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What is the most likely diagnosis? A 23-year-old man presents complaining of abdominal pain and headache. He appears quite knowledgeable about the differential diagnosis of his symptoms and tells the triage nurse that he must be admitted immediately. Physical examination reveals pain out of proportion to the findings. Results of diagnostic testing are unremarkable. Although his pain subsides after medications, he tells the nurse that he is not well enough to go home yet. He says that he has undergone "a battery of tests" for the same problem in the past, but he is vague about the results. 



A. Conversion disorder
B. Hypochondriasis
C. Malingering
D. Munchausen syndrome
E. Somatization disorder

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Psychiatry
Asked by Matthew, Last updated: Jun 09, 2020

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John Smith

John Smith

Answered Sep 09, 2016

Munchausen syndrome -the answer is d, munchausen syndrome.the most likely diagnosis for the patient in this case is munchausen syndrome, an uncommonly seen factitious disorder. it is characterized by a pattern of medical imposture that typically occurs over years. it is more common in men; munchausen by proxy, on the other hand, is more common in women with children. they often lie pathologically and use great detail when describing their symptoms; symptoms are often elaborate and have a dramatic flair. common complaints in munchausen syndrome include abdominal pain, headache, seizure, shortness of breath, asthma, chronic pain, chest pain, renal colic, and fever of unknown origin. symptoms can be created by self-abuse, such as self-injection of a foreign substance or putting feces in urine. the goal is not to obtain secondary gain, but rather relates to psychological needs to be in the patient role. conversion disorder and hypochondriasis are considered psychosomatic disorders. comversion disorder typically presents as a single symptom of neurologic character, most commonly voluntary motor or sensory symptoms such as paralysis, numbness, or tingling. hypochondriasis is common and occurs more commonly in men, with a peak incidence in the 30s. these patients typically complain of head, neck, and/or trunk pain. they place a high value on their health and have an increased sense of responsibility for their health, as well as a heightened aversion to death and dying. malingering is frequently associated with antisocial personality disorder; there is typically secondary gain. these patients might be homeless, drug-seeking, or avoiding a situation. there is often a discrepancy between the objective physical examination findings and the claimed stress or disability. they also can abandon their symptoms when no one is watching. somatization disorder is characterized by chronic or repetitive illness with numerous symptoms, often starting in childhood. the diagnosis is not typically made in the emergency department. there are seven characteristic symptoms, as follows: dysmenorrhea; sensation of a lump in the throat; vomiting; shortness of breath; burning in the sex organs; painful extremities; and amnesia lasting hours to days. prospective studies have demonstrated that the diagnosis of somatization disorder is correctly predicted when four or more of these symptoms are present.(marx [rosens], 1754-1765)
 

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