Medically Unexplained Symptoms

Question 1

Somatisation

Answer 1

physical symptoms unexplained by a medical disease

Question 2

Three categories of unexplained symptoms

Answer 2

Somatic symptom disorder

Factitious disorder

Malingering

Question 3

Features of somatic symptom disorder

Answer 3

Excessive time and energy devoted to the symptoms > 6 months
Symptoms are unintentional, motivation is unintentional

NOTE: NOT FAKING SYMPTOMS –> experiencing actual symptoms but no pathophysiological reason why

Question 4

What is illness anxiety disorder AKA? What is it? What type of disorder is it?

Answer 4

Illness Anxiety disorder = hypochondriasis

Preoccupation with having undiagnosed illness with mild or no somatic symptoms –> anxiety about health with excessive health-related behaviors e.g. repeatedly checking heart rate or moles

It is a type of somatic symptom disorder

Question 5

What is conversion disorder? What is a common feature of this?

Answer 5

Functional neurologic symptom disorder
Sudden onset following stressor – divorce, argument with a loved one, death
Normal neurologic workup – classic feature is positive findings incompatible with a disease such as absence of plantar flexion in a patient who can stand on his toes

Question 6

What is factitious disorder on self known as? What is the reason behind it?

Answer 6

On-self = Munchausen

Falsified medical or psychiatric symptoms done consciously out of desire for attention

Done for primary (internal) gain from illness –> patient feels better in the sick roles e.g. if afraid of work or to be alone, feels better/happier in hospital setting

Question 7

What is factitious disorder on others known as?

Answer 7

On others = Munchausen by proxy

Falsified medical symptoms by caregiver, often a parent of sick child or caretaker of elderly

Question 8

What is malingering? Why is it done? What type of symptoms does it often involve?

Answer 8

Consciously falsified medical symptoms

Done for secondary (external) gain –> allows patient to miss work but still get paid or obtain workman’s compensation

Often involved musculoskeletal symptoms (easier to fake)

Question 9

Difference between malingering and munchausen

Answer 9

Malingering –> self-limited until gain is achieved –> direct gain

Munchausen –> often persists as indirect gain