Munchausen syndrome by proxy (MSBP) is a condition where a caregiver, usually the mother, fabricates or induces illness in a child to gain attention from medical professionals. Common fabricated illnesses include bleeding, seizures, infections, and vomiting/diarrhea. It can be difficult to diagnose MSBP due to overlapping signs with real illnesses and reluctance of medical staff to believe deception is occurring. A thorough investigation of the child's medical history and symptoms is needed along with removing the child from the caregiver to make an accurate diagnosis and protect the child from further harm.
clinical assessment and treatment of oral malodour and halitosis.
includes microorganisms causing halitosis, volatile sulphur compounds and its relation to periodontal destruction.
clinical assessment and treatment of oral malodour and halitosis.
includes microorganisms causing halitosis, volatile sulphur compounds and its relation to periodontal destruction.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
From the National Marfan Foundation, this presentations gives an overview of Marfan syndrome and provides the school nurse with resources to identify students in need of an evaluation, make appropriate referrals, manage the healthcare and educational needs of the student, and to educate faculty and staff about the disorder. A free copy of the presentation is available to school nurses on our website at www.marfan.org.
Schizophrenia is a psychotic disorder. This mental condition can manifest itself in a variety of ways. The predominant difficulties associated with schizophrenia are related to a person's thinking, which is unusual or bizarre. Because the person's thinking is intermittently disordered, a person with schizophrenia may have a variety of behaviors that appear odd or strange to others. In addition, the person's speech is irrational or disjointed.
Pregnancy and SNRIs - Babies of women exposed to SNRIs during late pregnancy may develop complications that require hospitalization, respiratory support, and/or tube feeding. Other symptoms experienced by newborns are: seizures,
lack of oxygen in the blood, tremors, difficulty breathing, difficulty feeding, constant crying, and irritability. PPHN is associated with significant complications and even death. Women who take SNRIs after week 20 of pregnancy have a six-fold increase of delivering a baby with PPHN.
Davidson's Principles and Practice of Medicine 24th EditionLucky Gods
Conquer the world of medicine 🩺: Davidson's Principles and Practice of Medicine, 24th Edition is your ultimate companion!
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Dive into the fascinating depths of adult medicine, from common conditions to complex mysteries. Unravel the secrets of pathophysiology , master the art of differential diagnosis , and confidently navigate treatment plans like a true doctor ⚕️⚕️.
Ready to become the hero of your own medical journey? Open Davidson's and let the learning adventure begin! ✨
Velocardiofacial Syndrome Associated with Adolescent PsychosisCarlo Carandang
"Velocardiofacial Syndrome Associated with Adolescent Psychosis,"
Halifax, Nova Scotia, Canada; October 4, 2006
Psychiatry Clinical Case Conference at IWK Health Centre
*Learn clinical features of velocardiofacial syndrome (VCFS)
*Learn association of VCFS with psychosis and other psychiatric disorders
*Learn genetic and biochemical abnormalities leading to psychosis in VCFS
*Discuss case report of metyrosine in psychosis associated with VCFS
*Discuss case reports of VCFS in childhood-onset schizophrenia
Latest Post
dicembre 8, 2011
The Insanity Defense
This article was written as a guest post by Paola Giannetakis, member of the International Research Centre for Investigative Psychology.
View this document in it’s full glory by downloading the pdf here.
What is the Insanity Defense?
The legal defense by reason of insanity is primarily used in criminal prosecutions and is based on the assumption that at the time of the crime, the defendant was not sound of mind, and therefore, was incapable of appreciating the nature of the crime and differentiating right from wrong behavior. Allowing such typology of defense is based on the principle that civilized societies do not punish people who do not know what they are doing or are incapable of controlling their conduct.
Fitness to Stand Trial
The legal system distinguishes between two essential components used to evaluate an individual’s fitness to stand trial: competency and insanity. Competency refers to the capacity of a defendant to assist the case attorney and comprehend the contents of the allegations, while insanity refers exclusively to the mental state of the defendant at the time of the crime. The legal standards for defining insanity vary from state to state and from country to country. For example, in the US, a criminal act is not only regarded illegal, but it must also be accompanied by mens rea (a guilty mind). The defense of insanity derives from the M’Naghten rules in 1843, asserting, “It must be clearly proved that, at the time of committing the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or, if he did know it, that he did not know he was doing what was wrong.” (Post, 1963). Although the M’Naghten rule is still used, there are limitations.
Conceptualizations of Insanity
There is a twofold conception of the insanity defense. One type of insanity may be defined as “cognitive insanity”, where a defendant was suffering from a mental disease or defect at the time of the crime, which impaired his/her psychological ability to appreciate the wrongfulness of the act. A second type of insanity is based on the concept of “irresistible impulse”, where a defendant is psychologically able to appreciate and distinguish between right and wrong behaviors, but who has suffered from a mental disease leading to an inability to control his/her actions. Is also possible to define insanity as being:
1. Legally determined: the defendant is not considered criminally responsible if, as a result of a mental disorder or defect, he/she lacked the capacity to appreciate his/her misconduct as a violation of the law.
