Trastorno facticio en adultos: a propósito de un caso y revisión de literatura / Factitious disorder in adults: a case report and literature review

RESUMEN: El trastorno facticio consiste en falsificar, inducir o agravar las enfermedades para recibir atención médica, independientemente si están enfermas o no. El impacto que tiene esta patología va desde altos costos en salud asociado a la policonsulta, hospitalizaciones y tratamientos innecesarios; la funcionalidad y calidad de vida de estos pacientes, hasta el costo de vidas humanas. Este trastorno sigue siendo un desafío para los clínicos, puesto que no hay evidencia suficiente sobre la epidemiología, etiología, clínica y manejo dada su complejidad. En este artículo se presentará un caso clínico enfatizando en la evolución de la enfermedad, manejo inicial y posterior durante su hospitalización, junto con una actualización basada en la literatura, en torno al tratamiento de esta patología, con el fin de proponer intervenciones preventivas o protocolos que permitan evitar hospitalizaciones y tratamientos innecesarios. Luego se finalizará con la resolución del caso, pronóstico de esta enfermedad y una conclusión.

ABSTRACT Factitious disorder consists of falsifying, inducing or aggravating illnesses in order to receive medical attention, regardless of whether they are ill or not. The impact of this pathology ranges from high health costs associated with polyconsultation, hospitalizations and unnecessary treatments, the functionality and quality of life of these patients, up to the cost of human lives. This disorder continues to be a challenge for clinicians, since there is insufficient evidence on the epidemiology, etiology, clinic and management given its complexity. In this article, a clinical case will be presented, emphasizing the evolution of the disease, initial and subsequent management during hospitalization, together with an update based on the literature, on the treatment of this pathology, in order to propose preventive interventions or protocols that allow avoiding hospitalizations and unnecessary treatments. Then it ends with the resolution of the case, prognosis of this disease and a conclusion.

Insights into the clinical profile and comorbidities of factitious disorder in a multispeciality setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%­3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be openminded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

Bioética e sociedade: transtorno factício autoimposto e imposto a outro / Bioethics and society: factitious disorder imposed on oneself and imposed on another / Bioética y sociedad: trastorno facticio impuesto a uno mismo e impuesto a otro

Resumo: Objetiva-se compreender a síndrome de Münchhausen a partir da descrição das suas causas, dos critérios de identificação, dos sinais clínicos, do diagnóstico e do tratamento, bem como das assistências realizadas pela Enfermagem e pela equipe interdisciplinar com interface da Bioética. Trata-se de uma revisão narrativa de literatura de caráter exploratório reflexivo, com abordagem qualitativa. Realizaram-se buscas de estudos em periódicos publicados entre 2009 e 2019; a amostra final constituiu-se por 30 artigos, além de livros, manuais e normativas. Os resultados apresentados evidenciam o conhecimento da quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais, no qual a expressão "síndrome de Münchhausen imposto a si próprio" foi substituída por "transtorno factício autoimposto", e a "síndrome de Münchhausen por procuração" foi alterada para "transtorno factício imposto a outro", quanto à bioética. Indivíduos com o distúrbio factício tendem a buscar tratamento para si mesmo ou para outro. O comportamento desses pacientes aumenta a probabilidade de terem realmente uma doença física e até mesmo ir a óbito, causado pelo excesso de uso de medicações e pelos diversos procedimentos invasivos. Portanto, conclui-se que identificar o quadro clínico pode ser uma das primeiras iniciativas para a detecção e a prevenção. O tratamento deve se concentrar no manejo, com a possibilidade do uso da psicoterapia e de antidepressivos, antipsicóticos e ansiolíticos. A equipe de enfermagem e a multiprofissional devem estar atentas a sinais e sintomas para uma intervenção precisa e precoce, pois desempenham importante papel na identificação adequada do diagnóstico.

