munchausen

Munchausen’s syndrome

diagnosing, treating and my experience

Sharon Zheng MAU F1

what is Munchausen’s syndrome

the 'sick role'

a psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves.

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• 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

what causes munchausen'ssyndrome

SOME THEORIES SUGGEST THAT THEY MAY HAVE EXPERIENCED THE FOLLOWING...

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features

Borderline and antisocial traits

SYMPTOMS OR BEHAVIOURS ONLY PRESENT WHEN THE PATIENT IS BEING OBSERVED

PEREGRINATION

evidence of self induced physical signs

knowledge/experience in the medical field

multiple hospitalisations

SUBSTANCE MISUSE, ESPECIALLY OF PRESCRIBED ANALGESICS AND SEDATIVES

Vague and inconsistent histories

unusual or dramartic presentations

ACCEPTANCE, WITH EQUANIMITY , OF DISCOMFORT AND RISKS OF DIAGNOSTIC PROCEDURES, TREATMENTS AND OPERATIONS

FLUCTUATING CLINICAL COURSE, INCLUDING RAPID DEVELOPMENT OF COMPLICATIONS OR NEW PATHOLOGY IF INITIAL WORKUP FINDINGS PROVE NEGATIVE

RELUCTANCE BY THE PATIENT TO ALLOW HEALTHCARE PROFESSIONAL TO MEET FAMILY/PRIOR HEALTHCARE PROVIDERS

diagnosing munchausen's syndrome

can be difficult...

There's clear evidence of fabricating or inducing symptoms

The person's prime motivation is to be seen as sick

There's no other likely reason or explanation for their behaviour

consensus of multiple consultants

why is it important to diagnose/treat munchausen's syndrome?

Missing a diagnosis of severe factitious disorder can lead to inappropriate management and potential death

What to look for

- 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?

treating munchausen's syndrome

can be difficult...

gentle non-confrontational approach?

supportive confrontation

minimise medical contact

referral to psychiatrists

References

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.

THANK YOU!