Distinguished future physicians welcome to stomp on step 1 the only free video series
that helps you study more efficiently by focusing on the highest yield material.
This is the 4th video in the Psychiatry section and it is going to cover Malingering, Somatization,
Factitious Disorders and a few other related disorders.
This is a group of illnesses where the patient reports symptoms that have no medical explanation.
The patient may be deliberately misleading the physician or unaware that their complaints
have no identifiable cause.
Each of these is a diagnosis of exclusion.
Providers should not jump to the conclusion that a patient is “faking it” unless there
is sufficient evidence to suggest that, because you could potentially miss what is really
causing the patients symptoms.
Even Hypochondriacs and drug seekers really do get sick so even a previous history of
one of these disorders should not automatically lead to a diagnosis.
However, Physicians must also avoid prescribing unnecessary treatments and diagnostics tests
in these patients.
Possible “treatments” include scheduling periodic office visits to discuss the patients
concerns, referral for therapy or management of current stressors that could be contributing
to the problem.
We will start with Malingering which you can see here in the top right corner I give a
high yield rating of 1.
For those of you who aren’t familiar with the high yield rating, it is a scale from
0 to 10 which gives you an estimate for how important each topic is for the USMLE Step
1 Medical Board exam.
It is based on a number of factors including how frequently that topic appears in retired
Step 1 questions.
To learn more about the high yield rating you can click on this orange box here
So Malingering is when a psychiatrically healthy patient is intentionally fabricating or exaggerating
symptoms for personal gain.
After getting what they want which is sometimes called an external or secondary gain the symptoms
disappear.
The symptoms may also be absent when the doctor isn’t in the room, but become unbearable
as soon as the patient has an audience.
They are generally unwilling to undergo potentially harmful or painful treatments and tests.
They may become irritable when providers question their symptoms.
This isn’t really a psychiatric condition, because these people are acting logically
in order to get something valuable or get out of doing something they really want to
do.
Here are some examples for why a patient would malinger.
Obtaining narcotics, Legal compensation, getting disability payments, getting a lesser criminal
sentence or trying to get out of school, work or military duty
Factitious Disorder is when a psychiatrically unwell patient is consciously fabricating
or exaggerating symptoms to get attention or sympathy from medical providers, friends,
or family.
The benefits these patients seek from playing the sick role is sometimes referred to as
internal or primary gain.
These patients are often willing to undergo potentially harmful or painful treatment and
tests.
Munchausen Syndrome is a now outdated term for a severe chronic form of factitious disorder.
Factitious Disorder by Proxy is when a person “fakes” symptoms in a person they care
for in order to get attention or sympathy.
This usually involves an adult patient who is caring for a child or the elderly parent.
Somatization Disorder is A type of Somatoform Disorder where a psychiatrically unwell patient
unconsciously fabricates symptoms.
Their symptoms have no physical cause, but they are not aware of that.
They perceive their symptoms as being real and are not deliberating creating these symptoms.
They will have multiple vague complaints across various organ systems.
In the latest version of the Diagnostics and Statistical Manual which is sort of the like
the official encyclopedia which defines psychiatric disorders, Somatization has been renamed Somatic
Symptom Disorder.
They also got rid of the term hypochondriasis.
Most of the people previously diagnosed with hypochondriasis would now be classified as
having illness anxiety disorder.
However, you don’t have to worry about these recent changes in DSM 5 because it takes many
years for the exam to get updated.
You will most likely see the old names on your exam
Conversion Disorder is an extreme type of somatization that results in the patient suddenly
losing voluntary motor and/or sensory functions during a time of stress.
For example the patient will have sudden paralysis, blindness or paresthesia.
It looks like a stroke, but isn’t.
It is usually triggered by stress and most patients spontaneously recover.
Oddly many of these patients are not very concerned about their symptoms.
Here is a table summarizing the key points of what we have covered so far in this video.
If you would like to look it over you can pause the video or go to my website
to download it.