Munchausen by internet and false perinatal crises.

BACKGROUND: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. METHODS: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. RESULTS: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. CONCLUSIONS: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI.

Munchausen Syndrome.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.

The Incidence of Diagnosis of Munchausen Syndrome, Other Factitious Disorders, and Malingering.

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.

[Are artificial disorders common in palliative care? A Case report]. / Sind artifizielle Störungen im palliativen Kontext häufig? Ein Fallbericht.

The main task of palliative care specialists is to focus on symptom control such as pain, nausea or fatigue. Thorough anamnesis, physical examination, laboratory examination, and differential diagnosis can ensure appropriate treatment. In an increasing number of cases psychiatric conditions like depression or anxiety increase also occur so palliative care physicians need to be more prepared to handle them. The question of this case report is, how a palliative care specialist can distinguish between a malignant disease or neurological disease progression and a presentation primarily psychiatric in etiology, as is the case in factitious disorders. We are also interested in the incidence rate of such factitious disorders. Our case study demonstrates that it is rare but not impossible that a doctor will encounter factitious symptoms in the palliative setting. This suggest being aware of evidence of psychiatric origins even in discharge letters and referrals that indicate palliative care needs, to ensure that palliative care really is the best treatment option for the patient. We do believe such cases to be rare in a palliative setting, however.

Factitious disorders and Munchausen syndrome: the tip of the iceberg.

This population-based study evaluates the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy in a clinical setting. All children referred to the Pediatric Unit of the Department of Pediatrics of the Catholic University Medical School (Agostino Gemelli Hospital) in Rome were recruited between November 2007 and March 2010. An experienced interdisciplinary team of medical professionals analyzed all suspected cases. A total of 751 patients were hospitalized. Factitious disorders were diagnosed in 14/751 patients, resulting in a prevalence of 1.8%. Three of 14 (21.4%) patients fulfilled the criteria for Münchausen syndrome. Münchausen syndrome by proxy was identified in four of 751 patients, resulting in a prevalence of 0.53%. The perpetrator was the mother in three of four of these cases. The epidemiological data obtained in this population-based study indicate that the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy is higher than previously observed. Moreover, early detection was possible thanks to the awareness of an expert interdisciplinary team. We suggest that physicians must consider the possibility of these diagnoses whenever there are discrepancies in a child's illness presentation.

Stockholm syndrome manifestation of Munchausen: an eye-catching misnomer.

A young woman hospitalized herself for a picture resembling Stockholm syndrome (becoming a willing captive in a cult, sympathetic to the leader). After a short period of time, it became clear that she had used a false identity and had invented the story, leading to diagnoses of both Munchausen syndrome and dissociative identity disorder. Despite a long period of treatment, she eventually suicided. The authors examine the coexistence of these two unusual disorders and their possible shared etiologies in this complex case.

Munchausen's syndrome--more common than we realize?

Munchausen's syndrome is a condition whereby a patient deliberately simulates symptoms of an illness in order to gain admission to hospital and gain the sick role. It is an uncommon condition and is possibly underdiagnosed. This case-series examines the cases of three patients with Munchausen's syndrome who presented to a Dublin hospital within a four-month period. Two of the presentations involved the feigning of psychiatric symptoms. It is important that clinicians not only in psychiatry, but in all medical specialities have an awareness of this disorder, so that unnecessary procedures and treatments may be avoided.

Factitious disorders in neurology: an analysis of reported cases.

BACKGROUND: Factitious disorder (FD) is the deliberate production or simulation of symptoms in order to adopt the sick role. OBJECTIVE: The authors look at FD in the neurology setting. METHOD: The authors examined documented, published cases. RESULTS: FD cases in neurology are strikingly different from those in other specialties in terms of their demographics. Whereas the paradigm of FD in medicine as a whole is of the socially stable female healthcare worker, neurology continues to report largely the classic itinerant "Munchausen's" type. DISCUSSION: The authors explore two possible explanations for this: either that female healthcare workers with FD do not present neurologically, or that, if they do, they are diagnosed with conversion disorder.

