[Motor activity in psychogenic arm palsy confirmed by polysomnography (clinical case)]. / Dvigatel'naia aktivnost' pri psikhogennom paraliche, zaregistrirovannaia pri polisomnografii (klinicheskii sluchai).

According to current criteria, the diagnosis of psychogenic motor defect is based on the tests which allow recording of movements in the pseudo-paralyzed extremity. Using polysomnography, electromyography and videomonitoring of motor activities during sleep, movements in the pseudo-paralyzed left arm were recorded in a patient with Munchhausen syndrome and psychogenic plegia in the left arm. A reduced motor activity in the left side of the body, in particular in the pseudo-paralyzed arm was observed as well. Possibilities of using movement monitoring during sleep for the diagnosis of psychogenic motor defect are discussed.

Síndrome de munchausen en la infancia y la adolescencia: de la hiperfrecuentación de consultas al maltrato / Munchausen syndrome in childhood and adolescence: from very frequent visits to the doctor´s office to maltreatment

Los autores exponen el concepto actualizado de síndrome de Munchausen por podres. Caracterizan de forma actualizada y detallada: 1. Formas clínicas del síndrome de Munchausen. 2. Factores de riesgo familiar (en ambas figuras parentales y en el niño). 3. Características evolutivas. 4. Funcionamiento del sistema sanitario: hiperfrecuentados de servicios sanitarios. 4. Bases para la intervención terapéutica: primera etapa en los servicios pediátricos de Atención Primaria y segunda etapa en los servicios de Salud Mental de la Infancia. Se destaca la importancia de las técnicas de interconsulta y enlace desde los Servicios de Pediatría y Psiquiatría Infantil para el tratamiento del síndrome de Munchausen por poderes (AU)

The authors present an approach to the Munchausen´s Syndrome by Proxy. Focusing on the clinical features including psychopathological and psychosocial profile. Authors consider also family risk factors- both the parenting and the children, developmental characteristics and Health Care Services delivery its relationship with the impact on the clients attendance. The therapeutic interventions was implemented in tow phases: the first phase Primary Care Paediatric setting, and the second phase in Child Psychiatry Services. Authors emphasize the relevance of the liaison-consultation between Paediatrician and Child Psychiatrist as a key procedure to approach Munchausen´s Syndrome by Proxy treatment (AU)

Simulation of a pheochromocytoma--Munchausen syndrome.

A 46-year old female nursing sister was admitted to three different hospitals because of blood pressure crises of 300/150 mmHg which occurred up to six times a day. The rises in blood pressure were accompanied by headache, tachycardia and outbreaks of sweating. Raised catecholamine concentrations were repeatedly measured in the 24-hour urine and in the blood. The diagnosis of pheochromocytoma could therefore be regarded as confirmed. The investigations to establish the localization (including MIBG scintigrams carried out several times) showed negative results. Octreotide scintigraphy finally revealed a raised concentration of nuclides in the right adrenals. Selective venous blood samples showed markedly raised concentrations of adrenaline and noradrenaline in all regions investigated. After removing the right adrenal, which was of normal histological appearance, there was an improvement for six months. Afterwards, up to six blood pressure crises per day were observed once more. Fresh determination of catecholamines at various levels demonstrated the highest concentrations in the left iliac vein. It was then shown that the patient injected catecholamines intravaginally even during the angiographic investigation. A search of the patient s room revealed several ampoules containing noradrenaline and adrenaline as well as syringes and needles. - This case shows that in clinical pictures with typical clinical symptoms and negative results of repeated investigations a factitious disorder must be considered in terms of differential diagnosis especially when female patients with medical knowledge who have ready access to drugs are involved with a history comprising several stays in hospital which have not produced any clarification of their condition.

Urological aspects of Munchausen's syndrome.

Munchausen's syndrome (MHS) is classed among the self-manipulated disease but is frequently 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 'hemorrhagic 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 gets 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.

Tc-99m HMPAO brain SPECT scanning in Munchausen syndrome.

