WEEK 4: MEDICALLY UNEXPLAINED SYMPTOMS Flashcards
Describe the following terms used to refer to medically unexplained symptoms
HYSTERIA
NEUROSIS
PSYCHOSOMATIC
1.an old-fashioned term for a disorder characterized by neurological symptoms often accompanied by exaggeratedly or inappropriately emotional behavior, originally attributed to disease or injury of the nervous system and later thought to be functional or psychological in origin.
2.mental disorder that causes a sense of distress and deficit in functioning.
3.Psychosomatic refers to the link between mind and body. These are bodily symptoms caused by mental or emotional disturbances.
What are medically unexplained symptoms?
Medically unexplained symptoms (MUS) are symptoms that cannot be explained by a medical condition or disease. They are also called functional symptoms or somatic symptom disorders.
THE I DON’T KNOW WHAT I AM DEALING WITH SYMPTOMS
How are our body linked with our mind?
Research shows that there is two way communication between our brains and bodies. This happens because:
1.Signals travel down the nerves from the brain to the body … and back again from the body to the brain.
2.Natural chemicals, called ‘hormones’, circulate in the bloodstream. Some are produced by the brain and affect the body and some are made in the body and affect the brain and the way we feel.
Every day, thoughts, feelings and stresses play a part in making changes in our bodies - for example:
*when we feel embarrassed, we blush
*feeling worried or frightened can cause an uncomfortable feeling of “butterflies in the stomach”
*when we get upset we feel our throat tighten – “a lump in the throat”.
We also know that the way we think and feel can make us physically ill. For example:
*feeling low or stressed makes any pain we have feel worse
*long-term stress can make us more likely to have high blood pressure or a heart attack.
*A disease in the body can affect the way we think and feel.
What is the mind?
The mind, on the other hand, refers to our thoughts, feelings, perceptions, and consciousness.
The mind refers to a person’s understanding of things and also his conscience. Mind also refers to a person’s thought process.
What is the difference between the brain and mind?
*While brain is considered to be a physical thing, Â the mind is considered to be mental.
*Brain is made up of nerve cells and blood vessels whereas mind is not like that.
While brain has a definite shape, mind does not have one.
*We can see and touch the brain whereas it is not possible with mind.
*The brain is an important organ in the human body whereas the mind is not like that.
The brain, which is the centre of the nervous system, coordinates the movements, thoughts and feelings. The mind refers to a person’s understanding of things and also his conscience. Mind also refers to a person’s thought process.
The Brain has a definite place in the head, but with regard to mind, it is only supposed to be in the brain.
State possible explanations for medically unexplained symptoms
*An underlying but yet unidentified general medical condition
FOR EXAMPLE:
-chronic fatigue syndrome (CFS) – also known as ME
-irritable bowel syndrome (IBS)
-fibromyalgia (pain all over the body)
*Mood disorder
*A somatoform disorder
Somatoform disorder is a mental health condition that involves extreme health-related anxiety and a preoccupation with persistent somatic (physical) symptoms. These symptoms cause a person a disproportionate amount of distress and impair their daily functioning. They may be about seeking attention and sympathy. Or it might simply be a strong attachment to the idea of being ill or being the caretaker of someone who is ill.
*A psychotic disorder:
Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality and behave appropriately. Psychotic disorders are characterized by a loss of touch with reality characterized by altered thinking, perceptions, and behavior
*A factitious disorder
Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. The main aim is usually to gain the sick role.
Primary intention is to assume sick role. No external incentive
*Malingering:
malingering as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as :
-Insurance fraud or other form of financial gain
-To get time off work
-To get prescriptions for controlled medications
-Shirking obligations for military service
-Reducing work obligations
-An attempt to avoid prison time
*A general medical condition with prominent psychological factors e.g hyperthyroidism,
*cancer
State the symptoms associated with factitious disorder.
FACTITIOUS DISORDER
*A medical history that includes one or more previous serious or dramatic illnesses
*A history of seeking treatment with many different doctors and/or at many hospitals or clinics
*Having an extensive knowledge of medical terminology
*Knowing textbook descriptions of illnesses and symptoms
*Being willing or eager to have medical tests, be hospitalized or have surgery
*New symptoms appear after receiving negative test results or after a diagnosis is ruled out
*The patient doesn’t get better, even after having appropriate treatment
Outline the signs and symptoms associated with malingering disorder.
*A previous diagnosis of antisocial personality disorder
*A significant difference between a person’s stated injury or illness and the findings of a professional
*Refusal of the appropriate treatment for the illness they claim to have
*Someone is referred for treatment by a lawyer or involves a lawyer early in the diagnostic process, which can indicate a financial motive
State the examples of medically unexplained symptoms
Pain esp. back , chest, abdominal, joint
Headache
Fatigue
Palpitations
Dizziness
Nausea
Weakness
Loss of appetite
Constipation
Gas
Loose bowels
List the epidemiological and risk associations of medically unexplained symptoms
15- 20% of primary care patients
More common in women
More common in the young <30
History of childhood abuse
History of recent infections
Recent adverse events eg deaths
Previous h/o depression ,anxiety
4-10% go on to have an organic cause
30% have an associated psychological problem
75% remain unexplained at 12 months
25% persist for over 12 months
What is somatization?
Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them
Characterized by multiple symptoms in multiple organ systems that occurs over a period of several years resulting in significant impairment and/or treatment seeking.
What is the difference between somatization and somatoform disorders?
Somatoform disorders are a severe form of somatization where physical symptoms can cause great distress, often long-term. However, people with somatoform disorders are usually convinced that their symptoms have a physical cause.
Outline the Somatoform disorders
*Conversion disorder.
*Hypochondriasis.
*Body dysmorphic disorder.
*Pain disorder
*Somatization disorder
*Undifferentiated somatization disorder
Describe what happens in functional neurological disorder /CONVERSION DISORDER
features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning.
Signs and symptoms vary, depending on the type of functional neurologic disorder, and may include specific patterns. Typically, this disorder affects your movement or your senses, such as the ability to walk, swallow, see or hear. Symptoms can vary in severity and may come and go or be persistent. However, you can’t intentionally produce or control your symptoms.
The cause of functional neurologic disorder is unknown. The condition may be triggered by a neurological disorder or by a reaction to stress or psychological or physical trauma, but that’s not always the case. Functional neurologic disorder is related to how the brain functions, rather than damage to the brain’s structure (such as from a stroke, multiple sclerosis, infection or injury).
*One or more symptoms of altered voluntary motor or sensory function. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
What is hypochondriasis?
Hypochondriasis is a condition that makes you fear you have a serious illness.
Characterized by non-delusional preoccupation with fears of having, or the idea that one has, a serious disease based on the person misinterpretation of bodily symptoms.
