Posted in Psychology & Medicine

Munchausen’s Syndrome

Some people are known to overreact regarding their health, such as a hypochondriac thinking that she has kidney failure because her urine looks slightly frothier. However, some people far surpass the level of hypochondrias to the level of psychiatric disease.
Münchausen’s syndrome patients are known to exaggerate or create symptoms so that the doctor would pay attention to them. When the doctor investigates, treats and sympathises with the patient they gain satisfaction from all the attention they are receiving.
Although this may sound like hypochondrias, Münchausen’s is far more serious.

A Münchausen’s patients are known to cause symptoms just to get attention from others. For example, a common manoeuvre used is the injection of insulin to induce a hypoglycaemic seizure. When their symptoms are “treated”, the patient will most likely invent another factitious disease to be treated for a longer time. They will also seek out many different doctors when the attending doctor catches on to their act. In fact, a Münchausen’s patient will do almost anything to prolong medical care, even accepting unnecessary and risky procedures such as surgeries.

The key difference between Münchausen’s syndrome and hypochondriasis is that the patient is aware that they are not actually sick (hypochondriacs actually believe they are sick). The fundamental basis for Münchausen’s syndrome is the desire for attention. Thus, the main risk factor for developing Münchausen’s is childhood experience of seeing someone close (typically a family member) suffering a debilitating disease. For example, if a girl sees her sister suffering from leukaemia and receiving all the attention of everyone around her, she may develop feelings of jealousy and later try to duplicate the scenario. As a patient, the person feels safe and comfortable and this feeds their addiction to medical care.

As Münchausen’s patients are very proficient liars and act completely like an actual patient, doctors must rule out any diseases before suspecting that their patients have a psychiatric problem. However, some signs such as the patient being overly keen on receiving procedures such as biopsies or continuously developing random symptoms may indicate Münchausen’s.

Interestingly, a similar condition called Münchausen’s syndrome by proxy also exists, where a caregiver (e.g. mother) convinces a doctor that the person they are caring for (e.g. child) are sick. Unfortunately, as these patients actually cause illness in the child, it is considered a form of child abuse. Common “symptoms” include: growth problems, asthma, allergies, vomiting, diarrhoea, seizures and infections. This may lead to the child developing Münchausen’s syndrome in the future.

Posted in Psychology & Medicine

Korsakoff’s Syndrome

It is a well-known fact that excessive drinking leads to a so-called “blackout”. This form of memory loss is common in normal people and cannot be seen as a major illness. However, there is another disease that can be caused by excessive drinking called Korsakoff’s syndrome. Strictly speaking, this is not caused by alcohol but due to a thiamine (vitamin B1) deficiency and is commonly found in alcoholics and malnourished patients (it has also been reported to be caused by mercury poisoning and after centipede bites in Japan).

The six characteristic symptoms of this syndrome are: anterograde (cannot form new memories) and retrograde (cannot remember old memories) amnesia, confabulation, lack of detail in conversation, lack of insight and apathy.

Korsakoff’s syndrome patients show a very peculiar behaviour. As stated before they suffer from both anterograde and retrograde amnesia so not only can they not remember the past but they cannot make new memories either. Ergo, the brain uses information from its surroundings and attempts to recreate the lost memories, the result being confabulation. Confabulation is essentially what happens when the brain tries to fill in blanks in memories with false information. Confabulation is seen in everyday life too with healthy people but in the case of Korsakoff’s patients the effects are significantly more profound. For example, if you ask a patient what she did yesterday, she may look at your horse-print tie and claim she was horse-riding. If you ask the same question an hour later without your tie and instead holding a book with a photo of a Ferris wheel on the cover, she’ll state that she was at the amusement park. As one of the leading causes of amnesia and confabulation, Korsakoff’s should be suspected in any alcoholic or very underweight patient who keeps changing their stories around. 

As previously explained, the disease is caused by thiamine deficiency – therefore, the treatment is administering thiamine. But if the syndrome has persisted for a long time, the brain injury may be permanent. Also, treating the underlying alcoholism and malnutrition is important. 

If the thiamine deficiency is prolonged, it may lead to another disease called Wernicke’s encephalopathy. This is known as Wernicke-Korsakoff’s syndrome and in addition to the above symptoms, the patient may also experience confusion, tremors, nystagmus, paralysis of eye muscles, ataxia, coma and can eventually lead to death. All because of a deficiency of a single vitamin.

Who said nutrition is not important?

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(NB: Dory from Finding Nemo is one of the most accurate portrayals of amnesia in films)

Posted in Psychology & Medicine

ICU Syndrome

ICU stands for intensive care unit and is the place where patients are sent after an operation to stabilise and recover under supervision. ICU patients commonly have a very unique and strange post-operative experience.

ICU syndrome is a type of delirium where the patient experiences severe anxiety, fear, hallucinations or delusions. Although the cause has not been determined, it is likely related to post-op stress, the segregation and loneliness in the ICU room and confusion from coming out of anaesthesia. This is especially the case if an emergency situation led to the surgery being longer than expected or resulted in additional surgery, causing extreme confusion in the patient.

