1
|
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.
Collapse
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
| | | | | |
Collapse
|
2
|
Abraham-Bizot A, Greco C, Quartier P, Loschi S, Soyeux E, Ikowsky T, Lambert AS, Reiter F, Mikaeloff Y, Kone-Paut I. Medical child abuse: Medical history and red flags in French adolescents. CHILD ABUSE & NEGLECT 2023; 146:106523. [PMID: 37950944 DOI: 10.1016/j.chiabu.2023.106523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Medical child abuse (MCA; or Munchausen syndrome by proxy) is a severe form of adult and medical maltreatment of children. Currently, few data on MCA in adolescents exist. OBJECTIVE To describe the clinical characteristics and medical history of children and adolescents aged 10 to 18 years with suspected or confirmed MCA in the pediatric hospital setting. METHODS We included patients aged 10 to 18 years who were seen in five tertiary care hospitals in the Paris area and identified by physician recall such as suspected MCA between 2015 and 2021. RESULTS We included 29 adolescents; the mean (SD) age was 12.9 (10.8-15.0) years at suspected diagnosis. Medical wandering was common, with a mean of 23 (12.8-33.2) alleged symptoms and 33 (9.2-56.8) specialized consultations in a mean of six different hospitals. The mean number of emergency visits was 11.8 (0-25.9) and radiologic exams 24.3 (5-43.6). Overall, 62 % (18/29) of the adolescents had an underlying organic pathology. The impact of MCA on quality of life was major, with a high rate of school dropout (96 %). The mean delay to the suspected diagnosis was 5.8 (2.6-9) years, and even when recognized, it was rarely the subject of a social or judiciary report (only 42 % of adolescents). In total, 50 % of the adolescents subsequently exhibited Munchausen syndrome. CONCLUSION Adolescent MCA is poorly known among the medical profession. Increasing awareness, education and knowledge of risk factors could contribute to better care.
Collapse
Affiliation(s)
- Alexia Abraham-Bizot
- Adolescent Medicine Department, APHP Hôpital Bicetre, Le Kremlin Bicêtre, France.
| | - Céline Greco
- Department of Pain and Palliative Care Unit, APHP, Hôpital Necker-Enfants Malades, F-75015 Paris, France; IMAGINE Institute, INSERM, U1163, Université Paris Cité, F-75015 Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, RAISE Rare Disease Reference Centre, IMAGINE Institute, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Cité, France
| | - Solène Loschi
- Pediatric Emergency Department, APHP Hôpital Armand Trousseau - Sorbonne Université, INSERM UMR1153, Paris, France; Child protection Team, PEPS, APHP Hôpital Armand Trousseau - Sorbonne Université, France
| | - Esther Soyeux
- Department of Pain and Palliative Care Unit, APHP, Hôpital Robert Debré, Paris, France
| | - Tania Ikowsky
- Child protection Team, ESPER, APHP Hôpital Robert Debré, Paris, France
| | - Anne-Sophie Lambert
- Pediatric Endocrinology Department, APHP Hopital Bicetre, Le Kremlin Bicêtre, France
| | - Florence Reiter
- Pediatric Pain Unit, APHP Hôpital Armand Trousseau, Paris, France
| | - Yann Mikaeloff
- CESP, INSERM U1018, UFR Médecine, Université Paris-Saclay, F-91190 Gif-sur-Yvette, France; Child and adolescent protection Centre, APHP Hôpital Paul Brousse, Villejuif, France
| | - Isabelle Kone-Paut
- Pediatric rheumatology department and CEREMAIA, APHP Hôpital Bicêtre, Le Kremlin Bicêtre, France
| |
Collapse
|
3
|
Sun CF, Singh N, Tenzer MM, Kablinger AS. Factitious dermatitis in children and adolescents is highly comorbid with psychiatric disorders. J Psychosom Res 2023; 166:111170. [PMID: 36724627 DOI: 10.1016/j.jpsychores.2023.111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Factitious dermatitis (FD) is a psychocutaneous disorder characterized by self-induced skin lesions. FD is related to mental illness, but the correlation is poorly defined in the pediatric population. Our study aims to investigate the risk of psychiatric disorders diagnosed after the FD diagnosis in children and adolescents. METHODS We conducted a retrospective cohort study over a seven-year period (2016-2022) to measure the incidence and risk ratio of psychiatric disorders in patients under age 19 years. The FD cohort was defined as patients with FD (International Classification of Diseases, ICD-10-CM: L98.1); the control cohort was defined as patients who attended a regular dermatology visit by applying a diagnostic code of disease of the skin and subcutaneous tissue (ICD-10-CM: L00-99). RESULTS A total of 453 patients were identified for analysis. We found that FD patients were more likely to be diagnosed with anxiety disorder (Relative risk [RR] 7.63; P < 0.001), obsessive-compulsive disorder (RR 6.20; P < 0.001), attention-deficit hyperactivity disorder (RR 4.90, P < 0.001), depression (RR 2.27; p = 0.02), sleep disorder (RR 2.23; P = 0.01), impulse disorder (RR 2.20; P = 0.04), and conduct disorder (RR 2.14; P = 0.04) within 1 year following the diagnosis of FD. CONCLUSION FD is highly comorbid with psychiatric disorders. Though some practitioners believe FD could result from experimental or recreational behavior in children and adolescents, possible underlying psychiatric disorders should never be overlooked.
