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PubMed2001

A vicious circle: transgenerational attachment representations in a case of factitious illness by proxy.

Attachment theory offers a robust way to investigate transgenerational child maltreatment; first because there is a coherent theoretical hypothesis of how this might be mediated by the development of insecure working models of relationships, and second, because there is existing evidence from prospective studies that transgenerational attachment patterns can be predicted. Specifically, attachment theory may be particularly useful in cases of Fictitious Illness by Proxy (FIP), where the maltreating behavior is characterized bv disordered illness behavior and care-eliciting. We present a case history, using the Adult Attachment Interview (AAI), which examines attachment and child maltreatment in three generations. A single case history allows for hypothesis generation about the genesis of FIP behavior.

Child Abuse↗
PubMed1987

Autoimmune thrombocytopenia and primary biliary cirrhosis with hypoglycemia and insulin receptor autoantibodies. A case report.

A 43-year-old woman with spontaneous episodes of neuroglycopenic hypoglycemia was found to have immune-mediated thrombocytopenic purpura and primary biliary cirrhosis. Hypoglycemia along with hyperinsulinemia suggested insulinoma. Serum c-peptide levels were disproportionately low, raising the possibility of factitious hypoglycemia. The patient's plasma contained circulating insulin receptor autoantibodies, thought to cause hypoglycemia by their insulin-like actions. With prednisone therapy, her other autoimmune features improved, and the hypoglycemia eventually resolved. Hypoglycemia mediated by insulin receptor autoantibodies should be considered in patients with fasting hypoglycemia and features suggesting an underlying autoimmune disorder before pursuing more invasive procedures. High-dose steroids may be life-saving in this disorder.

Adult↗
PubMedDate not supplied

[Orientations and prospects in psychiatry].

It is pointed out that despite the promising light cast by biological psychiatry, the discipline remains totally in the dark about the aetiology of mental illness. It is also shown that recent statements by certain psychoanalysts are both factitious and illogical, hampering the progress of psychiatry that, today more than ever before, needs the cooperation of every school from the biological to the social, the psychodynamic and, above all the organic.

Humans↗
PubMed1992

Fever of unknown origin in the 1980s. An update of the diagnostic spectrum.

OBJECTIVE: To determine the relative proportions of the diagnostic categories in patients with fever of unknown origin who were examined in the 1980s. STUDY DESIGN: Prospective case series. SETTING: General Internal Medicine Service based at University Hospital, Leuven, Belgium. PATIENTS: One hundred ninety-nine consecutive patients meeting the classic criteria of fever of unknown origin who were treated in the 1980s. MAIN OUTCOME MEASUREMENT: The final diagnosis established at discharge or during follow-up. RESULTS: Infections were found in 45 patients (22.6%), tumors were found in 14 (7%), multisystem diseases were found in 42 (21.5%), drug-related fever was found in six (3%), factitious fever was found in seven (3.5%), habitual hyperthermia was found in five (2.5%), miscellaneous diseases were found in 29 (14.5%), and no diagnosis was reached in 51 (25.6%). CONCLUSIONS: Tumors were a less important cause of fever of unknown origin in the 1980s. The same holds true for some infectious diseases, such as abscesses and hepatobiliary disorders. Multisystem diseases were more frequently found, and the number of undiagnosed cases increased. Although these shifts in the disease spectrum in fever of unknown origin most probably resulted from a constellation of factors, we suspect that these changes are mainly due to easy and early diagnosis by new diagnostic modalities, such as ultrasonography and computed tomography, of previously common causes of fever of unknown origin.

Abscess↗
PubMed1987

[Artefact--diagnosis and therapy from the surgical viewpoint].

Factitious wounds are often overlooked when patients are treated. The experiences we have had with ten patients (nine women and one man) are discussed. A typical case report of a 19 year old female, who had been hospitalized 19 times, demonstrates the magnitude of the diagnostic and therapeutic problems involved in such cases. If the basic psychological disorder cannot be eliminated, medical treatment will remain unsuccessful.

Adult↗
PubMed1984

Munchausen's syndrome by proxy (child abuse) presenting as apparent autoerythrocyte sensitization syndrome: an unusual presentation of Polle syndrome.

Munchausen's syndrome was initially described in 1951. It has become increasingly recognized since that time. Recently, Munchausen's syndrome by proxy or Polle syndrome has been described. In this disease entity, a parent causes a factitious disease in a child. The disease may require extensive medical testing and the result may even be death. A wide variety of presentations of Polle syndrome have been reported including cardiac arrest, recurrent sepsis, and factitious bleeding. Autoerythrocyte sensitization, a syndrome of spontaneous purpura, was initially described in 1955. The diagnostic test described is intradermal injection of autologous blood which produces an area of painful purpura. The syndrome is therefore postulated to be due to hypersensitivity in the patient's own RBCs. The majority of patients with autoerythrocyte sensitization have had psychiatric disorders and the symptoms have improved only with psychotherapy. An infant who had a clinical picture of autoerythrocyte sensitization and who was later found to be a victim of Polle syndrome is reported.

Autoimmune Diseases↗
PubMed1983

Factitious illness. Dramatic deceit versus reality.

Patients with factitious illness present a particular challenge. Because they may be clever in their deception, they may be difficult to recognize as the fabricators of their apparent medical problem(s). Findings vary from relatively simple problems such as fever to more complex and often dramatic complaints of bleeding and pain. Differential diagnosis should include other, often more easily managed disorders such as somatoform disorders, malingering, antisocial personality, and schizophrenia. Because no definitive treatment exists, patients often consult many physicians, often in diverse geographical locations.

Diagnosis, Differential↗
PubMed2006

Fever of unknown origin in adults: evaluation of 144 cases in a non-university hospital.

The spectrum of diseases found in series of fever of unknown origin shows variation in relation to selection bias; particularly, selection of the most difficult cases in tertiary reference university centres. We present a series of 144 patients presenting to a non-university hospital between 1999 and 2005 (secondary level of the health care system) with a community-acquired fever of unknown origin. In 37 cases (25.7%), the reason for fever could not be explained. Among the 107 patients with a final diagnosis (74.3%), non-infectious inflammatory disorders represented the most prevalent category (35.5%), surpassing infections (30.8%), miscellaneous causes (20.6%) and malignancies (13.5%). 13 entities accounted for over 68% of diagnoses (sinusitis and occult dental infections, Q fever, Epstein-Barr virus and cytomegalovirus infections, lymphoma, colo-rectal adenocarcinoma, adult-onset Still disease, systemic lupus erythematosus, giant cell arteritis and/or polymyalgia rheumatica, rheumatoid arthritis, polyarteritis nodosa, factitious fever and habitual hyperthermia). As demonstrated in other studies, non-infectious inflammatory diseases emerge as the most prevalent diagnostic category. Giant cell arteritis and polymyalgia rheumatica were particularly frequent in the elderly. Epstein-Barr virus and cytomegalovirus infections and habitual hyperthermia were particularly frequent in the youngest patients. There were no major differences in repartition of diagnostic categories between this series and historical university series.

Adolescent↗
PubMed1979

Anticoagulant abuse: a psychotic syndrome?

A case of surreptitious ingestion of oral anticoagulants is presented. The patient, a 31-year-old nurse, was followed for more than 3 years and underwent thorough psychological and psychiatric evaluation. Anticoagulant malingerers are by no means rare; however, little is known about the psychiatric disturbances in these patients. The tendency has been to regard these patients as having neurotic or personality disturbances. The data in the present case suggest that factitious hemorrhagic disease is caused by a psychotic disturbance. The results of psychiatric therapy are discussed.

Adult↗
PubMed1979

Factitial bleeding: successful management with psychotherapy.

A young female nurse presented with unusual upper and lower-gastrointestinal bleeding, shown to be factitial. Following detection, she was successfully confronted and treated with psychotherapy. A plan for successful management of the Munchausen syndrome is discussed.

Adult↗
PubMed2005

The relationship between chronic cough and paradoxical vocal fold movement: a review of the literature.

SUMMARY: Chronic cough (CC) and paradoxical vocal fold movement (PVFM) are debilitating conditions. PVFM has been given many labels, including vocal cord dysfunction, Munchausen's stridor, functional inspiratory stridor, nonorganic functional or psychogenic upper airway obstruction, factitious asthma, psychogenic stridor, emotional laryngeal wheezing, and episodic laryngeal dyskinesia. Although CC and PVFM have been considered separate entities in many reports, there is preliminary support for the notion that there may be an underlying link between these two conditions. Speech pathologists have become increasingly involved in the treatment of these patients and therefore need to understand the theoretical background of these disorders, the pathophysiological links between the two, and the impact of voice disorders on these populations. The aim of this article is to review the current literature on CC and PVFM from a speech pathology perspective to provide a model for defining and conceptualizing the disorders and to provide a framework for management and future research.

Behavior Therapy↗
PubMed1977

Factitious skin lesions in a mother and two sons.

A family is described in which a woman, probably in a state of 'hysterical conversion', produced factitious lesions in her own skin (dermatitis artefacta) and in the skin of two sons (child abuse). Non-accidental injury to a child's skin may form part of a spectrum of skin artefacts in the parent.

