retired pediatrician.
http://www.slideserve.com/presentation/167092/factitious-disorder-and-cfs-i=
n-adolescents
Transcript
1. Factitious Disorder and CFS=0Bin Adolescents David S. Bell MD, FAAP
Associate Clinical Professor of Pediatrics State University of New
York at Buffalo January 12, 2007
2. Case Presentation 16 year old girl, acute mononucleosis 2 weeks out
of school with physician=92s note Did not recover; Persistent fatigue,
headaches, sore throat, myalgia, joint pains, nausea Bedridden 6
Months No Specific Diagnosis Referral to Social Services because of
school truancy
3. Case Presentation - 2 Failure to attend school considered
educational neglect. Educational neglect considered child abuse Court
action begun to remove child from family as a treatment for neglect
(=93parent-ectomy=94) School refused any educational support at home
because no medical diagnosis
4. Case Presentation - 3 Psychosocial evaluation revealed healthy,
=93intact=94 family, both parents were PhD=92s. No substance abuse,
adolescent was A student, no history of neglect or abuse. Case
continued 1 year, $20,000 spent in legal fees No education offered
during this time.
5. ME/CFS =0Bin Children and Adolescents Jason L, Porter N, Shelleby E,
et al. A case definition for children with myalgic
encephalomyelitis/chronic fatigue syndrome. Clinical Medicine:
Pediatrics 2008;1:1-5.
6. Adolescent CFS 1. Unexplained, persistent or relapsing chronic
fatigue over the past 3 months that was not the result of ongoing
exertion and was not substantially alleviated by rest. 2. Substantial
reduction in previous levels of social, educational, and personal
activities. 3. Specific symptoms within the five classic symptom
categories, which have persisted or recurred during the past 3 months
of illness, but may predate the reported onset of fatigue
7. Five Symptom Categories 1. Post-exertional malaise with loss of
physical or mental stamina, rapid muscle or cognitive fatigability. 2.
Unrefreshing sleep; disturbance of quantity and/or rhythm 3.
Myofascial pain, joint pain, abdominal and/or head pain 4. Two or more
neurocognitive manifestations 5. At least one symptom from two of
three subcategories: Autonomic manifestations Neuroendocrine
manifestations Immune manifestations
8. Somatoform Disorders Somatization Disorder Conversion Disorder Pain
Disorder Hypochondriasis Body Dysmorphic Disorder Malingering
Dissociative Disorders Factitious Disorder Munchausen=92s Syndrome
9. Both Factitious Disorder and Malingering "they are not so much
interested in treatment as they are in either seeking to =91enjoy=92 the
status of =91patient=92 or in obtaining a medical diagnosis for personal
gain."
10. Munchausen=92s by Proxy Illness in a child that is simulated or
produced by a parent or someone acting in loco parentis. Presentation
of the child for medical assessment and care, usually persistently,
often resulting in multiple medical procedures Denial of knowledge by
the perpetrator as to the etiology of the child's illness Abatement of
the child's acute symptoms when the child is separated from the
perpetrator. Excludes physical and sexual abuse and nonorganic failure
to thrive. Shaw. Factitious disorder by Proxy; Harvard Rev Psychiatry
16, 215-223, 2008
11. Pediatric Condition Falsification=0B(PCF) American Professional
Society on the Abuse of Children Diagnosis of PCF given to the child
victim Psychiatric Diagnosis of Factitious Disorder by Proxy (FDP)
given to the perpetrator Intentional falsification of symptoms by
perpetrator (parent) Ayoub. Definitional Issues in Munchausen=92s
syndrome by Proxy; 2003. Child Abuse Neglect 11:7-10
12. Hypochondriasis by Proxy Mild variants where maternal anxiety
leads to an exaggerated perception of the child as sick. Roth. How
=93mild=94 is Munchausen=92s syndrome by Proxy? Isr J Psychiat Relat Sci
1990;27:160-7
13. =93The diagnosis of [Factitious Disorder by Proxy] can be ruled out
in a child when the repeated and suspicious presentations for medical
care are found to result from illness that is wholely and credibly
accounted for in another way.=94 Shaw. Harv Rev Psychiatry.2008. p218
14. Case Presentation #2 16 year old girl, acute mononucleosis 2 weeks
out of school with physician=92s note Did not recover; Persistent
fatigue, headaches, sore throat, myalgia, joint pains, nausea
Bedridden 6 Months No Specific Diagnosis Referral to Social Services
because of school truancy
15. Case Presentation #2 Same chain of events, except: Case #1
occurred in 1986, Case #2 occurred in 2009 Case #2 cost family
$120,000 to maintain legal custody of their child
16. Summary CFS is a diagnosis that would specifically exclude PCF
(FDP) This information has not been distributed to pediatricians,
child abuse agencies, and educators. Medical abuse continues at this
time, causing serious educational, financial and social hardship
17. Action Points CDC and HRSA, should draft a document stating that
CFS is a serious medical condition and is recognized by legal
authorities, and is not caused by child abuse or neglect. CDC and HRSA
should notify public and private educational facilities concerning the
existence, prevalence, and symptoms of CFS. CDC and HRSA should insist
upon educational support of an ill adolescent.
18. Action Points 4. A clinical diagnosis (not research diagnosis) of
CFS be able to exclude PCF (FDP) unless proof of abuse is also found
(in which case CFS and abuse are co-existing conditions) 5. CDC should
attempt to educate physicians concerning the differences between CFS
and PCF 6. Engage the American Academy of Pediatrics to contribute to
diagnostic criteria and formulation of policies
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