Medically unexplained symptoms Flashcards
What are factitious disorders?
An example is a young girl presenting to hospital with hypoglycaemic attacks frequently= turns out her father is a diabetic and she has been taking his insulin to induce these attacks to avoid exams
Define functional disorders?
symptoms that appear not to be caused by physical disease
this lack of explanation due to visible pathology means they are often called medically unexplained symptoms
disturbance of function = including physiology, neurological and cognitive processes
describing symptoms as disorders of function is an acceptable way of doing this
What are some examples of functional disorders?
fibromyalgia irritable bowel syndrome tension headache non-epileptic attacks chronic pelvic pain atypical facial pain temporomandibular joint dysfunction
What is the epidemiology of functional disorders?
10-20% of adults will have experienced several MUS
15% of GP consultations
more common in females
more common in poorer socioeconomic backgrounds
runs in families
history of abuse
MUS cost around £3.1 billion per year
Why do they think MUS occur?
exaggerated stress resposne
attentional bias for unpleasant threatening stimuli
What are some symptoms of functional disorders and what are the consequences?
fatigue, lack of sleep, lack of concentration, headache, blackouts, chest pain, palptitations, breathlessness, nausea, bloating, abdominal pain, musculoskeletal pain, pelvic pain
experiencing multiple symptoms, the distress of the symptoms impacts on daily activities and seeking healthcare
symptoms can change over time
If a pt comes with a whole A4 page of symptoms = functional disorder
What functional disorders have recognised symptoms?
IBS and fibromyalgia
What symptoms are common in functional disorders?
depression and anxiety - 2x the rate in the patients with equivalent physical disability from organic disease
But MUS are NOT the same as depression and anxiety
pts with MUS will usually play down their emotions
sometimes MUS turn out to be organic disease
How are MUS managed?
source of diagnostic confusion
they can be frustrating for both doctors and patients
listen acknowledge suffering diagnose; functional disorder do not have to be diagnoses of exclusion target investigations explain and support be positive
cognitive and behavioural treatment
pharmacological treatment = antidepressants and atypical analegsics (gabapentin and pregabalin)
What is the nocebo effect?
the expectation by the patients that the treatment will be ineffective or harmful and that leads to increased reported side effects and discontinuation of treatment