Collapse
Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Neha Singh
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Martha M Tenzer
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, VA,USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| |
Collapse
|
4
|
Chen Y, Li L, Lu J. Purpura with regular shape in an adolescent: Beware of dermatitis artefacta. Front Pediatr 2022; 10:959064. [PMID: 36405818 PMCID: PMC9671281 DOI: 10.3389/fped.2022.959064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Purpura is common in pediatric patients, mostly diagnosed as IgA-related vasculitis (Henoch-Schönlein purpura), idiopathic thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP). However, in some cases, for example, cases with dermatitis artefacta, it could puzzle a physician or pediatrician for a long time, with great challenges in diagnosis. CASE PRESENTATION We present the case of a 13-year-old boy with recurrent painful purpura on both upper limbs. The physical exam was unremarkable, except for right blepharoptosis and scars from burns. The diagnostic tests were normal. Through repeated communication, the patient was finally diagnosed as having dermatitis artefacta, accompanied by underlying psychological problems. CONCLUSIONS Before dermatitis artefacta was diagnosed, we spent a lot of money and effort on the diagnosis. Therefore, in order to determine the diagnosis as soon as possible and save on unnecessary medical expenses, we propose a rapid process for the diagnosis of purpura of dermatitis artefacta in children.
Collapse
Affiliation(s)
- Yuhao Chen
- Department of Pediatrics, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
| | - Lin Li
- Pathology Department, West China Hospital of Sichuan University, Sichuan, China
| | - Jing Lu
- Department of Pediatrics, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
| |
Collapse
|
5
|
Şahin Önder S, Şahin Yılmaz AA, Şahin C, İlçe Z, Kalın S. A Patient with Severe Cervicofacial Subcutaneous Emphysema Associated with Munchausen's Syndrome: A Case Report. Turk Arch Otorhinolaryngol 2021; 59:230-233. [PMID: 34713009 PMCID: PMC8527538 DOI: 10.4274/tao.2021.2021-3-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 12/01/2022] Open
Abstract
Subcutaneous cervicofacial emphysema is a rare and life-threatening condition that results from various causes. In this report, we documented a case of a patient with severe subcutaneous cervicofacial emphysema a condition that falls under the umbrella of Munchausen’s syndrome and discussed the workup of this patient. Thorough diagnostic investigations seeking the etiology of the condition proved unsuccessful. When faced with cases of recurring subcutaneous cervicofacial emphysema, where the root cause remains ambiguous a diagnosis of Munchausen’s Syndrome should be considered.
Collapse
Affiliation(s)
- Serap Şahin Önder
- Department of Otolaryngology, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ayşe Aslı Şahin Yılmaz
- Department of Otolaryngology, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ceyhan Şahin
- Department of Pediatric Surgery, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Zekeriya İlçe
- Department of Pediatric Surgery, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Sevinç Kalın
- Department of Radiology and Imaging, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
6
|
Ruppert R, Jeremy Mao KH. The girl who cried wolf: A literature review and case report of pediatric factitious disorder. Clin Child Psychol Psychiatry 2021; 26:695-705. [PMID: 33624517 DOI: 10.1177/1359104521996742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric presentations of factitious disorder (Munchausen syndrome) remain underdiagnosed and poorly understood compared to adult cases. The purpose of this study is to review the current literature on child and adolescent factitious disorder in order to better understand the differences between pediatric and adult presentations of this disorder. We also present the case of an adolescent girl with factitious disorder; her hospital course draws attention to the excessive healthcare expenditures and risk of iatrogenic complications associated with this diagnosis. We utilized MEDLINE and Google Scholar databases to conduct our review. Despite the limited number of high-quality studies analyzing pediatric presentations of factitious disorder, our review yielded several important findings. Studies suggest that the general acceptance of somatization as a common way for young people to manifest emotional stress may explain the under-diagnosis of this disorder in pediatric populations. Studies also highlighted differences in the clinical characteristics of factitious disorder when patients are stratified by age; most notably, younger patients are more willing to admit intentional falsifications when confronted and more likely to accept treatment, making them a potentially more effective target for intervention.
Collapse
Affiliation(s)
- Ryan Ruppert
- Department of Psychiatry, Keck School of Medicine of USC, Los Angeles, USA
| | | |
Collapse
|
7
|
Brisinski ISV. Additional Aspects. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:67. [PMID: 33785121 DOI: 10.3238/arztebl.m2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Flohr S, Ramette A, Agyeman PKA, Duppenthaler A, Scherer C, Keller PM, Aebi C. Recurrent Mycobacterium chelonae Skin Infection Unmasked as Factitious Disorder Using Bacterial Whole Genome Sequence Analysis. Open Forum Infect Dis 2020; 7:ofaa506. [PMID: 33204765 PMCID: PMC7654377 DOI: 10.1093/ofid/ofaa506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Mycobacterium chelonae infections usually resolve with adequate therapy. We report the case of an adolescent with a chronic and progressive M chelonae infection refractory to combined antimicrobial and surgical therapy. Whole genome sequence analysis of consecutive isolates distinguished reinfection from recurrence and contributed to the diagnosis of a factitious disorder.
Collapse
Affiliation(s)
- Sarah Flohr
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Alban Ramette
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp K A Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Andrea Duppenthaler
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Cordula Scherer
- Department of Pediatric Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Peter M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Christoph Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Deps PD, Aborghetti HP, Zambon TL, Costa VC, Dadalto dos Santos J, Collin SM, Charlier P. Assessing signs of torture: a review of clinical forensic dermatology. J Am Acad Dermatol 2020; 87:375-380. [DOI: 10.1016/j.jaad.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
|
10
|
Sarkar S, Ghosh SK, Sil A. Stereotypical linear purpura of the upper limbs: A report of three cases of a rare psychocutaneous disorder and review of the literature. Indian J Psychiatry 2020; 62:212-216. [PMID: 32382185 PMCID: PMC7197830 DOI: 10.4103/psychiatry.indianjpsychiatry_356_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/02/2019] [Accepted: 12/25/2019] [Indexed: 11/09/2022] Open
Abstract
Mechanically induced purpura with its varied clinical presentations may often pose a great diagnostic challenge to the treating physician. In this report, we seek to familiarize clinicians with a relatively new and rarely diagnosed psychocutaneous disorder, stereotypical linear mechanically induced purpura of the upper limbs, which we had the chance to detect in three teenage girls from Eastern India. A review of the PubMed and Medline database reveals a paucity of information on this subject, especially in the English language literature. Only a handful of reports have been described worldwide till date. However, it is probably hitherto unreported from India.
