Münchhausen Syndrome: Psychopathology Management

Abstract

A case report on a patient with Münchhausen syndrome is presented and the psychopathological features are compared to other reports in the literature. Diagnosis and differential diagnosis are discussed with regard to other somatoform disorders such as conversion disorder and somatization disorder as well as to malingering and cenesthesic schizophrenia. The management of Münchhausen syndrome is aggravated by the low compliance in these patients, who expose themselves to serious complications of unnecessary medical and surgical procedures. Early diagnosis could to a considerable extent exclude these iatrogenic risks. We recommend that patients presenting the psychopathological features of a Münchhausen syndrome should be conservatively observed and an attempt to clarify both the medical and the psychiatric diagnosis should be made before any invasive procedure is undertaken.

Pseudomalabsorption of Levothyroxine: A Challenge for the Endocrinologist in the Treatment of Hypothyroidism

“…Some patients persist in low compliance in taking levothyroxine and are at risk for serious complications, sometimes also leading to unnecessary medical and surgical procedures. This psychiatric disorder, known as factitious disorder, is characterized by a fictitious history, exaggeration, aggravation, fluctuating physical symptoms, lying or using aliases, multiple hospital admissions without specific reasons, and extensive knowledge of medical symptomatology [1,2,8,22,28,29] . The purpose of this behaviour is to adopt the ''sick role.''…”

“…The clinician should adopt an empathic and understanding attitude while interacting with the patient [32] . These patients should be observed conservatively, and an attempt should be made to clarify both the medical and psychiatric diagnoses before any invasive procedure is undertaken [2,29] . The goal is to help patients express their emotional stress in a more acceptable and healthful manner.…”

“…Early recognition is important since it could, to a considerable extent, avoid iatrogenic risks. Patients are prone to drop out of therapy with the possibility of seeking medical attention from other physicians [8,18,29] . Avoiding confrontation with the diagnosis of non-compliance may lead to a better therapeutic outcome [1] .…”

“…This approach should be individually tailored in view of the sensitive nature of this diagnosis. Patients are more likely to accept psychiatric help, when they feel that their behaviour is accepted and understood as an expression of psychological (unconscious) factors [29] .…”

Rezidivierende Septikämien und gastrointestinale Verätzung

“…Beim Münchhausen-Syndrom betreiben die häufig männlichen Patienten sogenanntes "Krankenhauswandern", sie sind sozial desintegriert und haben vielfach ein niedriges Bildungsniveau.3 Die Kerngruppe der artifiziellen Störungen betrifft häufig alleinstehende Frauen, die durch dissoziale und invasive Selbstbeschädigung auffallen und ein gutes Bildungs-und Ausbildungsniveau, oft mit Berufen aus dem medizinischen Assistenzbereich, aufweisen[10]. Bei 10-15% der Betroffenen führen die Störungen zu letalen Komplikationen[7].3 Beim "Münchhausen-by-proxy"-Syndrom, wird, stellvertretend für den eigenen Körper, Kindern durch Bezugspersonen Schaden zufügt.…”