Munchausen's Syndrome

1. Munchausen's Syndrome Kara White Dr. Boissonneault

2. Case Study • “A Great Pretender Now Faces the Truth of Illness” • Miss Scott age 50 • Unhappy with childhood • Sexually abused and neglected • At age 16 had her appendix taken out • 1st time in her life she was happy

3. Case study cont… • Admitted herself into more than 600 hospitals • Had over 42 unnecessary surgeries • Would leave one hospital in the AM and be admitted to another by the PM • Has spent last year and a half truly sick • Yet no one believed her due to her reputation • Finally a doctor did some tests and she needed immediate surgery • Miss Scott is now on her death bed

4. 3 Types • Munchausen's Syndrome • Munchausen's Syndrome by Proxy (MSBP) • Munchausen's Syndrome by Internet (CyberMunch)

5. Munchausen's Syndrome • “a condition characterized by habitual presentation for hospital treatment of an apparent acute physical illness, the patient giving plausible and dramatic history, all of which is false; it is a subtype of factitious disorder.” • Usually very knowledgeable about their “illness” • Very convincing • Most model physical disorders, even though the disease itself is a psychological one

6. Munchausen’s vs. Malingerers vs. Hypochondriacs • Malingerers seek medical attention to get themselves out of work, to collect drugs or even insurance • Munchausen's pt’s seek strictly for medical attention • Hypochondriacs think that they are sick • Munchausen's pt’s are fully aware that they are not sick

7. Types Of Patients • They research an ailment and then fake the symptoms through acting • Faked heart attack on a plane • They actually do physical harm to their body to try to mimic a certain ailment • Injected drain cleaner into bladder to make bloody urine • Or they may even alter lab tests • Traded tubes after blood was drawn

8. MSBP • “a form of child abuse in which a parent induces a real or apparent symptoms of a disease in child.” • Usually biological mothers (90%) • Either falsify their child’s medical history or HPI • Or they inflict harm to the child to mimic a disease state

9. Common presentations of MSBP • GI bleed or UTI • Put blood in stool or urine sample • Vomiting or reflux • Administering ipeacac or other drugs • Diarrhea • Administering prunes or laxatives • Apnea (may lead to SIDS) • Suffocate child • Hypoglycemia • Administer insulin or withhold food

10. Characteristics of Perpetrator • Biological mother • Usually 20-30 • Seem to be loving and caring when around medical staff • ALL have some sort of marital conflict • 50% with medical training in past • Show little emotion when their child is in distress or pain

11. CyberMunch • Join support groups on the internet and then falsify stories about themselves so that others will show sympathy towards them and talk to them about their “misfortunes” • Article entitled “Cybersickness” • Plane crash, molested and diagnosed with leukemia • One woman who talked to her commented “To discover that my love and nurturing has been misdirected is like being taunted with my own illness….its devastating.”

12. SO….. • The big question is….how are we, as PA’s, supposed to recognize and then treat these patients????

13. Typical characteristics of Munchausen's Patients • Dramatic, but inconsistent medical history • Unclear symptoms that are not controllable and that become more severe once treatment has begun • Predictable relapses following improvement in condition • Extensive knowledge of hospitals and/or medical terminology • Presence of multiple surgical scars

14. Characteristics cont… • Appearance of new or additional symptoms following negative test results • Presence of symptoms only when the patient is being observed by others • Willingness or eagerness to have medical tests, operations or other procedures • History of seeking treatment at numerous hospitals • Reluctance by the patient to meet with family or prior doctors

15. Etiology • Not known, considered not only a psychological disorder, but a biological one as well • Possible link to personality disorders??? • Perpetrator • 80% with psychological or mental illness • 80% were once victims themselves • 60% have attempted suicide • 70% history of physical and mental abuse

16. Diagnosis • The most important step is recognition • Some of the more common presentations • Feign • Simulate • Exaggerate • Aggravate • Induce • A COMPLETE HISTORY is a must!!!!

17. Treatment • No current treatment • Best method is to get the patient to realize what they are doing to themselves • Cognitive behavioral therapy has been used, however, most patients are unwilling to try this • Pharmacological therapy has been useful only when other co morbid conditions exist

18. Conclusion • This is a REAL disorder • These patients have a very high chance of serious health problems • ~ 70% chance of dying from this condition if lifelong sufferer • Need to be loyal and compassionate with these patients • Take the time and get a COMPLETE HISTORY!!!!

19. Questions???? References upon request.