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At least 1,279 records · Page 71Linked to original sources
PubMed1992

[Münchhausen syndrome with severe iron deficiency anemia].

A patient with Münchhausen syndrome who had severe iron deficiency anemia (IDA) is reported. A 31 year-old female presented with irregular genital bleeding. However, gynecological examination disclosed no evidence of specific disorders causing bleeding. Tests for bleeding tendency and hemolysis were all negative. Although massive bleeding was absent, she had three episodes of a rapid fall in Hb level associated with marked fatigue and weakness, and subsequently rapidly developed serious IDA afterwards. Factitious bleeding was strongly suspected. Blood transfusion performed when the patient was not being watched failed to increase Hb, while transfusions given while the patient was watched were effective. She was not cooperative throughout the hospital course and was discharged on her own request. In outpatient clinic, the diagnosis was confirmed by the evidence that she diluted her own blood samples.

Adult↗
PubMed1981

Polle syndrome: chronic diarrhea in Munchausen's child.

A child with a complex history of chronic diarrhea and a seizure disorder, with multiple nondiagnostic previous evaluations, is presented. Under careful observation and with minimal diagnostic studies, the source of this child's chronic disorder was confirmed to be exogenous drug administration by the mother. Polle syndrome, a child-abuse variant of Munchausen syndrome, must be considered as part of an aberrant family social setting by adult or pediatric physicians who uncover a chronic factitious disease. More attention to psychosocial history gathering may preclude well-meaning, but unwarranted, multiple diagnostic endeavors.

Cathartics↗
PubMed2001

Munchausen syndrome.

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. With this self-inflicted disease, the patients characteristically travel from one hospital to another, feigning acute, usually spectacular illnesses. The patients willingly submit themselves to extensive as well as invasive diagnostic and therapeutic procedures. Munchausen syndrome is a psychiatric disorder that requires psychiatric treatment. Reconstructive surgical procedures may be required to correct the acquired deformities. The difficulty in Munchausen syndrome lies essentially in early recognition of the psychiatric syndrome. Two exceptional cases are reported, and diagnosis and treatment are presented in the light of the current literature.

Adult↗
PubMed1984

Malingering and associated syndromes.

Malingering is the false and fraudulent simulation or exaggeration of physical and/or psychological symptoms. It is not a mental disorder, but rather a behavior pattern that may coexist with objectively diagnosed disease. Whatever form it takes, malingering is defined as conscious, voluntary, goal-directed behavior; the presence of a clearly definable goal differentiates malingerers from those with other forms of factitious illness.

Humans↗
PubMed1988

Factitious injury of an extremity: a Munchausen variant.

Self-induced injury of one or more of the extremities may represent a distinct variety of Munchausen syndrome. The nature of the injury may be infectious, dermatologic or orthopedic. The mechanism may be secondary gain or another unconscious motivation that causes a craving for attention. In many cases, the underlying psychopathology is personality disorder.

Abscess↗
PubMed1987

Otolaryngologic cases of Munchausen's syndrome.

Münchausen syndrome (MS) is now a well recognized and demonstrated entity. This syndrome is characterized by patients who seek hospitalization and present factitious but usually well-rehearsed histories and symptoms. Five cases of MS, genuine by their ear-nose-throat-maxillofacial factitious signs, are presented. Two of the cases are related to the uncommon MS by proxy. In this subentity the parents fabricate pathological signs for their children. The psychodynamics and the clinical symptoms of our cases are described and the differential diagnoses of malingering, conversion disorders, and hypochondriasis are brought to attention.

Adult↗
PubMed1991

Integration of medical and psychiatric management in self-mutilation.

