[Factitious diseases in oncology]. / Les pathologies factices en oncologie.

Factitious diseases and pathomimias and particularly Munchausen's syndrome, due to their rarity, are poorly diagnosed by medical teams working in oncology. Consequences can be serious and result in unadapted surgery or non justified implementation of chemotherapy and radiotherapy regimens. These patients simulate diseases in order to attract medical attention. They might become belligerent and are likely to promptly discharge themselves from hospital if they do not get the desired attention or are unmasked. With two following case reports and literature review, we would like to alert clinicians about difficulties encountered in diagnosis and management of factitious disorders. When faced with this diagnosis, the patient will tend to deny reality and break contact with the medical team who exposed him. Medical peregrinating behavior surrounded by conflicts with medical team, past psychiatric illness, history of working in the medical and paramedical field and social isolation can guide the diagnosis. Somaticians and especially surgeons working in the oncologic field must remain vigilant about this diagnosis and collaborate with either the psycho-oncologic team or the consultation-liaison psychiatric team. Some recommendations for medical professionals how to cope with these patients will be suggested.

Historical and literary roots of Münchhausen syndromes: as intriguing as the syndromes themselves.

Hieronymus Carl Friedrich Freiherr von Münchhausen (1720-1797) was a famous eighteenth-century teller of extravagant stories. In 1785, Rudolph Erich Raspe anonymously published the first book-form edition of Münchhausen's Tales, and a German translation was made available by Gottfried August Bürger the following year. Since that time, these adventures remained a best seller, and the name of the Baron was twice referred to in psychiatric terminology: "Münchhausen syndrome" coined by Richard Asher in 1951 and "Münchhausen syndrome by proxy" coined by Roy Meadow in 1977. This chapter examines the legitimacy of these terms in the light of historical and literary records and analyzes the synonyms or clinical types as found in medical publications.

The origins of factitious disorder.

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable when applied to the potentially larger numbers involved in workers' compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor-patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder.

Investigating the Barons: narrative and nomenclature in Munchausen syndrome.

Recounting stories of the 18th-century Baron von Münchhausen, the unauthorized appropriation of his name into literature, and Richard Asher's subsequent medical use of the name Munchausen 150 years later, this article examines the narratives that are told about and through Munchausen syndrome that create meaning within medicine. By analyzing a half-century debate over the name of the illness, this article discusses how the medical literature invests meaning in names and how names create meaning through narrative with effects on the practice of medicine.

Baron Münchhausen and the syndrome which bears his name: history of an endearing personage and of a strange mental disorder.

Munchausen syndrome, a mental disorder, was named in 1951 by Richard Asher after Karl Friedrich Hieronymus, Baron Münchhausen (1720-1797), whose name had become proverbial as the narrator of false and ridiculously exaggerated exploits. The first edition of Münchhausen's tales appeared anonymously in 1785 (Baron Münchausen's narrative of his marvelous travels and campaigns in Russia), and was wrongly attributed to German poet Gottfried August Bürger who actually edited the first German version the following year. The real author, Rudolph Erich Raspe, never claimed his rights over the successive editions of this book. This paper reviews the extraordinary personality of Baron Münchhausen, and the circumstances which led Rudolph Erich Raspe, Gottfried August Bürger, and Richard Asher to pay homage to this very endearing personage.

Münchhausen: el Barón, el síndrome y su implicancia dermatológica / Münchhausen: the Baron, the syndrome and its dermatological implications

El síndrome de Munchausen conjuga manifestaciones multisistémicas, fingidas y autoprovocadas, en cuyo contexto la piel tiene participación preponderante como órgano de expresión de conflictos y emociones. Severas perturbaciones psicológicas, entre ellas la compulsión por mentir, labilidad de lazos afectivos, soledad y marginación son la base conductual de estos pacientes. Se hace una revisión de la evolución histórica del síndrome, sus características y el rol de las dermatitis artefactas en su presentación clínica, con punto de partida en la vida aventurera de su inspirador, el Barón Karl von Müschhausen. Asimismo se sugiere un tratamiento interdisciplinario, basado en el trabajo conjunto de dermatólogos y psiquiatras, para mejorar el pronóstico generalmente pobre y en ocasiones incierto de los afectados por esta condición

M³nchhausen: el Barón, el síndrome y su implicancia dermatológica / M³nchhausen: the Baron, the syndrome and its dermatological implications

El síndrome de Munchausen conjuga manifestaciones multisistémicas, fingidas y autoprovocadas, en cuyo contexto la piel tiene participación preponderante como órgano de expresión de conflictos y emociones. Severas perturbaciones psicológicas, entre ellas la compulsión por mentir, labilidad de lazos afectivos, soledad y marginación son la base conductual de estos pacientes. Se hace una revisión de la evolución histórica del síndrome, sus características y el rol de las dermatitis artefactas en su presentación clínica, con punto de partida en la vida aventurera de su inspirador, el Barón Karl von M³schhausen. Asimismo se sugiere un tratamiento interdisciplinario, basado en el trabajo conjunto de dermatólogos y psiquiatras, para mejorar el pronóstico generalmente pobre y en ocasiones incierto de los afectados por esta condición (AU)

The college suspended.

A satirical account of the raising of the Royal College of Physicians and its suspension from a balloon for three months is included among Baron Munchausen's later surprising adventures. Portrayals by artists of this flight of fancy involving the College are not widely known. Three pictorial representations of the raising of the College are shown and some of the historical context of the tall tale is given.