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At least 415 records · Page 23Linked to original sources
PubMed1993

Apnea and factitious illness (Munchausen syndrome) by proxy.

OBJECTIVE: Munchausen syndrome by proxy (MSP) is recognized in the differential diagnosis of apparent life-threatening events, but the early signs and the full spectrum of this presentation are not well recognized. We aim to describe MSP presenting with apnea to illustrate this spectrum and the evolution in our management over a period of 10 years. PATIENTS AND RESULTS: Eleven children in five families seen in one institution and assessed by one team are described in detail. The children had apnea and/or pallor, but with a wider age range than usually seen with apparent life-threatening events, sometimes associated with other injuries, and a large percentage of parents were health care providers. In no case was apnea witnessed by health care professionals other than the parents. There were frequent disagreements in management between professionals and, consequently, delays in considering the diagnosis at first. There were two deaths. A team developed, allowing the diagnosis of MSP to be considered sooner and the cases to be assessed and managed consistently. CONCLUSION: MSP is part of child abuse, and it needs to be recognized by all physicians. Family assessment is required and the development of a team interested in MSP facilitates assessment and management.

Apnea↗
PubMed1993

Munchausen syndrome by proxy: social work's role.

Munchausen syndrome by proxy is the diagnosis used to describe a variation of child abuse whereby the parent or adult caregiver fabricates a medical history or induces symptoms in the child, or both, resulting in unnecessary examinations, treatments, hospitalizations, and even death. This article reviews the assessment procedures, provides case studies, and describes family dynamics of the syndrome. The authors make recommendations for team management of the child-family system and recommendations for social workers. They propose broadening the assessment of the family on the basis of knowledge of the widespread physical and economic oppression of women and children in our society.

Child↗
PubMedDate not supplied

At mother's mercy: the nightmare of Munchausen syndrome by proxy.

Munchausen syndrome by proxy is a form of child abuse in which a parent simulates or produces illness in a child for the purpose of engaging in a supportive relationship with a physician or other health care provider. The child suffers from the parent's actions and is subjected to significant morbidity due to extensive medical diagnostic procedures ordered by the unsuspecting physician. The purpose of this paper is to provide a better understanding of this disorder with respect to presentation, pathogenesis, and recognition.

Child, Preschool↗
PubMed1995

Is it Munchausen syndrome by proxy?

We describe two cases of children who were victims of illness fabricated by their mothers. Such clinical situations are identified as Munchausen syndrome by proxy (MSP). Although considered a form of child abuse, MSP often goes unrecognised in paediatric practice. The two children involved were unnecessarily investigated, and the underlying problems in the mothers were identified only after several hospital admissions. One mother had a major psychiatric disorder, and the other had serious marital problems. Maintaining a high degree of suspicion regarding inexplicable illness in a child with inappropriate or incongruous symptoms and signs, even when parents behave in an exemplary manner, would help in early diagnosis and management.

Child, Preschool↗
PubMed1996

[Münchhausen syndrome by proxy between two adults].

OBJECTIVES: Münchhausen syndrome by proxy has been well described in the case of a women producing or pretending symptoms in one of her children, leading that child to have numerous medical interventions. The case of two adults has been seldom described and the differences in the psychopathological features of the two situations are not well known. METHODS: We report our observation of a Münchhausen syndrome in a married couple where the wife injected tranquilizers to her husband, inducing repeated episodes of coma. Complex interactions between the pathological personalities of the husband and wife were present. Prominent features of the wife's personality included a narcissistic deficiency, poor defenses and signs of depression. DISCUSSION: Practioners should be aware of this peculiar pathology to avoid delayed diagnosis and its dramatic consequences. Appropriate medical, psychiatric, as well as legal measures must be taken.

Adolescent↗
PubMedDate not supplied

Munchausen syndrome by proxy.

This article provides an overview of Munchausen syndrome by proxy. It examines current definitions and looks at the varied clinical presentations. The characteristics of the perpetrators are described with a view to aiding early identification and intervention.

Child↗
PubMed1996

Munchausen-by-proxy syndrome: countertransference as a diagnostic tool.