The traditional management of factitious patients with self-inflicted injuries consists of medical/surgical treatment of the physical lesions, followed by psychiatric referral. The former is assigned to the dermatologist, the surgeon, or the primary care physician. More often than not, the subsequent psychiatric referral for treatment of the psychiatric disorder underlying and actually causing the self-mutilation fails because of self-mutilators' notorious resistance to psychiatric help. The integration of a psychiatric strategy into the medical management is more effective than a sequential division of medical/surgical and psychiatric treatment. This integrated treatment strategy is based on three key issues: education of the medical team in understanding the self-mutilation as a morbid form of help-seeking behavior, the judicious use of confrontation as a therapeutic tool, and the combination of psychotropic drug treatment with psychotherapeutic techniques.

Adult↗
PubMed1986

Beer potomania: an unusual cause of symptomatic hyponatremia.

A 43-year-old woman presented to the emergency department with acute agitation, confusion, and tonic seizures. She had a history of drug abuse, most notably beer, which constituted her major dietary intake. The patient's seizures were at first thought to be factitious in association with an acute psychosis; however, her serum sodium concentration was 110 mEq/L and urine sodium was 14 mEq/L. The patient responded to IV hypertonic saline and subsequently recovered completely. Beer potomania, the most likely etiology for this patient's hyponatremia, is a rare disorder in which dietary sodium and protein insufficiency lead to dilutional hyponatremia.

Adult↗
PubMed2003

[Leptin levels in female patients with restrictive and purgative types of anorexia nervosa].

BACKGROUND: Anorexia nervosa is an eating disorder with typically chronic course. Two subtypes of anorexia nervosa have been described based on the pattern of eating behavior. Restrictive form of anorexia nervosa is characterized by chronically decreased food intake, while the purgative subtype typically consists of alternating episodes of fasting and overnutrition with factitious vomiting. METHODS AND RESULTS: The aim of this study was to compare anthropometric parameters, serum levels of fat-derived hormone leptin, cholesterol, triacylglycerols and serum leptin/body mass index ratio in patients with restrictive and purgative subtypes of anorexia nervosa respectively. Significantly lower body weight (37.79 +/- 3.93 vs. 49.63 +/- 9.84 kg, p < 0.05), body mass index (13.51 +/- 1.43 vs. 17.75 +/- 2.64 kg/m2, p < 0.05),), body fat percentage (13.28 +/- 2.83 vs. 18.9 +/- 5.65%, p < 0.05), serum leptin (1.117 +/- 0.95 vs. 5.88 +/- 4.7 ng/ml, p < 0.05) and cholesterol levels (4.14 +/- 1.78 vs. 6.31 +/- 1.27 mmol/l, p < 0.05) were found in patient with restrictive relative to purgative subtype of anorexia nervosa. In contrast, no difference in triglyceride levels between both groups was found. Serum leptin levels positively correlated with body mass index and body fat percentage only in patients with purgative subtype of anorexia nervosa (body mass index r = 0.95, p < 0.001, body fat percentage r = 0.64, p < 0.05) but not in those with restrictive subtype. CONCLUSIONS: In conclusion, we demonstrated that serum leptin levels were significantly lower in restrictive relative to purgative subtype of anorexia nervosa. We suggest that this difference is primarily due to distinctions in body fat content.

Adult↗
PubMed1995

Stool composition in factitial diarrhea: a 6-year experience with stool analysis.

OBJECTIVE: To evaluate the utility of stool water analysis in the management of patients with chronic diarrhea. DESIGN: Retrospective analysis of 6 years of experience. SETTING: A specialized laboratory in a major referral center. PATIENTS: 325 patients with diarrhea who were referred for stool chemistry analysis. Fecal analysis was requested by many internists and gastroenterologists. Patient records were reviewed to establish the final and most likely cause of diarrhea. RESULTS: One third of patients provided samples that were inappropriate for analysis, but data from 202 persons were available. The usefulness of the general separation of cases of chronic diarrhea into those in which patients had predominantly osmotic pathophysiologies and those in which patients had predominantly secretory pathophysiologies was confirmed, but overlap and intra-individual variability limited the usefulness of this approach in individual patients. Thirty-five patients (17%) had a diagnosis of factitial diarrhea (30 because of laxative use and 5 because of fluid added to stools). CONCLUSIONS: Among selected subpopulations, the chemical analysis of fresh stools has a role in the evaluation of obscure examples of chronic diarrhea. It is especially useful in identifying factitial diarrhea.