Summary: The objective is to understand Münchhausen syndrome, with the description of its causes, identification criteria, clinical signs, diagnosis and treatment, as well as the assistance provided in nursing and the interdisciplinary team regarding bioethics. This paper is a narrative review of literature with a reflective exploratory nature, and a qualitative approach. We searched for studies in journals published between 2009 and 2019, and a final sample consisting of 30 articles, in addition to books, manuals and regulations. The results presented corroborate the claims in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, in which the term "Münchhausen syndrome imposed on self" was replaced by "factitious disorder imposed on self", and the "Münchhausen syndrome by proxy" was changed to "factitious disorder imposed on another", in Bioethics. People with factitious disorder tend to seek treatment for themselves or for others. The behavior of these patients increases the likelihood of physical illness and even death, caused by overuse of medications and as a result of various invasive procedures. Therefore, it is concluded that identifying the clinical picture may be one of the first initiatives for detection and prevention. Treatment should focus on management, being able to use psychotherapy, antidepressants, antipsychotics, and anxiolytics. The nursing team and the multidisciplinary team must be alert to the signs and symptoms for accurate and early intervention since they play an important role in the proper identification of the diagnosis.

Resumen: El objetivo es comprender el síndrome de Münchhausen, con la descripción de sus causas, criterios de identificación, signos clínicos, diagnóstico y tratamiento, así como la asistencia brindada en enfermería y el equipo interdisciplinario en cuanto a la bioética. Es una revisión narrativa de la literatura con un carácter exploratorio reflexivo, con un enfoque cualitativo. Se realizaron búsquedas de estudios en revistas publicadas entre 2009 y 2019, y una muestra final que consta de 30 artículos, además de libros, manuales y reglamentos. Los resultados presentados corroboran el conocimiento de la quinta edición del Manual Diagnóstico y Estadístico de los Trastornos Mentales, en el que el término "síndrome de Münchhausen impuesto a uno mismo" fue reemplazado por "trastorno facticio autoimpuesto", y el "síndrome de Münchhausen por proxy" se alteró a "trastorno facticio impuesto a otro", ante la Bioética. Las personas con trastorno facticio tienden a buscar tratamiento para sí mismas o para otros. El comportamiento de estos pacientes aumenta la probabilidad de tener una enfermedad física e incluso la muerte, causada por el uso excesivo de medicamentos y como resultado de varios procedimientos invasivos. Por lo tanto, se concluye que identificar el cuadro clínico puede ser una de las primeras iniciativas para la detección y la prevención. El tratamiento debe centrarse en el manejo, poder usar psicoterapia, antidepresivos, antipsicóticos y ansiolíticos. El equipo de enfermería y el equipo multidisciplinario deben estar atentos a los signos y síntomas para una intervención precisa y temprana, pues desempeñan un papel importante en la identificación adecuada del diagnóstico.

Uma visão atualizada da anafilaxia idiopática: a ausência de evidência não é a evidência de ausência / An updated view of idiopathic anaphylaxis: absence of evidence is not evidence of absence

