Munchausen Syndrome in Emergency Medicine Treatment & Management

Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...

Updated: Feb 10, 2011

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Prehospital Care
Emergency Department Care
Consultations
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Prehospital Care

Emergency medical services (EMS) care will be directed at the initial presenting symptoms. It is unlikely that prehospital teams will be able to effectively establish a diagnosis of Munchausen syndrome, they should not attempt to do so.

Emergency Department Care

Initial care and stabilization of patients with Munchausen syndrome is driven by the presenting symptoms.

The fact that symptoms may well be the result of sophisticated lying or of self-injury or self-intoxication by the patient does not make the workup and treatment of those symptoms any less necessary.

Consultations

If in doubt, consult the appropriate specialist for the purported illness and arrange for admission to the hospital.

If the diagnosis of Munchausen syndrome is clear, psychiatric consultation and referral should be offered to the patient even if admission for the patient's medical problems is declined. The patient nearly always declines such referrals, and a refusal should be documented in the patient's record.

Although not intuitively obvious, persons with Munchausen syndrome generally do not meet criteria for involuntary admission to hospital. They are neither homicidal nor suicidal, and their mental illness does not incapacitate them (in most cases) sufficiently to impair their ability to carry out their activities of daily living. They thus fail statutory criteria for involuntary commitment as it is set forth in many states' laws. Psychiatric consultation should be sought if the issue is unclear in the state or province of the physician.

Proceed to Medication

Contributor Information and Disclosures

Author

William Ernoehazy Jr, MD, FACEP Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida

William Ernoehazy Jr, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Robert Harwood, MD, MPH, FACEP, FAAEM Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine

Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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