Munchausen Syndrome in Emergency Medicine Workup

  • Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Feb 10, 2011
 

Laboratory Studies

  • Depending upon the presenting complaint, any laboratory test used in the ED may be indicated in the initial evaluation of patients with underlying Munchausen syndrome.
  • Laboratory results that are atypical in pattern (eg, dramatically positive results, paradoxically normal results) may be an early indication of the presence of a factitious illness. Efforts may then be made to refine the diagnosis.
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Imaging Studies

  • As with laboratory testing, almost any imaging technique used in the ED may be indicated in the initial workup.
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Procedures

  • If the initially credible impression suggests severe enough disease or the attempts the patient has made to mimic organic illness have themselves produced sufficient illness and/or injury, appropriate procedures for workup and/or treatment must be undertaken.
  • Clinicians often become frustrated at the thought of performing invasive procedures on healthy people.
  • Persons with Munchausen syndrome often develop remarkable skill in inducing or duplicating symptoms. Further, the ED physician has a duty not to ignore organic disease where it is plausibly believed to exist. These factors, in concert, often make the performance of such procedures unavoidable.
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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.

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.

References

  1. Olry R. Baron Munchhausen and the syndrome which bears his name: history of an endearing personage and of a strange mental disorder. Vesalius. Jun 2002;8(1):53-7. [Medline].

  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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