A anafilaxia idiopática não apresenta etiologia conhecida. A sua prevalência é estimada entre 10-35% de todas as modalidades de anafilaxia. A sintomatologia apresentada é a mesma de qualquer outra anafilaxia: urticária, angioedema, ruborização, prurido, hipotensão arterial, taquicardia, manifestações gastrointestinais (disfagia, náusea, vômitos, cólicas abdominais, diarreia), asma, edema laríngeo, tontura e síncope. A mortalidade é rara. Não há transmissão genética, mas 40% dos pacientes são atópicos. É mais frequente nos adultos do que nas crianças, e principalmente em mulheres. É um diagnóstico de exclusão. Ocorre ativação mastocitária com desgranulação citoplasmática dos mediadores de anafilaxia (triptase, histamina, entre outros). É uma anafilaxia com boa resposta aos corticoides, e, portanto, caso não haja resposta adequada a doses eficazes de prednisona/prednisolona, o seu diagnóstico deve ser revisto. O diagnóstico diferencial da anafilaxia idiopática inclui: a mastocitose sistêmica indolente, síndromes de ativação mastocitária monoclonais, alergia à galactose-alfa-1,3 galactose, anafilaxia induzida por exercícios (com e sem dependência alimentar e medicamentosa), angioedema hereditário (congênito e adquirido), feocromocitoma, síndrome carcinoide, anafilaxia oral acarina, alergia ao Anisakis simplex, disfunção das cordas vocais, síndrome escombroide, alergia ao sêmen, alergia ao látex, manifestações psicossomáticas (síndrome do pânico, globus hystericus e a síndrome de Münchausen), bem como as tradicionais e mais frequentes modalidades de anafilaxia (alergia a alimentos, medicamentos e insetos). O tratamento na crise aguda da anafilaxia idiopática é o mesmo do que nas demais anafilaxias, incluindo a administração intramuscular imediata de epinefrina. Deve haver uma generosa e prolongada prescrição de corticoterapia oral, e também a instituição de medicação preventiva (anti-histamínicos anti- H1 e anti-H2, cetotifeno, albuterol oral, montelucaste, cromoglicato de sódio, e por último o omalizumabe). Os pacientes devem portar epinefrina autoinjetora e ser instruídos sobre como agir em caso de um episódio anafilático. Eles respondem bem à administração de epinefrina. A corticoterapia oral, por 4-6 semanas, pode induzir uma remissão completa.

Idiopathic anaphylaxis is a condition of unknown etiology. Its prevalence ranges from 10 to 35% of all cases of anaphylaxis. Clinical symptoms and signs are those of classic anaphylaxis, including urticaria, angioedema, flushing, itching, hypotension, tachycardia, gastrointestinal manifestations (dysphagia, nausea, vomiting, abdominal cramps, and diarrhea), asthma, laryngeal edema, dizziness, and syncope. Mortality is rare. There is no genetic transmission, but about 40% of patients are atopic. It is more common in adults than in children, affecting mainly women. It is considered a diagnosis of exclusion of other known forms of anaphylaxis. Mast cell activation occurs with cytoplasmatic degranulation of mediators of anaphylaxis (tryptase and histamine, among others). Because idiopathic anaphylaxis is a steroid-responsive condition, if it is not controlled with adequate doses of prednisone/prednisolone, the diagnosis should be challenged. The differential diagnosis of idiopathic anaphylaxis includes indolent systemic mastocytosis, clonal mast cell activation syndromes, galactose-alpha-1,3- galactose allergy, exercise-induced anaphylaxis (both food- and drug-dependent and -independent), hereditary angioedema (congenital and acquired), pheochromocytoma, carcinoid syndrome, oral mite anaphylaxis, Anisakis simplex allergy, vocal cord dysfunction, scombroid poisoning, semen allergy, latex allergy, psychosomatic conditions (panic attacks, globus hystericus, and Münchausen syndrome), and the classic forms of anaphylaxis (food, drug, and insect allergies). Treatment of acute idiopathic anaphylaxis is the same as in the other forms of anaphylaxis, including intramuscular epinephrine, but with prolonged oral corticosteroid therapy. It might also include other oral preventive medications (H1 and H2 antihistamines, ketotifen, oral albuterol, montelukast, sodium cromoglycate, and recently omalizumab). Patients should have an epinephrine auto-injector and be instructed on self-management of anaphylaxis. Good response to epinephrine is observed, and oral corticosteroid therapy for 4-6 weeks can induce complete remission.

A case report of type 1 diabetes mellitus and factitious hypoglycemia in a patient with Munchausen Syndrome / Hipoglucemia facticia: el caso de un paciente con diabetes mellitus tipo 1 y síndrome de Munchausen

SUMMARY Munchausen syndrome is rarely considered as a first diagnosis, especially in a type 1 diabetic patient presenting with hyperinsulinemic hypoglycemia. The diagnosis should be considered when episodes of hypoglycemia are persistent, and tests suggest a possible exogenous source of insulin. We report a case of a 26-year-old man with multiple hypoglycemic episodes and a long known diagnosis of diabetes type 1 who was referred to our institution after multiple in and out patient consultations in other institutions. He arrived with persistent hypoglycemia, even after withdrawal of insulin therapy on medical record, but persistent self-administration and misuse, without health care professional knowledge, of insulin therapy. He was diagnosed with factitious hypoglycemia after psychiatric evaluation. The patient improved with psychotherapy and family support as well as strict vigilance of insulin administration.

