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A 23-year-old student nurse presented with polymicrobial bacteremia and symptoms suggestive of a renal abscess. After extensive evaluation, including an exploratory laparotomy, failed to reveal the source of sepsis, factitious illness owing to self-inoculation was suspected. In the absence of urologic, biliary or gastrointestinal obstruction self-inoculation must be considered in all patients with polymicrobial bacteremia.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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We describe a case of a 70-Year-old man who presented subacute pseudo-dementia due to a dural fistula. Neurological assessment and the reversibility of the symptoms after embolization support the originality of this observation.
Symptomatic urolithiasis is usually treated with narcotic pain management. This leads to the potential for use of its symptoms for personal gain. Historically, the typical presentation of a narcotic-seeking "stone patient" was a history of radiolucent stones and an intravenous contrast allergy. With the increased use of non-contrast-enhanced computed tomography to evaluate patients suspected of having acute urolithiasis, we have seen a change in the strategy of narcotic-seeking patients. We report 2 patients with pelvic calcifications on non-contrast-enhanced computed tomography feigning symptoms of urolithiasis to receive narcotic drugs.
200 patients admitted consecutively to the Neuropsychiatric Institute, Sydney, with the provisional diagnosis of dementia were investigated. The diagnosis was confirmed in 164 patients, 16 patients had a chronic organic brain syndrome not characterised by intellectual deterioration, and 20 patients had pseudodementing functional illnesses. A potentially reversible cause of the dementia was found in 13 patients: these comprised 11.5% of the demented patients aged 45 to 64 years and 3.8% of the demented patients aged 64 years and older. It is recommended that all patients with a provisional diagnosis of dementia be investigated early in the course of their illnesses in anticipation of the finding of a reversible dementia or a treatable pseudodementing illness.
32 children and 4 adults had extensive investigation and treatment for epilepsy because of false seizures invented or induced by a relative, usually the mother. They also suffered needless hospital admissions and restriction of education and activities. Follow-up of the children suggests a danger of abnormal illness behaviour continuing into adult life. For a few young children seizures are really anoxic episodes caused by the parent. In some cases these lead to brain damage and death, and an important association with sudden unexplained death of infancy (cot death) is emerging.
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The definition of Munchausen Syndrome by Proxy is reviewed and considered in the context of the overlap with other harmful behaviors of parents. The high incidence of personal abnormal illness behavior in the perpetrators is leading to increasing concern about the safety of children who are cared for by parents who have abnormal illness behavior.
The recent trial and conviction of Kathy Bush for abusing her daughter is used to illustrate (1) the nature of the motivation, in at least some cases of MBP, and (2) the importance of distinguishing the motivation found in MBP from that found in other forms of child abuse and other conditions involving factitious illness production.