[Munchausen's syndrome: a factitious disorder? A case report]. / Le syndrome de Munchausen: un trouble factice? Présentation d'un cas clinique.

Munchausen's syndrome is classified as a chronic factitious disorder with predominant physical signs and symptoms. Several symptoms are specific to this disorder, such as travelling and pseudologia fantastica. Others symptoms, such as multiple physical complaints with no organic substrate, are shared with somatoform disorders. We report a case showing how difficult it is to diagnose a Munchausen syndrome. We discuss also the opportunity to classify such a syndrome as a factitious disorder. Indeed, several authors suggest classifying Munchausen syndrome as a subtype of somatoform disorders, as those two disorders share a lot of characteristics.

Functional neuro-ophthalmology.

Patients with physical signs and symptoms for which no adequate organic cause can be found may receive any one of a large range of diagnostic labels, including functional illness, functional overlay, hysteria, hysterical overlay, conversion reaction, psychophysiological reaction, somatization reaction, hypochondriasis, invalid reaction, neurasthenia, psychogenic reaction, psychosomatic illness, malingering, and Münchausen syndrome. In this chapter, we describe both common and uncommon "functional" ocular symptoms and signs, including visual loss in one or both eyes, constricted visual fields and other field defects, various types of ocular motor dysfunction, including disorders of ocular motility and alignment, disorders of pupillary size and reactivity, and abnormalities of eyelid position and function. We also discuss and illustrate the methods by which the nonorganic nature of these manifestations can be determined. In many cases simple techniques performed in the clinic are sufficient to establish a diagnosis of nonorganic ocular disease, whereas in other cases ancillary studies such as electrophysiological testing may be necessary. The chapter also describes the appropriate approach that the physician should take when dealing with a patient who has proven functional ocular signs and symptoms.

Determinantes estructurales en el síndrome de Münchausen / Tittle

En este trabajo nuestra pretensión ha sido estudiar un trastorno que se supone más frecuente de lo que aparece en las estadísticas al uso; nos referimos al “síndrome de Münchausen”, denominado en las modernas clasificaciones como “trastorno facticio”, según terminología aconsejada por Spiro. La aproximación efectuada tiene que ver con un “análisis estructural”, con el que se ha pretendido filiar el citado trastorno en el marco de una de las tres “estructuras clínicas” descritas clásicamente. Para este menester hemos utilizado a una paciente, con ingresos repetidos en la Unidad de Agudos de nuestro hospital, como caso representativo de otros analizados. Debido a las características que presentan estos sujetos (entendidas aquí como “invariantes estructurales”), que se refieren a: transgresión, sometimiento del otro, vivir al servicio de la pulsión, mentir a costa de dañar a los demás, desafío, etc., hemos obtenido como resultado su inclusión en la “estructura perversa”. Entendemos que este discernimiento (estructural) es muy importante para el psiquiatra, pues supone dejar de filiar los comportamientos estudiados como pertenecientes a la histeria o de indicar que los realizan de modo “inconsciente”, al tiempo que induce a la adopción de una postura determinada ante el paciente

The purpose of this work is to study the Münchausen syndrome which is suposed to be more frequent than estadistic shows. In modern classifications this syndrome is called “facticious disorder”, according to the terminology on Spiro’s recommendation. Our approach from structural analysis, aim to insert this disorder as one of the three classical clinical structures. We used the representative case of a patient who was hospitalized over and over again, to set out findings from many others cases. The resultant characteristics from structural analysis as transgressions, lies, to subjugate other´s will looking out drives satisfaction..., reveal the structure of this disorder as a “perverse structure”. We think this distinction is very important for the psychiatrist in order not to confuse this syndrome with hysteria and unconscious phenomena and to adopt the proper attitude in its treatment

Anaesthetic abuse keratopathy as a manifestation of ocular Munchausen's syndrome.

Two patients, both with a history of major depressive disorder, presented with large bilateral corneal epithelial defects and ring-shaped stromal opacities. Both were initially treated unsuccessfully with topical antibiotic therapy for presumed infectious keratitis. One patient eventually admitted to topical anaesthetic abuse. In the second patient, signs of topical anaesthetic abuse and Munchausen's syndrome became evident. Cessation of anaesthetic use resulted in rapid resolution of the corneal epithelial defects in both patients. Anaesthetic abuse keratopathy is often a manifestation of underlying psychiatric illness, and psychiatric intervention is a very important part of management. To the authors' knowledge, this is the first report of ocular Munchausen's syndrome manifesting as anaesthetic abuse keratopathy.

Neuropsychiatric aspects in Munchausen's syndrome.

The case of a 27-year-old woman with Munchausen's syndrome is presented, in whom a history of cerebral palsy and pathological findings from electroencephalogram, cranial computed tomography, and neuropsychological assessment were prominent. It is argued that neuropsychiatric aspects may play a role in the development of Munchausen's syndrome in a subgroup of patients.

Munchausen's syndrome.

Munchausen's syndrome has been acknowledged for many years, receiving the name in 1951. In this article, the prevalence, patient characteristics, clinical presentations, possible concurrent conditions, aetiological factors, differential diagnosis, management and cost (to the patients and NHS) will be discussed.

