Cri du Chat syndrome

Disease Description (Causes and Symptoms)

• Definition: A psychopathology involving intentionally creating or feigning physical or psychological symptoms about oneself (self) in order to play the “sick role” (traditional name: Munchausen syndrome). In DSM-5 classification, it is primarily classified as factitious disorder (including self-injury or symptom feigning). When symptoms are manipulated in another person, it is distinguished as factitious disorder imposed on another (formerly called Munchausen by proxy).
• Causes and pathophysiology:
  • No clear biological cause is known. Psychosocial factors are central (attachment problems in childhood, experiences of overprotection or abuse, low self-esteem, and a craving for attention from others).
  • Psychopathological mechanisms: May be associated with a motivation to obtain emotional rewards (attention and sympathy) through the “sick role,” avoidance of autonomy, and identity problems.
• Main symptoms:
  • Reporting or inducing symptoms without objective medical evidence (self-injury, taking medications, manipulating test results, etc.).
  • Excessive knowledge of medical terminology and testing procedures, and visiting multiple hospitals and doctors (doctor/hospital shopping, peregrination).
  • Test or treatment results are inconsistent or unclear.
  • The “sick role” itself is often the motivation rather than compensation (financial or legal gain).
  • In the form involving another person (by proxy), the person actually makes the protected individual (primarily a child or an older adult) ill or claims that they are ill, causing continued use of medical services.

Treatment Methods

• General principles:
  • The key points are avoiding unnecessary invasive procedures and tests, building a reliable relationship with the patient, and providing collaborative management with mental health professionals.
  • Treatment outcomes are limited, and a long-term approach is necessary.
• Psychotherapy:
  • Psychotherapy (depth psychotherapy, cognitive behavioral therapy (CBT), interpersonal therapy, etc.) addresses motivation, emotional regulation, and interpersonal problems.
  • If conditions such as borderline personality disorder coexist, DBT (dialectical behavior therapy) may be considered.
• Pharmacological treatment:
  • There is no approved medication that directly corrects the nuance itself (the act of feigning symptoms).
  • Standard pharmacological treatment, such as SSRIs, is applied to coexisting psychiatric symptoms including depression and anxiety.
• Medical-system interventions:
  • Designating a single responsible physician (singular care coordinator) and sharing medical records to prevent duplicate tests and treatments.
  • A consistent position from the treatment team (empathetic while setting therapeutic limits), with strict review of unnecessary invasive procedures.
  • In cases involving another person by proxy, immediate referral to child welfare and legal authorities is necessary when required.
• Emergency care and hospitalization:
  • If self-injury or a life-threatening condition is induced, psychiatric hospitalization or concurrent trauma and medical treatment may be necessary.
• Precautions during treatment:
  • Direct blame or confrontational accusations should be avoided because they may cause the relationship to break down.
  • Thorough documentation (diagnostic clues, inconsistencies in behavior and claims, etc.).
  • Collaboration with family members and other medical institutions is necessary.

Checkpoints Before an Outpatient Visit (Including Example Questions)

• Items/materials to prepare:
  • A list of currently taken medications (including prescription drugs, over-the-counter drugs, herbal medicines, and supplements)
  • Copies of past diagnoses, hospitalizations, surgeries, and test results (if possible, include the dates and hospital names)
  • A diary recording when symptoms began, their course, and changes in symptoms (if available)
  • A list of recently visited hospitals and doctors, and copies of medical records
  • Mental health history (history of depression, anxiety, self-injury, etc.) and family history
• Key information to provide to healthcare professionals during an outpatient visit:
  • The circumstances that led to the onset of symptoms and the symptom pattern (when they worsen and what improves them)
  • Whether there is an impact on current daily functioning (work, studies, and home life)
  • Whether there is a risk of self-injury or a history of harming others (report honestly)
• Materials that may be helpful to show healthcare professionals during an outpatient visit:
  • Previous test images and reports, recent prescriptions, and records of hospital and doctor visits

Examples of General Questions to Ask a Doctor

• “What are the possible causes of this condition?”
• “What tests or treatment plan do you recommend, and what is their purpose?”
• “What are the side effects and expected benefits of this medication (or treatment)?”
• “What risks (complications) are expected if I do not receive treatment?”
• “How will mental health treatment be conducted, and how long might it take?”

Examples of Condition-Specific Questions

• “I (or the protected individual) have repeatedly visited multiple hospitals. How should we coordinate future healthcare use (such as designating a single coordinator)?”
• “When the hospital recommends an invasive procedure or test, how can this be safely limited, and what process will you use to decide when it is necessary?”
• (For those involved in the by-proxy form) “Could you tell me what protective measures and legal procedures are needed to ensure the safety of the child (or patient under protection)?”