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Additions from Queen's medical school students
editGood work compiling your suggestions. Here are come suggestions to make before you go live on the talk page. Once you have completed these, please leave it in your sandbox. I will go through it a second time and then we should be ready for the talk page. @Aamorra, Adrianda, Afsd95, Jwaserman, and Qmedbs: Please feel free to contact me (either leave me a note on here and flag it, or on my talk page, or via email) if you have any questions or need technical assistance inserting references etc. JenOttawa (talk) 17:14, 7 November 2017 (UTC)
'Looks much improved. Once you have verified that the table is all original content (no close paraphrasing), go ahead and remove my comments and add it to the talk page. Once in the talk page, do not remove comments, but please do respond to them~ Great work. JenOttawa (talk)'
Hello!
We are a group of first year medical students from Queen's University who are editing this page as part of a class assignment. We have compiled a list of suggestions to improve this article and would appreciate any community feedback before we proceed with these edits. Please find below a list of our suggestions:
1) In the diagnosis subsection, change: "A similar behavior called Munchausen syndrome by proxy has been documented in the parent or guardian of a child." To: "A similar illness, Factitious Disorder Imposed on Another (formerly Factitious Disorder by proxy), also exists. This entails a person (not necessarily a parent or guardian), presenting another individual as falsely sick.[1]"
2) In regards to the “diagnosis” section, since extensive research on factitious disorder is not available, a brief summary of disease types that have been mimicked and laboratory diagnostics used to differentiate these cases from true disease could be included using the following table: @JenOttawa This table summarizes the citation listed. It was create from the reviewed data in citation 2, not copied. Did you write this whole table yourself? Is all the content directly paraphrased from citation # 2, or is some text copied? I did not check, just wanted to make sure there are not copyright probs.
| Disease Mimicked | Method of Imitation | Laboratory/Diagnostic Confirmation |
| Bartter’s syndrome | • Surreptitious intake of diruetics
• Self-induced vomiting |
• High performance liquid chromatography (HPLC) analysis of urine
• Urine chloride analysis |
| Catecholamine-secreting tumor | Injection of ephinephrine into urine or blood stream | Adjunct analysis of increased Chromogranin A |
| Cushing’s syndrome | Surreptitious steroid administration | HPLC to differentiate endogenous and exogenous steroids |
| Hyperthyroid | Surreptitious thyroxine administration | Blood tests for free T4 and thyroid stimulating hormone |
| Hypoglycaemia | Exogenous insulin or insulin secretagogues | Simultaneous blood analysis of insulin, C-peptide, proinsulin, and insulin secretagogues |
| Sodium imbalance | Intake large quantities of salt | Measure fractional sodium excretion to differentiate intentional salt overload from dehydration. |
| Chronic diarrhoea | • Watered down stool samples
• Laxative abuse |
• Measure fecal osmolarity
• Urine analysis to screen for laxatives using gas chromatography or mass spectrometry |
| Induced vomiting | Although many alternatives possible, ipecacuanha ingestion | HPLC measurement of serum or urine for elevated creatine kinase, transaminases and ipecacuanha |
| Proteinuria | Egg protein injection into bladder, albumin (protein) addition to urine samples | Urine protein electrophoresis analysis |
| Haematuria | Blood introduction to urine samples, deliberate trauma to the urethra | Imaging to rule out insertion of a foreign body, monitor sample collection, analysis of red blood cell shape in samples |
3) In Munchausen syndrome#Treatment and prognosis, add the following to the end of the first paragraph: “Due to the uncommon and underlying nature of this disorder, it is hard to study as participation in studies is difficult to maintain after suggestion of factitious disorder diagnosis.[3] As such a prognosis is difficult to establish.[3]”
4) We suggest moving the following sentences to Munchausen syndrome#Signs and symptoms or Munchausen syndrome#Diagnosis, rather than Munchausen syndrome#Treatment and prognosis:
“There are several symptoms that together point to Munchausen syndrome, including frequent hospitalizations, knowledge of several illnesses, frequently requesting medication such as pain killers, openness to extensive surgery, few or no visitors during hospitalizations, and exaggerated or fabricated stories about several medical problems. Munchausen syndrome should not be confused with hypochondria, as patients with Munchausen syndrome do not really believe they are sick; they only want to be sick, and thus fabricate the symptoms of an illness. It is also not the same as pretending to be sick for personal benefit such as being excused from work or school.[5]” → Munchausen syndrome#Signs and symptoms section
“There are several ways in which the patients fake their symptoms. Other than making up past medical histories and faking illnesses, patients might inflict harm on themselves such as taking laxatives or blood thinners, ingesting or injecting themselves with bacteria, cutting or burning themselves, and disrupting their healing process such as by reopening wounds.[citation needed] Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times.” → Munchausen syndrome#Diagnosis section
5) I would like to change “Munchausen syndrome is a factitious disorder…” to “Munchausen syndrome, a term no longer in use, described a disorder wherein… Factitious disorder is now the term of choice by experts.”
