eMedicine Specialties > Emergency Medicine > Psychosocial

Munchausen Syndrome: Treatment & Medication

Author: William Ernoehazy Jr, MD, FACEP, Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida
Contributor Information and Disclosures

Updated: Feb 14, 2008

Treatment

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.

Medication

Drugs that may be proposed for a patient with Munchausen syndrome fall into 2 categories, (1) drugs used to treat the presenting symptoms, and (2) antipsychotic medications, which are used to treat the underlying condition.

The first category is necessarily broad because patients with Munchausen syndrome have portrayed nearly every disease known to medicine.

No good evidence exists that antipsychotic drugs have any effect on the course or prognosis of Munchausen syndrome.

More on Munchausen Syndrome

Overview: Munchausen Syndrome
Differential Diagnoses & Workup: Munchausen Syndrome
Treatment & Medication: Munchausen Syndrome
Follow-up: Munchausen Syndrome
References
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References

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  2. Steinwender C, Hofmann R, Kypta A, Leisch F. Recurrent symptomatic bradycardia due to secret ingestion of beta-blockers--a rare manifestation of cardiac Münchhausen syndrome. Wien Klin Wochenschr. Sep 2005;117(18):647-50. [Medline].

  3. Park TA, Borsch MA, Dyer AR, Peiris AN. Cardiopathia fantastica: the cardiac variant of Munchausen syndrome. South Med J. Jan 2004;97(1):48-52; quiz 53. [Medline].

  4. Elmore JL. Munchausen syndrome: an endless search for self, managed by house arrest and mandated treatment. Ann Emerg Med. May 2005;45(5):561-3. [Medline].

  5. Asher R. Munchausen's syndrome. Lancet. Feb 10 1951;1(6):339-41. [Medline].

  6. Bretz SW, Richards JR. Munchausen syndrome presenting acutely in the emergency department. J Emerg Med. May 2000;18(4):417-20. [Medline].

  7. Canogullari G, Ulupinar E, Teyin M, Balci Y. A forensic case of Munchausen's syndrome. J Forensic Leg Med. Apr 2007;14(3):167-71. [Medline].

  8. Eisendrath SJ. When Munchausen becomes malingering: factitious disorders that penetrate the legal system. Bull Am Acad Psychiatry Law. 1996;24(4):471-81. [Medline].

  9. Falagas ME, Christopoulou M, Rosmarakis ES, et al. Munchausen's syndrome presenting as severe panniculitis. Int J Clin Pract. 2004;58(7):720-2. [Medline].

  10. Feldman MD. Munchausen by Internet: detecting factitious illness and crisis on the Internet. South Med J. Jul 2000;93(7):669-72. [Medline].

  11. Feldman MD, Peychers ME. Legal issues surrounding the exposure of "Munchausen by Internet". Psychosomatics. Sep-Oct 2007;48(5):451-2. [Medline].

  12. Gregory RJ, Jindal S. Factitious disorder on an inpatient psychiatry ward. Am J Orthopsychiatry. Jan 2006;76(1):31-6. [Medline].

  13. Hall DE, Eubanks L, Meyyazhagan LS. Evaluation of covert video surveillance in the diagnosis of munchausen syndrome by proxy: lessons from 41 cases. Pediatrics. Jun 2000;105(6):1305-12. [Medline].

  14. Hopkins RA, Harrington CJ, Poppas A. Münchhausen Syndrome simulating acute aortic dissection. Ann Thorac Surg. Apr 2006;81(4):1497-9. [Medline].

  15. Huffman JC, Stern TA, Huffman JC, Stern TA. The diagnosis and treatment of Munchausen's syndrome. Gen Hosp Psychiatry. 2003;25(5):358-63. [Medline].

  16. Lad SP, Jobe KW, Polley J, et al. Munchausen's syndrome in neurosurgery: report of two cases and review of the literature. Neurosurgery. 2004;55(6):1436. [Medline].

  17. Rabinerson D, Kaplan B, Orvieto R, et al. Munchausen syndrome in obstetrics and gynecology. J Psychosom Obstet Gynaecol. 2002;23(4):215-8. [Medline].

  18. Smith MS. Factitious illness, malingering, and conversion disorder. In: Harwood-Nuss AL, Linden CH, Luten RC, et al, eds. The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1996:986.

  19. Zuger A, O'Dowd MA. The baron has AIDS: a case of factitious human immunodeficiency virus infection and review. Clin Infect Dis. Jan 1992;14(1):211-6. [Medline].

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Further Reading

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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

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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.

Medical Editor

Eric Kardon, MD, FACEP, Associate Staff, Division of Emergency Medicine, Athens Regional Medical Center
Eric Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert C Harwood, MD, MPH, Program Director, Chair, Department of Emergency Medicine, Christ Hospital and Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago Medical School
Robert C Harwood, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Chicago Medical Society, Illinois State Medical Society, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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