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.

Síndrome de Münchausen por poder en otorrinolaringología / Münchausen syndrome by proxy in otorhinolaryngology

El síndrome de Münchausen por poder es una forma de maltrato infantil, con graves consecuencias para el niño afectado. El diagnóstico de esta afección constituye un desafío para los médicos por su heterogeneidad en los síntomas y signos de presentación. Variadas manifestaciones otorrinolaringológicas están descritas en esta patología. En este artículo se presenta un caso clínico de otitis media crónica con otorragia en un paciente de 2 años, donde se logró establecer el diagnóstico de síndrome de Münchausen por poder a través de la identificación de elementos incongruentes en la historia clínica y finalmente por la detección in fraganti de la agresión por parte de la madre. En esta revisión se concluye que es necesario un alto índice de sospecha para identificar esta patología, la que debe ser una preocupación habitual del equipo de salud para evitar asi consecuencias graves en estos pacientes, tales como secuelas psiquiátricas o incluso la muerte.

Münchausen's syndrome by proxy is a form of child abuse with severe consequences for the affected child. The diagnosis of this condition is a challenge for physicians due to the heterogeneity of the presentation symptoms. A lot of otorhinolaryngological manifestations have been described in this syndrome. We present a case of a 2 year old patient with chronic otitis media and otorrhagia, where we could establish the diagnosis of Münchausen's syndrome by proxy through the identifications of incongruent elements on the clinical history and finally the direct visualization of mother's aggression. In this should be a common concern for health workers to avoid severe consequences in these patients like psychiatric diseases or even death.

Síndrome de Munchausen por procuração: quando a mãe adoece o filho / Munchaunsen Syndrome by proxy: when the mother makes the child sick

A síndrome de Munchausen por procuração é um tipo de abuso infantil,em que um dos pais, geralmente a mãe, simula sinais e sintomasna criança, com a intenção de chamar atenção pra si. Comoconsequência, a vítima é submetida a repetidas internações e exposiçãoa exames e tratamentos potencialmente perigosos e desnecessários,gerando sequelas psicológicas e físicas, podendo levar amorte. O presente artigo teve por objetivo relatar e relacionar com aassistência de enfermagem participante e atuante no cuidado multiprofissional,por meio de um plano de cuidados, um caso ocorridoentre 2011 e 2012 em um hospital público do Distrito Federal, Brasil,em que a criança tinha como sintomatologia central sonolência esangramentos.

Munchausen syndrome by proxy is a form of child abuse in whicha parent, usually the mother, simulates signs and symptoms on thechild, with the intention of attract attention to her. As a result, thevictim is subjected to repeated hospitalizations and exposure to potentiallydangerous and unnecessary tests and treatments, whichleads to psychological and physical consequences and possiblydeath. This article aims to report and relate to nursing active participantin multidisciplinary care through a care plan, a case thatoccurred between 2011 and 2012 in a public hospital of DistritoFederal, Brazil, where the child had symptoms like sleepiness andbleeding.

Síndrome de Munchausen por poder. Evaluación, diagnóstico. ¿Después que? / Munchausen by proxy syndrome. Evaluation - diagnosis and then what?

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.

Síndrome de Münchausen by proxy: enfoque forense / Munchausen syndrome by proxy: forensic approach

El síndrome de Münchausen by proxy es una forma de maltrato infantil cuyas consecuencias pueden ser tan graves como la muerte del niño, víctima de enfermedades ficticias provocadas por un cuidador del que es muy dificil sospechar.

Transtornos factícios por procuraçäo: discussäo de um caso / Factitious disorders by proxy: discussion of one case

Condrossarcoma é o sarcoma mais freqüente da laringe. Sua incidência é maior na cartilagem cricóide do que nas outras cartilagens da laringe, sendo raro que ele se origine na epiglote. Relatamos no texto um caso de condrossarcoma originado na epiglote, no qual foi realizada laringectomia subtotal com crico-hioidopexia - e realizamos revisão da literatura

Síndrome de Münchausen por poder: una presentación inusual / Münchausen by proxy syndrome: report of case

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

Síndrome de Munchausen por poder: un diagnóstico a considerar / Munchausenïs syndrome by proxy: a diagnosis to consider

Esta comunicación pretende mostrar un caso de Munchausen-por-poder que se presentó en un hospital de Santiago, planteando un importante desafío al equipo médico. El artículo intenta hacer una reflexión en torno a la problemática que generan estos casos que constituyen una forma de abuso físico muy elaborada y finamente perversa. Se realiza una definición y descripción de esta patología y se analiza en detalle el caso ocurrido. La mayor dificultad de este caso fue manterner el diagnóstico de Munchausen-por-poder vigente como una alternativa, aun cuando se planteó este diagnóstico desde el momento del ingreso. Por otra parte, los conflictos éticos y legales que esta situación produjo, expusieron a un niño pequeño a la posibilidad de quedar desprotegido e indefenso con alto riesgo vital

Is it Munchausen syndrome by proxy?

We describe two cases of children who were victims of illness fabricated by their mothers. Such clinical situations are identified as Munchausen syndrome by proxy (MSP). Although considered a form of child abuse, MSP often goes unrecognised in paediatric practice. The two children involved were unnecessarily investigated, and the underlying problems in the mothers were identified only after several hospital admissions. One mother had a major psychiatric disorder, and the other had serious marital problems. Maintaining a high degree of suspicion regarding inexplicable illness in a child with inappropriate or incongruous symptoms and signs, even when parents behave in an exemplary manner, would help in early diagnosis and management.

Factitious haematuria in a 12 year old boy

This paper reviews the current state of knowledge concerning a factitious illness known as Munchausen syndrome and the curious presentation of Munchausen syndrome by proxy. A detailed description of a 12 year old boy with factitious haematuria is then presented and case management discussed. Physicians and nurses should remain vigilant to the concept of factitious illness in explaining haematuria that does not fit the physiologic pattern

Child abuse in Saudi Arabia: Report of ten cases

Ten abused children under five years of age [four males, six females] were seen in King Faisal Specialist Hospital and Research Centre [KFSH and RC] between 1986G and 1992G. Two children died, five had serious injuries and three had moderately severe injuries. In one of the fatalities, the diagnosis was not suspected until four years after death, when her sister was diagnosed as a case of child abuse. Six children suffered varying degrees of physical neglect and abuse and sexual abuse. The remaining four children had Munchausen syndrome by proxy. Parentally induced illness should therefore be considered in the differential diagnosis of unusual illness with bizarre features, even if the parents' behavior appears normal

Orina de color y cantidad anormal / Urine of abnormal color and quantity

Siempre que sea posible es aconsejable observar la orina como parte del examen físico (micción en el pañal, micción espontánea en el lactante, muestra ex profeso y datos de información anamnésticos en el niño mayor). Normalmente la orina es de color amarillo ámbar más o menos pálido con variaciones del matiz por circunstancias diversas. Recién emitida es límpida y transparente