Collapse
Affiliation(s)
- Sharmila Sarkar
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| |
Collapse
|
11
|
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]
|
12
|
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]
|
13
|
Cortey C, Bréhin C, Claudet I. Purpura of the chin: Two consecutive cases. Arch Pediatr 2018; 25:280-282. [PMID: 29656038 DOI: 10.1016/j.arcped.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/09/2017] [Accepted: 02/18/2018] [Indexed: 11/17/2022]
Abstract
Two healthy children, a 10-year-old boy and a 13-year-old girl, both with no previous medical history, unrelated, presented with pinpoint purpura of the chin and the upper lip. It had appeared 2 days before and extended from the chin to the lower lip. Neither had fever or recent trauma, nor had they taken any medication. Their vital parameters and physical examination were normal. Their peripheral blood cell counts and coagulation parameters were normal. A week later, upon the follow-up consultation, the purpuric lesions had disappeared and both children reported they had played the glass game.
Collapse
Affiliation(s)
- C Cortey
- Pediatric Emergency Department, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - C Bréhin
- Pediatric Emergency Department, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France
| | - I Claudet
- Pediatric Emergency Department, Children's Hospital, CHU de Toulouse, 31059 Toulouse, France; UPS, Inserm, UMR 1027, université de Toulouse, 31059 Toulouse, France.
| |
Collapse
|
14
|
Eminson DM. Somatising in children and adolescents. 1. Clinical presentations and aetiological factors. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.7.4.266] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.
Collapse
|
15
|
Faedda N, Baglioni V, Natalucci G, Ardizzone I, Camuffo M, Cerutti R, Guidetti V. Don't Judge a Book by Its Cover: Factitious Disorder Imposed on Children-Report on 2 Cases. Front Pediatr 2018; 6:110. [PMID: 29721488 PMCID: PMC5915702 DOI: 10.3389/fped.2018.00110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Abstract
Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. We report here two new cases of FDIA. The first one is a 9-year-old boy with a history of convulsive episodes, reduced verbal production, mild psychomotor disorder and urological problems who underwent several invasive procedures and hospitalizations before a diagnosis of FDIA was made. The second is a 12 year-old girl with headache, abdominal pain, lipothymic episodes, seizures and a gait impairment, who was hospitalized in several hospitals before an FDIA was diagnosed.
Collapse
Affiliation(s)
- Noemi Faedda
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Valentina Baglioni
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Natalucci
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Ignazio Ardizzone
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Mauro Camuffo
- Child and Adolescent Neuropsychiatric Unit, Azienda USL Toscana Sudest, Grosseto, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Guidetti
- Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
16
|
Yates G, Bass C. The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) - A systematic review of 796 cases. CHILD ABUSE & NEGLECT 2017; 72:45-53. [PMID: 28750264 DOI: 10.1016/j.chiabu.2017.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Little is known about the perpetrators of medical child abuse (MCA) which is often described as "Munchausen's syndrome by proxy" or "factitious disorder imposed on another". The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature. METHOD A systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes. RESULTS Nearly all abusers were female (97.6%) and the victim's mother (95.6%). Most were married (75.8%). Mean caretaker age at the child's presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%). CONCLUSIONS From the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias.
Collapse
Affiliation(s)
- Gregory Yates
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
| | - Christopher Bass
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| |
Collapse
|
17
|
Hosteing S, Uthurriague C, Boralevi F, Mazereeuw-Hautier J. [A stereotypical clinical presentation of childhood linear purpura of the arms: Analysis of six cases]. Arch Pediatr 2016; 24:45-51. [PMID: 27956314 DOI: 10.1016/j.arcped.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/14/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Among causes of childhood purpura, other- or self-induced mechanical purpura, such as factitious purpura, needs to be considered. This cause is unfamiliar to pediatricians, usually compromising early diagnosis. We report on the cases of six children, seen between 1998 and 2014 at the Toulouse and Bordeaux Departments of Dermatology, presenting with a stereotypical linear purpura on the arms. All were females, aged 6-14 years. One patient had a psychiatric history, whereas the others were undergoing a stressful time period. All had several relapses and diagnosis was delayed in all. The patients presented with multiple oval or square purpuric macules, forming a discontinuous linear band. Some patients reported functional discomfort such as pain or pruritus. Lesions were always located on the arms and sometimes on other areas of the body. Biological assessments were normal and there was no vasculitis at skin histology. We retained the diagnosis of induced mechanical purpura. Psychological support was offered to four patients. One of them declared that the lesions were induced by classmates using suction. Another child declared that she caused the lesions herself, without explaining the mechanism. Outcome was favorable in five children (one was lost to follow-up), 1-4 years after diagnosis. In conclusion, induced mechanical purpura in children, although rarely described in the medical literature, must be kept in mind. Investigations should be carried out in cases with uncertain diagnosis. Underlying psychological distress should be sought.
