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Pract Neurol 2018 Nov 13. Epub 2018 Nov 13.

Nuffield Orthopaedic Hospital, Oxford Centre for Enablement, Oxford, UK.

Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. Read More

Ann Dermatol Venereol 2018 Oct 22. Epub 2018 Oct 22.

Département de dermatologie et vénéréologie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France.

Background: Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Read More

Int J Mol Sci 2018 Oct 21;19(10). Epub 2018 Oct 21.

Department of Human Genetics, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany.

Myelodysplastic syndrome (MDS) can easily transform into acute myeloid leukemia (AML), a process which is often associated with clonal evolution and development of complex karyotypes. Deletion of 5q (del(5q)) is the most frequent aberration in complex karyotypes. This prompted us to analyze clonal evolution in MDS patients with del(5q). Read More

J Eur Acad Dermatol Venereol 2019 Feb 31;33(2):263-266. Epub 2018 Oct 31.

Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.

Background: Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. Read More

J Clin Ethics 2018 ;29(3):185-190

Department of Neurology and Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA.

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. Read More

Behav Sci Law 2019 Jan 17;37(1):1-15. Epub 2018 Sep 17.

University of North Texas, Denton, TX, USA.

Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code. Read More

Blood Adv 2018 Aug;2(16):2127-2135

European Blood and Marrow Transplant Paris Study Office/CEREST-TC, Paris, France.

Patients with secondary AML (sAML) with antecedent myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPNs) tend to have high-risk disease based on the older age of patients, high-risk cytogenetics, and higher number of prior treatments. Allogeneic hematopoietic cell transplant (HCT) is the only potentially curative therapy available. Eight hundred and two adults with sAML and prior MDS/MPN who received a first HCT between 2000 and 2016 were included in the European Society for Blood and Marrow Transplant (EBMT) Acute Leukemia Working Party (ALWP) study. Read More

Nurs Clin North Am 2018 09;53(3):375-384

University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA.

Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. Read More

Ann Biol Clin (Paris) 2018 Aug;76(4):439-444

Département des laboratoires cliniques, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique, Pôle de recherche en endocrinologie, diabète et nutrition, Institut de recherche expérimentale et clinique, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique.

Our team of diabetologist is challenged by the case of a 41 year-old woman with recurrent hypoglycaemic episodes. Her clinical background was complex with, among others, a neuroendocrine tumor, a nonalcoholic steatohepatitis and an adrenal insufficiency; these conditions require the exploration of several potential causes. After excluding an endogenous etiology, a factitious hypoglycemia was quicky suspected by clinicians. Read More

J Pediatr Adolesc Gynecol 2018 Dec 7;31(6):637-639. Epub 2018 Jul 7.

Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Background: Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms.

Case: A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Read More

Am J Case Rep 2018 Jun 27;19:752-756. Epub 2018 Jun 27.

Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands.

BACKGROUND Pediatric condition falsification (PCF) is a rare form of child abuse in which a caregiver fabricates or induces illness in the child. The diagnosis is difficult and controversial and can easily include false positives. CASE REPORT A boy, 3. Read More

Clin Ter 2018 May-Jun;169(3):e129-e134

University of Padua, Department of Molecular Medicine.

Munchausen syndrome by proxy is a relatively rare behavioral disorder affecting a child's primary caregiver, typically the mother. Ethical dilemmas that physicians may face in such situations mainly concern the medical options for best protecting the child's welfare, that are important, in clinical pediatric practice, because critical conflicts might arise between health professionals and parents. In such cases, the physician's primary obligation is to protect the children involved, whose family environment may be essential to their wellbeing. Read More

J Med Case Rep 2018 Jun 18;12(1):168. Epub 2018 Jun 18.

Division of Mental Health and Addictions, University Hospital of North Norway, N-9291, Tromsø, Norway.

Background: The clenched fist syndrome/psycho-flexed hand, first described in the early 1980s, has not yet entered the major psychiatric textbooks. Curiously, the phenomenon has been illuminated mainly in journals and textbooks on hand surgery. There is a need to examine, describe, and understand this syndrome from a psychiatric perspective. Read More

Clin Nephrol 2018 Aug;90(2):102-105

Purpose: We sought to describe patterns of factitious urinary stone submission over time by investigating a contemporary stone analysis database and comparing two distinct time points.

