Medically unexplained things

Question 1

What are the 3 main features of Munchausen’s?

Answer 1

Simulated illness (mental or physical), pathological lying, wandering from place-place.
Symptoms can be simulated, pre-existing disease can be aggravated or disease may be induced.

Question 2

What is Munchausen’s by proxy?

Answer 2

Parent or carer producing fictitious illness in a person in their care.

Question 3

What is munchausens also known as?

Answer 3

factitious disorder

Question 4

Give 3 things that may precipitate or cause Munchausen’s.

Answer 4

1. Childhood abuse
2. low self-image
3. desire for self-punishment. A personality disorder, depression or substance abuse may be a feature.

Question 5

In general, what will the patient’s history be like for munchausens?

Answer 5

Long with unexplained symptoms, with many doctor changes. Will be vague about their life, inconsistencies in their history and a lack of expected physical signs

Question 6

Give 3 specific things people w munchausens can present with.

Answer 6

Curious seizures, dyspnoea, chest pain, etc etc etc

Question 7

Give 2 differentials for munchausens

Answer 7

Somatisation, Hypochondriasis (anxiety is the main feature, no physical signs, negative tests only give temporary relief if at all).

Question 8

What are medically unexplained symptoms?

Answer 8

Symptoms for which no organic cause can be identified.

Question 9

How common are medically unexplained things?

Answer 9

25% of GP appointments are for them. 1/3 of patients have a co-existing psychiatric diagnosis, usually depression or anxiety.

Question 10

Give 4 specific risk factors for MUS.

Answer 10

Female, physical illness or trauma, stressful childhood (incl. abuse), media campaigns highlighting specific diseases (house episode on the plane!)

Question 11

What are the 3 main types of complaint for MUS?

Answer 11

Pain in a specific location, functional organ disturbance, fatigue.
NB more likely if a history of anxiety or depression present

Question 12

What are the 2 underlying mechanisms to MUS?

Answer 12

Enhanced sense of bodily awareness (tending to amplify normal sensations, such as a heartbeat palpitations)
Mis-attribution of symptoms (rather than a symptom being random, i.e. a headache, it is due to a fatal brain tumour)

Question 13

When should you consider MUS? are ix appropriate?

Answer 13

Any patient with symptoms for more than 3 months, that cannot be readily explained. Investigations do not reassure in 50% and false +ve will lead to worsening. Essentially strike a balance.

Question 14

Give 3 things that can be used to treat MUS

Answer 14

Taking patient seriously - increasing physical activity, amitriptyline/SSRIs, CBT is good

Question 15

What is somatisation? How is it different to MUS?

Answer 15

Expression of psychological illness through physical symptoms. Multiple, recurrent and frequently changing symptoms for several years (>2) before psychiatrist referral.
MUS is not an expression of underlying psychiatric illness.

Question 16

What is associated with somatisation?

Answer 16

History of sexual or physical abuse. Increased rates with IBS and chronic pain patients.

Question 17

What is the typical patient for somatisation?

Answer 17

Females below 30. Lots of PTSD patients have it.

Question 18

What worsens people’s sx in somatisation?

Answer 18

stress

Question 19

What is often present alongside people’s symptoms?

Answer 19

Lifelong history of ‘sickliness’

Question 20

Give 3 cardiac, GI, neurological and a GU symptom.

Answer 20

Cardiac: SOB, palpitations, Chest pain. GI: D+V, abdo pain, nausea. Neurological: headaches, dizziness, amnesia, weakness, vision loss.
GU: impotence

Question 21

Give 3 things that can treat somatisation.

Answer 21

CBT and mindfulness, physical exercise, antidepressants can help if there is an underlying psychiatric disorder.