Collapse
Affiliation(s)
- S Hosteing
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
| | - C Uthurriague
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - F Boralevi
- Service de dermatologie pédiatrique, groupe hospitalier Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J Mazereeuw-Hautier
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| |
Collapse
|
18
|
Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry 2016; 41:20-8. [PMID: 27302720 DOI: 10.1016/j.genhosppsych.2016.05.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Patients with factitious disorder (FD) fabricate illness, injury or impairment for psychological reasons and, as a result, misapply medical resources. The demographic and clinical profile of these patients has yet to be described in a sufficiently large sample, which has prevented clinicians from adopting an evidence-based approach to FD. The present study aimed to address this issue through a systematic review of cases reported in the professional literature. METHOD A systematic search for case studies in the MEDLINE, Web of Science and EMBASE databases was conducted. A total of 4092 records were screened and 684 remaining papers were reviewed. A supplementary search was conducted via GoogleScholar, reference lists of eligible articles and key review papers. In total, 372 eligible studies yielded a sample of 455 cases. Information extracted included age, gender, reported occupation, comorbid psychopathology, presenting signs and symptoms, severity and factors leading to the diagnosis of FD. RESULTS A total of 66.2% of patients in our sample were female. Mean age at presentation was 34.2 years. A healthcare or laboratory profession was reported most frequently (N=122). A current or past diagnosis of depression was described more frequently than personality disorder in cases reporting psychiatric comorbidity (41.8% versus 16.5%) and more patients elected to self-induce illness or injury (58.7%) than simulate or falsely report it. Patients were most likely to present with endocrinological, cardiological and dermatological problems. Differences among specialties were observed on demographic factors, severity and factors leading to diagnosis of FD. CONCLUSIONS Based on the largest sample of patients with FD analyzed to date, our findings offer an important first step toward an evidence-based approach to the disorder. Future guidelines must be sensitive to differing methods used by specialists when diagnosing FD.
Collapse
Affiliation(s)
- Gregory P Yates
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Marc D Feldman
- Department of Psychiatry and Behavioral Medicine, University of Alabama, Tuscaloosa, AL, USA
| |
Collapse
|
19
|
Mitchell M, Blackburn M. "What We've Got Here Is Failure to Communicate": The Value of Reassurance. Hosp Pediatr 2016; 6:380-382. [PMID: 27146970 DOI: 10.1542/hpeds.2015-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Michael Mitchell
- Department of Pediatrics, Palmetto Health Children's Hospital, Columbia, South Carolina; and
| | - Melanie Blackburn
- Department of Pediatrics, Palmetto Health Children's Hospital, Columbia, South Carolina; and University of South Carolina School of Medicine, Columbia, South Carolina
| |
Collapse
|
20
|
Tiokhin L. Do Symptoms of Illness Serve Signaling Functions? (Hint: Yes). QUARTERLY REVIEW OF BIOLOGY 2016; 91:177-95. [DOI: 10.1086/686811] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
Abstract
BACKGROUND Youth have been assumed historically to be less capable of deception than adults, even though acts of deception in childhood are not uncommon. Relatively little attention has focused on how frequently they feign or exaggerate during healthcare evaluations. PURPOSE The current article reviews the literature relevant to using validity tests in children and adolescents, as well as provides a case example of a young adolescent providing noncredible effort and exaggerated symptomatology during neuropsychological evaluation after a mild traumatic brain injury. CONCLUSION Numerous case reports and case series have documented clearly that medical and neuropsychological noncredible presentations occur in children, likely more often than many practitioners believe. Thus far, research has found that the base rates of pediatric noncredible presentations are highest in children seen frequently by rehabilitation providers (i.e., children with persistent problems after mild traumatic brain injury and children from families seeking disability benefits on their behalf). Subjective clinical judgment is apt to be ineffective in consistently detecting noncredible presentations. Fortunately, recent research supports the use of several stand-alone validity tests in identifying noncredible pediatric data including the Test of Memory Malingering, Word Memory Test, and Medical Symptom Validity Test. If feigning and exaggeration are not considered in work-ups by rehabilitation practitioners, mismanagement and iatrogenic harm to the child can result.
Collapse
|
22
|
Alcántara Luna S, García Bravo B, Rodríguez Pichardo A, Camacho Martínez FM. Dermatitis Artefacta in Childhood: A Retrospective Analysis of 44 Patients, 1976-2006. Pediatr Dermatol 2015; 32:604-8. [PMID: 26058478 DOI: 10.1111/pde.12625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatitis artefacta (DA) consists of self-inflicted skin lesions that the patient denies having produced. OBJECTIVES To conduct a single-center retrospective clinical review of children and adolescents diagnosed with DA. METHODS From 1976 to 2006, data were collected on children diagnosed with DA who were seen in the Department of Dermatology in our hospital. Clinical and epidemiologic features are described. Forty-four children (mean age 12.9 yrs) were selected, representing 21.9% of the total patients with DA recorded (n = 201) during this period. RESULTS The most frequent clinical forms were excoriations (16 [36.4%]) and ulcers (10 [22.7%]), followed by blisters (7 [15.9%]), burns (3 [6.8%]), contact dermatitis (3 [6.8%]), hematomas (2 [4.5%]), panniculitis (1 [2.3%]), cheilitis (1 [2.3%]), and hyperpigmentation (1 [2.3%]). Sixteen were located exclusively on the face and neck, whereas 28 also had other locations (upper limbs, n = 10; lower limbs, n = 9; thorax, n = 5; abdomen, n = 4). Cutaneous lesions were treated with occlusive bandages using zinc paste or a plaster splint when necessary. CONCLUSION To our knowledge, this is the largest reported series of DA in childhood. This complicated psychodermatologic condition requires correct diagnosis, appropriate management, and psychiatric assessment.
