eMedicine Specialties > Emergency Medicine > Psychosocial
Munchausen Syndrome: Follow-up
Updated: Feb 14, 2008
Follow-up
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.
Miscellaneous
Medicolegal Pitfalls
- Rushing to a diagnosis of a factitious disorder and, as a result, missing the presence of an authentic organic disease, may result in litigation.
- Other pitfalls that might delay or adversely affect the care of the patient, causing morbidity and mortality include the following:
- Inadequate effort to distinguish Munchausen syndrome, malingering, and conversion disorders
- Misdiagnosing patients as having any of the factitious illness syndromes because of unpleasant personality traits
- Attributing symptoms to the Munchausen syndrome without proper investigation (Patients with documented Munchausen syndrome are as susceptible to develop true disease as any other patient.)
Special Concerns
As noted above, recent articles have reported a variation of Munchausen syndrome in which sufferers use Internet bulletin boards and patient self-help groups to further gratify their primary need to be sick. These deceptions, when challenged, often lead to extensive civil legal proceedings. Physicians may become involved as expert witnesses or as witnesses-of-fact to one of the Munchausen patient's multiple presentations to hospital.
Expert witnesses in such cases (or in cases where workers' compensation or tort are involved) must be prepared to make the distinction between primary and secondary gain clear to juries. They also need to be able to help juries distinguish between malingering, somatiform disorder, and Munchausen syndrome.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor, Craig Feied, MD, to the development and writing of this article.
More on Munchausen Syndrome |
| Overview: Munchausen Syndrome |
| Differential Diagnoses & Workup: Munchausen Syndrome |
| Treatment & Medication: Munchausen Syndrome |
 Follow-up: Munchausen Syndrome |
| References |
| « Previous Page |
References
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Further Reading
Keywords
Munchausen syndrome by proxy, MSBP, Munchausen syndrome, factitious illness, factitious disorder, cardiopathia fantastica, faking illness, factitious symptoms, self-injury, self-poisoning, unnecessary medical procedures, mental illness, malingering, psychiatric illness
