title: [Münchausen syndrome by proxy in a forensic psychiatric evaluation--the description of a case and ethical controversy].
abstract: OBJECTIVE
  Presentation of the difficulties in diagnosing Münchausen syndrome by proxy.
  
  
  METHODS
  Comparison of four different conclusions in forensic psychiatric opinions issued in one case, due to the need of answering to the questions of the court, in what periods and why was the deterioration of the child's health, in connection with an allegation that the mother has acted to his detriment. In the first medical-legal opinion the treating physician, while being the head of the ward and the person informing the police of the action against a child by the mother, recognised Münchausen syndrome by proxy. The second opinion was delivered by a psychologist, who stated that the mother distinguished the introspective attitude characterised by excessive, exaggerated accuracy, thoroughness, and did not give a unambiguous answer to the questions of the court. In the third opinion the experts accepted that the functioning of the subject does not create a threat to life and health of the child. The fourth opinion developed by the authors of this paper noted that in the analysed medical records of the childs' hospitalisation, no arguments were found to recognise Münchausen syndrome by proxy. RESULTS. In the conducted extended ambulant study of the subject and the analysis of the medical documentation of the 31 hospitalisations of the child showed that the improvement of the child's health was not associated in exclusion of pushing aside the mother from the child, but was the result of the consistency of the therapeutic treatment team, the continuation and the modification of the treatment.
  
  
  CONCLUSIONS
  In appointing the expert, the art. 196 of the Code of Criminal Procedure should be considered, which states that the expert should not be the treating doctor, because his opinion loses value impartiality. Diagnosis of Münchausen Syndrome by proxy itself stirs up numerous controversies..
authors.affiliation: Klinika Psychiatrii Sadowej IPiN w Warszawie.
authors.forename: Janusz
authors.initials: J
authors.lastname: Heitzman
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Opio
authors.forename: Alfreda
authors.initials: A
authors.lastname: Ruzikowska
authors.forename: Anna
authors.initials: A
authors.lastname: Pilszyk
mesh_terms: D002983:Clinical Competence; D003937:Diagnosis, Differential; D019468:Disease Management; D004992:Ethics, Medical; D005554:Forensic Medicine / Q000379:methods; D005555:Forensic Psychiatry / Q000941:ethics*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis* / Q000628:therapy*; D011368:Professional-Family Relations / Q000941:ethics*