Munchausen's Syndrome by Proxy Identified with an Implantable Electrocardiographic Recorder

Hoorntje, Theo M.; W, Langerak; Sreeram, Narayanswami

doi:10.1056/nejm199911043411919

Cited by 14 publications

(4 citation statements)

References 5 publications

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“…by smothering, there tends to be a significant delay between the onset of EEG and ECG changes and activation of the monitor ( fig 1B). 16 This is different from most spontaneous syncope episodes, where activation of the monitor tends to occur within seconds of the onset of ECG and EEG changes ( fig 1A).…”

Section: Tilt Testingmentioning

confidence: 79%

Syncope in childhood

McLeod¹

2003

Archives of Disease in Childhood

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Section: Tilt Testingmentioning

confidence: 79%

Syncope in childhood

McLeod¹

2003

Archives of Disease in Childhood

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“…Symptoms usually occur immediately. [17,18] 3. Poisoning or substance abuse, misuse of drugs -medicine not taken correctly can induce numerous side effects.…”

Section: What To Pay Particular Attention Tomentioning

confidence: 99%

Diagnostic problems of unusal somatic disorder - Munchausen syndrome by proxy

Matuszewska,

Babkiewicz-Jahn,

Szymańska

et al. 2024

J Educ Health Sport

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Introduction and purpose Munchausen syndrome by proxy is a factitious disorder characterized by the search for and induction of somatic symptoms, the falsification of laboratory results, and even the mutilation of a loved one, usually a child, by a parent or caregiver. Paediatricians often only have information about the child's condition from an interview with the child’s guardian, so it is very important to differentiate feigned disorders from real, sometimes difficult to diagnose, cases of illness. We may suspect them if the parent reports unusual symptoms in the child, insinuates further treatments and hospital stays, has above-average knowledge of medical terminology, and is aggressive towards the staff. Prominent among the causes of Munchausen syndrome by proxy are first and foremost the desire to focus the parent/carer’s attention on themselves and the expectation of recognition for their care and concern for the child. Methods and materials The following review was based on articles from the PubMed and Google Scholar databases. Key search terms included munchausen syndrome, munchausen syndrome by proxy, treatment, diagnosis, paediatric condition falsification, factitious disorder. Conclusions Due to the nature of this disorder, physicians of different specialities may come across it during their practice. Increasing their knowledge on this topic and the effects of Munchausen syndrome by proxy will allow the correct diagnosis to be established and appropriate psychiatric therapy with psychological care to be introduced, as well as protecting children who are victims of the actions of their caregivers.

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“…12,23,54 This method has been most helpful in detecting reflex syncopes with asystole 23,54 but has also been useful in showing that the cause of repeated episodes of loss of consciousness was intentional suffocation. 23 For long-term monitoring, an implantable electrocardiographic recorder has advantages, 23,61 but technical snags have been reported. 62 An additional benefit-so far only documented in adults-has been the unequivocal detection of generalized tonic-clonic epileptic seizures.…”

Section: Electrocardiographic Monitorsmentioning

confidence: 99%

Clinical Diagnosis of Syncopes (Including So-called Breath-Holding Spells) Without Electroencephalography or Ocular Compression

Stephenson

2007

J Child Neurol

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A recent article in this journal suggested that ocular compression during electroencephalography was useful in distinguishing "breath-holding spells and syncope" from epileptic seizures. The method proposed involved measurement of the RR interval on the simultaneously recorded electrocardiographic trace and determining both the absolute RR lengthening and the change in RR interval as compared with the baseline value. It is argued by the present author that this is not an appropriate way to come to a diagnosis in episodic loss of consciousness in children. It is pointed out that so-called "breath-holding spells" are reflex syncopes and that the diagnosis of reflex syncopes should be by clinical history, even if this means delaying the diagnosis until a future consultation. Published evidence on the nature and clinical diagnosis of reflex syncopes in infants and children is reviewed in depth. It is concluded that routine electroencephalography is not an appropriate investigation when the diagnosis of episodic loss of consciousness is in doubt and has the implicit danger of false positive "abnormality". Aside from scientific exploration of the developing autonomic nervous system, the only current indication for diagnostic ocular compression is to induce a syncope so that its nature may be better understood. Such a circumstance might be a history of an apparent reflex syncope but with atypical features, including prolonged post-syncopal unconsciousness such as might indicate epileptic absence status. Several additional investigations of a primarily cardiological nature may be indicated in some cases, but a wait-and-see policy is usually to be preferred.

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Munchausen's Syndrome by Proxy Identified with an Implantable Electrocardiographic Recorder

Cited by 14 publications

References 5 publications

Syncope in childhood

Syncope in childhood

Diagnostic problems of unusal somatic disorder - Munchausen syndrome by proxy

Clinical Diagnosis of Syncopes (Including So-called Breath-Holding Spells) Without Electroencephalography or Ocular Compression

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