OSCE- Prefinals Dec 2023

OSCE 

Case report - https://113riyagupta.blogspot.com/2023/12/case-of-65-years-old-female-with-syncope.html

What is the difference between Conversion disorder and Manchausen’s disorder?

CONVERSION DISORDER 
“ Conversion disorder-Conversion disorder, also known as functional neurological symptom disorder (FND), is a psychiatric disorder characterized by symptoms affecting sensory or motor function. These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions.”
The symptoms have no organic basis ,but cannot be controlled at will and are not intentional .
Criteria to diagnose Conversion disorder (DSM 5)- It categorises Conversion disorder as a part of -somatic symptoms and related disorders.

1. One or more symptoms of altered voluntary motor or sensory function.
2. Clinical findings can provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
3. Another medical or mental disorder does not better explain the symptom or deficit.
4. The symptom or deficit results in clinically significant distress or impairment in social, occupational, or other vital areas of functioning or warrants medical evaluation.

https://www.ncbi.nlm.nih.gov/books/NBK551567/#:~:text=Conversion%20disorder%2C%20also%20known%20as,diseases%20or%20other%20medical%20conditions.

MUNCHAUSEN SYNDROME - 

“Munchausen syndrome, also called factitious disorder imposed on self, is a psychiatric disorder in which a person assumes the role of a sick patient without the intention of external gain (time off from work, medications). Physical symptoms are intentionally produced with the purpose of gaining the appearance of a "sick patient."”

 It is not uncommon for the patient to purposefully induce symptoms, such as intentionally eating spoiled food, injecting insulin, picking at skin causing wounds, overdosing on medications, and not taking medications as prescribed. In addition, patients have been known to forge medical records and tamper with laboratory results.
Diagnosis with DSM 5
This criterion includes evidence that the patient is taking steps to intentionally and falsely represent a psychiatric or general medical condition without evidence of malingering, and the behavior is independent of other medical or psychiatric conditions, such as schizophrenia and delusional disorder 

https://www.ncbi.nlm.nih.gov/books/NBK518999/

LEARNING POINTS FROM CASE DISCUSSION

1. What is syncope and causes of syncope ?

2. How to differentiate between an unconscious patient with an organic disease or factitious disease ?

3. What is Munchausen’s syndrome ? What is Munchausen’s by proxy ?

4. What is a transient ischemic attack ?How do you diagnose a TIA?

5.Non structural causes of cerebral hypoperfusion .