Munchausen Syndrome by Proxy: medical diagnostic criteria

Medical diagnostic criteria for Munchausen Syndrome by Proxy are presented. The strength of the known facts may vary from case to case, and thus there may be different degrees of diagnostic conviction. Therefore, diagnostic criteria for a definitive diagnosis, and a possible diagnosis of Munchausen Syndrome by Proxy are provided. Because the gathering of evidence in a case may, ultimately, diminish or exclude the diagnosis of Munchausen Syndrome by Proxy, diagnostic criteria for the inconclusive determination and the definitely excluded diagnosis are also enunciated.     

Characteristics of hospital-based Munchausen Syndrome by Proxy in Japan

OBJECTIVE: This article explores characteristics of Munchausen Syndrome by Proxy (MSBP) in Japan, a country which provides an egalitarian, low cost, and easy-access health care system. METHODS: We sent a questionnaire survey to 11 leading doctors in the child abuse field in Japan, each located in different hospital-based sites. Child abuse doctors answered questions regarding the characteristics of MSBP cases for whom they had helped care. RESULTS: Twenty-one MSBP cases (20 families) were reported. Characteristics of the victims included: no differences based on sex, 4.6 years of age on average when MSBP was confirmed, and an average of 1.9 years duration of MSBP abuse. Biological mothers were at least one of the perpetrators in 95% of cases. Among the 12 cases (57%) who remained with their families, 2 victims died. Only 5% of perpetrators had a medical background or relatives who engaged in healthcare work. CONCLUSION: There are similar features of MSBP cases between Japan and other English-speaking countries, such as the UK or the US. However, perpetrators of MSBP in Japan did not have a medical background. Easier access to hospital resources in Japan may give greater opportunities for perpetrators to obtain medical knowledge from doctors or nurses. PRACTICE IMPLICATIONS: The findings suggest that perpetrators of MSBP should not be assumed to possess a medical background in a country which provides universal medical care such as Japan. A contributory factor of MSBP may be the high frequency of medical consultations and equal level of accessibility of medical resources for Japanese citizens. Social welfare services that need to decide on custody for MSBP victims should recognize the relatively high risk of life-threatening danger in their family of origin. Further collaboration between hospital staff including pediatricians, nurses, medical social workers and staff at the social welfare services is needed to protect children from MSBP.     

The deceit continues: an updated literature review of Munchausen Syndrome by Proxy

OBJECTIVE: This article presents an updated review of the literature of Munchausen Syndrome by Proxy (Factitious Disorder by Proxy, MBP). METHOD: Four hundred fifty-one cases of MBP were analyzed from 154 medical and psychosocial journal articles. RESULTS: Typical victims may be either males or females, usually 4 years of age or under. Victims averaged 21.8 months from onset of symptoms to diagnosis. Six percent of victims were dead, and 7.3% were judged to have suffered long-term or permanent injury. Twenty-five percent of victims' known siblings are dead, and 61.3% of siblings had illnesses similar to those of the victim or which raised suspicions of MBP. Mothers were perpetrators in 76.5% of cases, but as knowledge of MBP grows a wider range of perpetrators is identified. In a small number of cases, MBP was found to co-exist with secondary gain or other inflicted injury. CONCLUSION: Although published cases form a non-random sample, they add to knowledge about MBP and validate claims that it occurs. More knowledge about non-medical aspects of MBP, and more pooling of data, is desirable.     

Munchausen by Proxy in an international context

OBJECTIVE: The professional literature on Munchausen by Proxy (MBP) abuse consists of more than 400 articles, chapters, and books. Most have come from a handful of English-speaking industrialized countries. Our aims were to establish the extent to which published work about MBP has emerged from outside these countries, and to determine the characteristics of any reported cases. METHOD: Numerous health care computer databases were queried, and the results supplemented by materials accumulated less formally. RESULTS: We identified 59 articles from 24 countries describing at least 122 cases in 9 different languages. Among cases in which the information was available, the mother was the sole perpetrator in 86%, the victim was aged between 3 years and 13 years in 52%, and the victim was male in 54%. The presentations of MBP appear to be similar across the world with the exception of induced apnea, which emerged as notably uncommon in this review. An extensive table presents the characteristics of each case. CONCLUSIONS: MBP clearly is not a phenomenon unique to Western or highly medicalized societies. This form of abuse is being increasingly recognized and reported throughout the world. The literature from the US, Canada, UK, Australia, and New Zealand often presupposes access to resources, such as subspecialists and social service agencies, that may be seriously constrained in other countries. The contributions of professionals elsewhere will be vital in ensuring that the efforts in English-speaking industrialized settings to develop standards of care encompass an international perspective.     

