Clinical Director/Consultant Psychiatrist Newcastle Hospital Greystones.
Int J Psychiatry Clin Pract. 2003;7(1):33-9. doi: 10.1080/13651500310001040.
Our understanding of factitious disorders has expanded from that of medical and surgical exotica into that of a much broader psychiatric disorder. Patients can be divided into a nuclear group (classical Munchausen), a larger non-nuclear and less socially deviant group, and children involved by proxy. There are many aetiological theories, ranging from the psychoanalytic to the organic, and at least some cases are learned at home. Physicians and other professionals must be familiar with the general features of these disorders and have some idea of the potential breadth of presentation. Diagnosis is based on a high index of suspicion, some knowledge of the literature, and sound history taking, including the collection of substantiating evidence (e.g. reports from other treating agencies or from relatives). Management is controversial. Prolonged psychotherapy may help some adult cases. Child safety issues are paramount in the case of factitious disorder by proxy. Pseudoseizures are given special attention.
我们对人为疾病的理解已经从医学和外科学的新奇事物扩展到了更广泛的精神障碍。患者可以分为核心组（经典孟乔森综合征）、更大的非核心且社会偏差较小的组，以及代理参与的儿童。有许多病因理论，从精神分析学到有机，至少有一些是在家中学到的。医生和其他专业人员必须熟悉这些疾病的一般特征，并对潜在的广泛表现有一定的了解。诊断基于高度怀疑指数、对文献的一些了解以及详细的病史采集，包括收集证实证据（例如来自其他治疗机构或亲属的报告）。管理存在争议。长期心理治疗可能对一些成年病例有帮助。在代理人为疾病的情况下，儿童安全问题至关重要。假性发作需要特别关注。
