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Yee R, Sim SY, Chow WH, Rajasegaran K, Hong CHL. Munchausen syndrome by proxy: A narrative review and update for the dentist and other healthcare professionals. Dent Traumatol 2024; 40 Suppl 2:23-32. [PMID: 38459657 DOI: 10.1111/edt.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Munchausen syndrome by proxy (MSbP) is a form of abuse in which a caregiver with Factitious Disorder Imposed on Another (FDIA) fabricates or induces signs or symptoms in a person under their care to satisfy a self-serving psychological need. Unnecessary clinical evaluations, procedures, and treatments that are initiated based on falsification by the abuser inadvertently add to the trauma experienced by the victim. It is a form of abuse and the impact on victims can be severe, sometimes fatal, and far-reaching such as prolonged neglect and extension to affected siblings. The long-term exposure to MSbP may predispose the victim to eventually developing factitious disorder imposed on self (FDIS). While MSbP often involves child victims, elderly, adults, and pets have also been reported as victims. MSbP can be a diagnostic challenge, and the important keys to timely identification of MSbP include the ability to detect deception by caregivers through awareness, clinical suspicion, and careful review of available health records; it also involves collecting collaborative information from other relevant healthcare providers including dentists, schoolteachers, and social workers. To date, there are limited published cases of MSbP with oral findings. This paper provides a narrative review of the current understanding of MSbP with a section on cases with oral findings. This paper aims to increase awareness about the clinical presentations and management considerations for MSbP among dentists and other healthcare professionals.
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Affiliation(s)
- Ruixiang Yee
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - Sarah Ying Sim
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Wen Hann Chow
- General Paediatrics Service, KK Women's and Children's Hospital, Singapore
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Goh WY, Chan MPC. Factitious Disorder Imposed on Another in Palliative Care: A Case Report. J Palliat Med 2023; 26:1165-1167. [PMID: 36862535 DOI: 10.1089/jpm.2022.0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
In palliative care, many end-of-life (EOL) patients are physically dependent on their caregivers. These patients may also have difficulty expressing their needs because of their underlying disease and are vulnerable to abuse. Factitious disorder imposed on another (FDIA) describes a condition in which an individual intentionally feigns physical or psychological signs or symptoms in another person with the intention of deceiving medical providers. Although FDIA is a form of abuse that palliative care workers must be aware of because of its multiple impacts on EOL care, it has never been reported in the palliative care literature. In this case discussion, we highlight a woman with advanced dementia who was subjected to FDIA. We discuss the impact of FDIA on EOL care and the management of FDIA in palliative care.
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Affiliation(s)
- Wen Yang Goh
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Mark Peng Chew Chan
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
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Alkhattabi F, Bamogaddam I, Alsagheir A, Al-Ashwal A, Alhuthil R. Munchausen syndrome by proxy: a case report. J Med Case Rep 2023; 17:148. [PMID: 37013583 PMCID: PMC10071623 DOI: 10.1186/s13256-023-03848-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed. CASE PRESENTATION An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center. CONCLUSIONS One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.
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Affiliation(s)
- Fadiah Alkhattabi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia.
| | - Israa Bamogaddam
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Abdullah Al-Ashwal
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Raghad Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
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Fatade O, Ajibade OK. Medicolegal and Ethical Challenges in Diagnosing and Managing Factitious Disorder Imposed on Another (FDIA): A Case Report. Cureus 2022; 14:e31513. [DOI: 10.7759/cureus.31513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/17/2022] Open
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Pragst F, Hartwig S. Repeated poisoning of the life partner by thallium - a case of questionable Munchausen by adult proxy syndrome with ensuing attempted murder. Int J Legal Med 2022; 136:695-704. [PMID: 35190879 DOI: 10.1007/s00414-022-02791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
After the use of thallium as rat poison was banned, the knowledge about the severe and treacherous course of poisonings with this toxic metal has widely been lost. In the present case, the male victim sustained two insidious poisoning attacks in 2017 and 2020 by the perpetrator, his female life partner. In the first poisoning episode, he suffered from increasing heavy pain of the abdomen, stinging pain of both legs, persistent obstipation, hyperesthesia, and, after about 2 weeks, tuft-wise loss of hair as typical symptoms of the thallium poisoning. Within 7 weeks, he was successively examined in six hospitals with a wide variety of diagnostic methods, but a conclusive explanation of the complaints was not found. The possibility of a metal intoxication was then suggested by the perpetrator who privately arranged the analysis of a blood sample with the result of 175 µg/l thallium. Although a criminal poisoning was assumed, the perpetrator was not identified. After the victim left the perpetrator, she subtly executed a second poisoning attack with thallium sulfate (blood level 1230 µg/l after 1 day, urine level 4760 µg/l after 10 days, and hair concentrations 3.26-0.49 from proximal to distal in 9 segments). The perpetrator was sentenced to 10.5 years imprisonment for grievous bodily harm and attempted murder. Because of the behavior of the perpetrator, a Munchausen by proxy syndrome was discussed as a motivation of the first poisoning but was excluded by the psychiatric expert because of a missing antisocial personality disorder.