Collapse
Affiliation(s)
- Sara Alcántara Luna
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Begoña García Bravo
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | |
Collapse
|
23
|
Fabricated or induced illness in the oral cavity in children. A systematic review and personal experience. Cent Eur J Immunol 2015; 40:109-14. [PMID: 26155192 PMCID: PMC4472548 DOI: 10.5114/ceji.2015.50842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Münchausen syndrome by proxy (MSBP) describes a pattern in which a caregiver induces a disease in a child. The symptoms may manifest in the oral cavity. Material and methods PubMed was researched for articles between 1990-2014, presenting manifestations of MSPB, following PRISMA 2009 guidelines, and an in-house case of MSBP with oral manifestations was presented. Review Among 66 articles presenting MSBP symptoms, four included descriptions of oral lesions in five children. They included: tooth loss, ulcerations and ulcers on oral mucosa, scars due to old, healed lesions, bleeding, black tongue, polysialia, and discolouration and swelling in the lips. Münchausen syndrome by proxy with participation of the mother was diagnosed in four cases. Case A 13-year-old girl was hospitalised because of a non-healing ulcer of the septum, loose and lost mandibular teeth, skin lesions, and suspected immunodeficiency. She had been hospitalised numerous times at other facilities. Consultations and diagnostic tests did not confirm an organic disease. The patient and her mother agreed to undergo all examinations, and some symptoms ‘went away’ during the examinations. The behaviour of the patient and her mother during hospital stays, ambulatory care, and the psychiatric observations all pointed towards MPSB. They refused further treatment at the present facility. Conclusions A dentist should take into account the potential ‘fabrication’ of symptoms in a child by the latter or by a caregiver. Consultations with a paediatrician or psychiatrist enable a diagnosis and treatment.
Collapse
|
24
|
Özer Ü, Özgen G, Çeri V, Öztürk N, Türkcan A. Factitious disorder in adolescence. Turk Arch Pediatr 2015; 49:272-3. [PMID: 26078677 DOI: 10.5152/tpa.2014.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/06/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Ürün Özer
- Clinic of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, İstanbul, Turkey
| | - Güliz Özgen
- Clinic of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, İstanbul, Turkey
| | - Veysi Çeri
- Department of Child and Adolescent Psychiatry, Division of Child and Adolescent Psychiatry, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nur Öztürk
- Clinic of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Türkcan
- Clinic of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
25
|
Ring HC, Miller IM, Benfeldt E, Jemec GB. Artefactual skin lesions in children and adolescents: review of the literature and two cases of factitious purpura. Int J Dermatol 2014; 54:e27-32. [DOI: 10.1111/ijd.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hans Christian Ring
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Iben M. Miller
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Eva Benfeldt
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Gregor B.E. Jemec
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
26
|
Kirkwood MW, Peterson RL, Connery AK, Baker DA, Grubenhoff JA. Postconcussive symptom exaggeration after pediatric mild traumatic brain injury. Pediatrics 2014; 133:643-50. [PMID: 24616360 DOI: 10.1542/peds.2013-3195] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A minority of pediatric patients who have mild traumatic brain injury (mTBI) report persistent postconcussive symptoms. In adults, failure on validity tests, which help to detect exaggerated or feigned problems, is associated with symptom complaints. No pediatric studies have examined the relationship between validity test performance and symptom report. We hypothesized that children failing a validity test would report significantly more postconcussive symptoms than those passing. METHODS Using a consecutive clinical case series design, we examined 191 patients aged 8 to 17 years seen for neuropsychological evaluation after mTBI. Participants were administered a validity test (Medical Symptom Validity Test; MSVT) and completed a graded symptom scale as part of a neuropsychological battery. RESULTS A total of 23 participants (12%) failed the MSVT. The Fail group endorsed significantly more postconcussive symptoms than the Pass group, with a large effect size (P < .001; d = 1.1). MSVT performance remained a robust unique predictor of symptom report even after controlling for other influential factors (eg, female gender, premorbid psychiatric problems). CONCLUSIONS A subset of children who had persistent complaints after mTBI may be exaggerating or feigning symptoms. If such negative response bias remains undetected, errors in etiologic statements and less than optimal treatment may occur. Because the detection of invalid responding is well established in neuropsychology, clinical neuropsychologists should be incorporated routinely into clinical care for patients who have persistent complaints. To better control for noninjury effects in future pediatric mTBI studies, researchers should add validity tests to neurobehavioral outcome batteries.
Collapse
|
27
|
Abstract
Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver who falsifies and/or induces a child's illness, leading to unnecessary and potentially harmful medical investigations and/or treatment. This condition can result in significant morbidity and mortality. Although caregiver-fabricated illness in a child has been widely known as Munchausen syndrome by proxy, there is ongoing discussion about alternative names, including pediatric condition falsification, factitious disorder (illness) by proxy, child abuse in the medical setting, and medical child abuse. Because it is a relatively uncommon form of maltreatment, pediatricians need to have a high index of suspicion when faced with a persistent or recurrent illness that cannot be explained and that results in multiple medical procedures or when there are discrepancies between the history, physical examination, and health of a child. This report updates the previous clinical report "Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in the Medical Setting" The authors discuss the need to agree on appropriate terminology, provide an update on published reports of new manifestations of fabricated medical conditions, and discuss approaches to assessment, diagnosis, and management, including how best to protect the child from further harm.
Collapse
|
28
|
Bezner SK, Buchanan GR. Bleeding from the eyes and through intact skin: physiologic, structural, spiritual, or faked? Am J Hematol 2013; 88:713-6. [PMID: 23674472 DOI: 10.1002/ajh.23485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/02/2013] [Accepted: 05/07/2013] [Indexed: 02/03/2023]
Abstract
Patients with an apparent bleeding disorder can usually be diagnosed by a careful history, physical examination, and screening laboratory tests. However, at times the constellation of bleeding signs and symptoms fail to be explained by test results and/or our current understanding of hemostatic mechanisms. One such patient is the subject of the current report. She is a 13-year-old female with a history of striking bleeding manifestations, including spontaneous hemorrhage from her eyes, scalp, hands, and feet. She was evaluated by one of the authors at a teaching hospital in Mumbai, India in March 2009 during the filming of a National Geographic Channel documentary characterizing puzzling medical disorders encountered in India. Given her unusual bleeding manifestations, she received international media attention at the time. National Geographic and a film company in the United Kingdom subsequently expressed interest in highlighting the patient to document her seemingly rare hematologic disorder and contacted the American Society of Hematology to identify an American hematologist to further investigate the case. With consent of the family and collaboration with a hematologist practicing at a teaching hospital in Mumbai, filming commenced during March 2009 in an attempt to capture the patient's diagnosis and the cultural and medical milieu in which the bleeding events occurred.
