Patienter som lider av Münchhausens syndrom hittar på symtom och/eller skadar sig själva i syfte att få uppmärksamhet från sjukvårdspersonal. Det är en svårdiagnostiserad störning som är till skada för individen och hela sjukvårdssystemet. Det har gjorts få undersökningar om Münchhausens syndrom och därför intervjuades fem läkare för att öka kunskapen om Münchhausens syndrom och få svar på vilka möjligheter läkare har att kunna identifiera denna störning, samt vilka åtgärder som då kan bli aktuella. Resultatet visade att läkarna ansåg sig vara för lite insatta om Münchhausens syndrom och att de inte kunde vara helt säkra på att patienten inte hade de besvär som patienten påstod sig lida av. Det fanns heller ingen handlingsplan ifall läkarna misstänkte att en patient inte talade sanning om sitt hälsotillstånd. Kunskap och medvetenhet var två viktiga faktorer för att kunna identifiera och behandla patienter med Münchhausens syndrom. Urvalet kan ha påverkat studiens giltighet.

This study is a case-study of a patient who was diagnosed as having co-morbid Anorexia Nervosa and Factitious Disorder. It would appear that central to an understanding of both of these disorders is the patient's disturbed relationship to her own body. The existing literature on co-morbid Factitious Disorder and Anorexia Nervosa is rare, with only three cases published. A careful reading of these cases suggests that in all of these cases, Factitious Disorder may have been the primary diagnosis. In this case there was as overidentification with the patient role, and the patient's anorexic symptoms appeared to serve the function of meeting the patient's acute dependency needs. Thus, the patient's Anorexia Nervosa masked the Factitious Disorder and appeared to be secondary to the Factitious Disorder. It is argued that these disorders share several common dynamics, namely the inability to separate from the mother, high parental expectations as well as the use of the body as a transitional or pre-cursor object. In addition there are some common dynamics in the psychotherapy of these patients. All of these factors suggest that in both these disorders the developmental arrest may be located at a pre-verbal level.

Forensic researchers and practitioners continue to face challenges when attempting to differentiate deceptive response styles, notably when comparing malingering and factitious disorder. However, due to the great disparities in research available, forensic examiners may not be adequately informed for considering factitious presentations as a competing hypothesis to malingering. De-emphasis of factitious disorders may also be attributed to the lack of empirical research and poor conceptual understanding of the disorder. Velsor and Rogers conducted a thorough review of various factitious motivations, drawing a parallel to Rogers' explanatory models of malingering. Due to the need for a systematic measure of FPPs, the Inventory of Self and Interpersonal Problems (I-SIP) was developed, largely based on the explanatory models of FPP. The current study employed a construct validity approach to the I-SIP to examine its convergent and discriminant validity in a sample of 80 inpatients from a private psychiatric hospital. Providing strong evidence of construct validity of the I-SIP, dramatic differences emerged between malingered and factitious presentations with extremely large effect sizes (ds = 1.09 – 3.62). In particular, results indicated strong support for the nurturance explanatory model of FPPs, as over-investment in treatment providers was an especially strong discriminator (d = 3.62). Moreover, results highlighted the potential problem of misclassification of response styles, as the SIMS did not effectively distinguish between simulation groups. To avoid diagnostic issues, arguments are presented for the consideration of FPPs as a dimensional construct that vary over time and circumstances. Professional implications are discussed, including practical guidelines for evaluating FPPs in clinical and forensic contexts.

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. Cardiac Munchausen syndrome was first reported in 1953 and later referred to as cardiopathia fantastica. It is characterized by clinical manifestations of acute cardiac disease that are feigned and recurrent. Cardiopathia fantastica can have a variety of presentations similar to true cardiac disease. Most cases have presented with chest pain simulating acute coronary artery disease, but arrhythmias, hypertensive crises, abnormal biochemistry, and electrocardiographic findings have also been noted. These patients are willing to undergo expensive, invasive, and risky procedures to evaluate their simulated illness. This condition is likely to be significantly underreported. In some patients, the presence of abnormal findings that are clinically insignificant may complicate the investigative approach. Patients with this disorder consume a disproportionate amount of health care dollars and sometimes are left with residual deficits as complications of invasive procedures. In this review, we discuss the recognition, manifestations, and treatment of cardiopathia fantastica.

Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Previously known as Munchausen syndrome, this term is now reserved for severe, chronic, or dramatic cases. Multiple theories for the pathogenesis of FD have been proposed, but most studies point to the behaviors exhibited as a coping mechanism to address emotional stress and resolve unmet psychosocial needs. This case report describes a 31-year-old male who frequently presented to several Emergency Departments at hospitals within the Appalachian region with intentional ingestion of foreign objects. These scenarios ultimately required the patient to undergo approximately 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over the course of two years. The patient also had a significant history of suicide attempts by prescription medication overdose, although clinical workup and laboratory confirmation of such ingestion was varied. After two years of these frequent ED presentations, the patient was evaluated for FD upon voluntary admission to an inpatient psychiatric facility. Due to the need for anesthetic agents in the frequent EGD's performed on this patient, the possibility of drug-seeking as the motivating factor for this patient’s behavior and the possibility of a co-occurring substance use disorder were considered. Suicidality in FD and the lack of case reports and reliable research on the topic makes a challenging diagnosis and clinical course even more complex. Additionally, the clinical management of FD is unique, and no reliable studies have detailed an effective treatment plan. Thus, to add to the literature, the treatment and outcome to date for the patient presented here and the suicidal ideation and intentional overdoses complicating this case are discussed. Continued research and reporting of FD cases will help guide clinicians in the treatment and management of this challenging diagnosis.

The growing use of social media has facilitated the rapid spread of content, factual or not, and has fueled a culture built on followers and likes. Clinicians have reported increasing trends of illnesses and disorders among individuals who view content on such conditions. One of the reasons for this is faking for secondary gain, even to the extreme of Factitious Disorder. The aim of this study is to augment the literature on individuals who feign illnesses or their severity on social media. Participants (N=533) completed a survey consisting of demographic questions, questions about faking behaviors in relation to social media, their social media usage, the Abbreviated Marlow-Crowne Social Desirability Scale, Dark Triad Scale, and Leary Need to Belong Scale. Individuals with high-faking behaviors exhibited significantly higher psychopathy and a lower need to convey social desirability than individuals exhibiting no faking behaviors. By conducting further research and gaining a deeper understanding of these individuals, effective treatments can be provided leading to a possible decrease in the prevalence of such illnesses and disorders.

The number of visits in health care increases every year. It leads to higher standards of health care professionals the skills to be able to prioritize and distinguish those who are most in need of medical care. And requires ability to take a professional approach. Treatment tends to be a unique experience that can be of great significance for the individual. All individuals have in responding different conditions, benefits and limitations. Fraudulent behavior such as cheat- ing and lies occurs in the encounter between people daily in society. Tax fraud, illegal work, exam cheating and stealing are society everyday events. There is no exception in health care, health care professionals is to assist the suffering people, some time to cure, often to relieve and always comfort. It happens that patients seeking for medically unexplained symptoms, with cleverly imitated symptoms try to fool themselves to care, This is based on a pathologi- cal need for affirmation, which is achieved by taking the patient role. These patients are re- ferred with Münchausen syndrome or artificial interference. These patients, as well as a pa- tient safety risk to the other patients because they occupy large resources, moreover, they are a danger to themselves by frequent unwarranted examinations and treatments. The aim was to describe the health professionals' experiences of treatment of Münchausen patients in health care. As the approach chosen a literature review where relevant articles have been collected from the databases PubMed, CINAHL, Medline AND Psychinfo. The result of the literature review showed that health care professionals are experiencing the meeting with Münchausen patients with challenging available a feeling of being uncomfortable in responding. Feelings of frustration, skills shortages and the feeling that the relation becomes unnatural and disor- dered occurs. Additionally tend Healthcare professionals to question their own competence both theoretically and clinically. / Antalet besök inom hälso- och sjukvården ökar varje år. Det leder till högre krav på hälso- och sjukvårdspersonalens kompetens att kunna prioritera och urskilja de som är i störst behov av sjukvård. Samt ställer krav på förmåga till professionellt bemötande av vårdpersonal. Bemötande tenderar vara en unik upplevelse som kan ha stor betydelse för den enskilda indi- viden. Alla individer har i bemötandet olika förutsättningar, fördelar och begränsningar. Be- drägligt beteende så som fusk och lögner förekommer i mötet mellan personer dagligen i samhället. Skattebedrägerier, svartjobb, tentamensfusk och stölder är samhällets vardag. Det är inget undantag inom hälso- och sjukvården, hälso- och sjukvårdspersonalens uppgift är att bistå lidande människor, någon gång bota, ofta lindra och alltid trösta. Det förekommer att patienter söker för medicinskt oförklarbara symtom, med skickligt imiterade symtom försöker de lura sig till vård, detta grundar sig i ett sjukligt behov av bekräftelse, vilket uppnås genom att inta patientrollen. Dessa patienter benämns med Münchausen syndrom eller factitious disorder. Dessa patienter är dels en patientsäkerhetsrisk gentemot andra patienter eftersom de upptar stora resurser, dessutom är de en fara för sig själv genom ofta förekommande obefo- gade undersökningar och behandlingar. Syftet var att beskriva hälso- och sjukvårdspersonals upplevelser av bemötande av patienter med Münchausen syndrom inom hälso- och sjukvår- den. Som metod valdes en litteraturöversikt där relevanta artiklar har samlats in från databa- serna PubMed, CINAHL, Medline och PsykINFO. Resultatet av litteraturöversikten visade att hälso- och sjukvårdspersonal upplever mötet med Münchausen patienter utmanande men också med känslor av att vara obekväma i bemötandet. Känslor av frustration, kompetensbrist samt känslor av att bemötandet blir onaturligt och rubbat uppstår. Dessutom tenderar hälso- och sjukvårdspersonalen ifrågasätta sin egen kompetens både teoretiskt och kliniskt.

