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Hospital Addiction Syndrome

Munchausen Syndrome

Münchausen syndrome is a psychiatric factitious disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness in order to receive medical care.


Presentation

In patients with this syndrome, presentations vary. However common presentations include the following [7]:

  • Laparotimophilia migrans (desire for a laparotomy)
  • Hemorrhagica histrionica (excessive bleeding)
  • Neurologica diabolical (curious fits)
  • Cardiopathia fantastica (false heart attacks)
  • Consumption of drugs to present side effects (betablockers to bring about bradycardia etc.)
  • Inability of wounds to heal as a result of interference or contamination
  • Gastrointestinal disorders, with diarrhoea and vomiting being the major ones
  • Self-mutilation
  • Malnutrition and anemia
  • Skin discoloration as a result of coloured dye usage
  • Extensive history of unexplained illness with several changes of medical personnel
  • Showing of above average knowledge or a disease or inability to give off details of their illnesses
  • Inconsistencies in medical history
  • Hostility and excessive drama
  • Exaggerated answers to questions
  • Multiple operative scarring
  • Inability to show physical signs common with a condition they are supposedly suffering from

In almost all of these patients, a common occurrence is going on the internet to gather information about a disorder in a bid to mislead the medical personnel. This further increases difficulty in diagnosis.

Noncompliance
  • […] parent's motivation is not important. 5, 12 Although the original description referred to harmful medical care, subsequent authors have extended the appellation “Munchausen syndrome by proxy” to cases in which the only harm arose from medical neglect or noncompliance[doi.org]
  • Education as to risks of noncompliance with treatment recommendations is also important, ethically and legally, because the patient may wish to sign out of the hospital against medical advice.[emedicine.medscape.com]
Cushingoid
  • Factitious Cushing's syndrome Steroid administration to purposefully induce a Cushingoid state has been described; however, the abnormality in the blood results will depend on the glucocorticoid taken and its cross-reactivity within the cortisol assay[doi.org]
Pathologist
  • Byard and Wayne Boardman , The potential role of forensic pathologists in veterinary forensic medicine , Forensic Science, Medicine, and Pathology , 7 , 3 , (231) , (2011) . Frank R. Ascione, Marie S.[doi.org]
Recurrent Vomiting
  • RESULTS: Case #1 was diagnosed at the age of seven months with failure to thrive, severe recurrent vomiting, and recurrent unexplained fever. Medical tests performed were normal.[ncbi.nlm.nih.gov]
  • Gastrointestinal Recurrent Vomiting Case #1 was diagnosed at the age of seven months with failure to thrive, severe recurrent vomiting , and recurrent unexplained fever. Medical tests performed were normal.[symptoma.com]
Nipple Discharge
  • Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother.[ncbi.nlm.nih.gov]
  • [ncbi.nlm.nih.gov] Breast Bloody Nipple Discharge Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge , all of which are[symptoma.com]
Bloody Nipple Discharge
  • Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother.[ncbi.nlm.nih.gov]
  • [ncbi.nlm.nih.gov] Breast Bloody Nipple Discharge Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge , all of which are[symptoma.com]
Denial
  • In majority of cases, confrontation of the patients leads to denials of manufacturing a disease.[symptoma.com]
  • Matthew, aged 50 I was a leader in my industry but I was in denial about the fact my life was unmanageable due to alcohol.[kusnachtpractice.com]
  • […] characteristics: They are able to assume responsibility for their behavior They can improve their coping skills They can place their child’s needs above their own Patients with a poor prognosis may exhibit the following signs: They demonstrate a high degree of denial[emedicine.com]
Self Mutilation
  • [ncbi.nlm.nih.gov] psychiatrical Self Mutilation Inability of wounds to heal as a result of interference or contamination Gastrointestinal disorders, with diarrhoea and vomiting being the major ones Self - mutilation Malnutrition and anemia Skin discoloration[symptoma.com]
  • Google Scholar Kapfhammer, HP, Rothenhäusler, HB, Dietrich, E ( 1998 ) Artifactual disorders—between deception and self-mutilation: Experiences in consultation psychiatry at a university clinic [in German]. Der Nervenarzt 69(5): 401 – 409.[dx.doi.org]
  • Self-mutilation causing extensive scarring or loss of body parts, such as fingers. Malnutrition and anaemia.[patient.info]
  • Self-mutilation and suicide attempts are common in these individuals. The prognosis for Munchausen's syndrome is also poor; the statistics for recurrent episodes and successful suicides range between 30% and 70%.[minddisorders.com]
Delusion
  • Addiction Psychological dependence Hallucinations Delusions [reboundbehavioralhealth.com] Denial In majority of cases, confrontation of the patients leads to denials of manufacturing a disease.[symptoma.com]
  • Vomiting Excessive sweating Collapsing Cognitive symptoms: Hallucinations Poor concentration Lack of good judgment Experiencing breaks from reality Paranoia Psychosis Psychological symptoms : Anxiety Aggression and hostility Feelings of restlessness Delusions[harboroaks.com]
  • Potentially harmful medical care can range from a diagnostic search that subtly encourages and enables a caregiver's delusion through a full spectrum of invasive tests and medical or even surgical interventions.[doi.org]
  • Jaundice Coma Death Cognitive symptoms: Confusion Poor judgment Decreased ability to pay attention Short-term memory loss Psychosocial symptoms: Depression Anxiety Irritability Elation Relaxation Anger Addiction Psychological dependence Hallucinations Delusions[reboundbehavioralhealth.com]
Social Isolation
  • Most patients with factitious disorder have histories of abuse, trauma, family dysfunction, social isolation, early chronic medical illness, or professional experience in healthcare (training in nursing, health aid work, etc.).[my.clevelandclinic.org]
  • They may feel ashamed of their addiction, guilty for their babies’ diagnosis, and socially isolated and stigmatized. A strong support system is important for recovering addicts – and their young families.[700childrens.nationwidechildrens.org]
  • On the other hand, individuals are at an extremely high risk for depression due to the guilt, shame, relationship failure, social isolation, relational disruptions, substance abuse, and other devastating consequences that may come with the acknowledgement[castlecraig.co.uk]