2. Morally determined: the defendant lacks criminal responsibility if, as a result of a mental disorder or defect, he/she lacked the capacity to appreciate his/her misconduct as a violation of what a society deems unethical.
3. Subjectively determine
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. MSBP Definition
Child’s illness fabricated or induced by the parent
(usually the mother)
Mother develops a dependent relationship with her
child’s doctor / medical staff
3. Baron Hieronymus Karl Friedrich von
Munchausen
The baron was a mercenary in the 18th century.
In 1785, Rudolph Eric Raspe, badly in need of money,
wrote a book about the Baron’s travels: Original Travels
and Surprising Adventures
of Baron Munchausen.
The stories were marvelous, but fictitious
4. Munchausen Syndrome
In 1951, Richard Asher named a syndrome after the Baron
describing patients who present histories that are
dramatic
captivating
fictitious
5. Munchausen Syndrome by Proxy
In 1977, Roy Meadows published: Munchausen
Syndrome by Proxy:
The Hinterland of Child Abuse
He described several children who were hospitalized,
tested and treated for false illnesses that were made up
by their mothers
6. Presentations of MSBP
Persistent, puzzling illness
unresponsive to treatment
defies medical diagnosis
unusual lab data
Unusual/unexpected/exaggerated illness
Un-witnessed symptoms w/normal evaluation
13. Literature review
Donna Rosenberg: 1966 - 1987: 117 cases
mean age at diagnosis: 40 months
mean time between onset of symptoms & diagnosis: 15
months
long term mobility: 9% mortality plus 8% had serious
morbidity
all deaths in children < 3 y/o: apnea, LOC, bleeding,
seizures, diarrhea; 20% had been sent home after
confrontation
14. Conditions that should arouse
suspicion
Illnesses that are…
puzzling or unexplained
“Never seen anything like this”
not responding to treatment
following an atypical course
manifested only in the mother’s presence
15. Exam / Lab findings that are
suspicious
highly unusual results
discrepant with history
inconsistent with examination
clinically impossible
16. MSBP maternal behaviors
medically knowledgeable, educated
may have worked in the health care field
mother prefers to stay in the hospital rather than home
uncharacteristically calm
welcomes medical tests
reluctant to leave hospital
17. MSBP maternal behaviors
more interested in the medical procedures than in her
child’s welfare
spends more time with hospital staff than with her child
excessive praise for medical staff
18. Histories that are suspicious
Mother reports…
she had illnesses similar to her child’s
other unusual family illnesses
unsubstantiated family illnesses
unexplained illnesses / deaths in siblings
19. Overlap between MSBP
and the mother of an ill child
The child’s mother…
exaggerates child’s symptoms
is intolerant of minor problem & demands work-up
is knowledgeable about child’s illness
is calm about the child’s illness
gets along well with hospital staff
brings child to MD frequently
describes an illness that seems unexplainable
20. Indications of MSBP that overlap
with normal illnesses
MD’s observations differ from mother’s
Symptoms observed only if mother is present
Illness resolves after separation from mother
21. Doctor Shopping / Perceived
Illness
Mother is obsessed with obtaining medical treatment
for her well child.
Child is subjected to repeated and unneeded testing.
Evaluate degree of harm to child
Not MSBP
22. Enforced Invalidism
Child has no disability but treated as if one exists
special diet, restricted activities
Child has a disability
mother causes the disability to worsen or prevents the
child from getting better
Child abuse if harmful to child
MSBP?
23. Mother fabricates/causes illness
lies to the doctor about the child’s health
fabricates symptoms or signs of illness
actively induces symptoms
alters medical records
Child abuse
MSBP
24. Realization of possible MSBP
staff reluctance to believe deceit
divided loyalties
difficult to believe that they’ve been lied to
confusion between real & fictitious illness
continued unnecessary testing and procedures
need to make diagnosis of MSBP with certainty
continuing or increasing risk to the child
difficult to act / stop abuse without “proof”
25. MSBP Investigation
Review each illness / diagnosis
comprehensive review of histories / symptoms
“Unlimited” possibilities for deception
conference with all involved caretakers/physicians
detailed investigation of reported events
temporal relationship: mother / symptoms
validation of past illnesses / mother’s history
contact other family members / family physicians
Psycho-social evaluation of mother
look for motive / gain
26. Hospital Management
Discretion
control number of involved staff
limited chart documentation / hallway rounds
limited chart and record access by mother
Verification of symptoms
differentiate those observed by nurse vs mother
obtain fluids / materials for toxicologic analysis
if bleeding, test to differentiate child/mother/human
surveillance of mother and child (video or telemetry)
Southall David. Pediatrics 1997;100:735-760
27. Hospital Management
Removal of child from parent: diagnostic/protective
voluntary vs enforced
report to Child Protection Agency
careful planning: make the most of this time
Confrontation with mother / family
explain the diagnosis
offer psychiatric care for the parent / patient
anticipate suicidal behavior or escalation of deception
28. Indices of high risk to the child
Suffocation or poisoning
Child under 5 years old
Deaths of other children
Lack of recognition by mother
Mother with Munchausen Syndrome
Persistence of fabrication after confrontation
Family dysfunction, drug or alcoholism