title: A single case report of recurrent surgery for chronic back pain and its implications concerning a diagnosis of Münchausen syndrome.
abstract: While undergoing treatment in the psychiatric department, A.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrollable anxiety attack and in a state of fluctuating consciousness, was found to be suffering from a psychopathological condition characterized by pathological lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple invasive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slow-discharge morphine pump and the patient being granted a full disability pension. The continual increases in the doses of morphine suggested a tendency towards drug addiction. After providing a brief overview of the historical background and current concepts relating to the relationship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of Münchausen syndrome (the hypothesis best supported by the clinical evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not frequently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact.
authors.affiliation: Department of Medicine, University of Insubria, Varese, Italy. camilla.callegari@uninsubria.it
authors.forename: C
authors.initials: C
authors.lastname: Callegari
authors.forename: P
authors.initials: P
authors.lastname: Bortolaso
authors.forename: S
authors.initials: S
authors.lastname: Vender
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology; D001416:Back Pain / Q000601:surgery*; D003244:Consciousness Disorders / Q000523:psychology; D008192:Deception; D003937:Diagnosis, Differential; D005715:Gambling / Q000523:psychology; D006801:Humans; D008297:Male; D008306:Malingering / Q000523:psychology; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D009021:Morphine Dependence / Q000523:psychology; D009110:Munchausen Syndrome / Q000175:diagnosis* / Q000523:psychology*; D019635:Neurosurgical Procedures; D019637:Orthopedic Procedures; D011595:Psychomotor Agitation / Q000523:psychology; D012008:Recurrence; D012086:Reoperation
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine