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Guest Editorial
Modern Views of Autism

Eric Fombonne

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In Review
Autism Spectrum Disorders: Early Detection, Intervention, Education, and Psychopharmacological Management

Susan E Bryson, Sally J Rogers, Eric Fombonne

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Diagnosis and Epidemiology of Autism Spectrum Disorders
Lee Tidmarsh, Fred R Volkmar

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Genetic and Neurodevelopmental Influences in Autistic Disorder
Rob Nicolson, Peter Szatmari

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Original Research
Attitudes of Senior Psychiatry Residents Toward Persons with Intellectual Disabilities

Hélène Ouellette-Kuntz, Philip Burge, David B Henry, Elspeth A Bradley, Pierre Leichner

(PDF)


The Efficacy of 2 Different Dosages of Methylphenidate in Treating Adults With Attention-Deficit Hyperactivity Disorder

Rachelle Bouffard, Lily Hechtman,, Klaus Minde, Fiorella Iaboni-Kassab

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Delirium in Hospital: an Underreported Event at Discharge

Louis T van Zyl, Paul R Davidson

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Brief Communication
Removing Barriers to Treatment of First-Episode Psychotic Disorders

Derek J Scholten, Ashok K Malla, Ross MG Norman, Terry S McLean, Elizabeth M McIntosh, Chris L McDonald,, Michael Eliasziw, Kathy N Speechley

(PDF)


Book Reviews
(PDF)

Couple Therapy with Gay Men.
Reviewed by
Peter Moore, MD, FRCPC

What Forever Means After The Death of a Child.
Reviewed by
Philip Cheifetz, MD, FRCPC

Fighting for Mental Health: A Personal View.
Reviewed by
Paul Grof, MD, FRCPC

Understanding the Mind: The Nature and Power of the Mind. 2nd ed.
Reviewed by
Scott Bishop, PhD, CPysch Zindel Segal, PhD, CPsych


Letters to the Editor
(PDF)

Response of Catatonic Schizophrenia to Amisulpride: A Case Report

Medication Noncompliance Among Psychiatric Outpatients In Iran

Diogenes Syndrome in a Pair of Siblings

Treatment Option for Seasonal Affective Disorder

Factitious Anemia and Magnetic Resonance Imaging Abnormalities

Pregnancy and Respiratory Nocturnal Panic Attacks

Letters to the Editor

Factitious Anemia and Magnetic Resonance Imaging Abnormalities

Dear Editor:

Little is known about the causes and pathophysiology of factitious disorders. Several authors have proposed the possibility of preexisting organic cerebral lesions. Frontotemporal cerebral atrophy (1), marked hyperperfusion of the right hemithalamus (2), cerebral palsy (3), or areas of high signal in periventricular white matter in both hemispheres in T2-weighted magnetic resonance imaging (MRI) (4) have been respectively found in 4 patients who displayed Munchausen syndrome. We report a case of factitious anemia with MRI abnormalities, similar to those described by Fenelon and others (4).

Case Report

Ms O, a 35-year-old unmarried woman, was admitted to our psychiatric department after a suicide attempt. At psychiatric examination, Ms O did not fulfill DSM-IV criteria for any psychotic or affective disorder, and the suicide attempt rapidly appeared to be a response to perceived rejection. Throughout her hospitalization, Mrs O exhibited irritability, suggestibility, and poor insight.

A review of her medical record indicated a psychiatric history of factitious anemia that began at age 15 years and included many explorations and hospitalizations for 13 years. At age 28 years, she complained of transitory neurological symptoms, such as visual disturbances, paresthesia, and dizziness. Even so, the successive neurological examinations and complementary examinations (cerebrospinal fluid analysis, central visual field, and auditory, visual, and somatosensory-evoked potentials) were normal. The MRI of the brain, however, showed areas of high signal in periventricular white matter in both hemispheres in the T2-weighted sequence. These abnormalities, although not specific, first suggested the possibility of multiple sclerosis. Nevertheless, the normality of the different neurological examinations and the performed explorations did not favour this diagnosis.

Discussion

To our knowledge, this is the first report of MRI abnormalities in a patient with a factitious anemia. The first question raised is the link between the neurological symptoms and the MRI abnormalities. Although the diagnosis of multiple sclerosis cannot be invalidated, the absence of other objective neurological abnormalities does not support it. In this context, the subjective neurological complaints reported by the patient are consistent with the hypothesis of a neurological factitious disorder. The second remaining question is whether the MRI abnormalities that were found played a role in the development of factitious anemia.

This report raises an interesting question about cerebral lesions in the occurrence of pathomimia. To illuminate this association, we suggest further investigation to increase our understanding of the pathophysiology of factitious disorders.

References

1. Babe KS Jr, Peterson AM, Loosen PT, Geracioti TD Jr. The pathogenesis of Munchausen syndrome. A review and case report. Gen Hosp Psychiatry 1992;14:273–6.

2. Mountz JM, Parker PE, Liu HG, Bentley TW, Lill DW, Deutsch G. Tc-99m HMPAO brain SPECT scanning in Munchausen syndrome. J Psychiatry Neurosci 1996;21:49–52.

3. Diefenbacher A, Heim G. Neuropsychiatric aspects in Munchausen’s syndrome. Gen Hosp Psychiatry 1997;19:281–5.

4. Fenelon G, Mahieux F, Roullet E, Guillard A. Munchausen’s syndrome and abnormalities on magnetic resonance imaging of the brain. BMJ 1991;302:996–7.

Jérémie Aouillé, MD
Frédéric Rouillon, MD
Frédéric Limosin, MD, PhD
Créteil, France




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