Adult↗
PubMed1977

Clinical significance of circulating C-peptide in diabetes mellitus and hypoglycemic disorders.

Proinsulin is converted to insulin and C-peptide in the pancreatic in the pancreatic beta cells: the latter two peptides are secreted in equimolar concentrations. Thus, measurements of serum C-peptide provide a means of assessing pancreatic beta cell function in addition to that of insulin. This technique has proved particularly useful in insulin treated diabetic patients in whom the development of circulating insulin antibodies interferes with the radioimmunoassay of the hormone. The C-peptide assay has also been used to facilitate the diagnosis of various hypoglycemic conditions, including islet cell tumors and factitious injection of insulin. The extraction of C-peptide in the urine reflects average serum values over a period of time and urine C-peptide measurements are especially useful in children or individuals in whom repeated blood sampling is difficult.

Adenoma, Islet Cell↗
PubMed2004

Munchausen's syndrome in neurosurgery: report of two cases and review of the literature.

OBJECTIVE AND IMPORTANCE: Munchausen's syndrome is a rare psychiatric condition, in which patients seek medical treatment for factitious or self-induced medical problems. Reports in the literature of postoperative Munchausen's syndrome are extremely rare. The major obstacle to improving management of the patients with Munchausen's syndrome is increasing physicians' awareness and recognition of the disease. Although Munchausen's syndrome is rare, physicians probably will encounter at least one such patient at some point during their career and therefore should be aware of this disorder. CLINICAL PRESENTATION: We report two documented cases of postoperative Munchausen's syndrome in patients who underwent cranial neurosurgery. Both patients received complex flaps for closure of their cranial defects. Both patients later admitted to deliberately reopening their cranial wounds because of a psychological desire to continue their illness. INTERVENTION: The primary therapeutic objective is to achieve wound healing and stop the cycle of surgical procedures. Immediate confrontation with the patient often does more harm than good. Instead, psychiatric consultation, with the potential for nonsurgical management and behavior modification, should be obtained. CONCLUSION: Munchausen's syndrome is a rare psychiatric diagnosis, especially in the postoperative patient. The common clues to diagnosis are: 1) a nonhealing wound in the absence of risk factors for wound failure, 2) a history of psychiatric illness, 3) repeated bleeding from the wound site, and 4) a desire to continue the sick role. Early detection will allow proper psychiatric referral to prevent injuries to the patient, abuses to the medical system, and unnecessary operations.

Adult↗
PubMed1990

Self-induced hematuria.

Two patients, an adult and a child, are reported who presented with factitious hematuria secondary to self-induced finger sticks with contamination of unwitnessed urine samples. Feigned illness of this kind may be more common than generally appreciated.

Child↗
PubMed1997

[Factitious hyperchloremia disclosing bromide poisoning. 4 cases].

BACKGROUND: When routine blood chemistry shows elevated chloride alone, another anion (bromide, iodine, fluoride) may be involved. CASE REPORTS: Hyperchloremia and decreased anion gap was observed in four patients. Chloremia ranged from 134 to 174 mmol/l at initial blood tests. Careful history taking led to the discovery of long-term use of calcium bromogalacto-glucomate. Specific assay with inductively coupled plasma mass spectrometry (ICPMS) confirmed the presence of bromide in the blood. Chloridemia returned to normal levels after discontinuing use of bromine. DISCUSSION: Bromism is not a common diagnosis. Risks include neurological and psychiatric disorders due to bromide diffusion through the blood-brain barrier. Clinical manifestations have been described including skin lesions, digestive intolerance, and fever. Bromide is contained in certain prescription drugs. Patients should be warned against the adverse effects of overuse.

Adult↗
PubMed2005

[Factitious Cushing syndrome: two case reports].

INTRODUCTION: Search of corticosteroid use is an important precaution before any exploration of hypercorticism. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls. EXEGESIS: We report two cases of 29 and 60 years old male patients, referred for hypercorticism with patent features including metabolic and trophical signs. Laboratories findings revealed unelevated urinary cortisol values (40 and 27 microg/ day) in both cases with normal ACTH and normal plasmatic cortisol response to synacthène (32,5 and 35 microg/dl). Corticosteroid use, initially denied, was finally approved by the patients (hydrocortisone and dexamethasone for the first patient and betametasone for the second). So, they were assigned to psychiatric therapy. CONCLUSION: Our cases emphasize that corticosteroid misuse must be evoked in patients with unexpected hormonal assessment of pituitary adrenal axis despite patent clinical features of hypercorticism. Several specific tests are actually available for detect factitious Cushing syndrome. However, differential diagnostic remains difficult mainly with pseudo Cushing and cyclical Cushing syndromes.

Adolescent↗