ABSTRACT
ABSTRACT The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.
RESUMO A síndrome de Munchausen e a síndrome de Munchausen por procuração são condições caracterizadas pela invenção ou pela produção intencional de sinais ou sintomas de doenças, bem como alterações de exames laboratoriais. Indivíduos com esta síndrome fingem que estão doentes e tendem a procurar tratamento, sem ganho secundário, em diferentes serviços de saúde. Ambas as síndromes são condições bem descritas na literatura desde 1951. Elas são frequentemente observadas pelas equipes de saúde em clínicas, enfermarias hospitalares e prontos-socorros. Conduziu-se revisão narrativa, não sistemática da literatura, incluindo relatos de caso, séries de relatos de caso, artigos de revisão indexados no MEDLINE/PubMed de 1951 a 2015. Cada estudo foi revisado por dois especialistas em psiquiatria que, por meio de consenso, escolheram quais estudos seriam incluídos nesta revisão. Apesar da síndrome de Munchausen ter sido descrita pela primeira vez há mais de 60 anos, a maioria dos estudos conduzidos sobre esta condição são relatos de caso e revisões da literatura. A literatura é carente de estudos mais consistentes sobre epidemiologia, manejo terapêutico e prognóstico da síndrome. Sem dúvida, tais condições geram altos custos e procedimentos desnecessários nos serviços de saúde. Seu subdiagnóstico pode se dar pela falta de conhecimento das síndromes por parte dos profissionais de saúde, e à alta incidência de contratransferência aos pacientes e a outros que são expostos à alta morbidade e à mortalidade é justificada pelos sintomas impostos em si mesmo ou em terceiros.
Subject(s)
Humans , Child , Munchausen Syndrome by Proxy/diagnosis , Munchausen Syndrome/diagnosis , Child Abuse/diagnosis , Child Abuse/psychology , Munchausen Syndrome by Proxy/psychology , Munchausen Syndrome by Proxy/therapy , Diagnostic and Statistical Manual of Mental Disorders , Diagnosis, Differential , Munchausen Syndrome/psychology , Munchausen Syndrome/therapyABSTRACT
La presente investigación se desarrollo en el Hospital de Pediatría Juan P. Garrahan. La investigación se centro en analizar un fenómeno complejo tanto en su diagnóstico como en su tratamiento el Síndrome de Munchausen por poder. El Hospital de Pediatría Juan P. Garrahan, presenta un número elevado de casos con síndrome de munchausen, la cual constituye una forma de maltrato infantil. Aquí se simula o se produce enfermedad en un niño sano, por par te de quien lo cría, que es quien debería protegerlo y ampararlo. El objetivo final de un equipo interdisciplinario frente a este tipo de casos es, hacer un trabajo minucioso con el paciente, familia nuclear, red ampliada y personas significativas, con los recursos profesionales que correspondan, al contexto del paciente, a la red institucional (contra referencia), a fin de que ese niño no vuelva a sufrir ninguna forma de daño intencional. Como obstáculo para el tratamiento y seguimiento de estos niños y sus familias, en la práctica profesional de este Servicio Social, se observa escasa cantidad de equipos profesionales y centros especializados para tal fin, como así también interrogantes acerca de los resultados de las estrategias de intervención de las instituciones a las cuales se derivan estos niños y sus grupos familiares.
The present study was conducted at the Pediatric HospitalJuan P. Garrahan. The study focuses on the phenomenonof Munchausen by proxy syndrome, a complex syndromeboth in its diagnosis and treatment. At the Pediatric HospitalJuan P. Garrahan a high rate of cases of Munchausen by proxy syndrome, a form of child abuse, is found. In this syndrome the parent or caretaker, who is supposed to protectthe child, deliberately makes the child sick or simulates anillness. The main aim of an interdisciplinary team managingthese cases is to closely work with the patient, the close and extended family, and persons important to the child withthe necessary professional resources in an institutional net-work (counter referral) to protect the child from further intentional harm. In the practice of the Social Service of this institution, the main obstacle in the treatment and follow-up of these children and their families is the scarcity of professional teams and centers specialized in the syndrome as well as uncertainty about results of interventional therapies at the centers these children and their families are referred to.
Subject(s)
Humans , Male , Adolescent , Female , Infant , Child, Preschool , Child , Hospitals, Public , Hospitals, Pediatric/trends , Munchausen Syndrome by Proxy/diagnosis , Munchausen Syndrome by Proxy/etiology , Munchausen Syndrome by Proxy/therapy , ArgentinaSubject(s)
Humans , Male , Adult , Female , Infant , Maternal Behavior , Munchausen Syndrome by Proxy/diagnosis , Child Abuse , Fathers , Masochism , Mother-Child Relations , Patient Care Team , Personality Disorders , Psychotherapy , Sadism , Munchausen Syndrome by Proxy/etiology , Munchausen Syndrome by Proxy/psychology , Munchausen Syndrome by Proxy/therapy , Borderline Personality Disorder/diagnosisABSTRACT
We report a 12 year old girl that first consulted for fever with bilateral knee arthralgias. A neurological workout was started due to a progressive gait disturbance, but all results were incongruent with nerve or nerve root lesions, leading to the diagnosis of a functional paralysis. The patient worsened to the point of prostration. Due to the suspicion that the mother was inducing the symptoms, the patient was admitted to the hospital, where she improved notably. She was discharged walking. The improvement during hospital stay confirmed the diagnosis of a Münchausen by proxy syndrome, mimicking a disabling neurological condition