Kornelija Gudynaitė1, Alvydas Navickas2
1Vilnius Mental Health Center, Vilnius, Lithuania
2Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
A 43-year old female was admitted to a psychiatric hospital due to episodes of shouting and throwing medical documents from a balcony. Her mental state examination showed increased anxiety and suspiciousness, the patient was telling that her husband together with the doctors wants to take her daughter away. The patient‘s family history revealed that she was the older one of two children in the family and always felt unappreciated by her parents, who were showing more attention to her sister. Being sick played important role in her life because it helped her achieve otherwise unachievable parents’ attention and care. She left home early, got married and worked as an illustrator and administrator. At first her relationship with her husband was good, but after their daughter was born he became distant and detached. Patient‘s daughter, who was six-year-old at that time, over a period of three years has been hospitalized six times and consulted 58 times by various doctors. Previously she had a disability due to unspecified genetic disorder and now her mother was suspecting Asperger‘s syndrome. The patient told her daughter that she was sick, restricted her interactions with other kids, took her to kindergarten for a limited time, helped her to dress up and to eat. When suspicion for psychological abuse was raised, the head of Children‘s hospital informed Child protective services, drawing attention to no signs of particular chronic disease, normal test results, and occurring symptoms due to acute diseases. Patient got involved with social media, claiming that the doctor‘s behavior was improper and they weren’t able to help her sick child. After it doctor‘s treated her with hostility, organized various committees. The girl was examined at a child development center. It was noticed that her development is normal according to her age and there are marked disturbances in mother – child interaction. Following the court‘s order, the mother and child were separated and the child was put under the authority of the local child protection service. Once the father became capable of caring for the child, the girl was discharged. None of the previously reported symptoms recurred and it was decided that the girl is not eligible for disability. During her stay at a psychiatric hospital the mother remained calm, there were no observable psychotic symptoms, and the results of psychological assessment were unspecific. Patient‘s parents supported her husband and blamed her that she didn‘t know how to take care of her child. The patient denied harming the child and actively wrote complaints to different institutions, trying to prove her daughter‘s diagnosis and said that doctors were taking revenge on her. A diagnosis of delusional disorder was made. Patient‘s husband needed to change the place of living three times because the patient keeps finding them. Although during girl‘s multiple hospitalizations the doctors weren‘t able to prove that the mother causes all the symptoms, but positive separation test and reduction of symptoms lets to suspect Munchausen Syndrome by Proxy.