Materials And Methods: We retrospectively reviewed a single stone analysis lab database at two time points, 1990 and 2010, and compared total incidence of factitious stone submission, as well as gender patterns and type of factitious stone submitted.

Results: A total of 27,014 stones were analyzed, 16,216 (60%) from 1990 and 10,798 (40%) from 2010 with a decrease in total incidence from 2. Read More

Rev Med Interne 2018 Dec 26;39(12):912-917. Epub 2018 Apr 26.

Aix-les Bains, France.

Objectives: Chronic Lyme disease is a subject of scientific and social controversy in both Europe and the United States. The aim of our study was to analyze the pathway to diagnosis of patients believing they were affected by the disease, and to describe their real-life experience.

Method: A qualitative study was performed with 13 patients declaring themselves to be affected by chronic Lyme disease. Read More

J Dtsch Dermatol Ges 2018 May 24;16(5):559-564. Epub 2018 Apr 24.

Department of Dermatology, Jena University Hospital, Jena, Germany.

Background: Dermatitis artefacta is a relevant and frequently unrecognized clinical condition associated with self-harming behavior, in which unconscious manipulation causes skin lesions. While atypical lesions and an unusual disease course may give rise to clinical suspicion of a self-induced disorder, questioning and examining these patients usually fails to confirm or clarify this suspicion. In this setting, the dermatopathologist may be faced with the question whether there are any histological signs corroborating the diagnosis of dermatitis artefacta. Read More

G Ital Dermatol Venereol 2018 Aug 19;153(4):525-534. Epub 2018 Apr 19.

Department of Dermatology, Royal London Hospital, London, UK -

Dermatitis artefacta (DA) or artefactual skin disease (ASD) is a factitious skin disorder rarely reported in the pediatric population. Skin lesions are produced deliberately either consciously or in a dissociative state to satisfy an underlying psychological need. Children may present with acutely formed skin changes or with chronic lesions, quite often having seen other specialists during their journey. Read More

J Emerg Med 2018 06 5;54(6):815-818. Epub 2018 Apr 5.

Denver Health and Hospital Authority, Department of Emergency Medicine, Denver, Colorado.

Background: Malingering is when a patient feigns illness for secondary gain. While most patients with malingering manufacture or exaggerate symptoms, some patients may induce illness. Previous reports of malingering patients inducing illness include sepsis, kidney pain, migraine, and chest pain. Read More

Int J Dermatol 2018 Aug 6;57(8):885-893. Epub 2018 Apr 6.

Chief of the Dermatology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

Background: Stigma refers to the wounds reproduced on the human body, similar to the ones inflicted on the Christ during his crucifixion, on the palms, soles, and head, as well as the right or the left side of the chest, the lips and, the back. Whether they are genuine or fabricated, stigmata are still considered a medical enigma.

Objective: To summarize and analyze all available medical data about stigmata, integrating both its dermatological and psychiatric features. Read More

Arch Dis Child 2019 Jan 4;104(1):7-11. Epub 2018 Apr 4.

Child Health, Cardiff and Vale ULHB, Cardiff, UK.

Arch Dis Child 2019 Feb 4;104(2):110-114. Epub 2018 Apr 4.

Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.

Int J Environ Res Public Health 2018 03 29;15(4). Epub 2018 Mar 29.

Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06100 Perugia, Italy.

Background: In most of the cases regarding children, factitious disorders (FDs) are intentionally produced by parents. Less attention is paid to FDs in which a child or adolescent intentionally induces or falsifies the disease to attain a patient's role.

Case Presentation: A 13-year-old immigrated and adopted boy previously underwent an operation for renal joint syndrome and was affected by recurrent episodes of renal colic. Read More

Eur J Med Genet 2018 Oct 23;61(10):575-580. Epub 2018 Mar 23.

IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Salazar, Universidade do Porto, Porto, Portugal.

