Munchausen Syndrome

Question 1

Extreme example case of Munchausen pt?

Answer 1

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

Question 2

3 types of munchausen syndromes?

Answer 2

• munchausen’s
• munchausen’s syndrome by proxy (MSBP)
• cybermunch

Question 3

Definition of factitious disorder?

Answer 3

• a persons exaggerates or creates sxs of illnesses in themselves to gain investigation, tx, attention, sympathy, and comfort from medical personnel

Question 4

Malingering vs factitious disorder?

Answer 4

• 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

Question 5

Munchausen vs hypochodriacs?

Answer 5

• munchausen: pts know they are not sick

- hypochondriacs: believe they actually have the disease

Question 6

Etiology of munchausen syndrome?

Answer 6

• theories suggest that a hx of abuse or neglect as a child, or a hx of frequent illness requring hospitalization
• 4:1 females

Question 7

Sxs of munchausen sydrome?

Answer 7

• 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

Question 8

Typical characteristics of munchausen’s pts?

Answer 8

• 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

Question 9

Examples of common illnesses that munchausen pts show up with?

Answer 9

• 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

Question 10

What is munchausen by proxy?

Answer 10

• 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

Question 11

Signs and sxs of MSBP?

Answer 11

- most common:
bleeding from various sites
seizures
central nervous system depression
apnea

Question 12

Common presentation of MSBP of child and perpetrator?

Answer 12

• 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

Question 13

Characteristics of perp in MSBP?

Answer 13

• 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

Question 14

Common presentations of MSBP signs and sxs?

Answer 14

• 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

Question 15

Dx munchausen syndrome by proxy?

Answer 15

• most impt step is recognition
• some of the more common presentations:
  feign
  simulate
  exaggerate
  aggravate
  induce
• A complete HX is a must!

Question 16

Management of Munchausen syndrome by proxy?

Answer 16

• 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

Question 17

What is cybermunch?

Answer 17

• 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

Question 18

Why should munchausen syndrome be taken seriously?

Answer 18

• real disorder
• these pts have very high chance of serious health problems
• 70% chance of dying from this condition if lifelong sufferer
• need to be loyal and compassionate with these pts
• take the time and get a complete hx