[Infantile Munchausen syndrome. Etiology, diagnostic criteria, and treatment]. / El síndrome de Münchhausen infantil. Etiología, criterios diagnósticos y tratamiento.

In this paper, we study a special kind of child abuse, the Münchhausen Syndrome by proxy, which consists of a group of diseases that some parents invent in their own children. These parents describe false symptoms of disease in their children, or manipulate the bodies of their children in order to cause alterations. Their purpose is that the doctor will carry out diagnostic tests and medical treatments with the children who really aren't ill. Our objective is to understand this syndrome, so we can report the factors that influence its appearance, study the diagnostic guidelines and the importance of doing a correct differential diagnostic with other real pathologies, and we analyze the preventive and therapeutic measures that health professionals must carry out in children and in their parents. When these professionals understand this syndrome they will be able to detect it before children are subjected to more unnecessary suffering. And, they will be able to prevent that these aggressions on children continue.

[Factitious hypoglycemia--Munchausen syndrome in diabetes mellitus]. / Hypoglykaemia factitia--Münchhausen-syndroma diabetes mellitusban.

The medical history of a 43-year-old non-insulin-dependent diabetic patient is presented. The exact diagnosis of the cause of repetitive and severe hypoglycaemic episodes proved to be difficult. Finally, high serum insulin and low C-peptide values were found in peripheral venous blood during hypoglycaemia resulting in an elevated (> 1.0) molar ratio of insulin to C-peptide. The laboratory findings were assessed as consequences of surreptitious insulin administration. Factitious hypoglycaemia could be considered as a clinical manifestation of Munchhausen syndrome. Confronting the patient with evidences of surreptitious insulin injections, hypoglycaemic episodes abruptly discontinued to occur.

Munchhausen's syndrome in urology.

Munchhausen's syndrome (MHS) is classed among the self-manipulated diseases but frequently is not recognized as such. Patients suffering from MHS successfully obtain repeated invasive diagnostic management by the permanent presentation of various symptoms especially in the surgical branches of medicine. In urology the "haemorrhagic type", the "abdominal type" and the "neurological type" are predominant. In the course of his "history" the MHS patient shows definite organic lesions as a result of numerous artificial and iatrogenic procedures. Consequently diagnosis is more and more difficult. In the majority of cases psychotherapy ends after few psychiatric interviews in the initial stage of therapy. Increasing somatic lesions are predominant.

[Factitious disorder--an iatrogenic disease?]. / Uaegte sygdom--en iatrogen lidelse?

The case of a woman aged 31 years with numerous contacts with the health care system is reported. The patient presented an extremely varied pattern of complaints with pain as one of the most frequently recurring reasons for admission. During the past 12 to 13 years, the patient was admitted to inpatient units on numerous occasions and was submitted to numerous examinations, most of which revealed normal findings. This article lists a number of possible background causes which might permit a career like this to develop. Measures for prevention of similar "case-stories" in future are discussed.

Self-induced hematuria.

Two patients, an adult and a child, are reported who presented with factitious hematuria secondary to self-induced finger sticks with contamination of unwitnessed urine samples. Feigned illness of this kind may be more common than generally appreciated.

Medical and legal aspects of the Munchausen by proxy perpetrator.

The Munchausen by Proxy syndrome is described, and illuminated by case histories. A plea is put forward for the adoption into Israeli law of the doctrine of diminished responsibility, as perpetrators of crimes who suffer from the MbP syndrome are treated by the law as if they had no psychiatric disability.

Ocular Münchhausen syndrome induced by incest.

This report describes a young female patient whose long-lasting ocular problems were ultimately found to be due to self-induced damage of the corneas with chemicals, and later, self-inflicted perforation of the eye with a safety pin. More than one year after these ocular symptoms were presented, it was discovered that the eye diseases were in fact attempts by the patient to escape from the psychic anxieties which were the result of an incestuous relationship between the patient and her father.

The family systems of Munchausen syndrome by proxy.

Munchausen Syndrome by Proxy describes a parent who fabricates the appearance of physical illness in a child. Previous descriptions of the syndrome have focused exclusively upon medical or psychiatric assessments of the involved child and perpetrating parent. The family evaluations of two cases presented here suggest that Munchausen Syndrome by Proxy may be a systemic syndrome generated when a mother already possessing a somatoform or factitious disorder joins an enmeshed, authoritarian family system possessing a systemic history of exploitation of children. We suggest that measures instituted to protect the abused child must take into account the systemic function of the Munchausen by Proxy behavior in maintaining family stability, lest such measures be rendered ineffective by family members. When there is ongoing victimization of perpetrating parents in a similar pattern of dominance/submission within their own family of origin, disruption of these intergenerational patterns of exploitation may be a necessary component of treatment.

The onset of Munchausen's syndrome.

Although Munchausen's syndrome is well known, its mode of onset and development are poorly understood. The authors describe an individual whose developmental history was notable for dyslexia and pathological lying from early childhood, and who later developed Munchausen's syndrome following an explosive separation from his terminally ill father. The patient's simulated genitourinary problems related directly to his father's renal malignancy. The development of his Munchausen syndrome is discussed with reference to his traumatic separation from his father as well and to his preexisting character pathology and probable central nervous system dysfunction.