When years of many different diagnosis may turn into one – a case of munchausen syndrome

Introduction The term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”. Objectives To report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches. Methods Description of a clinical case based on medical records and a brief review on Munchausen syndrome. Results A 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance. Conclusions Munchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs. Disclosure No significant relationships.

Introduction: Patients with severe mental illness die 10-20 younger from general population. In addition to suicide, preventable physical diseases cause most deaths. The mental illness itself and stigma keep the patients from adequate treatment for physical ilnesses. Objectives: We aimed to investigate medical consultations for inpatients with severe mental illnes. Methods: We retrospectively evaluated medical records of patients diagnosed by schizophrenia, schizoaffective disorders, bipolar disorder, and depression between 1st Februrary 2018 and 30th January 2020. We excluded routine consultations before electroconvulsive treatment. Local ethichs committee approved the study. Results: Among total 475 consultations, %41.3 (n=196) was for male, and %58.7 (n=279) was for female patients. Mean age and standart deviation were 48.9 AE 13.9 for male, and 50.1 AE 13.7 for female (p>0.05). Comparing sexes oin terms of primer psychiatric diagnoses, the higher proportion was psychotic disorders for male, and for female it was mood disorders (p<0.05). The most consulted departments with percentage and number were: internal medicine %44.0 (n=209), neurology and neurosurgery %15.2 (n=72), physical medicine and rehabilitation %8.2 (n=39), dermatology %7.8 (n=37), cardiology %6.7 (n=32). We compared the proportions of consulted department between male and female. Male patients were consulted to dermatology more than female, and female patient were consulted to gynecology or urology more than male (p<0.05).
Conclusions: Awareness about physical diseases in paients with severe mental illness between healthcare workers, carries the potential to increase the patients' quality of life and lifespan. For future interventions the focus should involve healthcare worker in internal medicine and neurology, as well as in psychiatry.
Disclosure: No significant relationships. Keywords: medical comorbidity; psychiatry inpatient service; Severe mental illness

EPV0134
Breast cancer and post-traumatic growth: A systemical review study C. Yastıbaş 1 and İ.G. Yılmaz Karaman 2 * Introduction: Breast cancer is a serious threat to people's health. In addition to negative psychological disorders including depression, anxiety, and post-traumatic stress symptoms, positive changes such as post-traumatic growth (PTG) can be experienced. Objectives: The aim of this systematic review was to determine the variables related to PTG in people with breast cancer. Methods: We searched five database (SCOPUS, Cochrane, Medline, Science Direct, and Pubmed) starting from 1990, by guidance of PRISMA criteria, using the keywords "breast cancer", "post traumatic growth", "stress related growth", and "benefit finding". Results: There were conflicting findings regarding the relationship between PTG and following variables: sociodemographic variables such as age, education level, marital status, disease-related variables such as cancer stage, time since diagnosis, type of treatment. We observed that these variables may have a low effect on PTG. In addition, personality characteristics such as optimism, spirituality, and hope were found to be associated with PTG. Functional or problem-focused coping such as positive restructuring, acceptance, and religious coping, and ruminative thoughts predict PTG as a part of cognitive processing. Besides, social support has an important role in experiencing PTG. Conclusions: Psychosocial interventions for cancer patients are increasing day by day, but the scarcity of interventions which aims increase PTG is noteworthy. With this review, we recommend developing intervention programs that include functional coping strategies such as stress management, social skills training, cognitive techniques focused on ruminative thoughts, and positive restructuring.
for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: "falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards". Objectives: To report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches. Methods: Description of a clinical case based on medical records and a brief review on Munchausen syndrome. Results: A 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance. Conclusions: Munchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs. Introduction: Previous research has found that candidates for bariatric surgery usually present anxiety, depression, personality disorders and/or a tendency to binge eating. The situation related with the pandemic and the lockdowns during the 2020 are possible aggravating factors for these characteristics. Objectives: To study the more important psychological characteristics presented by candidates for bariatric surgery. Methods: 40 people between 29 and 65 years old (M=46.4, SD=9.1; 37.5% male, 62.5% female) were evaluated between July and December of 2020. The assessment consisted in an interview carried out by a clinical psychologist, and a pool of questionnaires to evaluate depression and anxiety symptoms (Beck Depression Inventory, BDI; and the Goldberg Anxiety and Depression Scale, GADS) the existence of a binge eating pattern (the Binge Eating Scale; BES) and personality traits (the Salamanca Screening Test). Results: The 25% of the sample had previous mental health antecedents. Eight people disclosed to feel stress in relation with the COVID-19, and 18 presented an emotional regulation strategy using food during the lockdown. 62.5% scored above the cut-off point on the BDI (mild=27.5%, moderate=20%, severe=15%) and a 40% and a 47.5% did it for the anxiety and the depression (respectively) GADS subscales. 20% presented a binge eating pattern according with the BES. Most common personality traits were histrionic (50%), emotionally unstable impulsive type (45%), and anxious (42.5%). Conclusions: These findings support the previous scientific literature. Psychological intervention programs may be considered to guarantee the surgery's success, especially when adverse contextual circumstances are presented.

EPV0137
Mind the gap! the lack of concordance in diagnostic in liaison psychiatry in a portuguese hospital