The authors report on an unusual reaction in clinicians interviewing known perpetrators of Munchausen-by-proxy syndrome (MBPS): an uncanny, ego-dystonic, and cognitively dissonant sense that the parent could not be the perpetrator, despite all clinical/forensic evidence. The authors suggest that this reaction can have various sources: One may be "as-if" character pathology in the parent, with the capacity to evoke, unconsciously, disbelief in the clinician. Given the poor treatment outcome reported in MBPS perpetrators, the authors suggest that, if confirmed, this finding will lead to more accurate psychiatric diagnosis of the parent, and more informed treatment of this potentially harmful or lethal syndrome.

Adult↗
PubMed1996

"Munchausen by proxy" syndrome in a small bowel transplant recipient.

Munchausen by Proxy is potentially one of the most harmful forms of child abuse with a reported mortality rate of nearly 10% and may be a secondary cause of chronic intestinal pseudo-obstruction. If MBP is suspected, prompt action should be taken to separate the mother and child to determine if the symptoms are legitimate or fabricated. Successful treatment depends on the collaboration between disciplines and cooperation of all staff members. It is important that MBP be ruled out in cases of CIP when these children are evaluated for transplant to prevent needless morbidity.

Adolescent↗
PubMedDate not supplied

Dilemmas facing nurses who care for Munchausen syndrome by Proxy patients.

Diagnostic practices, including video surveillance, in Munchausen Syndrome by Proxy can lead to multiple nursing dilemmas. A case study with discussion of these dilemmas and suggestions to deal with them is presented to help nurses cope more effectively with this difficult diagnosis.

Adaptation, Psychological↗
PubMed1998

The achievement by proxy spectrum in youth sports. Historical perspective and clinical approach to pressured and high-achieving children and adolescents.

This article, with examples of the descriptively defined three stages of achievement by proxy distorted (ABPD) behavior, should increase awareness of this field by facilitating communication, enabling child psychiatrists and other professionals to identify the "red flags" that can lead to abuse and exploitation of children and adolescents, and further contributing toward psychoeducation of self-help skills in parents and other adults with the goal of understanding motivations for ABPD behaviors and risky rationalizations, in addition to creating prevention strategies.

Achievement↗
PubMed2002

Use of ICD-9 coding as a proxy for stage of disease in lung cancer.

OBJECTIVE: To determine the validity of using ICD-9-CM codes indicating metastases as a proxy to classify lung cancer patients by stage of disease. RESEARCH DESIGN: This retrospective database analysis used diagnosis codes to classify subjects to either localized or advanced-stage disease and then compared this classification to the tumor registry staging, which was considered as the 'gold standard.' SUBJECTS AND MEASURES: Study subjects included all lung cancer patients treated at our academic institution during 1996-1997, who were also members of a large insurance company. Data were derived from inpatient cancer-related claims linked with our institution's tumor registry data. Advanced-stage disease (stages II to IV) was defined by claims indicating lymph node involvement or metastases (ICD-9 codes 196-199.1). The tumor registry stagings of the disease for these patients were clustered into two groupings, stages 0-I (localized) and stages II-IV (advanced). RESULTS: Tumor registry entries were identified for 66/77 (85.7%) patients. A total of 19 out of 22 local disease patients (sensitivity of 86.4%) and 30 out of 44 advanced disease patients (sensitivity of 68.2%) were classified correctly by ICD-9 code. A total of 19 out of 33 patients with local disease codes (PPV of 57.6%) and 30 out of 33 patients with advanced disease codes (PPV = 90.9%) were properly identified. CONCLUSIONS: For a population of lung cancer patients in an academic institution who were under a private insurance plan, the ICD-9 coding was associated with a sensitivity and positive predictive values that were consistent with previously reported estimates using Medicare-SEER data. The use of such data to classify patients to disease stages should be executed with caution as under-reporting might exist. Continued attention to discharge abstracting will be needed to improve the validity of this technique.

Humans↗
PubMed2006

Magnetic susceptibility measurements as proxy method to monitor soil pollution: development of experimental protocols for field surveys.

