Compliance with treatment in asthma and Munchausen syndrome by proxy.

Godding, Véronique; Kruth, M.

doi:10.1136/adc.66.8.956

Cited by 43 publications

(16 citation statements)

References 13 publications

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“…Bununla birlikte apne, kusma, ishal, bilinç durumu değişiklikleri, ateş, döküntü, alerjik deri lezyonları sık rapor edilen diğer bulgulardır. İngiltere'de alerji kliniklerine başvuran hastaların %5'inin, astım kliniklerine başvuran hastaların ise %1'inin MBP olduğu saptanmıştır (19). Apne ve immün yetmezlik tanısı olmayan çocuklardaki polimikrobial enfeksiyonlar en sık ve kafa karıştırıcı bulgulardır.…”

Section: Klinikunclassified

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

İnce¹,

Yurdakök²

2014

Turkish J Pediatr Dis

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GİRİŞDünya Sağlık Örgütü, bir yetişkin tarafından bilerek veya bilmeyerek yapılan ve çocuğun sağlığını, fi ziksel ve psiko-sosyal gelişimini olumsuz yönde etkileyen davranışları çocuk istismarı olarak tanımlamaktadır (1). Munchausen by proxy sendromu (MBP) çocuk istismarının çok ağır ve özel bir şeklidir. Hastanene hastane dolaşarak hastalık öyküleri uyduran veya oluşturan, bu nedenle gereksiz ve çok sayıda medikal veya cerrahi girişimler uygulanan hastaların "Munchausen sendromu" olarak tanımlamasından sonra Meadow, benzer durumu çocuklarında oluşturan ebeveynleri "Munchausen by proxy sendromu" olarak tanımladı (2). Türkçeye "vekâleten Munchausen sendromu" veya "vekâleten hastalık uydurma" olarak da çevrilebilecek olan bu sendromda ebeveyn ya da bakımveren, çocukta bir hastalık varmış gibi yapmakta veya hastalık yaratmakta ve «hasta» çocuğu doktora götürmektedir. Sonuçta gereksiz tanısal işlemler, cerrahi girişimler ya da medikal tedavi nedeniyle çocukta ciddi tıbbi zararlar oluşmaktadır. MBP karmaşık ve potansiyel olarak ölümcül bir çocuk istismarı formudur. Otuz yıldan uzun bir süre önce tanımlanmış olmasına rağmen tanı ÖZETMunchausen by proxy sendromu çocuk istismarının çok ağır ve özel bir şeklidir. Bir erişkin tarafından çocukta hastalık belirti ve bulgularının oluşturulması ile karakterize karmaşık ve potansiyel olarak ölümcül bir çocuk istismarı formudur. Sonuçta gereksiz tanısal işlemler, cerrahi girişimler ya da medikal tedavi nedeniyle çocukta ciddi tıbbi zararlar oluşur. Pek çok klinisyen fi ziksel veya cinsel istismarı oldukça iyi bilirken, Munchausen by proxy sendromu'nu tanımakta güçlük çeker. Tanı konulması ve ayırıcı tanı yapılmasında halen zorluklar vardır. Nadir, beklenmeyen bulgularla başvuran veya standart tedaviye cevap vermeyen her olguda Munchausen by proxy sendromu'dan şüphelenilmelidir. Tanı her olguya şüpheci yaklaşım ve özgün tanısal işlemler ile koyulabilir. Olguların multidisipliner bir ekip (Çocuk Koruma Birimi) tarafın-dan değerlendirilmesi şarttır. Bu derlemede Munchausen by proxy sendromu'nun epidemiyolojisi ve tanı basamakları tartışılacaktır. Anahtar Sözcükler: Çocuk, Çocuk istismarı, Munchausen by proxy sendromu ABSTRACTMunchausen syndrome by proxy is a very special and dangerous form of child abuse. It is characterized by a child with symptoms and signs of an illness that have been fabricated by an adult, usually the mother. Fabrication of those signs and symptoms leads to many unnecessary and painful investigations and treatments for the victim. Although many physicians are familiar with the sexual or physical abuse of children, they are unaware of this particular form of child abuse. Fortunately, awareness among pediatricians will increase as more cases are shared in the literature. Diffi culties remain in defi ning the condition, as well as in the detection and differentiation from other illness. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable fi ndings or treatment failures....

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Section: Klinikunclassified

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

İnce¹,

Yurdakök²

2014

Turkish J Pediatr Dis

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“…Thus, all provided data related to this special aspect receive excessive attention and are therefore reinforced. Godding and Kruth (1991) reported adverse psychosocial circumstances in all of the 17 famihes in which they assumed Munchausen syndrome by proxy as causation for asthma in childhood. In most cases they found a neglect of the children.…”

Section: Discussionmentioning

confidence: 97%

Munchausen syndrome by proxy and factitious illness: Symptomatology, parent-child interaction, and psychopathology of the parents

Ammermann¹,

Klein²,

Schmidt

1995

European Child & Adolescent Psychiatry

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The term Munchausen syndrome by proxy is used to diagnose children presenting symptoms of an organic disorder resulting from manipulations initiated by their caretakers. Even in early infancy it happens that injuries are induced, and that drugs, poisons or medicine are administered in order to provoke and feign clinical symptoms of severe diseases. Exact data on prevalence are not available but it is obvious that Munchausen syndrome by proxy is a rare psychiatric disorder. There is a body of evidence that Munchausen syndrome by proxy is nothing but the extreme of a broader clinical entity for which the term factitious illness has been introduced. In this group children are included whose mothers invent a history of disease in order to produce symptoms without actually damaging their children. It is not well established whether such a distinction is necessary and whether there are differences in long-term outcome. Onset of symptoms is as early as three weeks up to twelve years, and mean age of diagnosis according to a more comprehensive study is 3 1/4 year. The estimated mortality rate of children with Munchausen syndrome by proxy is 9 percent. In three of the four cases of children reported here clinical presentations were dominated by symptoms of central nervous disorders. All mothers showed unsure and inconsistent parental behaviour and inefficient coping. None of them received support from their partners, if present. In interaction the children always wanted to dominate their mothers. The high amount of personality disorders observed in the caretakers might be the reason for the often reported failure of psychotherapeutic interventions.

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“…It is of note that the literature reports that as many as 1% of asthma clinic attendees (Godding & Kruth, 1991), and 5% of allergy clinic patients (Warner & Hathaway, 1984) are MBP cases. Furthermore, there was a factor of 7 difference in the incidence by county in the McClure et al (1996) study, raising the possibility that MBP was being missed in certain areas of the country.…”

Section: To the Editorsmentioning

confidence: 99%

Corrections

Scheier¹

2004

Child Maltreat

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Compliance with treatment in asthma and Munchausen syndrome by proxy.

Cited by 43 publications

References 13 publications

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

Munchausen syndrome by proxy and factitious illness: Symptomatology, parent-child interaction, and psychopathology of the parents

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