Collapse
Affiliation(s)
- Stephanie K. Bezner
- Department of Pediatrics; University of Texas Southwestern Medical Center; Dallas; Texas
| | - George R. Buchanan
- Department of Pediatrics; University of Texas Southwestern Medical Center; Dallas; Texas
| |
Collapse
|
29
|
Kozlowska K, Foley S, Savage B. Fabricated illness: working within the family system to find a pathway to health. FAMILY PROCESS 2012; 51:570-587. [PMID: 23230986 DOI: 10.1111/famp.12000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The term medically unexplained symptoms refers to a clinical presentation where the child's symptoms and impairment cannot be explained by any known organic pathology, and may include conversion disorders, somatoform pain disorders, factitious disorder, and factitious disorder by proxy. In this case study, we present our treatment of a 9-year-old girl with a 2-year history of medically unexplained abdominal cramping and vaginal discharge. During the 9 months that we worked with this family, we were never able to clarify in our own minds the source of the child's symptoms--that is, who was responsible for their induction or who was the instigator or maintainer of the exaggerated symptoms. Nor did we come to fully understand the function of the symptoms in the family system. Our case report does not answer either of these questions. Instead, we describe how we worked with the family despite the ongoing ambiguities as to why the symptoms were occurring and who was inducing them. The functional outcome was disappearance of symptoms, return to full school attendance, and improved parenting behavior.
Collapse
Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | | |
Collapse
|
30
|
Brajon D, Cuny JF, Law Ping Man L, Studer M, Barbaud A, Schmutz JL. [Factitious purpura chin]. Ann Dermatol Venereol 2012; 139:599-600. [PMID: 22963975 DOI: 10.1016/j.annder.2012.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/22/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Affiliation(s)
- D Brajon
- Service de dermatovénéréologie, hôpital Brabois, CHU de Nancy, bâtiment des spécialités médicales, avenue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | | | | | | | | | | |
Collapse
|
31
|
Wallace DP, Sim LA, Harrison TE, Bruce BK, Harbeck-Weber C. Covert video monitoring in the assessment of medically unexplained symptoms in children. J Pediatr Psychol 2012; 37:329-37. [PMID: 22427700 DOI: 10.1093/jpepsy/jsr098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diagnosis of medically unexplained symptoms (MUS) occurs after thorough evaluations have failed to identify a physiological cause for symptoms. However, families and providers may wonder if something has been missed, leading to reduced confidence in behavioral treatment. Confidence may be improved through the use of technology such as covert video monitoring to better assess functioning across settings. METHODS A 12-year-old male presented with progressive neurological decline, precipitated by chronic pain. After thorough evaluation and the failure of standard treatments (medical, rehabilitative, and psychological) covert video monitoring revealed that the patient demonstrated greater abilities when alone in his room. Negative reinforcement was used to initiate recovery, accompanied by positive reinforcement and a rehabilitative approach. Covert video monitoring assisted in three subsequent cases over the following 3 years. RESULTS AND CONCLUSIONS In certain complex cases, video monitoring can inform the assessment and treatment of MUS. Discussion includes ethical and practical considerations.
Collapse
Affiliation(s)
- Dustin P Wallace
- Integrative Pain Management, Children's Mercy Hospital, Kansas City, MO 64108, USA.
| | | | | | | | | |
Collapse
|
32
|
|
33
|
Abstract
We describe a 10-year-old girl who presented with bizarre purpura. Both congenital and autoimmune hemorrhagic disorders were excluded based on her past medical history and physical and laboratory findings. Child abuse was also ruled out as purpura continued to develop after child-family separation. Histologic examination of the skin lesions revealed disruption of collagen fiber bundles. This finding indicated application of external force, leading to a definitive diagnosis of factitious purpura. Although it is very rare in school-age children, the diagnosis of factitious purpura should be included in the differential diagnosis of purpura in children. Histologic analysis of skin biopsies may aid in establishing the diagnosis.
Collapse
Affiliation(s)
- Kayo Yamada
- Department of Pediatrics, Nara Medical University School of Medicine, Kashihara, Japan
| | | | | | | | | |
Collapse
|
34
|
Ehrlich S, Pfeiffer E, Salbach H, Lenz K, Lehmkuhl U. Factitious Disorder in Children and Adolescents: A Retrospective Study. PSYCHOSOMATICS 2008; 49:392-8. [DOI: 10.1176/appi.psy.49.5.392] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
Affiliation(s)
- M Stephen Murphy
- Division of Reproductive and Child Health, Medical School, University of Birmingham, Birmingham B15 2TT.
| |
Collapse
|
36
|
Le Heuzey MF, Mouren MC. [Münchhausen syndrome by proxy]. Arch Pediatr 2008; 15:85-8. [PMID: 18178391 DOI: 10.1016/j.arcped.2007.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
Münchhausen syndrome by proxy is a factitious disorder, a disease produced or simulated by a parent, the mother in most cases. Clinical presentation is miscellaneous (factitious bleeding, epilepsy, apnea are frequent) and unusual. Physicians participate in the abuse by their therapeutic and diagnostical measures. It is very important to think about this diagnostic in any ambiguous situation in order to evaluate and protect the child.