A patient suffering from ICU syndrome tends to be extremely excited and unstable. They may develop intense paranoia or distrust (especially against medical professionals), which can lead to fits or dangerous acts such as pulling out cannulas and lines. A friend or loved one talking calmly to the patient has a great effect in helping the patient overcome the delirium. Therefore, allowing the family to visit to keep the patient company and calm is an effective way to prevent ICU syndrome. However, if the situation spirals out of control, a sedative or anti-psychotic may need to be administered.

A study states that about 25% of patients admitted to the ICU suffer from ICU syndrome. It is one of the most common causes of delirium and any patient can get it (elderly patients are more likely to). Interestingly, there is a theory that medical professionals are more likely to suffer ICU syndrome after an operation.
Nowadays, the term ICU syndrome or ICU psychosis is discouraged and is instead grouped under delirium (which is an actual psychiatric disorder, not just a general term).

Posted in Psychology & Medicine

Couvade Syndrome

A patient comes to a doctor complaining of the following symptoms: “I can’t sleep because my teeth have been aching for the past few weeks. My head is killing me and whenever I wake up in the morning my stomach hurts and I feel nauseous and want to vomit. Sometimes I have no appetite and sometimes I crave a certain food. My breasts have gotten bigger and my stomach is bulging quite a bit.”
The patient has been married for three years and in a few months will have a beautiful daughter.
What is the diagnosis?

Most people would immediately say “Pregnancy!”. But there is one small detail that was left out: the patient is a man.
It is common sense that men cannot be pregnant. So what is this man suffering from?

Couvade syndrome is also known as sympathetic pregnancy. In other words, the husband subconsciously copies his wife’s pregnancy and suffer the same symptoms. This syndrome can be severe enough to cause labour pains, nosebleeds and even post-partum depression.
The cause has not been established, but it is likely to be psychosomatic, where psychological symptoms are expressed through physical symptoms, or due to changes in hormone levels.

Posted in Psychology & Medicine

Diagnosis

A man comes in to a clinic and tells the doctor that he is in great pain.
It hurts if he prods his arm with a finger. The same applies to his leg and his torso.
He says that after looking on the internet, he is sure that he has fibromyalgia syndrome, and asks to be prescribed some painkillers. Also, he is worried that it could be necrotising fasciitis and demands a biopsy and antibiotics.

The doctor, without saying a word, gently grabs his hand, then squeezes his index finger. The man feels a shooting pain and screams in agony.

The diagnosis? A broken finger.

Posted in Psychology & Medicine

Locked-in Syndrome

Imagine that one day, you wake up, but then no matter how hard you try, you cannot move a single part of your body. Trying to roll out of bed, lifting your arm, or even moving your fingers is impossible. You think it is merely sleep paralysis, but you soon realise that it is not as simple as that, or even a dream. No voice escapes your throat.
The only thing you can do is blink and roll your eyes around.

Welcome to the world of Locked-in Syndrome (LIS), a neurological condition where your brain has no connection to all the muscles in your body. The actual symptoms list is: quadriplegia, paralysis of most facial muscles, inability to speak, with complete preservation of cognitive function (sometimes sensation too). In simpler terms, a LIS patient’s mind is essentially trapped inside an unmoving body, with only the senses and eyes to interact with the real world.

It is caused by damage to a part of the brainstem known as the pons, which not only carries motor nerve fibres to the spinal cord (where it then carries on to supply the muscles of the body), but is also the origin of some cranial nerves. This explains the symptoms of paralysis, even the face (e.g. damage to the facial nerve, or CN VII). More specifically, the damage only affects the pons and not the brain itself, meaning that cognition (thinking), intelligence, memory and sensation (if the fibres are spared in the brainstem) are completely functional.
This can be caused by trauma, stroke, drugs, degenerative neuropathies, or anything that can selectively damage the pons.

Due to the nature of the disease, there are no treatment or cures for LIS. Prognosis is very poor and most patients are not expected to regain motor control. This can be very distressing news to LIS patients, as it essentially means that they will be trapped in a motionless, voiceless body for the rest of their natural lives, which could feel like eternity. Although over 90% of the patients die within 4 months, some continue to survive for much longer periods. To improve their quality of life, methods have been developed to allow the patients to communicate, such as Morse code (by blinking eyes) or alphabet boards. Technology is allowing even better options such as eye-tracking and brain-computer interfaces, where a machine tries to interpret a pattern in brain activity, trying to relate a certain action to a pattern. This may allow simple communication such as yes/no answers.

Because of the almost complete paralysis, even professional neurologists often miss this condition, diagnosing the patient as being in a vegetative state.
What would it be like to be trapped in your own body – or “living corpse” as described by Alexandre Dumas in The Count of Monte Cristo – and not be able to tell others that you were still in there?

Posted in Psychology & Medicine

Alice In Wonderland Syndrome

There is a disease called Alice in Wonderland Syndrome. This causes patients to suffer massive migraines, while suffering visual hallucinations that alter their perception of what they see.
For example, they see objects as bigger or smaller than what they actually are, or even see them as upside-down. Because of this, people who have experienced this syndrome say that it was like living in a fairy tale. There is no known cure, but it is often temporary and will one day disappear like magic.

When you fall in love, the other person’s weaknesses seem smaller, their strengths seem bigger, and sometimes they turn your world upside-down. So is love like living in a fairy tale, or like suffering a disease?.

(Sourcehttp://fc07.deviantart.net/fs71/i/2010/120/e/9/Alice_in_Wonderland_by_UlaFish.jpg)