RESUMEN El síndrome de Munchausen rara vez es considerado como primer diagnóstico, especialmente en pacientes diabéticos tipo 1 con cuadro de hipoglicemia hiperinsulinémica. Debe pensarse en este diagnóstico cuando los episodios de hipoglicemia sean persistentes y los exámenes paraclínicos sugieran una fuente exógena de insulina. El siguiente es un reporte de caso de un paciente masculino de 26 años con múltiples episodios de hipoglicemia y diagnóstico conocido de diabetes mellitus tipo 1, quien fue referido a nuestro hospital universitario después de haber consultado en varias ocasiones y haber sido hospitalizado y dado de alta en otras instituciones. Ingresa por múltiples episodios de hipoglicemias, y que incluso al retirar las insulinas por orden médica, persistían los síntomas. Se encontró auto-administración de uso de insulinas sin el conocimiento de los profesionales de la salud, llegando al diagnóstico de hipoglicemia facticia después de valoración por psiquiatría. El paciente presentó mejoría con psicoterapia y apoyo familiar, además de vigilancia estricta de la administración de insulinas.

Síndrome de Münchhausen / Münchhausen síndrome

Resumen Introducción: síndrome de Münchhausen es un subtipo de trastorno facticio grave y crónico, que se caracteriza por la producción de mentiras patológicas ("pseudología fantástica") y una conducta errante, de médico en médico, fingiendo una enfermedad física. Objetivo: presentar el caso de un paciente con hipoglicemia refractaria secundaria al uso de insulina exógena en el contexto de un síndrome de Münchhausen. Discusión: el paciente presentó una sumisión inusual a las hospitalizaciones y a las pruebas diagnósticas, las cuales confirmaron la administración exógena de insulina para desencadenar los síntomas. Los rasgos paranoides y la mitomanía observada se asocian a un estado larvado, crónico y delirante, propio de síndrome de Münchhausen. Conclusión: el síndrome de Münchhausen es una condición psiquiátrica difícil de diagnosticar y que constituye un importante reto para el clínico, es poco reconocido, afecta la relación médico-paciente y presenta un alto costo para el sistema de salud debido al uso de innecesaria de baterías diagnósticas y procedimientos terapéuticos. (Acta Med Colomb 2019; 44:43-46).

Abstract Introduction: Münchhausen syndrome is a subtype of serious and chronic factitious disorder, characterized by the production of pathological lies ("fantastic pseudology") and wandering behavior from doctor to doctor, pretending a physical illness. Objective: to present the case of a patient with refractory hypoglycemia secondary to the use of exogenous insulin in the context of a Münchhausen syndrome. Discussion: the patient presented an unusual submission to the hospitalizations and to the diagnostic tests, which confirmed the exogenous administration of insulin to trigger the symptoms. The paranoid features and the mythomania observed are associated with a latent, chronic and delirious state, typical of Münchhausen syndrome. Conclusion: Münchhausen syndrome is a psychiatric condition that is difficult to diagnose and that constitutes an important challenge for the clinician; it is little recognized, affects the doctor-patient relationship and presents a high cost for the health system due to the use of unnecessary diagnostic and therapeutic procedures. (Acta Med Colomb 2019; 44: 43-46).

