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NS31 - Psychological Disorders 2 - Somatoform Disorders (ii) (conversion…
NS31 - Psychological Disorders 2 - Somatoform Disorders (ii)
conversion disorder/functional neurological symptom disorder
appears neurological on presentation
why functional?
having a physical illness rather than a mental illness subconsciously improves the person's functioning
symptoms can cause distress + impaired functioning
weakness, paralysis, abnormal movements, swelling/speech problems, seizures, sensory loss
clinical findings often incompatible with any medical condition
e.g. glove anaesthesia (has to be psychogenic as doesn't correlate with any dermatomes)
can be transient (sudden onset/termination) or chronic/persistent
can be associated with stress or trauma
La belle indifference often seen: patient can be unconcerned by symptoms
x2-3 more common in women
5% of referrals to neurology clinic end up with conversion disorder diagnosis
can be assessed using tests
e.g. Hoover's sign when patient can't move 1 leg
put your hand under good heel when patient is lying down and ask them to try lift the bad leg. If they can't lift the leg + you feel their good heel pushing into your hand the origin is neurological
if heel isn't pushing, they're subconsciously not trying to lift the leg
Illness anxiety disorder/hypochondriasis
preoccupation for 6+ months with having a serious illness, even though having no/very mild symptoms
increased health anxiety, excessive health related behaviours
sometimes avoids Dr appointments out of fear (maladaptive avoidance)
sometimes person does have a physical medical condition, but their reaction is disproportionate to illness severity
excess research
repeatedly seeks reassurance from Dr, friends, family
impacts QOL
equal prevalence in males + females (from 1.3-10%)
chronic, often with relapses
onset: early-middle childhood
Factitious Disorder/Munchausen syndrome
emotionally driven falsification of symptoms in oneself or others (by proxy - often to children)
patient IS AWARE they are making up symptoms
often in absence of obvious ext rewards
ingesting a poison, self-injury, false reporting
prevalence unknown in general pop, but about 1% of inpatients
intermittent episodes, usually occurring after a hospitalisation
onset: early adulthood
NOT MALINGERING
fabricating symptoms for a gain (e.g. money, avoiding work, obtaining drugs)
this isn't a mental disorder