Psychological problems presenting with physical symptoms Flashcards
What is Munchausen’s syndrome/Factious disorder?
This is a syndrome where patients fake illnesses to receive attention, playing the patient role.
There is intentional production of physical or psychological symptoms
This includes adding blood to urine, not taking medications or faking pain.
The patient relaxes and begins to be happier when he is receiving treatment.
What is Somatoform disorder?
Describes the presence of physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder.
It is an unconscious process.
Common presenting symptoms are gastrointestinal symptoms and abdominal pain, fatigue, weakness and musculoskeletal symptoms.
Patients can present with a dramatic range of physical symptoms which can lead to loss of functioning.
What is conversion disorder?
A psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes).
It is not an intentional process, and the symptoms are very much “real” to the patient.
It is linked to emotional stress.
What is Illness anxiety disorder (Hypochondriasis)?
Patients have excessive concern that they will develop a serious illness despite a lack of evidence.
Patients often demand unnecessary tests and investigations, and can be quite debilitated as a result of their constant worrying.
Patients with hypochondriasis typically have no or very few symptoms unlike Somatoform disorder where patients experience dramatic physical symptoms and experience a degree of disfunction.
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
What is Malingering?
Patients intentionally fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time.
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
What is La Belle Indifference?
La Belle Indifference is associated with conversion disorder.
It describes an inappropriate lack of concern over the symptoms they are experiencing.
For example, a patient who is suddenly unable to walk proclaims that it is not of any worry to them.
Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
How does dissociative disorder from conversion 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
What is sleep paralysis and how might it be managed?
Sleep paralysis is a common condition characterized by transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep. It is thought to be related to the paralysis that occurs as a natural part of REM (rapid eye movement) sleep. Sleep paralysis is recognised in a wide variety of cultures
Features
paralysis - this occurs after waking up or shortly before falling asleep
hallucinations - images or speaking that appear during the paralysis
Management
if troublesome clonazepam may be used
What is Hoovers sign
Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
Seen in conversion syndrome
When can chronic insomnia be diagnosed
Chronic insomnia may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week
What may be more suggestive of pseudoseizures (or dissociative seizures) on both history and examination than seizures?
• Asynchronous limb movements – often bizarre
• Resisting attempts to open eyes
• Protective/avoidance behaviour – i.e. patient doesn’t sustain injuries
• Emotional trigger for event e.g. happens during argument.
• No post-ictal period (generalised seizure often lengthy recovery)
• Patient able to recall what happened during the actual seizure.
• Tongue biting and incontinence very rare
• Prolonged seizure >3 mins
Malingering vs facticious symotoms
Malingering is intentionally reporting/producing symptoms for clear secondary gain (this is often monetary).
In factitious disorder a patient will feign symptoms (intentionally) but with no clear secondary gain other than to achieve the sick role and therefore care.
It is difficult to prove intentionality, however, it can be speculated.
Such patients should be treated non-judgementally and if on medical wards seen by liaison psychiatry with the treating team to help manage these often very complex cases safely.