Factitious disorder in children and adolescents: a retrospective study.

BACKGROUND: Factitious disorder (FD) presumably manifests at an early age, but epidemiological and clinical data about pediatric FD are still lacking. OBJECTIVE: The authors sought to study prevalence data of FD among referrals to a child-and-adolescent consultation-liaison service (CLS). METHOD: Authors conducted a retrospective survey of FD on 1,684 patients who were referred to the CLS from 1992 to 2003 (Sample I) and 12,081 patients who were treated in a tertiary-care child health center from 2003 to 2005 (Sample II). RESULTS: In Sample I, FD occurred in 0.7% and, in Sample II, in 0.03% of the cases. CONCLUSION: The prevalence of pediatric FD among referrals to a CLS is similar to those found in studies of adults, and patients share many clinical characteristics.

Síndrome de munchausen en la infancia y la adolescencia: de la hiperfrecuentación de consultas al maltrato / Munchausen syndrome in childhood and adolescence: from very frequent visits to the doctor´s office to maltreatment

Los autores exponen el concepto actualizado de síndrome de Munchausen por podres. Caracterizan de forma actualizada y detallada: 1. Formas clínicas del síndrome de Munchausen. 2. Factores de riesgo familiar (en ambas figuras parentales y en el niño). 3. Características evolutivas. 4. Funcionamiento del sistema sanitario: hiperfrecuentados de servicios sanitarios. 4. Bases para la intervención terapéutica: primera etapa en los servicios pediátricos de Atención Primaria y segunda etapa en los servicios de Salud Mental de la Infancia. Se destaca la importancia de las técnicas de interconsulta y enlace desde los Servicios de Pediatría y Psiquiatría Infantil para el tratamiento del síndrome de Munchausen por poderes (AU)

The authors present an approach to the Munchausen´s Syndrome by Proxy. Focusing on the clinical features including psychopathological and psychosocial profile. Authors consider also family risk factors- both the parenting and the children, developmental characteristics and Health Care Services delivery its relationship with the impact on the clients attendance. The therapeutic interventions was implemented in tow phases: the first phase Primary Care Paediatric setting, and the second phase in Child Psychiatry Services. Authors emphasize the relevance of the liaison-consultation between Paediatrician and Child Psychiatrist as a key procedure to approach Munchausen´s Syndrome by Proxy treatment (AU)

Síndrome de Munchausen por poderes / Munchausen Syndrome by proxy

El Síndrome de Munchausen por poderes (SMP) constituye una particular forma de maltrato infantil cuya gravedad radica en su elevada morbimortalidad, difícil diagnóstico y posterior manejo. En los últimos años se han producido modificaciones terminológicas para designar este raro trastorno, con frecuencia infradiagnosticado. Aportamos la experiencia de 6 casos de SMP diagnosticados en los últimos ocho años. En todos ellos el agente causal fue la madre, generalmente de bajo nivel socioeconómico, con desestructuración importante del núcleo familiar y hasta en el 50% de los casos con alteraciones en la personalidad. La edad media de la víctima fue de 8,4 años, habiendo transcurrido hasta el momento del diagnóstico un tiempo medio de 34 meses con más de 20 consultas médicas realizadas durante el mismo. Aunque no ha sido nuestro caso, está descrita una elevada probabilidad de presentar secuelas a largo plazo e incluso muerte. Proponemos el abordaje de toda sospecha de SMP por un Equipo Interdisciplinario. Entre las medidas a tomar por este equipo destaca el diseño de una puerta de entrada hospitalaria alternativa al servicio de Urgencias, decidir el momento de confrontación con la familia, medidas legales a tomar y elaboración de un plan de seguimiento-intervención

Munchausen Syndrome by proxy (MSP) is a particular form of child abuse whose seriousness results from its high rate of morbidity and mortality, difficult diagnosis and posterior management. In last years different terminological approaches have been made to designate it.. During the last eight years we have diagnosed 6 cases of MSP. In all of them the casual agent was the mother, presenting an important deterioration in her family and nearly 50% of cases with alterations in the personality. Victim´s medium age was 8,4 years, with a period of 34 months until the diagnosis was confirmed and more than 20 medical consultations during that time. Although it is not our experience, it has been reported a high rate of presenting long term consequences in child development, even death. We propose to establish an Interdisciplinary Team. Some points that must be dealt with by the team are to establish an alternative "entrance door" to the hospital other than that of the emergency services, decide the moment of confronting the family, taking legal measures and creating a long term intervention-monitoring plan

Factitious disorder on an inpatient psychiatry ward.

