I want to ask you a question ……When you are a doctor in the clinic and patient came to you complaining from different symptom What the causes you will think about to explain these symptomes

Medically unexplained symptoms Presence of physical signs cannot be explained by medical condition or direct effect of a substance or a mental disorder Psychological factor are the cause Lead to functional impairment We have differenttypes and different causes according to them

Suspicious symptoms Unconscious attempt to deceive Chief goal is psychological (primary gain) Factitious disorder Chief goal is external (secondary gain) Malingering Unconscious attempt to deceive Somatic symptoms disorder Illness anxiety disorder Conversion disorder If there is no medical explanation of symptoms that patient come with We will devide them into

Factitious disorder Create symptoms not exist He is ready to undergo any procedure or intervention Hurt themselves Alter tests (contaminating urine sample) Factitious disorder problem in relationship with their mothers People with factitious disorders deliberately create or exaggerate symptoms of an illness in several ways. They may lie about or fake symptoms, hurt themselves to bring on symptoms, or alter tests (such as contaminating a urine sample) to make it look like they or the person in their care are sick. because of an inner need to be seen as ill or injured, not to achieve a clear benefit, such as financial gain. People with factitious disorders are even willing and sometimes eager to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly ill or have a loved one who is ill. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties. Inner need to be seen as ill or injured To receive care and love from other Sever emotional difficulties

Symptoms Treatment: -Difficult because they do not want to be treated. History of seeking treatment at many hospitals Presence of symptoms only when the patient with others many surgical scars knowledge of hospitals and medical terminology Unclear changeable symptoms Dramatic inconsistent medical history Treatment: -Difficult because they do not want to be treated. -Talk therapy. -Medication in case of depression or anxiety What Are the Symptoms of Factitious Disorders? Possible warning signs of factitious disorders include: Dramatic but inconsistent medical history Unclear symptoms that are not controllable and that become more severe or change once treatment has begun Predictable relapses following improvement in the condition Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illness Presence of many surgical scars Appearance of new or additional symptoms following negative test results Presence of symptoms only when the patient is with others or being observed Willingness or eagerness to have medical tests, operations, or other procedures History of seeking treatment at many hospitals, clinics, and doctors offices, possibly even in different cities Reluctance by the patient to allow health care professionals to meet with or talk to family members, friends, and prior doctor Ttreatment: الطبيبيحاول تهديده بأن شخص حبيب له متأثر جدا لدرجة أنه يمكن أن يصبح مريض أو أن ينفصل عنه

False exaggerated physical or psychological problems There is external motivation (avoiding work- obtaining drugs- obtaining financial compensation) Malingering Management -Tell the patient that his symptoms do not meet the physician's objective criteria for diagnosis. Allow the person to save face. -Inform them that they are required to undergo invasive testing and uncomfortable treatments lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen لا يخاطر بأخذ أدوية أو تجربة عمليات Intentional production of false or grossly exaggerated physical or psychological problems. Motivation for malingering is usually external (e.g., avoiding military duty or work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs) Malingering is deliberate behavior for a known external purpose. It is not considered a form of mental illness or psychopathology

Somatic symptoms disorder Multiple somatic symptoms affect multiple organ systems Have an anxiety disorder. The distress they experience are real, regardless of whether or not a physical explanation can be found. Caused by displacement of unpleasant emotions into physical symptoms Pain Gastrointestinal complaints Sexual symptoms Multiple somatic symptoms affect multiple organ systems Caused by displacement of unpleasant emotions into physical symptoms sometimes leading to disability Mangment: The number of medical staff involved is better limited because the oppurtinity of the patient to express somatic complain decrease Avoid additional diagnostic procedure Many people who have SSD will also have an anxiety disorder. People with SSD are . The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning Shift the patient awareness to psychological factor Engorage return to normal activity Anti depressant useful when secondary depression develop. Lead to disability affects daily functioning

Management of somatic symptom disorder Encourage return to normal activity Shift the patient awareness to psychological factor The number of medical staff involved is better limited because the oppurtinity of the patient to express somatic complain decrease Anti depressant useful when secondary depression develop. Avoid additional diagnostic procedure

Illness anxiety disorder (health anxiety-Hypochondriasis) preoccupied with illness for ≥ 6 mo Minor physical symptoms May believe that is because of sever illness medical exam doesn't reveal a serious medical condition. Treatment SSRIS if there is underlying depression Cognitive behavioral therapy The patient has been no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn't reveal a serious medical condition. patients examine themselves repeatedly Treatment Sometimes serotonin reuptake inhibitors or cognitive-behavioral therapy

Conversion disorder Symptoms related to nervous system Sensory: paresthesia deafness blindness Reduction of inner tension Primary gain:

Management of conversion disorder Usually remit in short time Stress full events should be evaluated Avoid confrontation

Conclusion Suspicious symptoms Unconscious attempt to deceive Chief goal is psychological (primary gain) Factitious disorder Chief goal is external (secondary gain) Malingering Unconscious attempt to deceive Somatic symptoms disorder Illness anxiety disorder Conversion disorder If there is no medical explanation of symptoms that patient come with We will devide them into

Any questions ?

Done by: Lujaina Reda 131220264

References 1- manual of basic psychiatry. DR. Mohammed Al-Sughayir 2014. 2- Blueprints Psychiatry fourth edition. Michael J.Murphy and Ronald L. Cowan. 3- http://www.webmd.com/mental-health/factitious-disorders# 4- http://emedicine.medscape.com/article/293206-overview#a6 5- http://www.mayoclinic.org/diseases-conditions/factitious- disorder/basics/treatment/con-20031319 6- http://www.physio-pedia.com/Conversion_Disorder_Case_Study