Makindo Medical Notes

Related Subjects: |Introduction to Psychiatry |Assessment of the patient in Psychiatry |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis |Eating disorders in Children

📖 About

• Some patients present with physical symptoms for which no organic cause can be found. These fall under a group of conditions often called somatoform and related disorders.

🤒 Somatisation Disorder

• Chronic condition with multiple physical complaints lasting ≥ 2 years.
• Symptoms cause significant impairment in functioning.
• No identifiable organic cause — symptoms are linked to psychological distress.
• Patients often reject reassurance or negative test results.

😟 Hypochondriacal Disorder (Illness Anxiety Disorder)

• Preoccupation with having a serious illness despite medical reassurance.
• Misinterpretation of normal bodily sensations.
• Symptoms persist for ≥ 6 months.
• Causes significant distress and functional impairment in daily life.

🧠 Conversion Disorder (Functional Neurological Symptom Disorder)

• Presents with loss of motor or sensory function (e.g., paralysis, blindness, non-epileptic seizures).
• Symptoms are not consciously produced.
• May show secondary gain (e.g., avoiding responsibilities).
• Classically associated with “la belle indifférence” — patient seems oddly unconcerned about serious symptoms.

🌀 Dissociative Disorders

• Involve a disruption of memory, consciousness, identity, or perception.
• Examples: amnesia, fugue states, stupor.
• Dissociative Identity Disorder (DID) — previously “multiple personality disorder” — most severe form.

🎭 Munchausen’s Syndrome (Factitious Disorder)

• Intentional production or feigning of physical/psychological symptoms.
• Motivation is to adopt the “sick role,” not external rewards.

💰 Malingering

• Deliberate exaggeration or fabrication of symptoms for external gain (e.g., money, avoiding military duty, obtaining drugs).
• Key difference from factitious disorder: clear external incentive.

Cases — Medically Unexplained Symptoms (MUS)

• Case 1 — Persistent pain 🩹: A 40-year-old woman presents with chronic widespread musculoskeletal pain, fatigue, and poor sleep. Extensive investigations (FBC, U&E, autoimmune screen, imaging) are normal. She describes fluctuating symptoms but is worried about “something serious.” Diagnosis: fibromyalgia / MUS. Managed with explanation, CBT, graded exercise, and amitriptyline for sleep disturbance.
• Case 2 — Neurological-type symptoms 🧠: A 28-year-old man reports sudden episodes of leg weakness and tremor, but neurological exam is inconsistent and MRI brain/spine are normal. He is distressed, unable to work, and fears multiple sclerosis. Diagnosis: functional neurological disorder (MUS subtype). Managed with clear explanation, physiotherapy, and psychology referral.
• Case 3 — Gastrointestinal complaints 🍽️: A 35-year-old woman presents with bloating, abdominal pain, and alternating bowel habit. Endoscopy and colonoscopy are normal, coeliac serology negative. Symptoms worsen with stress. Diagnosis: irritable bowel syndrome (IBS, functional GI disorder). Managed with dietary advice (low FODMAP), reassurance, and stress management strategies.

Teaching Point 🩺: MUS are common in primary and secondary care. The key is to validate symptoms without over-investigating, provide a clear explanation (“real symptoms, but not due to structural disease”), and use a biopsychosocial approach with CBT, physiotherapy, and lifestyle strategies.