Munchausen Syndrome in Emergency Medicine Follow-up
- Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
Further Inpatient Care
- Inpatient admission will be indicated by the presenting symptoms.
- As mentioned in Procedures, there will come a time in the care of a patient with Munchausen syndrome when the suspicion of factitious illness has arisen, but evidence is insufficient to be certain of that diagnosis.
- Physicians have a duty not to miss authentic pathology in the patient with a factitious illness. The observation of such patients actually taking steps to feign a symptom in a controlled environment is often the final step in securing the diagnosis of Munchausen syndrome.
Further Outpatient Care
- At least one report exists of a patient being placed under legal restraint, house arrest, and mandatory outpatient psychiatric therapy in an attempt to deal with the patient's persistent disease.[4]
- Given the current poor success rate of psychiatric interventions in Munchausen syndrome such an approach seems appropriate only as a last resort, especially as recent case reports suggest that those with Munchausen syndrome can have long periods of apparent normalcy before symptoms recur.
Transfer
- Even if Munchausen syndrome is suspected, ordinary care must be provided until the patient is fully diagnosed. As with any other patient, if (1) a constellation of symptoms has placed, or appears to have placed, the patient in need of certain therapies, and (2) the initial hospital lacks the resources or staffing to deal with the symptoms in question, then transfer to a secondary or tertiary referral center should be arranged, in accordance with federal law and established clinical practice.
Complications
- Manifold complications may occur from the simulation of symptoms, depending upon the technique that the patient used to induce such symptoms. The severity of complications may range from trivial to lethal.
Prognosis
- The prognosis for patients with Munchausen syndrome generally is poor.
- There is no substantial understanding of the psychopathology of this disorder.
- Patients generally are unwilling to undergo therapy. Even if they are willing, no good therapeutic strategy exists.
Patient Education
- Patients with Munchausen syndrome may present in self-help groups; reports are now surfacing of such patients using Internet-based patient support groups to fulfill their need to "be sick." Physicians who assist such groups may run across such cases, or their colleagues may ask about such things, having become frustrated when dealing with such people.
- For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center. Also, see eMedicine's patient education article Munchausen Syndrome.
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