The authors present 6 cases of factitious disorder seen on a general adult inpatient psychiatry unit of a university hospital. They review the clinical features of this disorder and suggest that factitious disorder is much more prevalent among psychiatric inpatients than is commonly recognized. Strategies to assist in the diagnosis and management this disorder are detailed.

[Early onset Münchausen's syndrome]. / Síndrome de Münchausen de presentación precoz.

This study presents a clinical case description of a factitious disorder in a woman whose diagnosis was made during her childhood. The onset of the disorder took place at 12 years of age and the fundamental clinical characteristics are: limited frequency with which the diagnosis is made in this period of life as well as the multiple symptoms manifested by the patient, both abdominal as well as neurological and hemorrhaging ones. A careful analysis of the personality traits and biographic history of the patient was also performed. The characteristics of the factitious disorder in childhood, as well as the relationship of this syndrome with the personality disorders, are discussed.

[Munchausen syndrome: update]. / Le syndrome de Münchausen: mise au point.

Munchausen's syndrome has been described by Asher (1951) on the basis of 4 remaining permanent criteria, beyond its numerous expressive symptoms. The present work describes the usual process undergoing during their contacts with hospitals, collecting diagnosis criteria and differential diagnosis. Etiology hypothesis, possibilities of treatment, will be discussed both in a reflexive and preventive perspective, regarding the very high costs thus inferred, in terms of health (of the patients and the medical teams), and of financial and legal problems.

Cardiac Munchausen syndrome.

OBJECTIVE: To examine the reports on cardiac Munchausen syndrome for clinical characteristics. METHODS: Cases, case series, and related articles on the subject in all languages were identified through a comprehensive literature search. RESULTS: Fifty-eight cases of cardiac Munchausen syndrome were identified. Mean +/- SD patient age was 44 +/- 12 years (range, 23 to 71 years). Fifty-four patients (93%) were men. The most common presenting complaint was chest pain simulating acute coronary syndrome (86%). Syncope and dyspnea were also reported. Mostly, these patients were admitted directly from the emergency department to the coronary care unit. Acute myocardial infarction was the most common admitting diagnosis. The other admitting diagnoses were cardiac arrest and arrhythmia. The average number of hospital admissions for cardiac symptoms was 6 per patient (range, 1 to > 29 admissions). Numerous procedures including cardiac catheterization, coronary angiography, peripheral arteriography, permanent pacemaker placement, electrophysiological studies, intra-aortic balloon insertion, pulmonary artery catheter insertion, and electrical cardioversion have been performed in these patients. Twenty-four patients (41%) had history of undergoing prior multiple invasive procedures, but only 10 of these patients admitted having undergone these procedures. Ninety-five percent of patients altered their stories, with many leaving the hospital against medical advice when confronted with possibility of cardiac Munchausen syndrome as the correct unifying diagnosis. None of the patients reported for follow-up. CONCLUSION: Cardiac Munchausen syndrome results in unnecessary investigations and organ damage from unneeded aggressive procedures. There is scarce information available on the prognosis of these patients, especially in the long term.

Munchausen syndrome presenting in a patient who has undergone temporomandibular joint surgery.

Munchausen syndrome is a rare psychiatric disorder. Patients with Munchausen syndrome insist on and repeatedly undergo unnecessary investigations and operative treatments. No organic pathosis is demonstrated, and treatment consistently fails to alleviate the symptoms. This article presents a case report and a brief discussion to facilitate recognition and management techniques.