CC May 2016 Factitious disorder imposed on another (FDIA)

echoecho's version from 2016-07-31 16:11


Question Answer
Define FDIA?as fabricated mental or physical illness imposed on a child by a person caring for that child
FDIA was previously called what?Munchausen by proxy
What age groups are most likely affected? What % of children are > 6 years of age1) infant or toddler (median age at dx: 14 months to 2.7 years) 2) 25% of children are > 6 years of age
What % of affected children have a sibling who has died or is considered ill?25%
Generally, which parent is the perpetrator (75-100% of cases) and one who brings the child to the attention of the provider?mother
These mothers often have suffered childhood ______ and _____ themselves? They often experience what disorders as adults?1) abuse; neglect 2) pseudo seizures, fainting spells, abdominal pain, nausea, other somatoform disorders
Perpetrators frequently have some relation to what field of study?medical
Has FDIA been reported in all parts of the world? Which gender is more affected?1) yes 2) boys and girls are equally affected
What is the actual number of FDIA?unknown (as this type of abuse is often unrecognized and underreported)
What is an estimated incidence of FDIA?0.5 - 2 cases / 100,000 children less than 16 years of age
Give another estimated incidence of FDIA?0.53% in children 4-8 years of age
What is the FDIA mortality rate (which is higher if poisoning and suffocation are involved)?6-10%
When illness is simulated or fabricated, the caregiver may do whta?1) report non-existing symptoms 2) alter medical records 3) add blood to urine samples 4) report fever where none exists
If the illness is induced, what has the caregiver been doing?1) witholding or administering drugs at will 2) causing seizures 3) causing apnea by suffocating the victim
Can both simulated and induced methods frequently be perpetrated on the same victim?yes
The above resulting illness may lead to severe physical and psychological consequences in the child, including what?death
*** The most common presentations include?1) bleeding 2) seiqures 3) CNS depression 4) diarrhea 5) vomiting 6) apnea 7) fever 8) rash
Is there a single explanation for the behavior of the abusive parent?no
What proposal as to the cause of FDIA has been made?FDIA is a delusional disorder and the parent can't believe that the child is not ill
Sometimes the parent believes that child shares the same illness, give an example?post-viral syndrome
It is felt that the behavior is not the result of a desire for secondary gain, although the perpetrator may experience intangible gratification - give examples?1) attention and sympathy 2) feeling of control or manipulation 3) self-perception of their extraordinary parenting skills
Why is the dx of FDIA delayed many months from first contact (21.8 months in one study)?because of the reluctance of physicians to suspect mothers of abuse
Why are complete medical records not available?because the abusers change providers and hospitals frequently
Because there are no complete medical records, what is the result upon the victim?the child is exposed to numerous unnecessary tests, procedures and even surgery
What does the perpetrator do during the child's frequent hospitalizations?the perpetrator may hover and interfere with medications, IV infusions and other aspects of care for the child
What have been used in the hospital room to document the perpetrator's behavior, but law enforcement and legal advice need to be obtained?surveillance cameras
What suspcious behavior may point to FDIA?1) symptoms that do not respond to usual treatment 2) symptoms that are only observed in the perpetrator's presence 3) continual appearance of new symptoms 4) ongoing caregive requests for consultation with specialists
Fabricated symptoms during pregnancy, suce as ________ may lead to FDIA once the child is born?premature labor
*** Dx is difficult, but facilitated by what?1) awareness 2) high index of suspicion and team effort involving child protection agencies, social workers, legal consultants, specialists in child psychiatry and others
Educators also are faced with perpertrators who abuse children by insisting on services such as special education or use of a wheelchair when this is not needed. Often schools perform unnecssary testing to avoid what?more expensive court proceedings
Is FDIA a psychiatric dx?yes
Wht does treatment of FDIA consist of? therapy for both mother, child and other distant, uninvolved father, as well as siblings
Is FDIA considered as child abuse?yes (reportable to the law and other supportive agencies)
What is the prognosis?guarded (even after treatment) as the perpetrator, because of past experiences, may NOT benefit from therapy and abusive behavior may recur
Abused children may continue to complain of the s/s the mother fabricated for him even after being seperated from the abusive parent, true or false?true
Studies conclude that reunification of the child with the formerly abusive parent can lead to what?continued abuse
*** SUMMARY = Those affected are most likely an infant or toddler, what is the median age at dx?14 months to 2.7 years
*** SUMMARY = What % of children are > 6 years of age at diagnosis?25
*** SUMMARY = Which parent is the perpetrator in the vast majority of cases and in many cases has a relation to the _____ field?mother; medical
*** SUMMARY = Illness may be ______ or _____?simulated; fabricated
*** SUMMARY = Dx is often delayed resulting in extensive testing of the child, true or false?true