Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • unconventional behavior during history
  • emotional processing problems
  • recent life stressors
  • remote life stressors
  • multiple illness behaviors
  • unusual neurologic deficits
  • give-way weakness
  • inconsistent examination findings
  • false sensory findings
  • distractible symptoms
  • inconsistent paralysis
  • generalized seizure-like motor movements without loss of awareness
  • bizarre movements
  • gait disorders
  • functional (psychogenic) movement disorders

Other diagnostic factors

  • cognitive complaints
  • Hoover sign
  • speech disturbance
  • swallowing disturbance
  • pseudoclonus
  • convergence spasm

Risk factors

  • hx of sexual or physical abuse
  • hx of unstable childhood
  • hx of trauma-related disorders
  • female gender
  • alexithymia
  • neuroticism
  • previously poor doctor-patient relationships

Diagnostic investigations

1st investigations to order

  • laboratory testing
  • EEG
Full details

Investigations to consider

  • comprehensive neuropsychological testing
  • standardized personality testing
  • focused symptom inventories
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Cynthia Stonnington

Associate Professor of Psychiatry

Mayo Clinic

Scottsdale

AZ

Disclosures

CS is an author of a number of references cited in this monograph.

Erika Driver-Dunckley

Associate Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

EDD declares that she has no competing interests.

Katherine H. Noe

Assistant Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

KHN is a board member of the Epilepsy Foundation of Arizona.

Dona Locke

Associate Professor of Psychology

Mayo Clinic

Scottsdale

AZ

Disclosures

DL declares that she has no competing interests.

Peer reviewers VIEW ALL

Professor of Liaison Psychiatry

Director

Leeds Institute of Health Sciences

Leeds

UK

Disclosures

AH declares that he has no competing interests.

Assistant Clinical Professor

Department of Psychiatry and Behavioral Sciences

Department of Internal Medicine

University of California

Davis

Sacramento

CA

Disclosures

GLX may receive royalties as a co-editor of a book entitled Lippincott's Primary Care Psychiatry. He has no other competing interests.

Professor of Psychiatry and Emergency Medicine

Yale School of Medicine

Yale-New Haven Hospital

New Haven

CT

Disclosures

SP declares that he has no competing interests.

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