This longitudinal study aimed at determining predicting variables for middle and long-term psychological disturbance due pre-symptomatic testing (PST) for two late-onset neurological diseases, Huntington disease (HD) and TTR (transthyretin protein) familial amyloid polyneuropathy (FAP) Val30Met (now classified as Val50Met). 196 clinical records of persons who performed PST at least three years ago and answered to the two stages of evaluation (before PST and least 3 years after disclosure of results) were analysed. For this purpose, regression analysis was performed, showing that the Positive Symptom Distress Index (PSDI), psychoticism, somatization and paranoid ideation dimensions assume predictive value in the middle and long-term impact for total anxiety and PSDI. Read More

Vertex 2017 Mar;28(132):145-151

Servicio de Salud Mental Instituto de Investigaciones Médicas "A. Lanari", Facultad de Medicina, UBA.

We present a detailed case report that shows a woman patient who has Factitious Disorder manifested by the coexistence both of: A) typical/direct Munchausen and B) Munchausen by proxy or indirect: being the frst one (A) about the own person and the second one (B) about other people (most cases about their own young children). Furthermore, in the reported case we observed that the patient shown the particularity of having positive biological markers for Myasthenia Gravis (serology markers), and having inconsistent clinical manifestations that are typically observed in the exacerbation phase when she still continued in remission phase. In our own bibliographic research we couldn`t fnd anything about this case of "Mixed Munchausen Syndrome with organic comorbidity". Read More

Prim Care Companion CNS Disord 2018 Feb 22;20(1). Epub 2018 Feb 22.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Factitious disorder can present in multiple health care settings, with patients intentionally producing symptoms to assume the sick role. This assumption of the sick role can result in multiple hospitalizations with unnecessary diagnostic workup, as well as invasive diagnostic procedures that can lead to worrisome side effects. Differential diagnoses that should be ruled out include malingering, somatic symptom disorder, and anxiety disorders. Read More

Vestn Otorinolaringol 2018;83(1):72-74

L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152.

The authors describe a rare clinical case of psychogenic hearing loss in a female patient presenting Munchausen's syndrome with special reference to the objective and subjective methods designed to evaluate the hearing ability and used for diagnostics of this condition. Read More

Pediatr Diabetes 2018 06 21;19(4):823-831. Epub 2018 Feb 21.

Section of Pediatric Diabetes and Metabolism, DEOB, NIDDK, NIH, Bethesda, Maryland.

Background: Factitious hypoglycemia is a condition of self-induced hypoglycemia due to surreptitious administration of insulin or oral hypoglycemic agents. In adults, it is an uncommon, but well known clinical entity observed in individuals with and without diabetes.

Objectives: To report a case of factitious hypoglycemia highlighting diagnostic pitfalls, to identify common characteristics of children and adolescents with factitious hypoglycemia, and to examine whether the information on long-term outcome exists. Read More

Ann Hematol 2018 Jun 9;97(6):1111-1113. Epub 2018 Feb 9.

Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Einstein (Sao Paulo) 2017 Oct-Dec;15(4):516-521

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. Read More

J Anal Toxicol 2018 04;42(3):e35-e37

Institut de medicine légale, 11 rue Humann, F-67000 Strasbourg, France.

Hand Surg Rehabil 2018 Apr 29;37(2):110-113. Epub 2017 Dec 29.

Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.

Every doctor can be confronted, during his career, with patients presenting symptoms they created themselves. Because it is easily accessible, the hand is a favored target organ for these self-inflicted injuries. The diagnosis of factitious disorder of the hand is very difficult, rarely suggested and widely under-estimated. Read More

Rev Med Liege 2017 Dec;72(12):521

Service de Psychiatrie, Centre Hospitalier Universitaire Mohammed VI, Faculté de Médecine et de Pharmacie, Université Mohammed premier, Oujda, Maroc.

Psychol Res Behav Manag 2017 11;10:387-394. Epub 2017 Dec 11.

Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy.

A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. FD is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clear. Read More

Int J Psychiatry Med 2018 07 21;53(4):310-316. Epub 2017 Dec 21.

2 VA Central California Health System, Fresno, CA, USA.

Objective Factitious disorders are known to exist in the medical community but are not commonly diagnosed in clinical practice. The majority of the literature on factitious disorder comes from case reports or case series. This particular case is unusual because it describes a patient who initially presented with purely physical complaints, but over time, the symptoms transitioned into predominantly psychiatric concerns. Read More

Tex Heart Inst J 2017 10 1;44(5):338-340. Epub 2017 Oct 1.

