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.
In patients with this syndrome, presentations vary. However common presentations include the following :
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.
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 . 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.
Treatment requires collaborative effort of health care providers, social work, legal personnel and nursing . 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 . 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.
Due to the difficulty in tracking patients with Munchausen syndrome and the lack of follow-up studies, predicting prognosis is difficult .
Till date, no scientifically proven treatments have been brought forward.
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 :
The exact incidence of this condition is not known but it has been classified as rare . 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.
The pathophysiology of the syndrome remains unclear . 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.
There is no proven way to prevent Munchausen syndrome.
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.