Pediatric Clinic, Azienda Ospedaliera di Terni, 05100 Terni, Italy.
Pediatric Clinic, Università Tor Vergata, 00173 Rome, Italy.
Int J Environ Res Public Health. 2018 Mar 29;15(4):627. doi: 10.3390/ijerph15040627.
In most of the cases regarding children, factitious disorders (FDs) are intentionally produced by parents. Less attention is paid to FDs in which a child or adolescent intentionally induces or falsifies the disease to attain a patient's role.
A 13-year-old immigrated and adopted boy previously underwent an operation for renal joint syndrome and was affected by recurrent episodes of renal colic. The boy was admitted reporting acute left flank pain with scars on the mucous face of his prepuce and had a recent previous hospitalization for the same reason. Laboratory tests and radiological findings did not reveal any morphological or functional alterations. Self-induced FD was suspected, and a psychiatric consultation was performed. After psychiatric consultation and remission of the symptoms with a placebo, a diagnosis of Munchausen syndrome was suspected. The patient's uncle was not initially convinced of the diagnosis. Some videos clearly showed that the boy was handling his prepuce to excrete stones, explaining the scars. A therapeutic plan with psychiatrist support was later accepted with a positive outcome. No further signs and symptoms of renal colic were reported.
It is recommended that paediatricians include FD in the differential diagnosis of a persistent and unexplained medical condition. If suspicion arises, confirmation and long-term therapy by a group of qualified specialists, including psychiatrists, should be planned.
在大多数儿童病例中，做作障碍（FD）是由父母故意制造的。对于儿童或青少年故意诱导或伪造疾病以获得患者角色的 FD 关注较少。
一名 13 岁移民和收养男孩此前因肾关节综合征接受了手术，并反复发作肾绞痛。该男孩因同样的原因报告急性左侧腰痛，并在前阴粘膜上有疤痕，最近曾住院治疗。实验室检查和影像学结果未发现任何形态或功能改变。怀疑是自我诱导的 FD，并进行了精神病学咨询。在精神病学咨询和安慰剂缓解症状后，怀疑患有孟乔森综合征。患者的叔叔最初并不相信这个诊断。一些视频清楚地显示，男孩正在处理他的前阴以排出结石，这解释了疤痕的原因。后来接受了在精神科医生支持下的治疗计划，并取得了积极的结果。没有报告进一步的肾绞痛症状和体征。
建议儿科医生将 FD 纳入持续且无法解释的医疗状况的鉴别诊断中。如果出现怀疑，应计划由包括精神科医生在内的一组合格专家进行确认和长期治疗。
