· · Follow up: children that lived with foster

·        
Goal of people with disease- fake disease
to “trick and gain attention”

·        
1st described- Asher (1951)

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·        
Munchausen by Proxy- Meadow (1977)

·        
Proxy- involves a “caretaker” producing
illness

·        
Usually mother and child

·        
Prevalence rate – hard to determine

·        
Majority- “white female” “30-50 years old”

·        
Proxy- “white mother no exact age”

·        
Religion or socioeconomic status

·        
Short term, long term morbidity

·        
ST- “discomfort, no lasting impression”

·        
LT- “Permanent adverse effect”

·        
Possible child victims grow into adults
that do the same

·        
Detection and follow up range: 1-14 yrs.

·        
Important to remove child from perpetrator

·        
Follow up: children that lived with foster
parents after had no illness

·        
10 cases, child still lived with parent,
still had “sickness”

·        
Many long-term consequences due to MSBP
abuse

·        
Some participants surveyed had symptoms of
PTSD

·        
Victims have “lasting negative
psychological effects.”

·        
Fear of perpetrator when grown

·        
Perpetrator didn’t admit to abuse

·        
“Parent-child relationship”

·        
Reliance of child’s retrospective memory

·        
Blended case makes diagnoses difficult

·        
“Collision of symptoms between caregiver
and child”

·        
MSBP rates most likely underestimated

·        
“Developed, developing, and underdeveloped
countries”

·        
Risky to return victim home to perpetrator

·        
Argue with medical staff, then rejects
medical advice

·        
“Baron Von Munchausen”

·        
Baron no “medical operations and
procedures ”

·        
Various variety symptoms

·        
“Voluntary control of behavior”

·        
Attention seeking

Howe,
Gary L, et al. “Munchausen’s Syndrome or Chronic Factitious illness: A review
and Case presentation.” Journal of the National Medical Association, vol. 75,
no. 2, ser. 1983, pp. 175–181. 1983, www.ncbi.nlm.nih.gov/pmc/articles/PMC2561446

·        
Physical abuse vs psychological abuse

·        
“Physical or mental distress”

·        
Factitious disorder

·        
Supporting illness with stories

·        
Childhood deprivation and rejection,
substance abuse

·        
Treatment- range from none to leukotomy

·        
Many more treatments (therapy, hypnosis
etc.)

·        
Case study

·        
Ms. M, nervous bc of eviction from
apartment

·        
Mental evaluation: “paranoia, concreate
thinking, suicidal”

·        
30 yr old white woman

·        
Boyish features

·        
Many scars and sutures on arm

·        
Scarring also found on abdomen
(laparotomies)

·        
Sharp abdominal pain due to swallowing
glass prior

·        
Medical history: a lot of visits for
mental and physical complaints

·        
60 plus visits

·        
Not including ER and office visits

·        
“Moved at least 16 times over 10 years”

·        
‘Suicidal since 15″

·        
Addicted to drugs

·        
Adoptive mother “domineering and
emotionally abusive”

·        
Adoptive father “passive”

·        
Lied about her real parents

·        
Very intelligent with good knowledge of
medical terms and procedures

·        
High IQ scores

·        
All results from test came back as normal

·        
“Exaggerated need for affection and
emotional dependency”

·        
Last seen wearing cast on leg for apparent
surgery for chronic pain

·        
Signs of depression

·        
Traveled from Ohio to Florida staying at
medical and psychiatric wards 

·        
She views herself as “unlovable”

·        
Trying to removal part of body seen as
“defective”

·        
Patients usually reject therapy and have
antipathy for psychiatrist

·        
Sign out of hospital before medical
treatment

·        
Victim needs to establish trust with
medical identity

·        
Treatment plan needs to have long term
psychiatric care

·        
“psychosocial environmental plan”

·        
Plan base on individual needs

·        
Should try to improve family relationship

·        
“Support and guidance”

 

Zylstra,
Robert G, et al. “Munchausen Syndrome by Proxy: A Clinical Vignette.” Journal
of the Association of Medicine and Psychiatry, vol. 2, no. 2, Apr. 2000, pp.
42–45., www.ncbi.nlm.nih.gov/pmc/articles/PMC181203/.

·        
Gain sufficient self esteem

·        
Diagnosis- poorly understood and
controversial

·        
“extreme manifestation of factitious
disorder”

·        
Medical abuse

·        
Case study

·        
6yr old with case of pneumonia

·        
Mother said child has been coughing and
wheezing

·        
Also has fever and low urine output
according to mother

·        
History of illness

·        
All examinations were normal

·        
Cardiovascular and neurological exams came
back normal also

·        
Sugar levels began to fluctuate after
physician left the room

·        
IV tubing seemed to be leaking form needle
hole

·        
Mother removed from room, child’s sugar
levels were stable

·        
Mother confessed to maltreatment and child
was removed

·        
Elderly individuals also seen as victims

·        
Illness that can’t be explained

·        
Errors in finding and history

·        
Problems that occur only when perpetrator
is there

·        
Mother constantly at bedside

·        
Welcomes painful test on victim

·        
Death of unexpected infant

·        
Not confused with financial benefits

·        
Separation is key in diagnosing MSBP

·        
Important in protecting victim from more
problems

·        
Patterns of illness between siblings

·        
Record any irregularities

·        
Symptoms don’t match finding

·        
Or don’t fit disease

·        
A lot of hospital visits

·        
Improve with care from professional but
worsen when released

·        
Not leaving victims side

·        
Exaggerating

·        
Enjoy the attention received

·        
Symptoms need to be monitored by
professional

·        
Child protective services

·        
Unwilling to admit symptoms

·        
Psychotherapy

·        
More symptoms after negative results

·        
Eager to get more test done

·        
Link with personality disorder

·        
Reduce use medical resources