I would also change “Munchausen syndrome fits within the subclass of factitious disorder” to “Munchausen syndrome was the original term used to describe a condition with predominantly…”
6) Modify the introduction of Munchausen syndrome by proxy to incorporate the new terminology of ‘factitious disorder’ and use language that reduces villainization of the perpetrator.
*Remove “Munchausen syndrome is related to Munchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser.”
*Insert:“Factitious disorder is related to Factitious Disorder Imposed on Another (formerly Munchausen syndrome by proxy), which refers to a caregiver producing illness in a person under their care, typically a child, in order to satisfy a psychological need for praise or sympathy for their devoted care.[5]”
Many thanks to the Wikipedia community for your insights and feedback! :) Adrianda (talk) 16:54, 7 November 2017 (UTC)
Practice citation insert: Laboratory Diagnosis of Munchausen [6]
A summary of more common and reported cases of factitious disorder (Munchausen syndrome), and the laboratory tests used to differentiate these from authentic disease is provided below:[6]
| Disease Mimicked | Method of Imitation | Laboratory/Diagnostic Confirmation |
|---|---|---|
| Bartter’s syndrome |
|
|
| Catecholamine-secreting tumor | Injection of ephinephrine into urine or blood stream | Adjunct analysis of increased Chromogranin A |
| Cushing’s syndrome | Surreptitious steroid administration | HPLC to differentiate endogenous and exogenous steroids |
| Hyperthyroid | Surreptitious thyroxine administration | Blood tests for free T4 and thyroid stimulating hormone |
| Hypoglycaemia | Exogenous insulin or insulin secretagogues | Simultaneous blood analysis of insulin, C-peptide, proinsulin, and insulin secretagogues |
| Sodium imbalance | Intake large quantities of salt | Measure fractional sodium excretion to differentiate intentional salt overload from dehydration. |
| Chronic diarrhoea |
|
|
| Induced vomiting | Although many alternatives possible, ipecacuanha ingestion | HPLC measurement of serum or urine for elevated creatine kinase, transaminases and ipecacuanha |
| Proteinuria | Egg protein injection into bladder, albumin (protein) addition to urine samples | Urine protein electrophoresis analysis |
| Haematuria | Blood introduction to urine samples, deliberate trauma to the urethra | Imaging to rule out insertion of a foreign body, monitor sample collection, analysis of red blood cell shape in samples |
References
edit- ^ Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed. ed.). Washington, D.C.: American Psychiatric Association. ISBN 978-0-89042-554-1.
- ^ Kinns, H; Housley, D; Freedman, DB (May 2013). "Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis.". Annals of clinical biochemistry. 50 (Pt 3): 194–203. PMID 23592802. doi:10.1177/0004563212473280.
- ^ a b Bass, C., & Halligan, P. (2014). Factitious disorders and malingering: Challenges for clinical assessment and management. The Lancet, 383(9926), 1422–1432. https://doi.org/10.1016/S0140-6736(13)62186-8
- ^ Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed. ed.). pg 324. Washington, D.C.: American Psychiatric Association. ISBN 978-0-89042-554-1.
- ^ Burton MC, Warren MB, Lapid MI, Bostwick JM. Munchausen syndrome by adult proxy: a review of the literature. J Hosp Med. 2015 Jan;10(1):32–5. https://www.ncbi.nlm.nih.gov/pubmed/25274180
- ^ a b Kinns, H; Housley, D; Freedman, DB (May 2013). "Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis". Annals of clinical biochemistry. 50 (Pt 3): 194–203. doi:10.1177/0004563212473280. PMID 23592802.