Medically unexplained symptoms Flashcards
Define somatisation
patients experience distressing physical symptoms associated with abnormal thoughts, feelings, and behaviours in response to these symptoms
They may result from psychological stress that is unconsciously (without awareness) expressed somatically.
Define Conversion disorder
voluntary motor or sensory function deficits that suggest neurological or medical conditions but are rather associated with clinical findings that are not compatible with such conditions
Define medically unexplained symptoms (ICD-10)
Multiple, recurrent and frequently changing physical symptoms of ≥2 years duration
- Symptoms may be referred to any part or system of the body
- The disorder is chronic and fluctuating → disruption of social, interpersonal and family behaviour
- Complicated Hx of contact with medical care
What are the features of hypochondrial disorder
Persistent belief in the presence of an underlying serious DISEASE e.g. cancer
Patient refuses to accept reassurance of negative test results- they do NOT get relief from negative test results
Patients may go ‘doctor shopping’ whereby they see ≥ 1 doctor for the same problem
Co-morbid anxiety and/or depression common
Patient maintains their belief despite being told otherwise (overvalued idea)
What are the features of conversion disorder
Typically involves loss of motor or sensory function in the absence of a somatic cause
Patient may be indifferent to their apparent disorder- la belle indifference
Patients do not consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
What are the features of factitious disorder/Munchausen’s syndrome
The intentional production of physical or psychological symptoms
People are faking/feigning symptoms
May go as far as contaminating urine samples, creating skin lesions, or feigning amnesia
Often triggered by psychological distress and the individual experiences some benefit from being looked after
What is Munchausen’s by proxy
symptoms are feigned into proxy, often a child
(This is often primary gain)
What are the features of malingering
Fraudulent stimulation or exaggeration of symptoms with the intention of financial or other gain
(This is often secondary gain- i.e. prescribed drugs, money, benefits)
What are the features of body dysmorphic disorder
Patient’s are preoccupied with an imagined or minor defect in their physical appearance e.g. large nose.
Exclude other conditions such as delusional disorder (somatic delusions)
Preoccupation causes significant distress and impairment of functioning such as other discussing the body part with others and presenting to medical professionals such as surgeons.
Concerns can be reduced but often temporary
What are the features of chronic fatigue syndrome
AKA myalgic encephalomyelitis
May follow a viral infection e.g. glandular fever, but also arises spontaneously
No clear aetiology
Extreme fatigue, people are typically exhausted by mild exertion
Poor concentration, myalgia, sore throat, depression
What is the management for medically unexplained symptoms
- Therapeutic assessment: full Hx and physical exam
- explain and re-assure
- Supportive management:
- Encourage to discuss difficult emotions
- Involve social network
- Antidepressants (tension headache, IBS, fibromyalgia)
- CBT
- Graded exercise
What is the prognosis for medically unexplained symptoms
Shorter duration and milder symptoms = better
Over 1/4 of people with MUS attending primary care and 2/3 of people with functional neurological symptoms remain symptomatic after a year
Rates of suicide in people with CFS are significantly higher than in the general population
Counselling for a patient with MUS
This is a functional syndrome, it is common and well-established
These are usually self-resolving, if we can figure out what is keeping the symptoms there
I think that if we do tests, they are going to be normal. I think that it’s best, and if you disagree we can discuss, that we should not do any more investigations. You’ve already had a lot of investigations which are not without risk or harm to the body - they do take a toll. I don’t want to subject you to any more needles or tests
Your examination was normal, but these headaches have been causing you a lot of pain, haven’t they?
Sometimes people can get symptoms like this when under pressure. Pressure can also cause things like being shaky and tearful
Do you think it’s possible that this has been having an effect on your headaches/health
What we see sometimes is this cycle where because you are worried about something, it increases muscle tension. This in turn give you a headache, which is what makes you believe that you have a brain tumour, which increases your worry further and so forth (can draw a diagram)
