Created on May 9, 2023
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diagnosing, treating and my experience
Sharon Zheng MAU F1
a psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves.
the 'sick role'
what is Munchausen’s syndrome
- illness, abuse, deprivation in childhood
- Identifying with a close friend or relative who has had a serious illness
- Reliving an earlier serious illness over and over again due to difficulty understanding or coping with the experience
- very low/ inflated self image
- Presence of personality disorder, depression, or substance abuse
SOME THEORIES SUGGEST THAT THEY MAY HAVE EXPERIENCED THE FOLLOWING...
what causes munchausen'ssyndrome
ACCEPTANCE, WITH EQUANIMITY , OF DISCOMFORT AND RISKS OF DIAGNOSTIC PROCEDURES, TREATMENTS AND OPERATIONS
SYMPTOMS OR BEHAVIOURS ONLY PRESENT WHEN THE PATIENT IS BEING OBSERVED
RELUCTANCE BY THE PATIENT TO ALLOW HEALTHCARE PROFESSIONAL TO MEET FAMILY/PRIOR HEALTHCARE PROVIDERS
SUBSTANCE MISUSE, ESPECIALLY OF PRESCRIBED ANALGESICS AND SEDATIVES
FLUCTUATING CLINICAL COURSE, INCLUDING RAPID DEVELOPMENT OF COMPLICATIONS OR NEW PATHOLOGY IF INITIAL WORKUP FINDINGS PROVE NEGATIVE
Vague and inconsistent histories
knowledge/experience in the medical field
unusual or dramartic presentations
evidence of self induced physical signs
Borderline and antisocial traits
consensus of multiple consultants
The person's prime motivation is to be seen as sick
There's no other likely reason or explanation for their behaviour
There's clear evidence of fabricating or inducing symptoms
diagnosing munchausen's syndrome
can be difficult...
Missing a diagnosis of severe factitious disorder can lead to inappropriate management and potential death
why is it important to diagnose/treat munchausen's syndrome?
- scrutinise patient's notes before interview- read all GP notes- Look fro inconsistencies-look for evidence of pathological lying- speak to informants -exaggerating to convince or deceive-is litigation and disability payment involved?
What to look for
minimise medical contact
referral to psychiatrists
gentle non-confrontational approach?
treating munchausen's syndrome
can be difficult...
1. Asher R. Munchausen's syndrome. Lancet. 1951;1(6650):339–341.2. Meadow R. ABC of child abuse. Munchausen syndrome by proxy. BMJ. 1989;299(6693):248–250. Review. 3. World Health Organization (WHO) The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: WHO; 1993. 4. Ben-Chetrit E, Melmed RN. Recurrent hypoglycaemia in multiple myeloma: a case of Munchausen syndrome by proxy in an elderly patient. J Intern Med. 1998;244(2):175–178. Review. 5. American Psychiatric Association (APA) In: Manual diagnóstico e estatístico e transtornos mentais DMS-5. 5a ed. Nascimento Maria lnês Corrêa, Machado Paulo Henrique, Garcez Regina Machado, Pizzato Rêgis, Rosa Sandra Maria Mallmann da., translators. Porto Alegre: Artmed; 2013. pp. 325–327. Transtorno factício. 6. Yonge O, Haase M. Munchausen syndrome and Munchausen syndrome by proxy in a student nurse. Nurse Educ. 2004;29(4):166–169.