Collapse
Affiliation(s)
- M-F Le Heuzey
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
| | | |
Collapse
|
37
|
Hässler F, Zamorski H, Weirich S. [The problem of differentiating between sudden infant death syndrome, fatal Munchausen's syndrome by proxy, and infanticide]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:237-44; quiz 245-6. [PMID: 17970367 DOI: 10.1024/1422-4917.35.4.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sudden infant death syndrome (SIDS) is the most common type of post-neonatal death in infants under 1 year of age. It is defined as the sudden death of an infant that is unexpected on the basis of the child's history and unexplained by a thorough post-mortem examination. The incidence of SIDS in Germany has fallen from 1.7 per 1000 live births in 1990 to 0.62 in 2000. In the U.K. the incidence was 0.56 in 1998. According to the literature, 5 to 11 percent of deaths recorded as SIDS may be disguised homicides. These homicides can be caused by a Munchausen's syndrome by proxy (MSBP). Munchausen's syndrome by proxy is defined as an extreme form of abuse wherein the caregivers produce symptoms of illness in a child by means of internal or by external manipulation. Using case reports, this paper examines some difficulties in differentiating between SIDS, MSBP, and homicide. CASE REPORT In a family with three children, the youngest daughter died suddenly of suffocation at the age of 17 months. Before her death, the child had been admitted 11 times to different hospitals for various reasons. The mother reported that her daughter was admitted for epileptic seizures, suffocation attacks, and diarrhoea. No noticeable organic signs or symptoms were found during the child's stays in a hospital. The girl was discharged each time without symptoms and without a clear-cut diagnosis. Toxicological analysis of the blood revealed the presence of caffeine. Clinically, an accidental death appeared to be unlikely. CONCLUSIONS When assessing cases of SIDS, a MSBP, or homicide, practitioners should be on the lookout for recurrent symptoms of illness, repeated hospitalisation and/or consultation of physicians, multiple diagnostic procedures without establishment of a clear-cut diagnosis, a certain resistance to therapy, illness or unnatural death of siblings, and repeated signs of poisoning or suffocation. Differentiation between SIDS, MSBP, and homicide should be extensive and done with great care since the legal consequences differ vastly according to the facts of the matter.
Collapse
Affiliation(s)
- Frank Hässler
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter des Universitätsklinikums Rostock.
| | | | | |
Collapse
|
38
|
Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007; 27:855-71. [PMID: 17804131 DOI: 10.1016/j.cpr.2007.07.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 06/04/2006] [Accepted: 02/07/2007] [Indexed: 01/30/2023]
Abstract
A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.
Collapse
Affiliation(s)
- D Mary Eminson
- Bolton Hospitals NHS Trust, Child and Adolescent Mental Health Services, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton BL4 OJR, UK.
| |
Collapse
|
39
|
Abstract
The high visibility of dermatologic diseases and their easy accessibility make the skin a primary and direct target for dysfunctional behaviors. Self-harm tendencies can frequently be expressed through dermatologic lesions, and dermatitis artefacta falls within this clinical frame. The occurrence of this cutaneous manifestation in children is very rare, with a peak of greater frequency in adolescence. We describe the characteristics of a multidisciplinary intervention-dermatologic and psychologic. Our pediatric patient displays a dermatologic picture that has no etiologic confirmation. The source of this disorder must therefore be found in socio-relational difficulties within the family and school environments, which lead the patient to self-harm behaviors that have a high communication value.
Collapse
Affiliation(s)
- Enzo D Finore
- Clinical Psychology and Psychosomatic Psychotherapy Service, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | | | | | | | | | | |
Collapse
|
40
|
Angus J, Affleck AG, Croft JCR, Leach IH, Slater DN, Millard LG. Dermatitis artefacta in a 12-year-old girl mimicking cutaneous T-cell lymphoma. Pediatr Dermatol 2007; 24:327-9. [PMID: 17542895 DOI: 10.1111/j.1525-1470.2007.00418.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatitis artefacta or factitious disease may be unrecognized in children. We present a 12-year-old girl who had an unusual facial lesion on the chin, which was self-inflicted but histologically mimicked cutaneous T-cell lymphoma. Our report emphasizes both the potential diagnostic pitfalls and the importance of clinicopathologic correlation.
Collapse
Affiliation(s)
- Janet Angus
- Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
| | | | | | | | | | | |
Collapse
|
41
|
Larochette AC, Chambers CT, Craig KD. Genuine, suppressed and faked facial expressions of pain in children. Pain 2006; 126:64-71. [PMID: 16860478 DOI: 10.1016/j.pain.2006.06.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 05/26/2006] [Accepted: 06/09/2006] [Indexed: 11/22/2022]
Abstract
Children's efforts to hide or exaggerate facial expressions of pain were compared to their genuine expressions using the cold pressor task. Fifty healthy 8- to 12-year-olds (25 boys, 25 girls) submerged their hands in cold and warm water and were instructed about what to show on their faces. Cold 10 degrees C water was used for the genuine and suppressed conditions and warm 30 degrees C water was used for the faked condition. Facial activity was videotaped and coded using the Facial Action Coding System to provide objective, detailed accounts of facial expressions in each condition, as well as during a baseline condition. Parents were subsequently asked to correctly identify each of the four conditions by viewing each video clip twice. Faked expressions of pain in children were found to show more frequent and more intense facial actions compared to their genuine pain expression, indicating that children had some understanding but were not fully successful in faking expressions of pain. Children's suppressed expressions, however, showed no differences from baseline facial actions, indicating that they were able to successfully suppress their expressions of pain. Parents correctly identified the four conditions significantly more frequently than would be expected by chance. They were generally quite successful at detecting faked pain, but experienced difficulty differentiating among the other conditions. The results indicate that children are capable of controlling their facial expressions of pain when instructed to do so, but are better able to hide their pain than to fake it.
