Medically unexplained symptoms Flashcards
Somatisation disorder
a) Defined by the presence of…?
b) For how long?
c) Patient reaction to reassurance/negative test results?
Somatisation disorder
- Physical SYMPTOMS for at least 2 years
- Patient refuses to accept reassurance or negative test result
Hypochondrial disorder
a) Defined by the belief of…?
b) Patient reaction to reassurance/negative test results?
Hypochondrial disorder
- Persistent belief in presence of underlying DISEASE (often cancer)
- Refuses to accept reassurance of negative test results
Conversion disorder
a) Defined by the presence of actual medical…?
b) Typical features?
Conversion disorder
- Actual medical SIGNS – typically neurological (loss of motor/sensation - stroke mimic)
- Doesn’t consciously feign the symptoms
- May have La Belle indifference (unconcern)
Dissociative disorder
a) Defined by…?
b) Common psychiatric symptoms
Dissociative disorder
- ‘separating off’ memories from normal consciousness
b) Psychiatric symptoms:
- amnesia
- fugue (loss of awareness of identity)
- stupor (state of near unconsciousness, lack of awareness or response to stimuli)
The 3 main presenting ‘unexplained symptoms’:
- Pain in different locations
- Functional disturbance of organ systems
- Fatigue or exhaustion
Risk factors and triggers for MUS
- Long term conditions with anxiety and depression
- Childhood abuse
- Female gender
- Personality disorder
Triggers:
- Recent infection
- Current physical illness
- Death or severe illness of loved one
Munchausen’s syndrome
- 3 core features
Munchausen’s syndrome.
- Intentional production of symptoms in themselves (or production of symptoms in another - by proxy)
- Simulated illness: either physical or psychiatric.
- Pathological lying (pseudologia fantastica).
- Wandering from place to place (peregrination): the patient typically presents to numerous different hospitals, using different names
Malingering
Fake/exaggerated symptoms in order to gain something (money, medication)
Management of MUS
Management of MUS:
- Be there for the patient
- reassure, connect.
- Focus on social aspects
- symptoms - when they started, the impact on their life
- remove blame from the patient
- explain symptoms in terms they understand (eg. “stress causing muscle tension, experienced as pain”)
- generates ideas about symptom management
- Most patients with MUS will improve when the GP gives an explanation for symptoms that makes sense - Treat what is treatable
– pain ladders
- maximise treatment and symptom control in chronic disease (COPD, angina etc.) - Screen for depression and treat appropriately
– PHQ-9, HAD - Non-medical treatment
– physio, CBT, MDT approach to management.
- SHARE THE PLAN with the patient - Investigations and referrals
– expectation management
- discuss the possibility of normal results
- Be clear with the specialist with what the question is
- copy patients into letters and agree goals
- Recognising that NOT investigating may be best for the patient
- reassure patient they will be taken seriously - Safety net
- red flags
- risk management
Exploration of psychosocial stressors:
- The BATHE technique
- Background: ‘What is going on in your life?’
- Affect: ‘How do you feel about it?’
- Trouble: ‘What troubles you the most about that situation?’
- Handle: ‘What helps you handle that?’
- Empathy: ‘This is a tough situation to be in. Your reaction makes sense to me.’
Munchausen’s by proxy:
3 main techniques used by the carer
Fabrication of signs and symptoms.
- This may include fabrication of past medical history.
Falsification of hospital charts and records and specimens of bodily fluids.
- This may also include falsification of letters and documents.
Induction of illness by a variety of means.
