Munchausen's syndrome and other factitious disorders

Factitious disorders including Munchausen's syndrome are likely encountered by all clinicians during their career. Neurologic presentations are common, especially with Munchausen's syndrome by proxy. An appropriate index of suspicion and nonjudgemental confrontation and psychiatric consultation facilitate a successful clinical approach. Redefining the factitious illness as psychiatric with continued involvement of a primary physician and family support are also keys to successful management. Underlying psychiatric syndromes need to be assiduously evaluated and steadfastly treated. Prognosis is best for patients who do not meet criteria for Munchausen's syndrome or who have psychosocial supports and less severe personality pathology.