Concerns about research and prevention strategies in Munchausen Syndrome by Proxy (MSBP) abuse

There would seem to be three motives for research into Munchausen Syndrome by Proxy (MSBP) abuse; first to enhance treatment; second to enhance our understanding of the psychopathology of those who carry out the abuse; and third to find interventions to prevent its occurrence. We will argue that only the first justification is valid. The second and third should be questioned for several reasons including: MSBP abuse is the wrong kind of event to think of in terms of categorical diagnosis; rare events are inherently difficult to predict; and better research targets are available. We propose that research energy would be more productively directed towards furthering our understanding of somatization and certain problematic aspects of modern pediatric practice. We offer suggestions as to appropriate areas for research.     

On the importance of motivation in Munchausen by Proxy: the case of Kathy Bush

The recent trial and conviction of Kathy Bush for abusing her daughter is used to illustrate (1) the nature of the motivation, in at least some cases of MBP, and (2) the importance of distinguishing the motivation found in MBP from that found in other forms of child abuse and other conditions involving factitious illness production.     

Munchausen syndrome by proxy

Munchausen syndrome by proxy is a form of child abuse in which a disorder of the child is fabricated by a parent. Although often considered rare, it may have been overlooked frequently in the past. The reported cases of children with Munchausen syndrome by proxy range in age from infancy to 8 years. Their "illnesses" consist of fabricated histories, inflicted physical findings, altered laboratory specimens, and induced disorders. The perpetrator usually is the child's mother, who may have Munchausen syndrome. Consequences of the syndrome may include painful tests, frequent hospitalizations, potentially harmful treatment, and death. The diagnosis can be made when medical and social histories are characteristic of the syndrome and clinical findings are absent, suggestive of induced illness, or resolve upon separation of the child and parent. Suspicion of the syndrome should be discussed with the family once the safety of the child is insured, and the case should be reported under the child abuse reporting law of the state. Social, family, and medical histories must be obtained and verified, and court intervention should be considered. Four patients who illustrate typical features of the syndrome are described.     

Munchausen syndrome by proxy: A family affair

Munchausen syndrome by proxy is an unusual form of child abuse: a child presents with an illness that has been factitiously produced by a parent, typically the mother. A case of chronic illicit insulin administration to a one-year-old girl is described. Despite temporary separation of the child from the mother and long-term psychiatric intervention, factitious illnesses continued, including urine specimen contamination, laxative-induced diarrhea, suspected bladder catheterization, and suspected poisoning. Retrospective review of the medical records of the mother and two siblings demonstrated previously unrecognized evidence of factitious illnesses. The medical records contained evidence of 30 separate episodes of suspected or documented factitious illness in these four members of the same family. This unique family illustrates the significant morbidity of Munchausen syndrome by proxy and a poor response to psychiatric treatment.     

利用代理服务器建立网上教室

随着信息高速公路的快速发展,Internet已逐步成为学校计算机教学的重要内容,本文对网上教室的建设作一点探讨.     

Munchausen by proxy: a case, chart series, and literature review of older victims

The history of an older child victim of Munchausen by proxy (MBP) is described. He was referred for evaluation after repeated sinus surgeries for recurrent sinus infections believed to be related to a falsified history of an immunodeficiency. The perpetrator was the mother of this 14-year-old victim, consistent with the majority of such cases. This case prompted a review of cases of MBP in older children reported in our hospital as well as a literature search for other cases in older children. METHODS: This study was a chart review of children over 6 years of age who had been evaluated by social services at the Children's Hospital at the Cleveland Clinic and reported as cases of Munchausen by proxy to Child Protective Services between January 2001 and June 2003. Also, an OVID, Psychline, and Pubmed literature review of published cases of Munchausen by proxy were identified, and cases occurring in the older child were selected for review. RESULTS: Older children who are the victims of Munchausen by proxy may have an induced illness, but falsified reports of symptoms and medical history to coerce the child to undergo medical procedures may be more common. Collusion of the victim with the perpetrator may also become a factor as the child ages and adopts the deception. Given the complex relationship that exists between the parent and child, it is difficult to predict whether the victim either will assist the caregiver in maintaining the factitious illness or be able to recognize the falsification. CONCLUSIONS: Older children who are the victims of Munchausen by proxy may fear consequences of revealing the factitious illness. Physicians must consider the possibility of this diagnosis whenever there are discrepancies in a child's illness that makes a factitious illness a consideration.     