Munchausen Syndrome in Orthopedics / 대한정형외과학회잡지

Munchausen syndrome is a rare factitious disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. These patients distort their medical history, undergoing dangerous diagnostic and therapeutic procedures, often resulting in misdiagnosis. Management of this syndrome requires collateral history taking, sound clinical approach, exclusion of organicity, and addressing psychological issues. We report a 54-year-old female, who underwent orthopedic surgery 13 times. She was always unsatisfied with her surgical outcomes, and underwent additional surgical treatment of the shoulder, elbow, wrist, and knee joint. She repeatedly complained of joint pain, which was much more exaggerated than expected from her examination results. Therefore, we considered artificial arthrosis for a differential diagnosis of unclear arthrosis, and paid special attention when she exhibited odd behaviors.

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review / Síndrome de Munchausen e síndrome de Munchausen por procuração: uma revisão narrativa

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.

Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

Modelo de los clientes que compran productos farmacéuticos / Model of customers buying pharmaceuticals

Entre el año 2010 y 2012 se realizó una investigación doctoral en la cual el autor combinó su experiencia académica en el análisis del comportamiento en la conducta de los consumidores, con su experiencia como consultor e investigador privado de la industria farmacéutica. Demostró que hasta ese momento no existía un modelo o perfil que permitiera conocer al comprador de medicamentos en las farmacias. El autor logró obtener el modelo o perfil analizando las conductas de los compradores de medicamentos que visitan las farmacias, razón por la cual la investigación doctoral se ha considerado pionera a nivel mundial, dado que no existían en ese momento antecedentes en esa específica área del conocimiento, ni del lado de la administración, ni del lado farmacéutico, con lo cual la tesis se ha convertido en el complemento que le faltaba al Marketing farmacéutico, que a la fecha sigue enfocado a la visita diaria de los representantes a hospitales, clínicas, regentes y consultorios particulares. La investigación determinó que la automedicación es un concepto usado por las personas de forma indulgente. El trabajo destaca cómo con la teoría de las expectativas racionales no solo se confirma su aspecto teórico y su ausencia en los compradores de medicinas, lo cual el autor resume en la máxima si racionaliza la compra en términos económicos, no lo hace en términos de salud. la misma teoría puede vincular siete patologías médicas con la automedicación.

Between 2010 and 2012 a doctoral research was carried out in which the author combined his academic experience in the analysis of behavior in consumer behavior, with his experience as a consultant and private investigator of the pharmaceutical industry. He showed that until that moment there was no model or profile that allowed knowing the buyer of medicines in pharmacies. The author managed to obtain the model or profile by analyzing the behavior of drug buyers who visit pharmacies, which is why doctoral research has been considered a pioneer worldwide, given that there were no antecedents in that specific area of knowledge at that time. , neither on the side of the administration, nor on the pharmaceutical side, whereupon the thesis has become the complement that Pharmaceutical Marketing lacked, which to date remains focused on the daily visit of representatives to hospitals, clinics, regents and private offices. The investigation determined that self-medication is a concept used by people in an indulgent way. The work highlights how the theory of rational expectations not only confirms its theoretical aspect and its absence in the buyers of medicines, which the author summarizes in the maximum if it rationalizes the purchase in economic terms, it does not do it in terms of health . The same theory can link seven medical pathologies with self-medication.

El problema del hospitalismo en la medicina rioplatense y el rol de los saberes psi en la subjetivación de la maternidad y la infancia (1933-1965) / The Problem of Hospitalism in the River Plate Medicine and the Role of Psi Knowledge in the Subjectivation of Motherhood and Childhood (1933-1965) / O problema do hospitalismo na medicina rioplatense e o papel dos saberes psi na subjetivação da maternidade e a infância (1933-1965)

