Psychologically determined disorders

Neurologists frequently see patients with symptoms or inconsistent signs that are not explicable in terms of any recognized neurological disease process. Often it is clear that such symptoms and signs are being manufactured psychologically, either consciously or, more often, by an unconscious process. Such patients are frequently polysymptomatic, and may have a long history of consulting other specialists, particularly abdominal, dental, gynaecological, and otorhinological surgeons. They run the risk of developing secondary abnormalities induced by surgical and other invasive procedures. Psychologically determined symptoms are a very common cause of neurological out-patient referral. Of those with psychogenic disorders, pain is the commonest symptom, followed by motor symptoms, gait disturbances, dizziness, blackouts, sensory symptoms, and visual dysfunction (Lempert et al. 1990). Depressive and anxiety disorders are twice as common in those with psychologically determined disorders and those with emotional disorders have a greater number of somatic symptoms but are unenthusiastic about psychiatric treatment.Clinical syndromes including Briquet’s syndrome, hypochondriasis, conversion disorder, body dysmorphic disorder and pain disorders are explained and described. The presentation and characteristics of malingering (a process of deliberate deceit, in which symptoms are fabricated) is described, including Munchausen’s syndrome.In addition, associated psychiatric states and the symptoms and physical signs of psychologically determined disorders are discussed. Finally, the management and prognosis of psychologically determined states are outlined.