Münchausen syndrome

[winterallsummer]

Many of us are familiar with drug seekers, pts who feign or over exaggerate their symptoms in hope to get admitted for dilaudid and/or discharged with other opaites and anxiolytics. These cases almost always reveal themselves and the patients show overt drug seeking behavior more times than not.

 

Much more disturbing is chronic factitious syndrome or so called Münchausen syndrome. These patients are typically pleasant, cooperative, educated and with social status and support. I encountered a patient whom had undergone myriad surgeries and invasive procedures and testing, living with lines and drains and "well known" at many local and out of state hospitals, in fact who had given up any reminiscent of a normal life and spent the majority of their life in hospitals. The exam benign but the patient with that "off feeling" that a finger cannot be placed on, had the scant abnormalities seen on labs and vitals ever so rarely to suggest real disease. A detailed chart review showed only proof of iatrogenic diseases done as a result of unproven Illness, despite a "thorough" work up.

 

The patient was admitted for the routine problems they sufferered from, issues had been raised in the past but of course in the days beyond searching of patient rooms and dramatic confrontation, no formal diagnosis of chronic factitious syndrome was made. To my knowledge they were discharged after a several day stay and have not returned since, although they seem to be admitted almost every single month within my or another's facility.

 

Wondering what others experience with this disease has been. It can be quite shocking what some patients will subject themselves too, and I am talking well and far beyond the patient who bounces around ERs and had a cholecystectomy a year ago. Interested in others anectodal experiences and thoughts. Also I am NOT talking about the Münchausen by proxy syndrome here or drug seekers, but the patient suffering from true and severe chronic factitious disease.

[jmj11]

One of my "poor  man's test" is pulling up their radiology history. A young, healthy person with 10 radiological exams (unless they are a bull rider or professional football player) in the last three years is, in my opinion suggestive of a somatization disorder. Those who have had 50, starts to suggest Münchausen ( especially if they were during admissions for Fever of UKO, etc.)

 

The first time I heard of this was when I was a PA student and we had a wonderful psychiatrist professor who told us about a consult he just did on a U of Kentucky lab tech (I think they are often in the medical field) who was admitted many times for abscesses all over her body and even septicemia.  Then she was caught injecting fecal lab specimen material with a syringe into her abdominal wall.

[winterallsummer]

It really shocks me to see what some people will do as far as causing abscesses, other infections, weight loss, etc, and for which the gain of (being hospitalized and living out the "patient role") seems so bizarre. I have ran across many psych patients that were "frequent fliers," drug addicts of various forms (cyclic vomiting syndrome, dermatitis artefacta, those with extensive "elective" surgeries). For me that is not so surprising as I have seen people do some pretty extreme things for drugs. And the psych patients who are constantly in psych facilities also seems to sort of "make sense" as they are getting support, fed, room, etc. same could be said for homeless pts. But the patients doing this for what appears to be the sole reason of being sick and in the hospital, I really cannot understand, especially at what lengths like they'll go to such as the example in the above post.

 

I read some old case studies and apparently up until the early 2000s, people were actually searching pts rooms and writing them up about this. This included someone who actually kept a syringe and needle and a Petri dish of bacteria!! And they found it in their room and confronted the pt. There are some very interesting case studies like this but now that kind of thing of course is not done.

 

I also am perplexed about the FUO. Even though I'm aware people can somehow falsify their temperature and remember learning about it in PA school, with the nurses around a

[winterallsummer]

*and all I still am unsure how/if people are actually doing this.

 

It's pretty rare for me to run into these patients but from time to time I do. And with their past chart, medicolegal issues, lab findings (and apparently some pts are using lasix to become hyponatremic), plus the iatrogenic and self induced harm and nosocomial exposure they have inflicted to them, they actually can get quite sick.

[sk732]

As you've noted, many if not most, of these patients are very intelligent, often have a scientific or medical background, and use those to try to pull the wool over people's eyes.  One of the fixations that's been observed is not so much wanting that patient life as trying to prove that their care providers aren't as smart as they are, especially folks that feel devalued in their tech job or couldn't get into medical school for one reason or another.  They then concoct something within themselves that will definitely cause symptoms but without a meaningful explanation...which leads to either sympathy or to their caregiver being quite confounded.  Either way, win win for them.  The difference between outright liars (seekers and such) and Muchausen cases is the secondary gain is longer term and quite a bit more pathologic - much like a serial killer that taunts the police and the public.  Starting to wonder now about someone I was looking after in the ER last night now...

 

SK