Munchausen and Munchausen syndromes by proxy: some notes from Psychology

The article aims to present some notes of psychology about Munchausen syndromes (MS) and Munchausen by Proxy (SMPP), seeking to understand the terms and symptoms. And, later, provide subsidies to health professionals for a possible intervention and treatment. From a review of the literature, through consultation of electronic data and published books available, prioritizing the texts from 1999 to 2019 on the subject. It is observed that the literature points to Munchausen Syndrome as a more common pathology than is diagnosed affecting well-informed individuals about the medication to be used for the treatment of the disease they believe they have. While in Munchausen Syndrome by Proxy the victims are children usually taken to the health service by their mothers or guardians. Improvement in care becomes essential, especially when the victim is the child.


INTRODUCTION
The Baron of Muchausen was a German military man who participated in the war against the Turks in the mid-18th century, became a figure known for wandering the cities, telling fanciful stories of impossible deeds. The English physician Richard Ascher paid tribute to this character by using the term Munchausen Syndrome to designate a psychiatric disorder.
An important characteristic observed in these patients in relation to the disorder their reluctance to perform psychological treatment after hospital discharge. When confronted with this possibility there is an intensification of the signs and symptoms presented. It is difficult to understand the reasons why these individuals develop this condition, especially when the simulation of symptoms occurs with a child, and is produced by his own mother, precisely the one who should be responsible for the care and protection of the child. It is believed that the intention is to benefit from the care provided by the health team for the supposed disease presented by the child (PIRES and MOLLE, 1999).
The research was guided by the following question: how should be the attitude adopted by professionals in the face of a case of Munchausen Syndrome, especially when the victim is a child and the mother or responsible for her care is the person who produces the disease, assuming it indirectly by proxy.
The theme is scientifically relevant, because currently there are few studies related to the subject, rarely addressed in the curricula of health professionals. Professionals find it difficult to diagnose the syndromes, among other factors, due to the little knowledge that is available about them, due to a scarce literature on the subject. In addition, many patients deny the existence of a psychiatric disease, in addition to the perpetrator's attitude of denying any type of accusation, in cases of Munchausen Syndrome by Proxy. It is essential to understand the signs and symptoms related to the syndromes, knowing the characteristics of those involved and the mechanisms used in the simulation, in order to provide subsidies for health professionals in the recognition of these pathologies for a possible intervention and more appropriate treatment.  (NETO et al., 2017). Currently for diagnosis and probable treatment, it is considered that simulated complaints usually affect different organs or vary in the course of the disease.

The International Statistical Classification of Diseases and Related Health Problems (ICD-10)
is within the Group Other personality and adult behavior disorders (F68 present within fictitious disorders). Characterized by recurrent simulation and manipulation of symptoms, sometimes with self-mutilation. In order to cause signs and symptoms that resemble a pathology. The motivation is intrinsic and aims to assume the role of patient to receive medical treatment. It is often associated with major personality and relationship disorders. The fundamental strategy in the management of these patients is early diagnosis, according to Aranha et al. (2007), in order to prevent an increase in suffering and the risk of unnecessary self-injury and examination. In early stages of the disease, a psychiatric intervention tends to be successful, in addition to an auxiliary psychotherapy in strengthening identity and self-esteem.
It is essential to establish a therapeutic bond with the patient. Powell and Boast (1993) cited by Gattaz et al. (2003)  However, there is no consensus on the best therapeutic approach to be adopted for the treatment of Munchausen syndrome (ARANHA et al., 2007)., The use of antidepressant, neuroleptic and anxiolytic medications reduce anxiety, and has shown satisfactory results when used (GATTAZ et al., 2003).
Munchausen Syndrome by Proxy is a pathology considered as a serious form of child violence, since the child presents false pathological conditions, produced by one of his guardians, usually the mother. It is necessary for the professional to contact the Child Protection Committee, social services, mother and child are referred to the Children's Court (BORGES, 2016). Braga (2007) mentions the tripartite technique by quoting Bleichmar (1992), the mother and child can be attended simultaneously, since the relationship between both is shaken, this type of psychotherapy, could enable the rescue of the bond between mother and child, lost in the midst of pain and suffering. Therefore, the mother presents an emotional difficulty and needs to be welcomed by the team, in a multidisciplinary work. So she can find support and accept the treatment of her pathology. there is an intensification of the signs and symptoms presented and when they cannot manipulate the situation they try to escape from the hospital service. The recognition of the disease by the health team is essential for treatment. Although the role and performance of health professionals in view of this situation are not yet well defined, especially the psychologist due to the lack of information and publication, about the diagnosis and management of the syndrome. And many patients deny the existence of a psychiatric Munchausen and Munchausen syndromes by proxy: some notes from Psychology www.nucleodoconhecimento.com.br disease. The study in question can be seen as a basis for further research to broaden the discussion and understanding about the subject.