Last reviewed: 27 Jun 2021
Last updated: 07 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

Investigations to consider

  • comprehensive neuropsychological testing
  • standardised personality testing
  • focused symptom inventories

Treatment algorithm

Contributors

Authors

Cynthia Stonnington, MD
Cynthia Stonnington

Associate Professor of Psychiatry

Mayo Clinic

Scottsdale

AZ

Disclosures

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

Erika Driver-Dunckley, MD
Erika Driver-Dunckley

Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

EDD declares that she has no competing interests.

Katherine H. Noe, MD, PhD
Katherine H. Noe

Associate Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

KHN declares that she has no competing interests.

Dona Locke, PhD
Dona Locke

Professor of Psychology

Mayo Clinic

Scottsdale

AZ

Disclosures

DL declares that she has no competing interests.

Peer reviewers

Allan House, MD

Professor of Liaison Psychiatry

Director

Leeds Institute of Health Sciences

Leeds

UK

Disclosures

AH declares that he has no competing interests.

Glen L. Xiong, MD

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.

Seth Powsner, MD

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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