Este trabalho teve o objetivo de avaliar parâmetros biológicos de A. kuehniella em dietas artificiais com variações de composição, com vistas a otimizar sua criação massal, aumentando a quantidade e, consequentemente, a qualidade dos ovos produzidos para a criação de Trichogramma spp. A pesquisa foi dividida em duas fases. Na primeira fase, foram avaliados parâmetros biológicos de A. kuehniella criada em dietas artificiais compostas por farinha integral de trigo de 6 diferentes variedades (97%) e levedura (3%); as variedades testadas foram Coodetec 150 (testemunha), BRS Parrudo, BRS Guamirim, BRS 327, BRS 328 e BRS 374. Na segunda fase, foram avaliados os mesmos parâmetros sobre dietas compostas por farinhas de trigo integral e de milho amarelo isoladamente (100%), farinha de trigo integral (50%) e farinha de milho amarelo (50%), e diferentes proporções de levedura adicionadas à farinha de trigo (3%, 5% e 8%). Os parâmetros avaliados foram: duração (dias) e viabilidade (%) do período ovo-adulto, peso (mg) de adultos (machos e fêmeas), razão sexual, longevidade (dias) de fêmeas e machos, ritmo diário de oviposição das fêmeas e viabilidade dos ovos produzidos. Concluiu-se que a produção de ovos da traça A. kuehniella independe da variedade de trigo utilizada na sua criação; as melhores dietas artificiais para a criação massal de A. kuehniella foram aquelas compostas por 97% de farinha de trigo integral e 3% de levedura (dieta 1), 50% de farinha de trigo integral e 50% de farinha de milho amarelo (dieta 2) e 100% de farinha de trigo integral (dieta 3); a dieta artificial de menor custo, que proporcionou o melhor desenvolvimento para A. kuehniella, foi aquela composta por 100% de farinha de trigo integral. / The objective of this research was to evaluate biological parameters of A. kuehniella in artificial diets with composition variations, aiming to optimize its mass rearing, increasing the quantity and the quality of the produced eggs for Trichogramma spp. rearing. The research was divided into two phases. In the first one, biological parameters of A. kuehniella reared on artificial diets composed of whole wheat flour of 6 different varieties (97%) and yeast (3%) was evaluated; the tested varieties was Coodetec 150 (control), BRS Parrudo, BRS Guamirim, BRS 327, BRS 328 and BRS 374. In the second phase, the same parameters was evaluated on diets composed of wheat and yellow corn flour alone (100%), whole wheat flour (50%) and yellow corn flour (50%), and different proportions of yeast added to the wheat flour (3%, 5% and 8%). The evaluated biological parameters for both phases were: duration (days) and viability (%) of egg-adult period, adult male and female weights (mg), sex ratio, adult male and female longevity (days), daily rhythm of oviposition and viability of the produced eggs. It was concluded that the A. kuehniella eggs production is not correlated to the wheat variety used as component of the artificial diet for its rearing; the best artificial diets for the mass rearing of A. kuehniella are those composed by whole wheat flour (97%) and yeast (3%) (diet 1), whole wheat flour (50%) and yellow corn flour (50%) (diet 2) and whole wheat flour (100%) (diet 3); with regard to cost-benefit, the lowest cost artificial diet that provides the best development for A. kuehniella is that composed by whole wheat flour (100%).

Este trabalho teve o objetivo de avaliar parâmetros biológicos de A. kuehniella em dietas artificiais com variações de composição, com vistas a otimizar sua criação massal, aumentando a quantidade e, consequentemente, a qualidade dos ovos produzidos para a criação de Trichogramma spp. A pesquisa foi dividida em duas fases. Na primeira fase, foram avaliados parâmetros biológicos de A. kuehniella criada em dietas artificiais compostas por farinha integral de trigo de 6 diferentes variedades (97%) e levedura (3%); as variedades testadas foram Coodetec 150 (testemunha), BRS Parrudo, BRS Guamirim, BRS 327, BRS 328 e BRS 374. Na segunda fase, foram avaliados os mesmos parâmetros sobre dietas compostas por farinhas de trigo integral e de milho amarelo isoladamente (100%), farinha de trigo integral (50%) e farinha de milho amarelo (50%), e diferentes proporções de levedura adicionadas à farinha de trigo (3%, 5% e 8%). Os parâmetros avaliados foram: duração (dias) e viabilidade (%) do período ovo-adulto, peso (mg) de adultos (machos e fêmeas), razão sexual, longevidade (dias) de fêmeas e machos, ritmo diário de oviposição das fêmeas e viabilidade dos ovos produzidos. Concluiu-se que a produção de ovos da traça A. kuehniella independe da variedade de trigo utilizada na sua criação; as melhores dietas artificiais para a criação massal de A. kuehniella foram aquelas compostas por 97% de farinha de trigo integral e 3% de levedura (dieta 1), 50% de farinha de trigo integral e 50% de farinha de milho amarelo (dieta 2) e 100% de farinha de trigo integral (dieta 3); a dieta artificial de menor custo, que proporcionou o melhor desenvolvimento para A. kuehniella, foi aquela composta por 100% de farinha de trigo integral. / The objective of this research was to evaluate biological parameters of A. kuehniella in artificial diets with composition variations, aiming to optimize its mass rearing, increasing the quantity and the quality of the produced eggs for Trichogramma spp. rearing. The research was divided into two phases. In the first one, biological parameters of A. kuehniella reared on artificial diets composed of whole wheat flour of 6 different varieties (97%) and yeast (3%) was evaluated; the tested varieties was Coodetec 150 (control), BRS Parrudo, BRS Guamirim, BRS 327, BRS 328 and BRS 374. In the second phase, the same parameters was evaluated on diets composed of wheat and yellow corn flour alone (100%), whole wheat flour (50%) and yellow corn flour (50%), and different proportions of yeast added to the wheat flour (3%, 5% and 8%). The evaluated biological parameters for both phases were: duration (days) and viability (%) of egg-adult period, adult male and female weights (mg), sex ratio, adult male and female longevity (days), daily rhythm of oviposition and viability of the produced eggs. It was concluded that the A. kuehniella eggs production is not correlated to the wheat variety used as component of the artificial diet for its rearing; the best artificial diets for the mass rearing of A. kuehniella are those composed by whole wheat flour (97%) and yeast (3%) (diet 1), whole wheat flour (50%) and yellow corn flour (50%) (diet 2) and whole wheat flour (100%) (diet 3); with regard to cost-benefit, the lowest cost artificial diet that provides the best development for A. kuehniella is that composed by whole wheat flour (100%).

Malingering is the deliberate production of feigned symptoms by a person seeking external gain such as: financial compensation, exemption from duty, or leniency from the criminal justice system. The Test Translation and Adaptation Guidelines developed by the International Test Commission (ITC) specify that only tests which have been formally translated into another language and validated should be available for use in clinical practice. Thus, the current study evaluated the psychometric properties of a Spanish translation of the Structured Interview of Reported Symptoms (SIRS). Using a simulation design with 80 Spanish-speaking Hispanic American outpatients, the Spanish SIRS was produced reliable results with small standard errors of measurement (SEM). Regarding discriminant validity, very large effect sizes (mean Cohen's d = 2.00) were observed between feigners and honest responders for the SIRS primary scales. Research limitations and directions for future research are also discussed.