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Functional movement disorders are the most challenging movement disorders to diagnose and treat. Phenomenology and disease course are variable. This group of disorders includes tremor, dystonia, myoclonus, parkinsonism, speech and gait disturbances, and other movement disorders that are incongruent with patterns of pathophysiologic (organic) disease.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Patients with bodily distress, hypochondriasis and chronic pain experience symptoms that impair their functioning and cause them significant degrees of discomfort. They also represent a significant public health challenge. Problems in classification/nosology continue to bedevil this area, and these difficulties – along with the use of the language of psychiatric classification, which most patients find unacceptable – continue to led to the DSM/ICD terms being little used in day-to-day clinical practice, including liaison psychiatry. Biological, psychological and social factors are relevant to both the aetiology and the maintenance of these syndromes, as well as to their treatment. In recent years, a variety of effective biological and psychosocial approaches to treatment have been developed, and these patients can now be considered as a group for whom medical and psychological approaches should be offered.
To review the diagnosis of Munchausen syndrome by proxy, a factitious disorder, in which symptoms are induced or feigned, usually in a child, by the caregiver. The involved caregiver seeks to gain attention or sympathy and often has a psychological need to maintain the sick role. We highlight the diagnostic difficulties and factors that may help with diagnosis in an otolaryngology setting.
Method:
We present the case of Munchausen syndrome by proxy presenting with hearing loss in a five-year old boy, who was diagnosed eight years after his initial presentation. A literature review of Munchausen syndrome by proxy cases presenting with ENT symptoms is provided.
Conclusion:
Munchausen syndrome by proxy is a diagnosis that otolaryngologists should be aware of, particularly where recurrent or persistent illnesses in children, especially those involving otological symptoms, are refractory to the usual treatments.
We present the case of Munchausen’s syndrome by proxy (MSBP) in which the mother spat and placed blood in her child’s ear, and videoed the result, in order to gain the attentions of the medical profession. This is the first case report of this kind and may represent a disturbing trend in the use of digital photography and video to support factitious illnesses.
Otolaryngological manifestations of factitious disorders are rare. The case of a health care worker who injected her face and orbits with air in order to masquerade as facial cellulitis is presented. The literature and treatment strategies are reviewed.
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