Medically Unexplained Symptoms

Question 1

Hypochondriasis/illness anxiety

• diagnosis
• investigations
• management

Answer 1

Persistent worry for 6 months min of presence of up to 2 serious physical conditions
-presumed deformity/illness => causes distress

Investigate for any underlying physical cause

Clearly explain absence of physical illness/diagnosis and set boundaries on future consultations/referrals
Treat underlying psychiatric issues (depression, anxiety)

Question 2

Factitious disorder/Munchausens

• diagnosis
• investigations
• management

Answer 2

Persistent intentional symptom production

• no external motivators (financial, medications, escape responsibilities => malingering)
• often combined with personality/relationship disturbances

Thorough history, examination
-multiple admissions, investigations, surgical scars may be a clue

Communicate with GP and local services where patient is likely to attend to maximise awareness of possible presentations
Manage other underlying psychiatric illness

Question 3

Somatisation disorder

• presentation
• management

Answer 3

6+ physical symptoms over 2+ years which cannot be explained by physical reasons
-GI, CV, GU, skin, pain

Investigate for any underlying physical cause

Treat any other underlying psychiatric issues (depression, anxiety)

Question 4

Conversion disorder

• presentation
• management

Answer 4

Acute onset of physical symptoms (often neuro) after stressful events
-sudden paralysis, blindness

Investigate symptoms to rule out any physical causes

Reassurance - few weeks/months
Treatment of other underlying psychiatric condition (depression, anxiety)

Question 5

Dissociative disorder

• presentation
• management

Answer 5

Feeling disconnected from yourself and the world, often associated with trauma
-amnesia, stupor

Investigate symptoms to rule out any physical causes

Talking therapy - cope and manage symptoms
Treatment of other underlying psychiatric condition (depression, anxiety)