The limits of Munchausen's syndrome

Factitious disorders in a general hospital setting: clinical features and a review of the literature

Factitious disorder is an uncommon, but probably underdiagnosed, condition associated with considerable morbidity, mortality, and health care expenditure. This diagnosis was made in 10 (0.8%) of 1,288 patients consecutively referred to the psychiatric consultation-liaison service of a tertiary-care general hospital. Seven of 10 identified cases were female. Associated psychiatric disturbances included substance use, psychogenic pain disorder, malingering, dysthymic disorder, and borderline personality disorder. Only two cases accepted ongoing psychotherapy. One death due to factitious behavior occurred during the brief period of follow-up. Greater awareness of this condition among primary caregivers is necessary in order to improve case identification and to reduce associated morbidity.

Thiopental-facilitated interview in respiratory Munchausen's syndrome

We report an unintentional thiopental-facilitated interview in a patient presenting with apparent respiratory failure as a manifestation of Munchausen's syndrome. Unnecessary intubation was avoided and correct diagnosis was made using the thiopental interview. Patients with suspected Munchausen's syndrome represent a difficult dilemma for the emergency physician. Use of the barbiturate-facilitated interview in the emergency department may reveal the diagnosis and prevent unnecessary procedures and hospitalization.