Objetivos: contribuir a la indagación histórica de la relación entre los saberes sobre lo psíquico y la medicina infantil rioplatense, tomando como eje el problema del hospitalismo, término que alude a la desmejora psicofísica producida a raíz de la permanencia del niño en nosocomios o instituciones de crianza en común. El análisis de dicha problemática permite iluminar ciertos cambios en la concepción pediátrica del desarrollo infantil, la maternidad y la crianza, que pueden apreciarse hacia la década de 1960. Desarrollo: las primeras décadas del periodo estudiado muestran que las intervenciones médicas en casos de hospitalismo se centraron en la supervivencia del niño. Los problemas suscitados durante la crianza en instituciones promovieron una revalorización de la crianza familiar y del papel central de la madre, en virtud del lazo biológico con su hijo. La circulación de los hallazgos de John Bowlby dio lugar a una reformulación del problema del hospitalismo y del desarrollo infantil. El estudio de los vínculos emocionales del niño con su madre cobró gran importancia en relación con su salud mental y su adaptación social. Conclusiones: estas ideas, en cierto sentido novedosas, se inscribieron en un entramado previo de concepciones y valoraciones médicas acerca del niño, la maternidad y la crianza. La recepción local de las ideas de Bowlby contribuyó así al sostenimiento de la imagen tradicional de madre y reforzó la división social de roles, en función del género, al atribuirle a la mujer la categoría de "organizador psíquico" del niño.

Objective: This article aims at contribute to the historical investigation of the relationship between psychological knowledge and the River Plate's childhood medicine, focusing on hospitalism, which refers to the psychophysical deterioration as a result of the child stay in hospitals or upbringing institutions. The analysis of this problem illuminate certain changes in the Pediatric conception of child development, maternity and rearing that can be seen during the 60's. Content: The first decades of the period under study show that in cases of hospitalism the aim of medical interventions was mainly to keep the child alive. The problems during the rearing in institutional contexts promoted a revaluation of the family upbringing and the central role of the mother, biologically tied to her child. John Bowlby's findings circulation led to a reformulation of the problem of the hospitalism and child development. The study of the emotional bonding between mother and child became important for child's mental health and social adaptation. Conclusions: these ideas were part of a previous network of medical concepts and valuations about child, motherhood and rearing. The local reception of Bowlby's ideas gave support to the traditional image of mother and reinforced the social division of roles according to gender by attributing to women the category of "psychic organizer" of the child.

Objetivos: contribuir à indignação histórica da relação entre os saberes sobre o psíquico e a medicina infantil rio-platense tomando como eixo o problema do hospitalismo, termo que alude à piora psicofísica produzida por causa da permanência da criança em nosocômios ou instituições de criação em comum. A análise de dita problemática permite iluminar algumas mudanças na concepção pediátrica do desenvolvimento infantil, a maternidade e a criação que podem apreciar-se na década de 1960. Desenvolvimento: as primeiras décadas do período estudado mostram que as intervenções médicas em casos de hospitalismo se centraram na supervivência da criança. Os problemas suscitados durante a criação em instituições promoveram uma revalorização da criação familiar e do papel centras da mãe, em virtude do laço biológico com o seu filho. A circulação dos achados de John Bowlby levou a uma reformulação do problema do hospitalismo e do desenvolvimento infantil. O estudo dos vínculos emocionais da criança com a sua mãe adquiriu grande importância em relação com a sua saúde mental e a sua adaptação social. Conclusões: estas ideias, em certo sentido novas, se inscreveram em uma rede prévia de concepções e valorações médicas acerca da criança, a maternidade e a criação. A recepção local das ideias de Bowlby contribuiu assim ao sustento da imagem tradicional de mãe e reforçou a divisão social de papeis em função do gênero ao atribuir à mulher a categoria de "organizador psíquico" da criança.

Associação de Cardiopathia fantastica e Dermatitis artefacta em paciente submetido a implante de marcapasso / Combination of Cardiopathia fantastica and Dermatitis artefacta in patients undergoing permanent pacemaker implantation

Cardiopathia fantastica é o termo utilizado para a variante cardíaca da síndrome de Munchausen, condição na qual o paciente busca atendimento médico repetidamente por doenças factícias. Relatamos um caso de síncope induzida por administração inadequada de fármacos cronotrópicos negativos, que resultou em implante de marcapasso definitivo, seguido de reações cutâneas sobre a loja do marcapasso. O acompanhamento da paciente mostrou que as alterações cutâneas eram lesões factícias (Dermatitis artefacta). Apresentamos também uma breve revisão sobre as reações alérgicas a dispositivos cardíacos eletrônicos implantáveis, abrangendo sua fisiopatologia e alternativas terapêuticas disponíveis.

