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1.
Internist (Berl) ; 61(3): 321-325, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31996976

RESUMO

A 32-year-old woman with maple syrup urine disease presented with recurring episodes with hypoglycaemia and cerebral seizures. In most cases a connection to the inborn metabolic disorder is assumed, resulting in symptomatic treatment. Due to these treatments invasive procedures are required. This leads to prescriptions of multiple medications and medical aids. After 2 years of unexplained symptoms a routine examination led to the diagnosis of factitious disorder. The patient received the offer for psychiatric/psychotherapeutic treatment. Further prognosis remains uncertain.


Assuntos
Transtornos Autoinduzidos/diagnóstico , Hipoglicemia/etiologia , Doença da Urina de Xarope de Bordo/complicações , Convulsões/etiologia , Adulto , Transtornos Autoinduzidos/psicologia , Feminino , Humanos , Doença da Urina de Xarope de Bordo/psicologia , Prognóstico
2.
J Infus Nurs ; 43(1): 39-46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31876773

RESUMO

Factitious disorder, formerly known as Munchausen syndrome, is a type of mental illness in which patients fabricate symptoms to gain attention or sympathy. When considering a patient with factitious disorder as a candidate for infusion therapy, the clinician must be aware of the challenges associated with providing an invasive treatment to high-risk patients while promoting safety.


Assuntos
Enfermagem Cardiovascular , Cateterismo Periférico/instrumentação , Transtornos Autoinduzidos/diagnóstico , Administração Intravenosa , Adulto , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico
5.
J Wound Care ; 28(Sup6): S1-S92, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31169055

Assuntos
Ferimentos e Lesões/terapia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/patologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/patologia , Transtornos da Coagulação Sanguínea/terapia , Calciofilaxia/complicações , Calciofilaxia/diagnóstico , Calciofilaxia/patologia , Calciofilaxia/terapia , Eritema Endurado/complicações , Eritema Endurado/diagnóstico , Eritema Endurado/patologia , Eritema Endurado/terapia , Transtornos Autoinduzidos/complicações , Transtornos Autoinduzidos/diagnóstico , Transtornos Autoinduzidos/terapia , Hidradenite Supurativa/complicações , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/patologia , Hidradenite Supurativa/terapia , Humanos , Livedo Reticular/complicações , Livedo Reticular/diagnóstico , Livedo Reticular/patologia , Livedo Reticular/terapia , Equipe de Assistência ao Paciente , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/patologia , Poliarterite Nodosa/terapia , Púrpura de Schoenlein-Henoch/complicações , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/patologia , Púrpura de Schoenlein-Henoch/terapia , Pioderma Gangrenoso/complicações , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/patologia , Pioderma Gangrenoso/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/terapia , Vasculite/complicações , Vasculite/diagnóstico , Vasculite/patologia , Vasculite/terapia , Ferimentos e Lesões/diagnóstico
6.
Dermatol Online J ; 25(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31220899

RESUMO

Factitious disorder imposed on self is characterized by self-induction. Dermatitis artefacta, the cutaneous subtype of factitious disorder imposed on self, can have a variety of atypical presentations. A 36-year-old woman with an extensive past medical history presented with painful nodules on her abdomen, thighs, and arms. Histologic evaluation identified panniculitis with foreign body material seen under polarization. Chart review from previous hospital visits established a history of factitious disorder imposed on self and upon subsequent search of the hospital room, syringes with an unknown substance were found. Factitial panniculitis should be considered in cases with atypical lesions or locations that do not conform to the presentation of organic causes of panniculitis. Management should include a multidisciplinary approach that prioritizes patient safety and establishes a therapeutic patient-provider relationship.


Assuntos
Transtornos Autoinduzidos/diagnóstico , Corpos Estranhos/patologia , Paniculite/patologia , Pele/patologia , Adulto , Feminino , Humanos , Paniculite/diagnóstico
7.
Hautarzt ; 70(11): 883-887, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31175372

RESUMO

We present four clinicopathological correlated cases of young patients with cryothermic dermatitis artefacta. They were initially misdiagnosed as primary bullous dermatoses or fixed drug eruptions. Cryothermic dermatitis artefacta can imitate authentic dermatoses such as linear IgA bullous dermatosis, herpes virus infection, bullous pemphigoid or fixed drug eruption. It should be considered as differential diagnosis in uncommon cases of recurrent bullae in adolescent and young adult patients. We summarize helpful clinical and histopathological criteria for correct diagnosis and therewith causative treatment.