Collapse
Affiliation(s)
- Anne-Claire Larochette
- Department of Psychology, Dalhousie University, Pediatric Pain Research Lab, IWK Health Centre, Canada
| | | | | |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW Factitial skin diseases are characterized by unusual patterns of skin lesions that do not conform to any known dermatologic condition and that are consciously or subconsciously fabricated by the patient. This review summarizes the current literature regarding the diagnosis and management of factitial dermatoses in children. RECENT FINDINGS Neurotic excoriations, acne excoriee and trichotillomania are the most common factitial skin diseases seen in children. Dermatitis artefacta is also seen in children, but is less common. In many cases, the development of factitial skin disease is associated with a comorbid psychiatric condition or identifiable psychosocial stressor. With regard to the management of factitial dermatoses in children, it is of paramount importance for the clinician to establish an appropriate physician-patient-family relationship. Although controlled studies in children are lacking, pharmacologic and/or nonpharmacologic adjunctive therapy can be helpful in the treatment of these difficult conditions. SUMMARY The diagnosis and management of factitial skin diseases in children is a challenge. Clinicians caring for children should be able to recognize the common factitial dermatoses that are seen in the pediatric population. The conveyance of support and acceptance by the physician is essential to the treatment process. Both psychotherapy and psychopharmacology can be important adjunctive treatments.
Collapse
Affiliation(s)
- Kara N Shah
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA.
| | | |
Collapse
|
43
|
Síndrome de Munchausen y gestación. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2005. [DOI: 10.1016/s0210-573x(05)73504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
44
|
Saez-de-Ocariz M, Duran-McKinster C, Orozo-Covarrubias L, Ruiz-Maldonado R. Dermatitis artefacta in a teenager after awareness of his HIV-positive diagnosis. Clin Exp Dermatol 2005; 30:92-3. [PMID: 15663518 DOI: 10.1111/j.1365-2230.2004.01665.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Abstract
OBJECTIVES AND METHODS Munchausen Syndrome by Proxy (MSP) may significantly hamper the normal development of children. Our aim was to describe the first two Israeli children who fit this diagnosis. RESULTS Case #1 was diagnosed at the age of seven months with failure to thrive, severe recurrent vomiting, and recurrent unexplained fever. Medical tests performed were normal. No improvement was noted following prolonged treatment, which included several surgical interventions. Case #2 was hospitalized at the age of four years because of recurrent convulsive episodes. Medical examinations performed were normal, and there was no improvement in the reported seizure disorder despite continuous treatment. In both cases, MSP was suspected because of a persistent illness that could not be explained by adequate medical basis, and because the symptoms and signs occurred only in the mother's presence. A confrontation was made, leading to rapid deterioration of the hitherto devoted relationship of the mother of case #1 with her child, and of the previous cooperative relationship of both mothers with the medical staff. Removal of both children from their families ensued, with considerable improvement within a brief period, which continued in a one- to two-year follow-up period. CONCLUSIONS The study reviews the required diagnostic criteria for MSP and possible treatment options.
Collapse
Affiliation(s)
- Maria Moldavsky
- Pediatric Psychiatry Unit, Wolfson Medical Center, Holon, Israel.
| | | |
Collapse
|
46
|
Affiliation(s)
- Maureen Rogers
- Children's Hospital Medical Center, Westmead, NSW, Australia
| |
Collapse
|
47
|
Saez-de-Ocariz M, Orozco-Covarrubias L, Mora-Magaña I, Duran-McKinster C, Tamayo-Sanchez L, Gutierrez-Castrellon P, Ruiz-Maldonado R. Dermatitis artefacta in pediatric patients: experience at the national institute of pediatrics. Pediatr Dermatol 2004; 21:205-11. [PMID: 15165196 DOI: 10.1111/j.0736-8046.2004.21303.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatitis artefacta is a factitious disorder in which there is deliberate conscious production of skin lesions. There are only a few reports that evaluate instances of dermatitis artefacta in the pediatric population. The aim of this retrospective study was to assess the characteristics of patients with this disorder who were seen at the National Institute of Pediatrics in Mexico City. The records of all patients diagnosed with dermatitis artefacta from January 1980 to December 1999 were analyzed. There were 29 patients (25 females, 4 males). The upper limbs and the face were the most commonly involved areas. Superficial erosions were the most frequent initial event, and residual lesions consisted of scars and crusts. Time taken to diagnosis was on average 10 months. Half of the patients were lost to follow-up. No correlation was found between the length of time from the disease onset to diagnosis, the type of lesions, and the clinical outcome. Twelve patients had an associated systemic disorder. The possible association with chronic disease has not been sufficiently stressed and demonstrates the importance of providing psychological support for these patients. Psychiatric diagnoses were anxiety, depression, and personality disorder. No correlation was found between the psychiatric diagnosis and the outcome of dermatitis artefacta. A young age at presentation, which has been considered important as a favorable prognostic sign, could not be demonstrated in our patients.
Collapse
|
48
|
Affiliation(s)
- Herbert Schreier
- Department of Psychiatry, Children's Hospital and Research Center at Oakland, CA, USA
| |
Collapse
|
49
|
Abstract
We report two cases of bathtub suction-induced purpura. Two girls, ages 9 and 14 years, developed recurring purpura "spontaneously" in the same lower back location and in the same U-shaped distribution. The patients had similar histopathologic findings, with extravasated erythrocytes and a sparse superficial inflammatory infiltrate. After extensive evaluation, one patient eventually admitted to self-inducing her lesions by creating suction against a bathtub. The second patient denied self-inflicting her lesions; however, her purpura improved when she stopped taking baths.
Collapse
Affiliation(s)
- Maeran C Landers
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | |
Collapse
|
50
|
Abstract
The deliberate production or feigning of signs or symptoms in a child by a caretaker is well recognized as factitious disorder by proxy, a psychiatric condition commonly reported in the pediatric literature. However, it is not as well recognized that the false illness portrayal may also be the result of a parent instructing the child to malinger. A case report of a 13-year-old patient who feigned an immobile upper extremity for the purpose of obtaining a legal settlement is presented. Physicians are encouraged to make protecting the child from parental or iatrogenic harm a priority. Recommendations for careful confrontation and expedient resolution are made.
Collapse
Affiliation(s)
- John T Stutts
- Division of Pediatric Gastroenterology and Nutrition, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | | | | |
Collapse
|