Cardiopathia fantastica is the cardiac variant of Munchausen syndrome, a condition where patients repeatedly seek medical consultation for factitious diseases. We report a case of syncope induced by an inadequate administration of negative chronotropic drugs, which resulted in permanent pacemaker implantation, followed by the appearance of cutaneous reactions over the pacemaker pocket. This patient´s follow-up showed that the cutaneous disease consisted of factitious lesions (Dermatitis artefacta). We also present a brief review on allergic reactions to cardiac implantable electronic devices, including its pathophysiology and available therapeutic strategies.

Transtorno facticio en obstetricia reporte de caso / Factitious disorder in obstetrics: case report

Introducción: El síndrome de Münchausen es la condición más estudiada del trastorno facticio con síntomas físicos; sin embargo, su presentación clínica durante la gestación es poco frecuente y es escasa la literatura al respecto. Objetivo: Presentar un caso de trastorno facticio en obstetricia. Método: Revisión y análisis de caso clínico. Resultados:Se presenta el caso de una mujer de treinta años de edad con gestación de seis semanas, quien consulta en múltiples ocasiones por un cuadro de emesis y dolor abdominal. Fueron varios los diagnósticos con los que cursó la paciente y se llegaron a excluir patologías como porfiria intermitente aguda, colon narcótico, epilepsia abdominal y espasmo esofágico. La paciente expresó su deseo de interrumpir el embarazo en la semana 21 de gestación. Esta se llevó a cabo una vez su caso fue presentado a junta médica que concluyó que existen condiciones tanto orgánicas como mentales que representan un alto riesgo para la salud de la paciente. Conclusión: Por su alta complejidad, estos trastornos constituyen un reto para el clínico, particularmente en las fases iniciales de su presentación. Los trastornos facticios son rara vez sospechados y diagnosticados, incluso en el ámbito hospitalario; por ende, es de suma importancia educar a los profesionales de la salud en atención primaria y en el medio hospitalario para identificarlos y poder orientar un adecuado manejo y tratamiento…

Introduction: Munchhausen’s syndrome is the best-studied type of factitious disorder with predominantly physical signs and symptoms. However, its clinical presentation during pregnancy is rare and literature on the subject is scarce. Objective: To present a case of factitious disorder during pregnancy. Method: Review and analysis of a clinical case. Results: The case of a 30-year-old woman six weeks pregnant who consults on multiple occasions with emesis and abdominal pain is discussed. Various different diagnoses were considered and pathologiessuch as acute intermittent porphyria, narcotic bowel syndrome, abdominal epilepsy, and esophageal spasm were discarded. The patient expressed her desire to terminate the pregnancy at week 21. The pregnancy was terminated after a medical panel concluded that there were both organic and mental conditions that placed the patient’s health at risk. Conclusions: Factitious disorders are very complex and extremely challenging to the clinician especially during the initial phases. They are seldom suspected and rarely diagnosed even in hospital settings. Therefore it is of utmost importance to educate healthcare professionals in the detection of this disorder to ensure proper management and treatment…

Dermatite factícia desencadeada pela síndrome de Münchausen / Factitial dermatitis as a consequence of Munchausen syndrome

Dermatite factícia refere-se à condição em que as lesões cutâneas são autoinduzidas e resultam de algum distúrbio psiquiátrico. As lesões podem se apresentar de diversas formas e ser produzidas por grande variedade de meios. Apresenta-se um caso raro de paciente com dermatite factícia desencadeada pela síndrome de Münchausen, que se refere a indivíduos que intencionalmente produzem sintomas físicos com o intuito de atender a uma necessidade de receber atendimento médico frequente.