Assuntos
Vesícula/etiologia , Dermatite/diagnóstico , Dermatite/psicologia , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/psicologia , Vesícula/psicologia , Dermatite/etiologia , Diagnóstico Diferencial , Transtornos Autoinduzidos/diagnóstico , Humanos , Adulto Jovem
8.
BMJ Case Rep ; 12(5)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31076490

RESUMO

Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that is, weakness of both lower limbs and right upper limb. Diagnosis of FD was made after detailed clinical evaluation, review of past medical records that revealed extensive evaluation to rule out physical illness, and inability to find any associated stressful event or material gain associated with illness. Management was largely supportive and was based on psychotherapy. Identification of FD depends on a high index of suspicion by the physician and the presence of atypical and medically unexplainable signs/symptoms.


Assuntos
Transtornos Autoinduzidos/diagnóstico , Paralisia/psicologia , Psicoterapia , Transtornos Autoinduzidos/complicações , Transtornos Autoinduzidos/fisiopatologia , Transtornos Autoinduzidos/reabilitação , Humanos , Masculino , Paralisia/etiologia , Paralisia/reabilitação , Modalidades de Fisioterapia , Apoio Social , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Behav Neurol ; 2019: 3891809, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944662

RESUMO

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.


Assuntos
Erros de Diagnóstico/estatística & dados numéricos , Transtornos Autoinduzidos/epidemiologia , Simulação de Doença/epidemiologia , Síndrome de Munchausen/epidemiologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Transtornos Autoinduzidos/diagnóstico , Feminino , Humanos , Incidência , Masculino , Simulação de Doença/diagnóstico , Pessoa de Meia-Idade , Síndrome de Munchausen/diagnóstico , Adulto Jovem
11.
Australas Psychiatry ; 27(5): 456-461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31032624

RESUMO

OBJECTIVES: To explore the presence of dopamine dysregulation syndrome in non-Parkinson's disease patients receiving dopamine replacement therapy. METHODS: Electronic searches were conducted of Medline, Embase, PsycINFO and PreMedline to capture articles related to dopamine misuse or factitious disorder combined with the presence of dopamine replacement therapy or a non-Parkinson's disease population. In total, 430 articles were reviewed and studies that addressed dopamine dysregulation syndrome in non-Parkinson's disease patients were included. RESULTS: Nine case reports were identified. CONCLUSIONS: The pathophysiology underlying dopamine dysregulation syndrome has been thoroughly explored with numerous mechanisms posited. What remains unclear is whether dopamine dysregulation syndrome is a phenomenon specific to Parkinson's disease, as indicated in the proposed diagnostic criteria. A more useful predictor of susceptibility to dopamine dysregulation syndrome may be temperamental traits such as novelty seeking and impulsivity, which overlap with predisposing factors for an addiction disorder.


Assuntos
Comportamento Aditivo/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Dopaminérgicos/efeitos adversos , Dopamina/efeitos adversos , Uso Indevido de Medicamentos , Transtornos Autoinduzidos , Temperamento , Humanos
12.
Am J Med Sci ; 357(5): 411-420, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30879737

RESUMO

BACKGROUND: The objective of this study was to describe presentation, natural history, management and long-term outcomes of patients with psychogenic purpura (PP), also known as Gardner-Diamond Syndrome. METHODS: In this retrospective study, records of patients with a diagnosis of PP seen at Mayo Clinic, Rochester from 1976 to 2016 were reviewed. Available literature regarding PP was also comparatively reviewed. RESULTS: Seventy-six patients with a diagnosis of PP were identified and 54/76 (71%) experienced a prodromal sensation. The Condensed MCMDM-1 bleeding score, excluding cutaneous manifestations, was <3 in 91% of patients. Laboratory tests of primary and secondary hemostasis were normal. Fifty-four percent of patients had an underlying psychiatric diagnosis. Management approaches included psychological counseling and psychiatry evaluation in 44 patients. Pharmacologic treatment for 30 patients included psychotropic agents, antihistamines, hormonal medications and anti-inflammatory agents. At a median follow-up of 5years (range 1-34),13/28 (46.4%) experienced recurrent ecchymoses and 6 continued to seek hematology follow-up at Mayo Clinic, Rochester. Our data was similar to the aggregate data from case reports in the literature. CONCLUSIONS: For patients with unexplained recurrent ecchymosis a diagnosis of PP should be considered. Diagnosis is one of exclusion and initial evaluation should include documenting a bleeding score and obtaining laboratory tests assessing primary and secondary hemostasis. The relatively low bleeding scores together with laboratory assessments support that PP is primarily a dermal rather than a systemic bleeding diathesis. In our cohort, addressing psychological stressors was the most effective treatment; however pharmacologic therapy can be used for refractory disease.