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Affiliation(s)
- Fritz Pragst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Forensic Medicine, Turmstraße 21 (Haus N), 10559, Berlin, Germany
| | - Sven Hartwig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Forensic Medicine, Turmstraße 21 (Haus N), 10559, Berlin, Germany
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Bursch B, Emerson ND, Sanders MJ. Evaluation and Management of Factitious Disorder Imposed on Another. J Clin Psychol Med Settings 2019; 28:67-77. [DOI: 10.1007/s10880-019-09668-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Di Lorenzo R, Lannocca L, Burattini M, Vasta A, Galletti M, Minarini A, Mongelli F, Sportiello S, Rovesti S, Ferri P. Early death in Munchausen syndrome: A case report. Clin Case Rep 2019; 7:1473-1477. [PMID: 31428370 PMCID: PMC6692973 DOI: 10.1002/ccr3.2254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/04/2019] [Accepted: 05/19/2019] [Indexed: 12/30/2022] Open
Abstract
This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks.
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Affiliation(s)
- Rosaria Di Lorenzo
- Department of Mental Health and Drug Abuse, Psychiatric Intensive Treatment FacilityAUSL ModenaModenaItaly
| | | | | | - Andrea Vasta
- Department of Mental Health and Drug AbuseAUSL ModenaModenaItaly
| | - Martina Galletti
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alessandro Minarini
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Francesca Mongelli
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | | | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
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Reis Carneiro D, Sousa M, Morgadinho A, Januário C. Dopamine dysregulation syndrome induced by proxy. BMJ Case Rep 2019; 12:e228495. [PMID: 31101748 PMCID: PMC6536167 DOI: 10.1136/bcr-2018-228495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 11/04/2022] Open
Abstract
Dopamine dysregulation syndrome is a rare complication of Parkinson's disease (PD) treatment. We present a 70-year-old woman with a long-standing PD and a clinical picture compatible with dopaminergic dysregulation, which was ultimately revealed to be induced by her companion. Patient's exuberant choreiform dyskinesia led to a potential financial advantage when performed outside the hospital but excessive dopamine intake also occurred during hospital admission, without any obvious reward for the abuser. Even in cases where there is no place for a definitive diagnosis, deceptive behaviours must be identified as their management is based on psychological and social support in parallel to the adjustment of PD therapy.
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Affiliation(s)
- Diogo Reis Carneiro
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Mário Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Ana Morgadinho
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Cristina Januário
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
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Lopez-Rico M, Lopez-Ibor JJ, Crespo-Hervas D, Muñoz-Villa A, Jimenez-Hernandez JL. Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. The provider's knowledge of diagnostic criteria and treatment options for Munchausen syndrome and Munchausen syndrome by proxy promotes better outcomes for patients. Without an early diagnosis and intervention, the patient is at high risk for severe complications, including organ failure and mortality.
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Affiliation(s)
- Brittany Abeln
- University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA.
| | - Rene Love
- University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA
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Sousa Filho DD, Kanomata EY, Feldman RJ, Maluf Neto A. Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. ACTA ACUST UNITED AC 2018; 15:516-521. [PMID: 29364370 PMCID: PMC5875173 DOI: 10.1590/s1679-45082017md3746] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/28/2017] [Indexed: 11/22/2022]
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.
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Moreno-Ariño M, Bayer A. Munchausen syndrome by proxy-illness fabricated by another in older people. Age Ageing 2017; 46:166-167. [PMID: 27856413 DOI: 10.1093/ageing/afw217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marc Moreno-Ariño
- Fundacio Hospital Asil de Granollers, Servicio de Geriatría, Granollers, Catalunya, Spain
| | - Antony Bayer
- Department of Geriatric Medicine, Cardiff University School of Medicine, University Hospital Llandough, Penarth CF64 2XX, UK
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Gomila I, López-Corominas V, Pellegrini M, Quesada L, Miravet E, Pichini S, Barceló B. Alimemazine poisoning as evidence of Munchausen syndrome by proxy: A pediatric case report. Forensic Sci Int 2016; 266:e18-e22. [DOI: 10.1016/j.forsciint.2016.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/31/2016] [Accepted: 08/04/2016] [Indexed: 11/25/2022]
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Barros AJS, Rosa RG, Telles LEDB, Taborda JGV. Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature. J Forensic Sci 2016; 61:280-3. [DOI: 10.1111/1556-4029.12873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/29/2014] [Accepted: 12/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alcina Juliana Soares Barros
- Instituto Psiquiátrico Forense Maurício Cardoso; Avenida Diário de Notícias n 200, Room 909, PO Box 90810080 Porto Alegre Brazil
- Universidade Federal do Rio Grande do Sul; Rua São Manoel, 963- Rio Branco, Porto Alegre - RS, 90620-110 Brazil
| | - Regis Goulart Rosa
- Instituto Psiquiátrico Forense Maurício Cardoso; Avenida Diário de Notícias n 200, Room 909, PO Box 90810080 Porto Alegre Brazil
- Universidade Federal do Rio Grande do Sul; Rua São Manoel, 963- Rio Branco, Porto Alegre - RS, 90620-110 Brazil
| | - Lisieux Elaine de Borba Telles
- Instituto Psiquiátrico Forense Maurício Cardoso; Avenida Diário de Notícias n 200, Room 909, PO Box 90810080 Porto Alegre Brazil
- Universidade Federal do Rio Grande do Sul; Rua São Manoel, 963- Rio Branco, Porto Alegre - RS, 90620-110 Brazil
| | - José Geraldo Vernet Taborda
- Instituto Psiquiátrico Forense Maurício Cardoso; Avenida Diário de Notícias n 200, Room 909, PO Box 90810080 Porto Alegre Brazil
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