1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

12. 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

13. Any questions ?

14. Done by:
Lujaina Reda

15. References
1- manual of basic psychiatry. DR. Mohammed Al-Sughayir Blueprints Psychiatry fourth edition. Michael J.Murphy and Ronald L. Cowan disorder/basics/treatment/con