Workup

The first step in diagnosis is to keep in mind that even people with this disorder can have genuine underlying ailments they may not be aware of [8]. These must be ruled out first before Munchausen syndromes are investigated.

When signs of the syndrome are suspected, investigation must be kept to a minimum. However, basic procedures for responding to the symptoms of the patient and their signs generally need to be followed. During diagnosis, care should be taken to avoid giving patients room to interfere with samples.

For instance, some of them may put blood in urine while others may interfere with charts. Also, some may ingest toxic substances or ingest themselves with toxic substances all in a bid to produce an abnormality.

Abnormal ECG

Treatment

Treatment requires collaborative effort of health care providers, social work, legal personnel and nursing [9]. The patient needs to be confronted gently with any suspicions in a supportive manner geared towards presenting the patient’s psychological distress as the main source of illness. Psychiatric treatments should also be offered to the patient.

In majority of cases, confrontation of the patients leads to denials of manufacturing a disease [10]. However, some of them will admit it. Many of them will get angry when confronted and will discharge themselves from a hospital in a bid to continue feigning illness elsewhere. This brings about the long history of changing medical personnel often seen during workup.

Prognosis

Due to the difficulty in tracking patients with Munchausen syndrome and the lack of follow-up studies, predicting prognosis is difficult [6].

Till date, no scientifically proven treatments have been brought forward.

Etiology

Due to the fact that majority of people with this condition refuse to cooperate with psychiatric treatment or physiological profiling, there is very little evidence available regarding the possible causes of Munchausen syndrome. However, following research and years of study, several factors have been identified as possible cause of the Munchausen syndrome. They include the following [3]:

  • Emotional trauma or illness during childhood (which usually led to regular medical attention at the time)
  • Personality disorder 
  • A vendetta against the authority or health professionals in a location. 

Epidemiology

The exact incidence of this condition is not known but it has been classified as rare [4]. Studies show that only 0.2%-1% of medical inpatients show factitious disorders but 9.3% of patients with fever of unknown etiology have the syndrome. Also, figures show that 40% of people with brittle diabetes intentionally manipulated their diets so as to make their condition unstable.

The condition is seen mostly in the male sex and there is racial predilection as most of the patients are white. The typical age bracket at which this condition is seen is between ages 30-50.

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of the syndrome remains unclear [5]. Studies have not pointed at any brain defect or dysfunction as the reason for the disorder even though neurocognitive deficits as well hyperperfusion of the right hemithalamus have been suggested in some isolated cases. There is no evidence to show confirmation of the suspicion in a larger sample of cases. EEG scans have also not been specific for this disorder.

Prevention

There is no proven way to prevent Munchausen syndrome.

Patient Information

Munchausen syndrome refers to a condition where an individual knowingly fakes, stimulates or induces an injury just to be treated like a patient.

There are no clear reasons why people do this. Some do it for the fun of it while others have an end target only known to them in mind.

The condition is seen mostly in adults and can only be treated when the patient is ready to listen to medical personnel and receive psychiatric therapy as well as general counselling. 

References

Article

  1. Asher R. Munchausen's Syndrome. Lancet. 1951;1:339-41.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013:324-6.
  3. Mountz JM, Parker PE, Liu HG, Bentley TW, Lill DW, Deutsch G. Tc-99m HMPAO brain SPECT scanning in Munchausen syndrome. J Psychiatry Neurosci. Jan 1996;21(1):49-52.
  4. Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. Fall 1990;31(4):392-9.
  5. Fliege H, Grimm A, Eckhardt-Henn A, Gieler U, Martin K, Klapp BF. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. Jan-Feb 2007;48(1):60-4.
  6. Drob SL, Meehan KB, Waxman SE. Clinical and conceptual problems in the attribution of malingering in forensic evaluations. J Am Acad Psychiatry Law 2009; 37:98.
  7. Gavin, H. On Feigned and Factitious Diseases, on the Means Used to Simulate or Produce Them, and on the Best Methods of Discovering Impostors. John Churchill, London 1843.
  8. Kwon EJ, Dans M, Koblenzer CS, et al. Dermatitis artefacta. J Cutan Med Surg 2006; 10:108.
  9. Park TA, Borsch MA, Dyer AR, Peiris AN. Cardiopathia fantastica: the cardiac variant of Munchausen syndrome. South Med J 2004; 97:48.
  10. Chapman JS. Peregrinating problem patients; Munchausen's syndrome. J Am Med Assoc 1957; 165:927.

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Last updated: 2019-07-11 20:21