Assuntos
Doenças Autoimunes/etiologia , Doenças Autoimunes/terapia , Transtornos Autoinduzidos/etiologia , Transtornos Autoinduzidos/terapia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/terapia , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/terapia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Estudos Retrospectivos , Adulto Jovem
14.
Medicine (Baltimore) ; 98(6): e14152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732130

RESUMO

RATIONALE: Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease. PATIENT CONCERNS: An 11-year-old female patient had a history of hemoptysis or hematemesis for 6 months and suffered with paroxysmal syncope for a month. DIAGNOSIS AND INTERVENTION: A series of examinations had been launched to evaluate any possible malformation or abnormalities of the patient including fiberoptic bronchoscopy, cardiac catheterization, gastroscopy, nasolaryngoscopy, electrocardiogram, electroencephalogram, and enhanced magnetic resonance image of the paranasal sinus. Several methods had been performed and tried to stop hemoptysis such as taking hemostatic medications, lavage of fiberoptic bronchoscopy, and embolism for abnormal bronchial arterial using cardiac catheter. All the interventions, however, failed to achieve our treatment goal. Given that more careful observation during hospitalization had been done, and we suspected the symptom of hemoptysis from this patient might be originated from an FD. OUTCOMES: Based on the diagnosis of FD, targeted psychological intervention was provided by experts. After the treatment completed, the patient did not present hemoptysis anymore. LESSONS: FD is an uncommon type of disease. This rare case described here is to help us to reconsider the long diagnosis process of hemoptysis with a series of examinations including some invasive procedures, whether all the examinations and interventions are necessary for a nonsevere hemoptysis patient.


Assuntos
Transtornos Autoinduzidos/complicações , Transtornos Autoinduzidos/diagnóstico , Hemoptise/etiologia , Criança , Diagnóstico Diferencial , Transtornos Autoinduzidos/terapia , Feminino , Humanos
16.
J Cutan Med Surg ; 23(3): 277-281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30654637

RESUMO

BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a separate entity. RESULTS: Eight patients were male and 5 patients were female. All patients reported pain and presented with crusts consisting of dried saliva and topical medications adherent to the surface of the lips. These patients expressed great concern with their condition, and reported several previous, ineffective treatments. Simple reassurance only was not effective; saline compresses alleviated symptoms for a few patients. Most patients were lost to follow-up. Biopsies were not performed on all patients. CONCLUSION: This particular type of cheilitis artefacta has been previously described, but some features described herein are new and allow a specific approach: patient's behavior, the "protrusion sign," and possible improvement with antidepressants. For these cases, we propose the term ointment pseudo-cheilitis because it comprises the nature of the attached material and the lack of true inflammation. Further psychiatric characterization is a logical next step in further characterizing this difficult-to-treat condition.


Assuntos
Queilite/classificação , Transtornos Autoinduzidos/classificação , Comportamento Autodestrutivo , Adolescente , Adulto , Brasil , Queilite/psicologia , Queilite/terapia , Transtornos Autoinduzidos/psicologia , Transtornos Autoinduzidos/terapia , Feminino , Humanos , Masculino
18.
Ann Dermatol Venereol ; 146(2): 135-140, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30361163

