ZEYNEP TÜRKMEN, SELDA MERCAN, Can ÇALICI, Serkan TURKDOGRU, NEYLAN ZİYALAR

[Munchausen by Proxy Sendromu (MbPS) Şüphesi olgularında Biyolojik Örneklerin ve Toksikolojik Analizin Önemi]

Çocuk istismarının bir türü olarak MbPS olguları, genellikle bir yetişkinin çıkar sağlamak adına çocukta hastalık durumu yaratmasına dayalı adli olgulardır. Burada söz konusu olan çıkar kavramı, maddi boyutlu değil, doymak bilmeyen ilgi görme ihtiyaçlarını karşılamak, sağlık çalışanları ile sürekli aynı ortamda bulunma isteği gibi psikolojik ve duygusal boyutu olan bir durumdur. Bu tür olgularda, böyle bir istismarın varlığını ortaya koyacak delilleri yakalamak ve ortaya çıkarmak, çocuk ve yetişkin (özellikle failin anne olması durumunda) arasındaki bağın hassas bir bağ olmasından dolayı kolay değildir. Ayrıca tüm sağlık çalışanlarının her türlü suç şüphesini ilgili adli merciye bildirme yükümlülükleri bulunmaktadır. MbPS olgularında, yaratılan hastalık tablosunun bir ilaç etken maddesi aracılığı ile olduğu durumlarda, klinikteki MbPS şüphesini doğrulamak için mağdurdan alınacak biyolojik örneklerin ve toksikolojik analizin, teşhisin konmasına önemli katkısı olduğu bilinmektedir. Bu çalışma, MbPS olgularını, ihmal sonucu meydana gelen kasıtlı olmayan ilaç zehirlenmeleri tanısından ayırmak için, biyolojik örneklerin toplanması ve uygun analiz yöntemlerinin seçilmesi konusunda farkındalık yaratabilmek amacıyla hazırlanmıştır.

The Importance of Biological Samples and Toxicological Analysis in Suspected Munchausen by Proxy Syndrome (MbPS) Cases

As a kind of child abuse MbPS cases are the forensics ones, in which illness is produced and/or simulated by an adult, particularly parent or someone who is in loco parentis, to gain interest. By interest mentioned here is not pecuniary but providing psychological and emotional needs like getting attention insatiably and coexisting with the healthcare professionals. Because of the sentimental connection between child and the adult (particularly the mother), it is complicated to prove and demonstrate this kind of child abuse with evidences in these cases. Besides health care profesionals are responsible to inform judicial authorities in case any criminal suspicion. In MbPS cases, if the illness is produced and/or simulated via active subtance of a medicine, it makes serious contribution to get biological samples from victim for toxicological analysis to diagnose the maltreatment. This review is aimed to manifest the difference between unintended drug intoxication by negligence and MbPS cases, also create awareness about the importance of collecting biological evidence and using appropriate analysis methods in mentioned incidents.

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