Adolescent↗
PubMed1996

Factitious illness by proxy. Munchausen syndrome by proxy.

BACKGROUND: Since 1977 a literature has grown describing examples of factitious illness by proxy (FIP). METHOD: The literature in English was searched using MEDLINE and supplemented by a manual search. Extracted data focused on terminology of a spectrum of behaviours, clinical features and psychopathology of perpetrators. RESULTS: There has been difficulty with the use of terminology and classification of psychiatric disorders. CONCLUSIONS: The spectrum of FIP is wide. Suggestions are made for the use of terminology and classification when FIP is identified.

Adult↗
PubMed1981

[Misdiagnoses and mismanagement in thyroid diseases (author's transl)].

Measures prior to diagnosis and treatment already installed were assessed retrospectively in 8501 patients with suspect thyroid disease between the years 1976 and 1979. In 10.5% of these patients there were 11.2% misdiagnosis or wrong treatment. The most common misdiagnoses were hyperthyroidism in euthyroid patients (1.9%), hypothyroidism in euthyroidism (0.8%), non-recognition or non-aspiration of cold nodules (0.9%), missing a goitre (0.6%). Among diagnostic methods the radio-iodine test was reason for a wrong diagnosis most commonly (66%). The TRH-test proved to be least erroneous, technical reasons being the cause of the 9.6% of misdiagnoses. The most common mismanagements were due to lack of prophylaxis of recurrence after goitre operation (1.5%), external irradiation of the thyroid gland with radium or Roentgen rays (0.7%), and during thyroid hormone treatment of goitre (1.3%). Iatrogenic disease existed mainly as factitious hyperthyroidism (0.7%), non-treated hypothyroidism after treatment with radio-iodine of hyperthyroidism (0.1%), and as goitre recurrence due to lack of prophylaxis of recurrence (0.8% of all patients). As every 10th patient was subjected to misdiagnosis or mismanagement, shifting to endocrinological advisory centers may prevent future mismanagement of thyroid disorders.

Berlin↗
PubMed1975

Factitial panniculitis and necrotizing fasciitis in juvenile diabetes.

A fifteen-year-old diabetic girl developed multiple inflammatory areas on the extremities and abdominal wall at the site of insulin injection. The bizarre clinical manifestations led to great difficulties in determining both its etiology and its treatment. However, three months after her initial hospitalization, we found that the lesions were probably secondary to self-injection with a chemical agent rather than a result of insulin allergy. If idiopathic recurrent dermal infection is observed, then factitial origin should be suspected.

Abdomen↗
PubMed1995

HIV-related cases among 2,094 admissions to a psychiatric hospital.

OBJECTIVE: Admissions to an acute care psychiatric hospital were studied to determine what proportion of admissions were for HIV-related psychiatric disturbances, what evidence exists that the HIV-related admissions constitute a new population of psychiatric inpatients, and whether any psychiatric variables distinguish patients with HIV-related disorders from patients without such disorders. METHODS: Charts for 2,094 consecutive admissions to the hospital in a three-year period were reviewed. Chi square analyses and t tests were used to compare various groups of HIV-related admissions and non-HIV-related admissions on sociodemographic characteristics, length of stay, history of psychiatric hospitalization, and other clinical measures. RESULTS: One-hundred and sixty-three admissions (7.8 percent of the total admissions) were judged to be HIV related. The largest category of HIV-related admissions, nearly half, were patients experiencing functional or psychological complications of HIV infection or risk. AIDS-phobic patients, who expressed irrational concerns about infection, accounted for 20.2 percent, and patients with organic manifestations for 18.4 percent. If the AIDS-phobic, HIV-bereaved, and factitious HIV-positive admissions were excluded, the rate of HIV-related admissions was 5.2 percent. CONCLUSIONS: Psychiatric hospitals can expect a significant but not overwhelming number of HIV-related admissions.

Adolescent↗