RESUMO

BACKGROUND: Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent. Herein we report on a case of pathomimicry in a context of hidradenitis suppurativa. PATIENTS AND METHODS: A teenage girl whose main previous medical history consisted of grade-2 obesity and an episode of pubic abscess was seen at our clinic for axillary lesions. She presented in a state of negligence, was suspicious and aggressive, and refused to undress. After gaining her trust, clinical examination revealed prominent ulcerations (each with a granulated base) at a distance from the folds in the axillary areas, as well as typical hidradenitis lesions of Hurley Grade 2 with purulent openings and rope-like scars from the inguinal folds. Hospitalization was recommended and a positive outcome was achieved under antibiotic therapy with doxycycline, topical alginate and hydrocellular dressings. A psychiatric evaluation concluded that the patient was presenting dysmorphophobic narcissistic weakness, probably in reaction to recurrent harassment at school since childhood. Once she developed trust with us, which was difficult to establish, the patient admitted to having caused the lesions herself. Given the history and clinical data, as well as the negative laboratory tests, a diagnosis of pathomimicry was made. DISCUSSION: Several cases of dermatological pathomimicry (sustainment by the patient of an ulcer with a known cause, contact with an allergen found in eczema, or renewed use of a medication implicated in toxiderma) or systemic disease (insulin injection in a diabetic patient) have been reported. To the best of our knowledge, this is the first description of pathomimicry associated with hidradenitis suppurativa. Regarding therapy, aftercare should be multidisciplinary. Confessions should not be forced and confrontations, which risk serious psychiatric collapse, should be avoided. A reassuring attitude enables psychiatry to be applied once trust has been sustainably established, hence the crucial role of the dermatologist.


Assuntos
Transtornos Autoinduzidos/psicologia , Hidradenite Supurativa/psicologia , Comportamento Autodestrutivo/psicologia , Adolescente , Antibacterianos/uso terapêutico , Axila , Bullying/psicologia , Transtornos Autoinduzidos/patologia , Feminino , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/patologia , Humanos , Obesidade/psicologia , Úlcera Cutânea/patologia
19.
Int J Dermatol ; 58(7): 782-787, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30238440

RESUMO

Gardner-Diamond syndrome (GDS) is a rare psychodermatological condition characterized by the formation of spontaneous, painful skin lesions that develop into ecchymosis following episodes of severe physiological or psychological stress. The majority of GDS cases occur in young adult females, and although the etiology of this rare disorder is unknown, there appears to be a psychological component correlated with the coexistence of previous psychiatric diagnoses. Due to the rare nature of this disorder, there exist few guidelines for prompt clinical diagnosis and optimal treatment. Here, a systematic review was conducted to include 45 cases of patients with GDS to better understand clinical presentation as well as current treatment options. Ultimately, GDS is a diagnosis of exclusion after other coagulopathies and causes of purpura are ruled out. High clinical suspicion following laboratory and clinical exclusion of known physiological causes is necessary for diagnosis. Selective serotonin reuptake inhibitors (SSRIs) and corticosteroids are cost effective first line treatments for GDS with proven efficacy in symptomatic relief. GDS refractory to initial treatment may require regular psychotherapy and titrated SSRI dosages to achieve long-term success. This review of available case studies serves to comprehensively describe the clinical presentation and available treatment approaches to this rare psychodermatological disorder.


Assuntos
Doenças Autoimunes/terapia , Transtornos Autoinduzidos/terapia , Glucocorticoides/administração & dosagem , Psicoterapia , Transtornos Psicóticos/terapia , Doenças Raras/terapia , Inibidores de Captação de Serotonina/administração & dosagem , Dermatopatias Vasculares/terapia , Adolescente , Adulto , Idade de Início , Doenças Autoimunes/diagnóstico , Criança , Relação Dose-Resposta a Droga , Transtornos Autoinduzidos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Doenças Raras/diagnóstico , Fatores Sexuais , Dermatopatias Vasculares/diagnóstico , Adulto Jovem
20.
Behav Sci Law ; 37(1): 1-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30225846

RESUMO

Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Building on Rogers' central motivations for malingering, the current article provides four explanatory models for FPPs; three of these parallel malingering (pathogenic, criminological, and adaptational) but differ in their central features. In addition, the nurturance model stresses how patients with FPPs attempt to use their relationship with treating professionals to fulfill their unmet psychological needs. Relying on these models, practical guidelines are recommended for evaluating FPPs in a forensic context.


Assuntos
Diagnóstico Diferencial , Transtornos Autoinduzidos/psicologia , Psiquiatria Legal , Simulação de Doença/diagnóstico , Criminologia , Decepção , Humanos
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