Transcript Kara White
Munchausen's Syndrome Kara White Dr. Boissonneault Case Study “A Great Pretender Now Faces the Truth of Illness” Miss Scott age 50 Unhappy with childhood Sexually abused and neglected At age 16 had her appendix taken out 1st time in her life she was happy Case study cont… Admitted herself into more than 600 hospitals Had over 42 unnecessary surgeries Would leave one hospital in the AM and be admitted to another by the PM Has spent last year and a half truly sick Yet no one believed her due to her reputation Finally a doctor did some tests and she needed immediate surgery Miss Scott is now on her death bed 3 Types Munchausen's Syndrome Munchausen's Syndrome by Proxy (MSBP) Munchausen's Syndrome by Internet (CyberMunch) Munchausen's Syndrome “a condition characterized by habitual presentation for hospital treatment of an apparent acute physical illness, the patient giving plausible and dramatic history, all of which is false; it is a subtype of factitious disorder.” Usually very knowledgeable about their “illness” Very convincing Most model physical disorders, even though the disease itself is a psychological one Munchausen’s vs. Malingerers vs. Hypochondriacs Malingerers seek medical attention to get themselves out of work, to collect drugs or even insurance Munchausen's pt’s seek strictly for medical attention Hypochondriacs think that they are sick Munchausen's pt’s are fully aware that they are not sick Types Of Patients They research an ailment and then fake the symptoms through acting 1. Faked heart attack on a plane They actually do physical harm to their body to try to mimic a certain ailment 2. Injected drain cleaner into bladder to make bloody urine Or they may even alter lab tests 3. Traded tubes after blood was drawn MSBP “a form of child abuse in which a parent induces a real or apparent symptoms of a disease in child.” Usually biological mothers (90%) Either falsify their child’s medical history or HPI Or they inflict harm to the child to mimic a disease state Common presentations of MSBP GI bleed or UTI Vomiting or reflux Administering prunes or laxatives Apnea (may lead to SIDS) Administering ipeacac or other drugs Diarrhea Put blood in stool or urine sample Suffocate child Hypoglycemia Administer insulin or withhold food Characteristics of Perpetrator Biological mother Usually 20-30 Seem to be loving and caring when around medical staff ALL have some sort of marital conflict 50% with medical training in past Show little emotion when their child is in distress or pain CyberMunch Join support groups on the internet and then falsify stories about themselves so that others will show sympathy towards them and talk to them about their “misfortunes” Article entitled “Cybersickness” Plane crash, molested and diagnosed with leukemia One woman who talked to her commented “To discover that my love and nurturing has been misdirected is like being taunted with my own illness….its devastating.” SO….. The big question is….how are we, as PA’s, supposed to recognize and then treat these patients???? Typical characteristics of Munchausen's Patients Dramatic, but inconsistent medical history Unclear symptoms that are not controllable and that become more severe once treatment has begun Predictable relapses following improvement in condition Extensive knowledge of hospitals and/or medical terminology Presence of multiple surgical scars Characteristics cont… Appearance of new or additional symptoms following negative test results Presence of symptoms only when the patient is being observed by others Willingness or eagerness to have medical tests, operations or other procedures History of seeking treatment at numerous hospitals Reluctance by the patient to meet with family or prior doctors Etiology Not known, considered not only a psychological disorder, but a biological one as well Possible link to personality disorders??? Perpetrator 80% with psychological or mental illness 80% were once victims themselves 60% have attempted suicide 70% history of physical and mental abuse Diagnosis The most important step is recognition Some of the more common presentations Feign Simulate Exaggerate Aggravate Induce A COMPLETE HISTORY is a must!!!! Treatment No current treatment Best method is to get the patient to realize what they are doing to themselves Cognitive behavioral therapy has been used, however, most patients are unwilling to try this Pharmacological therapy has been useful only when other co morbid conditions exist Conclusion This is a REAL disorder These patients have a very high chance of serious health problems ~ 70% chance of dying from this condition if lifelong sufferer Need to be loyal and compassionate with these patients Take the time and get a COMPLETE HISTORY!!!! Questions???? References upon request.