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題名 | Munchausen症候群:以三兄弟失眠為表徵之個案報告=Munchausen Syndrome by Proxy Presentation with Insomnia in Three Siblings: A Case Report |
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作者 | 周文君; 李連冀; 李昱; | 書刊名 | 臺灣精神醫學 |
卷期 | 14:2 2000.06[民89.06] |
頁次 | 頁71-77 |
分類號 | 415.872 |
關鍵詞 | 代理型佯病症; 兒童虐待; 精神病理學; 複式求醫行為; Munchausen syndrome by proxy; Child abuse; Psychopathology; Pluralistic help-seeking behavior; |
語文 | 中文(Chinese) |
中文摘要 | 目的:代理型佯病症大多由小兒科醫師提出,主因是臨床上以生理症狀較多,此一個案以失眠做為唯一精神症狀,同時加諸於三個兒子,實為罕見。 病例報告:個案為42歲的女性,堅稱:三個兒子自幼即有嚴重失眠,自覺已影響孩子的生長和發育,長達十幾年的病程,不斷的求醫,所有的醫療方式和行為,均由母親獨自決定,甚至孩子因不當的治療,引起副作用,仍堅持就醫。經過詳細診斷性和家庭動力性會談,確定個案為代理型佯病症,安排個別心理治療和家族治療,個案漸漸將問題從孩子的失眠,對焦於婚姻的挫敗及不安全感下,接受長達一年多的治療,已有明顯改善,病情趨於穩定,目前仍持續門診規則追蹤。 結論:由於代理型佯病症無外在誘因下,以兒童替代性做為患者角色,對兒童深具潛在的致病性及致命性,屬於兒童虐待的一種,提醒臨床醫師針對國人習慣性的複式求醫行為,能警覺此一疾患發生之可能性,以避免不必要或侵入性之醫療措施,實為一重要課題。 |
英文摘要 | Objective: Munchausen syndrome by proxy is characterized by a parent who attempts to deceive medical personnel into believing that her child is ill. The content of deception may include a feigned history of illness and the induction of illness in the child. Case report: We present the case of a 40-year-old mother who insisted her three sons had long term insomnia since they were 2 or 3 years old. These three children aged 12, 13 and 15 years were forced to receive many kinds of treatments including folk therapy, herb drugs and other unnecessary procedures. Although they were suffering from severe side effects of medications, these children cooperated with their mother and accepted the illness of insomnia. Based on the perceived negative effects and high risk of mortality, a series of physical examinations and psychodynamic interviews was arranged. After detailed evaluation, these illness behaviors met the criteria of factitious disorder in DSM-IV. Munchausen Syndrome by proxy was diagnosed. Individual psychotherapy and family therapy was given for one year. The case gradually accepted the treatments and maintained regular follow-up. Conclusion: Our patient claimed that her children had insomnia as a symptom/sign for pluralistic help seeking. This illness history could be easily feigned. This case reminds us of the need to prevent child abuse and to provide protection for the children of patients with this disorder. |
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