In the framework of the development of new methods for measuring and monitoring soil pollution, this paper deals with the use of magnetic methodologies to monitor the heavy metals presence in soils. In particular it shows a procedure for collecting magnetic susceptibility measurements in order to interpret them as proxy variable for monitoring heavy metals in soils. Magnetic measurements are carried out using a magnetic susceptibility meter with two different probes for in situ field surveys. The experimental procedure is divided in two parts. In the first part we carry out laboratory tests aimed to evaluate, for both the probes, the effective investigation depth for soil, the measurement reproducibility under different conditions, and the influence of water content. We complete this part comparing in situ measurements obtained by means of two probes with different characteristics. In the second part we carry out tests to evaluate the relationships between heavy metal levels and magnetic susceptibility values of soil samples. We investigate the variability of the magnetic susceptibility measurements contaminating different soil samples with well known concentration of heavy metals. Moreover we study the correlation between magnetic susceptibility values and metal concentrations, determined by means of AAS, in soil samples collected during a field survey. Results suggest that a careful check of the experimental procedure play a crucial role for using magnetic susceptibility measurements for heavy metals in situ monitoring. This is very helpful both for improving the quality of data and for making simpler data interpretation.

Environmental Monitoring↗
PubMed1992

Advance directives, proxies, and the practice of surgery.

The Patient Self-Determination Act, in effect since December 1991, promises to have a major impact on the practice of surgery. Advance directives will often allow surgery but prohibit the use of resuscitation, ventilators, and artificial feeding. If, however, such interventions are called for as part of an operation or standard postoperative care, should they be utilized despite the prior directive? This article examines this question by reviewing typical surgical cases illustrating the distinction between terminal and advanced illness, the extent of a surgical consent, and differences between proxies and advance directives.

Advance Directives↗
PubMedDate not supplied

Munchausen by proxy syndrome: the triad of abuse, self-abuse, and deception.

The Munchausen By Proxy Syndrome (MbPS) is a complicated phenomenon whereby a peculiar threefold relationship between perpetrator, victim, and medical staff develops. This triad is based on abuse of the child, deception of the doctor, and, in many cases, self-abuse or passivity of the victim towards the perpetrator's deeds. We have analyzed the interrelationship between the perpetrator, the victim, and the medical authority, in light of the mother's pathology.

Child↗
PubMed1987

Web of deceit: a literature review of Munchausen syndrome by proxy.

Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 cases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.

Adult↗
PubMed1989

Munchausen syndrome by proxy: a survey of professionals' knowledge.

This study examined professionals' knowledge of a relatively rare form of child abuse, Munchausen syndrome by proxy (MSBP). Eighty-six professionals representing hospital or other medical settings, community services programs, the state children's service agency, and various law enforcement agencies were surveyed. Results indicated that professionals employed in medical or hospital settings were three times more likely to have heard of the syndrome than those employed by community service agencies. Journal articles and colleagues were the most popular sources of information pertaining to MSBP. Respondents identified 77 possible cases of MSBP in their caseloads over the past year. Findings suggest the need for educating community professionals as well as the possibility that the incidence of MSBP has been grossly underestimated. Implications for future research and preventive efforts are discussed.

Adult↗
PubMed1990

Hunger ratings are not a valid proxy measure of reported food intake in humans.

Hunger ratings have been used as proxy measures of food intake although their validity has not been established. To address this issue, 12 female and 12 male adults of normal weight recorded food intake and hunger ratings every waking hour for 7 consecutive days. Discrepancies were noted in the correlation between hunger ratings and computed energy intake on weekdays vs. weekends, and no significant correlations were observed for individual subjects. Eating often occurred when hunger ratings were low or had not increased, and few individuals displayed a significant correlation between hunger ratings and number of eating occurrences. It was concluded that hunger ratings are not a valid index of energy intake computed from food records or number of eating occurrences.

Adult↗
PubMed1990

Münchausen's syndrome by proxy as a form of child abuse.

Munchausen's syndrome by proxy (MSBP) is an emotional disorder in which the parent, almost always the mother, induces or fabricates illness in her child in order to gain medical attention. Although numerous case studies exist in pediatric and medical literature, most nurses are unaware of the warning signs of this disorder. Psychiatric consultation liaison nurses are in an ideal position to identify and intervene in MSBP situations and can also support the pediatric nursing staff through feelings of denial, shock, and guilt as they recognize the syndrome and its danger to the child.

Child Abuse↗