Factitial dermatitis is a condition in which skin lesions are self-inflicted as the result of a psychiatric disorder. The lesions may be presented in various forms and produced by a wide variety of means. This report refers to the case of a patient with factitial dermatitis triggered by Munchausen syndrome, which refers to individuals who intentionally provoke physical symptoms in themselves in order to satisfy a need to receive frequent medical attention.

A Case of Munchausen Syndrome by Proxy / 대한소아신경학회지

Munchausen syndrome by proxy(MBP) is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. MBP is thought to be rare. We report the case of 11-year-old girl who presented with general weakness, dizziness, headache, and nausea and she was suspected of Munchausen syndrome by proxy.

[Facticious hypoglycaemia and diabetes: diagnosis difficulty]

There are many facticious diseases, and their diagnosis is often difficult, facticious hypoglycaemia due to auto-administration of insulin or secondary to insulin secretagogues drugs are probably under estimated. We report the case of a 25 years old woman who presents a particular facticious hypoglycaemia. she pretends to be treated for diabetes with insulin injection for 2 years. We suspect the [facticious diabetes] since she has normal fasting blood glucose level and without hyperglycaemia after her hypoglycaemic episodes, we decided to stop insulin injections, and realize that hypoglycaemia only happen when her husband comes and disappear when she has no visitors. Insulinemia and C-peptide coupled of the blood glucose level in addition to the oral provocated hyperglycemia confirm the diagnosis of facticious hypoglycaemia. the patient denied the insulin injection and we concluded she has a Munchhausen syndrome

El barón enfermo: síndrome de Münchausen / The sick baron: Münchausen’s syndrome

El Síndrome de Münchausen es una entidad psiquiátrica relativamente rara en la cual el paciente se provoca a sí mismo, o a las personas, a su cargo múltiples sintomatologías de manera deliberada, pudiendo resultar incluso en amputaciones o muerte. Lo hace de una forma consciente pero sin ningún tipo de ganancia primaria presente, sólo por el “placer” de sentirse atendido por el personal asistencial. Es una patología que plantea todo un reto para el clínico, puesto que no posee un cuadro sindrómico típico.

Münchausen’s Syndrome is a psychiatric disease that’s considered as relatively rare; in which the patients causes multiple symptoms and diseases Either to themselves or the people around them, with the possibility of resulting in amputations or even death. The patient engages in this behavior being conscious of what he’s doing, butwith no secondary gain at all, just the “pleasure” of feeling taken care of by the medical personnel. It is a disease that lacks a characteristic clinical course, therefore is of great difficulty to the doctor to diagnose properly an in time.

Child abuse and neglect in the Arab Peninsula

To provide an overview of the problem and patterns of child abuse and neglect in the 7 countries of the Arab Peninsula, and to highlight some of the difficulties and shortcomings. This study was conducted by reviewing medical literature, published between January 1987 and May 2005. In addition, reports were obtained from regional meetings and professional organizations. Each study or report was reviewed, assessed, and summarized. Three studies from Kuwait identified 27 children; 22 with physical abuse, 3 with sexual abuse, and 2 with Munchausen's syndrome by proxy [MSP], and 3 deaths. Eleven case reports from Saudi Arabia identified 40 abused children; 24 with physical abuse, 6 with sexual abuse, 4 with MSP, and 6 with neglect. Fatal outcome was documented in 5 children. In Oman, 5 cases of MSP were reported. A total of 150 hospital-based cases were reported from Bahrain; 50 with physical abuse, 87 with sexual abuse, and 10 with both forms of abuse. In Yemen, population based surveys revealed a wide spread use of corporal punishments and cruelty to children at homes, schools, and juvenile centers, which ranged from 51-81%. Children in the Arab Peninsula are subjected to all forms of child abuse and neglect. Child abuse is ignored or may even be tolerated and accepted as a form of discipline, abused children continue to suffer and most abusers go free, unpunished and untreated. Confronting these realities is a necessary step in the long and hard road to break silence, respond to and prevent child abuse and neglect in the Arab Peninsula