Regional cerebral blood flow was studied in a patient with Munchausen syndrome using high resolution Tc-99m HMPAO SPECT. The scan demonstrated marked hyperperfusion of the right hemithalamus. The cranial CT scan was normal. The abnormal right hemithalamic blood flow is discussed in relation to the hypothesized neuropathy of this disorder.

Síndrome de Munchausen en niños: informe de dos casos / Munchausen syndrome in children: clinical considerations and report of two cases

Se señala la existencia de una forma poco conocida de maltrato en los niños. Síndrome de Munchausen "by proxy" mediante la presentación de dos casos clínicos vistos en el Depto. de Medicina Interna del Instituto Nacional de Pediatría. Consideramos necesario enfatizar la forma de presentación de dicha entidad clínica, señalando la exactitud de datos clínicos tal y como los familiares los presentaron a los médicos, el número de profesionales que participaron en la atención de estos niños así como el exagerado número de estudios de laboratorio y gabinete realizados. La discrepancia en la terminología para señalar esta patología da la oportunidad de emplear el término de "síndrome de Munchausen en niños" para podermo diferenciar del empleado en psiquiatría. La necesidad de alertar a la comunidad médica que de una u otra forma atiende niños sobre estas formas poco comunes de maltraro permitirá en primer término reconocer y tratar tempranamente esta problemática pediátrica lo que a su vez evitará un reforzamiento de las actitudes del perpetrador

Munchausen syndrome by proxy and apnea (MBPA). A survey of apnea programs.

The authors sent questionnaires to 127 apnea monitoring programs asking whether they had treated patients whose apnea appeared to have been induced by a parent (Munchausen syndrome by proxy-apnea, or MBPA). Fifty-one programs (40%) reported 54 cases of this kind from among their 20,090 monitored patients (0.27%). The authors obtained further information on 32 of these patients, 83% of whom presented with infantile apnea before the third month of life. Although medical problems were documented, including apnea, the clinical condition of these infants was inconsistent with the multiple life-threatening episodes typically reported by parents. Twenty-one of the infants reportedly received cardiopulmonary resuscitation at home, 15 had ambulance calls to the home, and 24 were rehospitalized. Child Protective Service agencies were consulted for 12 patients, 5 of whom were placed in foster homes. Three index infants and five siblings are known to be dead, and one additional infant is severely brain damaged from abuse.

Cerebral dysfunction in the Munchausen syndrome.

Brain dysfunction has been noted Munchausen syndrome patients but rarely explored. We describe five Munchausen syndrome patients who all appeared intellectually intact because of their excellent verbal skills. However, formal neuropsychological assessment testing revealed deficits in conceptual organization, management of complex information, and judgement. We suggest that subtle but important neuropsychological impairment may contribute significantly to the aberrant behavior of Munchausen syndrome patients. Typical Munchausen behaviors such as irascibility, the desperate search for care, and pseudologia fantastica, may be understood as solutions to problems created by brain damage.

[Factitious diseases and Münchausen's syndrome]. / Les maladies factices et le syndrome de Münchausen.

Factitious diseases in which the symptoms are simulated or created intentionally are very varied: functional manifestations, haemorrhages, anaemia, pyrexia, metabolic disturbances (hypoglycaemia, hypokalaemia, hyperthyroidism, etc.), skin lesions and others. Different symptomatic associations are possible. The Munchausen syndrome which is mainly seen in anglo-saxon countries, is characterised by a long history of factitious symptoms in subjects with psychological profiles which are difficult to define because of the very behaviour of the patients themselves. Besides this syndrome, many psychological disorders have been described in patients presenting with factitious symptoms. One particular form is the creation of factitious diseases in children by their parents. The diagnosis of factitious disease is always difficult and confirmatory proof cannot always be obtained apart from certain cases in which laboratory tests show the presence of drugs in the plasma or urine. Psychotherapy which appears to be essential for these patients is generally very difficult to achieve.