400 Münchhausen Syndrome With An Elderly Victim Refusing Admission : Look For Drug Abuse, Incest, Violence, Alcohol

Conference: 
Author(s): 
P. Moeremans
Mechelen
Text: 
Aim: to detect and prove factitious disorder in an elderly family member caused by a caretaker who is aiming to assume the sick role by proxy.
Methods: Screening for intentional production or feigning of physical signs or symptoms in an elderly who is cared for in the family. Clues to suspicion are:
1/ many home visits without a firm established diagnosis,
2/ history is not given by the patient but by the caretaker,
3/ inconsistent laboratory test results and urging to test,
4/ bruises or wounds on uncommon sites on the body,
5/ more pathology comes when minimised by the doctor,
6/ amazing (para-) medical or pharmaceutical knowledge,
7/ doctor shopping, frequent pseudo-urgent house calls,
8/ pathological lying or factitious disorder of the caretaker,
9/ the caretaker can't get convinced to leave for a moment.
Excluded are external incentives, such as economic gain. Both the perpetrator and the victim are treated with emphatic in depth exploration of the causes and SSRI treatment (selective serotonin re-uptake inhibitors).
Results: Four cases are identified and confirmed after in depth questioning of all not institutionalised patients aged over 60 years old in a family practice ( N= 687).
1/ Bird red cells put in the urine of her mother. Own arm oedema by cuff. Sex between husband and her daughter.
2/ Substitution of insulin by diclofenac sc, later hepatitis B injection by the lover of her battered drunk daughter.
3/ Substitution of miconazole paste by lassar paste by granddaughter to stay at home. She was always teased at work.
4/ Substitution of theophyllin by warfarin by a stepson. He hides stubs in her house and compulses her to anal sex.
Quite often, some collaboration of the victim coexists. In depth study reveals often more dirty family secrets as incest, violence, alcohol, drug abuse. All these cases responded favourably to SSRI therapy for both patients.
Conclusion:
when considering factitious disorder by proxy in elderly, try a gentle but in depth search for incest, drugs, violence and alcohol and prescribe SSRI for both patients.
Literature: 
400 Münchhausen Syndrome with an Elderly Victim Refusing Admission : Look for Drug Abuse, Incest, Violence, Alcohol