controllable and that become more severe once treatment has begun
3. Predictable relapses following improvement in condition
4. Extensive knowledge of hospitals and/or medical terminology
5. Presence of multiple surgical scars
6. Appearance of new or additional symptoms following negative test results
7. Presence of symptoms only when the patient is being observed by others
8. Willingness or eagerness to have medical tests, operations or other procedures
9. History of seeking treatment at numerous hospitals
10. Reluctance by the patient to meet with family or prior doctors

Question 10

Examples of signs and symtpoms:
1. Self-induced infections?

2. Surreptitious ingestion of medicines, vitamins, minerals?
3. Self-induced injury?
4. Phlebotomy (self or animal)?

• Thermometer manipulation or substitution of thermometer?
• Simulation of the clinical manifestations of specific diseases or syndromes (sometimes using falsified medical records or contamination of body fluids)?

Answer 10

1. wounds, abscesses, bacteremia, sepsis, fever
2. diarrhea, vomiting, hypokalemia (laxatives and/or diuretics), renal failure, hypomagnesemia, salt poisoning, Bartter’s syndrome, hypoglycemia, pheochromocytoma (epinephrine injection), hyperthyroidism, bleeding or purpura from coagulation disorder (dicumarol, heparin), bone marrow depression, liver disease (vitamin A toxicity)
3. unhealed wounds, bruises, deformities, dermatoses (may also be induced by ingestion of certain drugs), reflex sympathetic dystrophy
4. anemia, melena, hematochezia, hematemesis, hematuria
5. fever
6. cancer, AIDS, cystic fibrosis, pancreatitis, insanity, depression, multiple sclerosis, seizures, pain syndromes, renal stones, proteinuria

Question 11

Münchausen by Proxy

(medical child abuse) is what?

Answer 11

Fabricating or inducing illness in a child by the parent or primary caregiver in order to get attention, that results in persistent medical evaluation.

Question 12

1. Münchausen by Proxy
   (medical child abuse) the illness does not occur when what?
2. What makes this type of abuse dangerous? 3

Answer 12

1. The illness does not occur when the child and the caregiver are separated.
2. • Elusive,
   • potentially lethal, and
   • frequently misunderstood form of child abuse

Question 13

Characteristics of Perpetrator

6

Answer 13

1. Biological mother
2. Usually 20-30
3. Seem to be loving and caring when around medical staff
4. ALL have some sort of marital conflict
5. 50% with medical training in past
6. Show little emotion when their child is in distress or pain

Question 14

Common presentations of MSBP

1. GI bleed or UTI?
2. Vomiting or reflux?
3. Diarrhea? 2
4. Apnea?
5. Hypoglycemia? 2

Answer 14

1. GI bleed or UTI
   - Put blood in stool or urine sample
2. Vomiting or reflux
   - Administering ipeacac or other drugs
3. Diarrhea
   - Administering prunes or
   - laxatives
4. Apnea (may lead to SIDS)
   - Suffocate child
5. Hypoglycemia
   - Administer insulin or
   - withhold food

Question 15

MSBP

What is the most important step in Dx?

Answer 15

The most important step is recognition

Question 16

MSBP
Some of the more common presentations on history and physical?
5

Answer 16

1. Feign
2. Simulate
3. Exaggerate
4. Aggravate
5. Induce

A COMPLETE HISTORY is a must!!!!

Question 17

What is typically necessary for MSBP treatment?

Answer 17

Hospitalization is typically necessary.

Question 18

What is CyberMunch?

Answer 18

Join support groups on the internet and then falsify stories about themselves so that others will show sympathy towards them and talk to them about their “misfortunes”

Question 19

~___% chance of dying from this condition if lifelong sufferer

Answer 19

70