Psych

Question 1

A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain. On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself. This is an example of:

	Hypochondrial disorder
	Conversion disorder
	Malingering
	Munchausen's syndrome
	Somatisation disorder

Answer 1

Malingering

Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years patient refuses to accept reassurance or negative test results

Hypochondrial disorder = persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Conversion disorder
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Dissociative disorder
dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Munchausen’s syndrome
also known as factitious disorder
the intentional production of physical or psychological symptoms

Malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain