Yapay bozukluk, bir hastalığın klinik belirtilerin hasta tarafından bilerek hasta rolünü benimsemek için ortaya çıkartan psikiyatrik bir hastalıktır. Kontrol edilemeyen diyabet melitus hastalarında bazen neden yapay bozukluktur. Bu makalede kan şekeri kontrol edilemeyen 17 yaşında diyabetli bir kızı sunuyoruz. Yüksek kan şekeri ve bazen diyabetik ketoasidoz belirtiler gösteren hastada dikkatli izleme sonucunda şeker ölçümü öncesi parmağına hurma sürüp kan şekerin yüksek çıkmasına neden olarak hastanede kalmak için yaptığı ortaya çıkmıştır. Bu yazıda kan şekeri kontrol edilemeyen diyabetik hastalarda yapay bozukluğun ayrıcı tanılar arasında gözden kaçırılmaması gerektiğini belirtiyoruz.
Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.
___
1. Alinejad NA, Oettel DJ. Factitious disorder as repeated diabetic ketoacidosis: a case report. Innov Clin Neurosci 2011; 8(2):41-47.
2. Ehlers W, Plassmann R. Diagnosis of narcissistic self-esteem regulation in patients with factitious illness (Munchausen syndrome). Psychother Psychosom 1994; 62(1-2):69-77.
3. Lorenzo Pelizza, Simona Pupo. Brittle diabetes: Psychopathology and personality. J Diabetes Complications 2016; 30(8):1544-1547.
4. Schade DS, Drumm DA, Duckworth WC, Eaton RP. The etiology of incapacitating, brittle diabetes. Diabetes Care 1985; 8(1):12-20.
5. Kapfhammer HP. [Somatoform and factitious disorders in clinical medicine]. Wien Med Wochenschr 2005; 155(23-24):524-536.
6. Kovacs CS, Toth EL. Factitious diabetes mellitus and spontaneous hypoglycemia. Consequences of unrecognized Munchausen syndrome by proxy. Diabetes Care 1993; 16(9):1294-1297.
7. Jermendy G. [Factitious hypoglycemia-Munchausen syndrome in diabetes mellitus]. Orv Hetil 1995; 136(1):31-33.
8. Sheehy TW. Case report: factitious hypoglycemia in diabetic patients. Am J Med Sci 1992; 304(5):298-302.
9. Waickus CM, de Bustros A, Shakil A. Recognizing factitious hypoglycemia in the family practice setting. J Am Board Fam Pract 1999; 12:133-136.
10. Schade DS, Burge MR. Brittle diabetes: etiology and treatment. Adv Endocrinol Metab 1995; 6:289-319.
11. Plassmann R. Inpatient and outpatient long-term psychotherapy of patients suffering from factitious disorders. Psychother Psychosom 1994; 62(1- 2):96-107.