在Linux平台上代理服务器的应用

我校计算机中心的局域网里 ,有近 4 0台客户机 ,全部安装Ｗｉｎｄｏｗｓ98,一台服务器安装ＷｉｎｄｏｗｓＮＴ4 .0 ,客户机安装了ＴＣＰ/ＩＰ通信协议。以前是将其中一台客户机安装ＩＳＤＮ和Ｗｉｎｄｏｗｓ2 0 0 0 ,然后客户机共享上网。网络工作正常 ,但是当超过 10多台客户机同时上网时 ,感到速度较慢 ,而且有时不稳定。针对这种现象 ,我们选用了在Ｌｉｎｕｘ平台上应用代理服务器 (Ｓｑｕｉｄ)来解决多机共享上网速度慢的问题。1　Ｌｉｎｕｘ及Ｓｑｕｉｄ简介通常在局域网里多台客户机同时上因特网的方式有两类 :一类为软件路由 ,代表软…     

Diagnostic, expanatory, and detection models of Munchausen by proxy: extrapolations from malingering and deception

OBJECTIVE: The overriding objective is a critical examination of Munchausen syndrome by proxy (MSBP) and its closely-related alternative, factitious disorder by proxy (FDBP). Beyond issues of diagnostic validity, assessment methods and potential detection strategies are explored. METHODS: A painstaking analysis was conducted of the MSBP and FDBP literature as it relates diagnostic and assessment issues. Given the limitations of this literature, extrapolations were provided from the extensive theory and research on malingering as a related response style. RESULTS: Diagnostic formulations for both MSBP and FDBP de-emphasize the clinical characteristics of the perpetrator. In the case of FDBP, inferential judgments about motivation (e.g., adoption of a sick role) are challenging on conceptual and clinical grounds. When explanatory models from malingering are applied, most research has focused pathogenic models, often allied with psychodynamic thought. Finally, clinical methods for the assessment of MSBP and FDBP are not well developed. CONCLUSIONS: Refinements in the conceptualization of MSBP and FDBP can be provided through prototypical analysis. Drawing from malingering research, explanatory models should be expanded to include adaptational and criminological models. Finally, detection strategies for MSBP and FDBP must be formally operationalized and rigorously validated.     

The layering of mathematical interpretations through digital media

How might understanding emerge when learners engage mathematical phenomena through digital technologies? This paper considers the ways children’s mathematical thinking was influenced by their interpretations through various pedagogical discourses and how understanding emerged through those various filters. Current research into using digital technologies in mathematics education is predominantly positioned within two theoretical perspectives, semiotic mediation and the instrumental approach. Meanwhile, within a contemporary hermeneutic position, mathematical learning comprises a process of interpretation, where understanding is seen as a formative process as the learner views events from fresh, ever-evolving perspectives. Concepts are then seen in ongoing formation. This paper examines learning through a contemporary hermeneutic frame and the contention is that this opens opportunity for learning to be perceived in alternative ways.     

论股东表决权的个别代理

股东表决权个别代理是股东表决权代理人,以股东本人的名义,向公司作意思表示或受领意思表示,代理效果归属股东本人的代理。股东表决权个别代理人向公司递交授权委托书,参加股东大会,从而代表股东行使表决权。股东表决权个别代理分为一般表决权代理和表决权征集两种。二者在制度理念、适用范围、法律效力与责任归属等方面有较大区别。     

校园网中代理服务器的应用

章就如何使用代理服务器实校园网的管理,结合具体的校园网络环境,在简要描述了代理服务器的概念、主要功能及特点,并比较了当前几种代理服务器产品的情况下,给出了在校园网中的代理服务器的具体实现方法及配置过程。