Anaesthesia 2018 01;73(1):124

Health Education North West (Mersey), Liverpool, UK.

Dent Update 2017 Mar;44(3):261

Front Neurol Neurosci 2018 17;42:81-86. Epub 2017 Nov 17.

Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chronic. The syndrome was named after Karl Friedrich Hieronymus, Baron von Münchhausen (1720-1797), a German nobleman who became famous as a narrator of false and exaggerated exploits. Read More

Front Neurol Neurosci 2018 17;42:72-80. Epub 2017 Nov 17.

This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Read More

Front Neurol Neurosci 2018 17;42:1-22. Epub 2017 Nov 17.

Laboratory for Cognitive and Neurological Sciences, Département de Médecine, Université de Fribourg, Fribourg, Switzerland.

Ganser's syndrome is a rare and controversial condition, whose main and most striking feature is the production of approximate answers (or near misses) to very simple questions. For instance, asked how many legs a horse has, Ganser patients will reply "5", and answers to plain arithmetic questions will likewise be wrong, but only slightly off the mark (e.g. Read More

Haematologica 2018 02 3;103(2):237-245. Epub 2017 Nov 3.

Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany.

No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcomes and risk factors in 698 patients, treated with different strategies. The median overall survival from relapse was 4. Read More

J Am Osteopath Assoc 2017 11;117(11):724

Cureus 2017 Jun 13;9(6):e1348. Epub 2017 Jun 13.

Department of Medicine, FMH College of Medicine and Dentistry.

Munchausen syndrome (MS) was first reported in 1951 by Richard Alan John Asher as a factitious disorder. It is a condition in which the patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i. Read More

Retin Cases Brief Rep 2018 Fall;12 Suppl 1:S46-S50

Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.

Purpose: To report a case of factitious self-inflicted handheld laser-induced maculopathy.

Methods: A 29-year-old man presented to our clinic complaining of a step-wise progressive loss of vision that abruptly began in his left eye but then became bilateral. He underwent comprehensive ocular examination, including visual acuity testing, biomicroscopic, dilated funduscopic examination, structural optical coherence tomography, en face structural optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Read More

Clin J Gastroenterol 2017 Oct 21;10(5):447-451. Epub 2017 Aug 21.

Department of Gastroenterology, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK.

Acute upper gastrointestinal (GI) bleeding is a common condition in the UK with 50-70,000 admissions per year. In 20% of cases no cause can be found on endoscopy. Here, we present the case of a young female patient who was admitted on three occasions with large volume haematemesis and bleeding from other sites. Read More

Z Orthop Unfall 2017 Aug 16;155(4):477-498. Epub 2017 Aug 16.

Despite modern conservative and surgical procedures, the number of amputations of the lower limb remains at a consistently high level. With the demographic changes and the consequent prevalence of atherosclerosis and diabetes mellitus, there is a steady increase of the risk factors that can lead to an amputation. The cause, which ultimately leads to the loss of the affected limb is therefore a symptom of the underlying disease. Read More

Chest 2018 Feb 8;153(2):528-543. Epub 2017 Aug 8.

Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Wake Forest University School of Medicine and Wake Forest Baptist Medical Center, Winston-Salem, NC; Division of Allergy and Clinical Immunology, Department of Medicine, W.G. (Bill) Hefner VA Medical Center, Salisbury, NC; Division of Allergy and Clinical Immunology, Department of Medicine, Kernersville Health Care Center, Kernersville, NC. Electronic address:

Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Read More

J Forensic Sci 2018 May 2;63(3):771-775. Epub 2017 Aug 2.

School of Psychology, University of Central Lancashire, Preston, UK.

In Munchausen by proxy (MBP) maltreatment, increasingly termed "medical child abuse" (MCA), a caregiver fabricates or induces illness in another. The perpetrator's goal for the behavior is to meet personal emotional needs by forcing unnecessary or misguided medical or psychological treatment. Generally, a mother is the perpetrator and her child is the victim. Read More