title: Culture and Munchausen-by-proxy syndrome: the case of an 11-year-old boy presenting with hyperactivity.
abstract: OBJECTIVE
  To discuss some of the challenges presented to the clinician who deals with a possible Munchausen-by-proxy (MBP) syndrome.
  
  
  METHODS
  The case of an 11-year-old boy presenting with hyperactivity is discussed. Information from the initial assessment and the 9-month follow-up period is presented. We highlight some cultural considerations as they apply to this immigrant family. A commentary by Dr H Schrier follows the presentation.
  
  
  RESULTS
  The positive outcome is discussed in relation to the validation of the diagnosis as well as to cultural issues.
  
  
  CONCLUSIONS
  Cultural issues and dynamic factors may be important when we consider the diagnosis of MBP syndrome in an immigrant family with different expectations from our health care system.
authors.affiliation: Department of Psychiatry, Montreal Children's Hospital, Quebec.
authors.forename: E L
authors.initials: EL
authors.lastname: Amirali
authors.forename: R
authors.initials: R
authors.lastname: Bezonsky
authors.forename: R
authors.initials: R
authors.lastname: McDonough
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000208:ethnology; D002170:Canada; D002648:Child; D003469:Culture; D005192:Family Health / Q000208:ethnology*; D005196:Family Therapy; D005500:Follow-Up Studies; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology; D002094:Republic of Belarus / Q000208:ethnology; D016896:Treatment Outcome