What would the pre-requisite qualifications be for this? I've always wondered whether Munchhausen's was more a physiological problem rooted in primarily neurobiological factors, or whether it is a phenomenon found in cultures with poor external emotional support for many long-term caregivers.

Not so much qualifications, but more about perspectives... I think you raise some interesting points there. I specify the design on my LinkedIn page (please feel free to connect - uk.linkedin.com/in/jonathanjewell/) thus:

TADS (Munchausen's Syndrome)

'Developing a system through the convergence of epidemiology and decision-science to find a conceptual model and practical tool that allows the control and prediction of potential candidate Munchhausen clients. A system is needed that is structurally and functionally resistant - even when the theory/tool enters the public domain - to being undermined, circumvented or permitting emulation of discriminants, which meets 5 9's performance level in detection of Munchhausen's syndrome.'

Now, my view is that there is a way to do that is based on decision science principles, but the goal as I specify it is a) to 5 9's (i.e. 99.99% accurate) and b) developing a system that even when you know how it works, you can't trick it.

Any ideas welcome!

Well, I would think that if we could examine the traits needed for diagnosis as determined primarily by the World Health Organization's ICD, and to a lesser extent the American DSM (although the DSM has had a dubious history of cultural bias damaging its legitimacy such as the classification of homosexuality as a mental disorder only a half century ago)...

A questionnaire could be designed which would seem to be a general mental health survey to the patient in question, though it would be specifically designed in order to identify patterns of malingering consistent with munchausens, rather than to diagnose depression or anxiety disorders despite seeming so to the average, uninformed individual.

To really break down the error of margin, however, I think the only way to legitimately claim a 99% accuracy rating is to undertake the painstaking process of having appropriately trained researchers examine known munchausen's patients to look for biological factors which may be responsible (for instance, it is now thought that predisposition towards PTSD may be significantly hereditary [~30% by some sources]) in the genome, as well as trying to identify neurotransmitter imbalance or other congenital brain dysfunction.

If no evidence of a correlation between development of Munchausen's and a physiological predisposition can be found, I doubt that a 99% accuracy rating could be achieved through psychoanalysis or ethnography alone. I think the best bet in such a scenario would be to rely on the standard police tactic of having the individual repeat the story many times in succession to various individuals and trying to find inconsistencies in the patient's story.

But being practical here, I think that the most practical option is designing a very long, very complex questionnaire which would be administered by a healthcare team consisting of at least one general physician (or perhaps a specialist?), at least one psychiatric MD, at least one kind of therapist trained in psychoanalysis, perhaps an anthropologist who can obtain data from the patient without overtly appearing to be engaged in clinical observation, and several technicians and specialists who can be trained to look for things such as excessive, attention-seeking medical complaints and the like.

It could never be foolproof in such a format, but it could be reasonably accurate if it were long enough and accompanied by fail-safes such as unconsciously baiting the patient to display malingering tendencies or to forget the story they've created and slip up on the details.

http://apps.who.int/classifications/icd10/browse/2010/en#/F68.1

Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]

The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm in order to produce symptoms or signs. The motivation is obscure and presumably internal with the aim of adopting the sick role. The disorder is often combined with marked disorders of personality and relationships.

Hospital hopper syndrome

Münchhausen syndrome

Peregrinating patient

Excl.:

factitial dermatitis (L98.1)

person feigning illness (with obvious motivation) (Z76.5)

F68.8

Other specified disorders of adult personality and behaviour

Character disorder NOS

Relationship disorder NOS

In my opinion, Münchhausen sydrome is a severe disorder of doctor-patient relationship (or of mother-child- physician relationship in case of Münchhausen by proxy syndrome). Therefore we should not speak of a nosologic entity but of one of the complex pseudopathies (unlike "psychopathy").

A questionnaire could help in all medical unexplained syndromes, to find out the rare M'hausen syndrome, as we are too late in most cases treated by intensive interventions (ICU)  without any psychological anamnesis and without any knowlegde of the physician-patient-relationship inducing pseudopathia.