unexplained_symptoms_flashcards
What characterizes somatisation disorder?
Multiple physical symptoms present for at least 2 years; patient refuses to accept reassurance or negative test results.
What is illness anxiety disorder (hypochondriasis)?
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 functional neurological disorder (conversion disorder)?
Typically involves loss of motor or sensory function; the patient doesn’t consciously feign the symptoms or seek material gain; patients may be indifferent to their apparent disorder - la belle indifference.
What is dissociative disorder?
Dissociation is a process of ‘separating off’ certain memories from normal consciousness; involves psychiatric symptoms e.g. amnesia, fugue, stupor; dissociative identity disorder (DID) is the most severe form.
What is factitious disorder (Munchausen’s syndrome)?
The intentional production of physical or psychological symptoms.
What is malingering?
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain.
summarise unexplained symptoms
Unexplained symptoms
There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:
Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
Illness anxiety disorder (hypochondriasis)
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
Functional neurological disorder (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
Factitious disorder
also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms
Malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
A 25-year-old man presents to his GP demanding a CT scan of his abdomen. He states it is ‘obvious’ he has cancer despite previous negative investigations. This is an example of a:
Hypochondrial disorder
Conversion disorder
Munchausen’s syndrome
Dissociative disorder
Somatisation disorder
Hypochondrial disorder
Unexplained symptoms
Somatisation = Symptoms
hypoChondria = Cancer
The correct answer is Hypochondrial disorder. This condition, also known as illness anxiety disorder, is characterised by excessive worry about having a serious illness despite having no or only mild symptoms. The individual may have an intense preoccupation with the idea that they have a severe disease based on normal body sensations or minor symptoms and the belief persists despite medical reassurance. In this case, the patient’s insistence on having cancer even after negative investigations suggests hypochondriasis.
Conversion disorder, now referred to as functional neurological symptom disorder, is incorrect. This condition involves patients presenting with neurological symptoms such as weakness, paralysis or fits without a neurological cause. They are not consciously producing these symptoms and it often occurs in response to stressful situations.
Munchausen’s syndrome is incorrect. It’s a type of factitious disorder where the person repeatedly and deliberately acts as if he has a physical or mental illness when he is not really sick. People with Munchausen syndrome are willing to undergo painful or risky tests and operations in order to get sympathy and attention associated with being sick.
Dissociative disorder is also incorrect. Dissociative disorders involve problems with memory, identity, emotion, perception, behaviour and sense of self which can lead to disruptions in consciousness, memory loss (amnesia) or identity changes - none of these features are seen in this scenario.
Finally, Somatisation disorder does not fit the description either. Somatisation disorder is characterised by recurrent and multiple somatic complaints for which medical attention has been sought but no physical cause found over many years starting before 30 years of age. These complaints cannot be explained fully by any known general medical condition or any other mental disorder. The patient here does not report multiple somatic complaints but rather insists on one specific diagnosis - cancer.
A 16-year-old girl is brought for review by her father. She is a talented violinist and is due to start music college in a few weeks time. Her parents are concerned she has had a stroke as she is reporting weakness on her right side. Neurological examination is inconsistent and you suspect a non-organic cause for her symptoms. Despite reassurance about the normal examination findings the girl remains unable to move her right arm.
What is the most appropriate term for this behaviour?
Hypochondrial disorder
Munchausen’s syndrome
Somatisation disorder
Conversion disorder
Munchausen’s-by-proxy syndrome
Conversion disorder
Functional neurological disorder (conversion disorder) - typically involves loss of motor or sensory function
This is a typical conversion disorder. There may be underlying tension regarding her musical career which is manifesting itself as apparent limb weakness.
