Early death in Munchausen syndrome: A case report

Lorenzo, Rosaria Di; Lannocca, Ludovica; Burattini, Maritea; Vasta, Andrea; Galletti, Martina; Minarini, Alessandro; Mongelli, Francesca; Sportiello, Salvatore; Rovesti, Sergio; Ferri, Paola

doi:10.1002/ccr3.2254

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…In the present study, around half of the patients diagnosed with FD initially presented to the ED. This is in agreement with a number of case reports regarding FD [ 20 , 22 , 23 ]. However, other studies also reported patients presenting to outpatient clinics of different disciplines [ 14 ].…”

Section: Discussionsupporting

confidence: 93%

Factitious Disorder in Seven Patients: A Saudi Experience

Qasim¹,

Samman²,

Alalwan³

et al. 2021

Cureus

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BackgroundFactitious disorder (FD) is a psychiatric disease where signs and symptoms are produced, falsified, or exaggerated consciously in the absence of clear external motivations. Through needless medical visits, costly investigatory testing, and potentially long hospital stays, patients with FD waste valuable time and resources, which affects both the patient and the healthcare system. It can be very challenging for physicians who have never encountered patients with FD to recognize them promptly as symptoms of FD vary greatly. MethodologyThis was a retrospective study of patients diagnosed with FD attending King Abdulaziz Medical City in Riyadh, Saudi Arabia, a tertiary care military hospital and one of the most prominent academic and referral medical institutions in the country. Using the BESTCare health information system, we reviewed patients' electronic health records from January 2015 to December 2020. The diagnosis of FD was based on the International Classification of Diseases and Related Health Problems 10th edition. ResultsA total of seven patients were included in the study, of whom five (71%) were males and two (29%) were females. Of the total seven patients, three were 21 years old and younger, one was 38 years old, and three were 56 years old and older. Three (43%) patients were married and four (57%) were single. In terms of occupation, three (43%) patients were retired, one (14%) worked in a private company, one (14%) was unemployed, and two (29%) were students. A total of four (57%) patients initially presented to the Emergency Department (ED), and only three (43%) presented to the outpatient clinics. Induced disease or injury was found in five (71%) patients. Induced skin injury was found in four (57%) patients. Counseling and psychotherapy were only offered to one (14%) patient. ConclusionsFD remains a rare psychiatric condition that is difficult to recognize. Despite a small sample size, FD in the present study showed a male predominance, affecting patients of all age groups. About half of the patients presented initially to the ED. Induced disease or injury was the most commonly reported pattern of clinical presentation. Induced skin injury was the most common clinical presentation found in around half of the patients. We believe that the number of FD patients in the present study is likely underreported and is expected to be higher. This highlights the need for better awareness of FD among physicians in different medical fields. We emphasize that there is a need for better professional training in the identification of FD.

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Section: Discussionsupporting

confidence: 93%

Factitious Disorder in Seven Patients: A Saudi Experience

Qasim¹,

Samman²,

Alalwan³

et al. 2021

Cureus

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“…This case highlights how easily a patient can be subjected to unnecessary interventions and receive large quantities of powerful medications. While our patient's signs and symptoms were not immediately life-threatening, the potential for fatal outcomes in these patients cannot be ignored [1] . Repeated unnecessary exposures to GA in his case provided an increased risk of mortality.…”

Section: Discussionmentioning

confidence: 76%

Alleged recurrent traumatic shoulder dislocation in a young male patient – Diagnostic and management considerations

Murphy

Carroll

McColgan

et al. 2022

Trauma Case Reports

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A young male presented to a nearby hospital with a left shoulder dislocation after an alleged kickboxing injury. The patient reported worrying clinical findings including excruciating pain and absent sensation distally. Reduction was successful but his shoulder re-dislocated shortly after. His reported symptoms worsened and he was transferred to our institution. Imaging findings were not immediately concerning and he went to theatre the next day for an examination under anaesthetic. His shoulder was re-located easily and an immobiliser applied. Less than an hour later, the patient managed to re-dislocate his shoulder in recovery. He was subjected to another general anaesthetic and successful reduction. He absconded the following day after being declined multiple and increasing doses of opioid analgesia. He re-presented three weeks later with similar clinical findings but a different mechanism of injury. Further exploration of his collateral history revealed that he had been using a false identity. He had presented to all hospitals in our city within the previous 6 months. Once confronted, he did not return to these hospitals. He was also capable of self-relocating his shoulder. This case bore a striking resemblance to a case described by Warren in 2000 of a young lady with an apparently dislocated shoulder presenting to multiple city hospitals looking for analgesia and general anaesthetics. We wished to highlight the diagnostic and ethical challenges associated with these patients. They are vulnerable and so a high index of clinical suspicion is needed on the part of the surgeon to avoid unnecessary interventions. Effective communication between orthopaedic departments is a key recommendation from this case to mitigate risk of harm to these patients.

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“…10 Individual physical and emotional costs and risk to FD patients, whose behaviour in some cases may constitute a form of self-harm, are marked with frequent exposure to inadvertent iatrogenic investigation and unnecessary treatments leading to morbidity in itself, and even death. 11 Diagnosing FD is often only possible through systematically sourcing collateral information and scrutinising any available medical records. 8 Unless suspicious clinicians invest considerable time to confirm objectively or discredit reported conditions while investigating new symptoms, the diagnosis will be missed.…”

Section: Discussionmentioning

confidence: 99%

Utilisation of the Australian government initiative MyHealth Record to support the clinical approach to factitious disorder

Alchin

Overton

George

et al. 2020

Internal Medicine Journal

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Recently, the Australian Digital Health Agency launched MyHealth Record to the public. As of July 2019, 90.1% of Australians hold records with this service, allowing 16 400 health organisations access to >28 million clinical documents. The streamlining of patient data was intended to facilitate sharing of information and improve communication between medical providers, while promoting efficiency in clinical practice. We have identified a hitherto unrecognised application of this infrastructure in the identification and management of factitious disorder, a rare yet highly diagnostically challenging condition involving intentional feigning of illness, which presents a significant resource burden to the Australian health system.

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Early death in Munchausen syndrome: A case report

Cited by 8 publications

References 18 publications

Factitious Disorder in Seven Patients: A Saudi Experience

Factitious Disorder in Seven Patients: A Saudi Experience

Alleged recurrent traumatic shoulder dislocation in a young male patient – Diagnostic and management considerations

Utilisation of the Australian government initiative MyHealth Record to support the clinical approach to factitious disorder

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