Factitious disorder imposed on another (FDIA), also called Munchausen syndrome by proxy (MSbP), is a condition in which a caregiver creates the appearance of health problems in another person, typically their child. This may include injuring the child or altering test samples. The caregiver then presents the person as being sick or injured. Permanent injury or death of the victim may occur as a result of the disorder. The behaviour occurs without a specific benefit to the caregiver.The cause of FDIA is unknown. The primary motive may be to gain attention and manipulate physicians. Risk factors for FDIA include pregnancy related complications and a mother who was abused as a child or has factitious disorder imposed on self. Diagnosis is supported when removing the child from the caregiver results in improvement of symptoms or video surveillance without the knowledge of the caregiver finds concerns. Those affected by the disorder have been subjected to a form of physical abuse and medical neglect.Management of FDIA may require putting the child in foster care. It is not known how effective therapy is for FDIA; it is assumed it may work for those who admit they have a problem. The prevalence of FDIA is unknown, but it appears to be relatively rare. More than 95% of cases involve a persons mother.The prognosis for the caregiver is poor. However, there is a burgeoning literature on possible courses of therapy.The condition was first named, as "Munchausen syndrome by proxy", in 1977 by British pediatrician Roy Meadow.
When in the circulation, about 99% of both substances are bound to plasma proteins, namely to albumin and alpha-1-acid glycoprotein to equal amounts.The liver enzymes CYP2C8 and, to a lesser extent, CYP3A4, hydroxylate and dealkylate the active substance, thereby inactivating it. Besides, ACT-333679 is glucuronidized by the enzymes UGT1A3 and UGT2B7. The terminal half-life of selexipag is 0.8 to 2.5 hours, that of the active metabolite is 6.2 to 13.5 hours. History
The U.S. Food and Drug Administration (FDA) granted selexipag orphan drug status for PAH. It was approved by the FDA on 22 December 2015.In Europe, the drug was approved in May 2016. Society and culture
Economics
The expected price for the drug in the US is $160,000 to $170,000 per patient before rebates. References
External links
"Selexipag". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03187678 for "Safety Study of the Switch From Oral Selexipag to Intravenous Selexipag in Subjects With Stable Pulmonary Arterial Hypertension" at ClinicalTrials.gov