Is fibromyalgia a psychosomatic illness?

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I have banished "pseudoseizures" from my vocabulary. "Non-epileptic" is so much more usefully descriptive.

Edit: Corrected autocorrect

Yeah, I don't personally use it. But I went on a Facebook rant when a GomerBlog article used the term and associated it with malingerers.

That isn't what cheesed me off. What cheesed me off was the comments by emergency professionals who didn't know the difference either.


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That's a shame. Because "pseudo" has a specific meaning in medicine. My favorite medical condition ever is probably pseudopseudohypoparathyroidism. I suppose you'd probably want to change that to "non-hypoparathyroidism non-hypoparathyroidism."

Those fakers clogging up my ED with their imaginary parathyroid problems!


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yeah the only out bipolar physicians I know are attendings that have their **** 100% together, and if dude is a surgeon I'm guessing he went through more on the hypomanic side of things

I read a story of bipolar FM doc in CA who had successfully practiced 30 years who lost his license over politics and his diagnosis was used against him

there's a reason there's attorneys that essentially specialize in representing docs with MH issues to the med board

If it were me, I would not be out about that stuff until well into attending-hood, if at all

I thought I had ADHD once. Turned out I was just burned out and an urban northeasterner living in the Midwest where interrupting people is considered rude.


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The danger with all of the pseudo stuff is for us to collude with the other staffs defensive reactions to patients to deal with their own uncomfortability with mental illness. Helping the EM or IM docs to navigate this better and with less frustration helps our patients more and makes us more tespected/liked by them. When we have a solid and respectful conceptualization and workable plan for the patient, then everything works better. They feel the same way about our patients as we do when there is a cardiac arrest. "I hope to God someone here knows more about this than I do."
 
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Oh we exist, we're just obviously not part of the real world seeing as to find us you have to follow a yellow brick road and ask for directions to Oz - that's Oz the Apocalyptic Wasteland , not Oz the Great and Powerful. I hear it's ruled by some bloke called 'Max'. ;)
I KNEW that was a documentary! My wife insisted it wasn't. (She didn't think the portrayal of nursing mothers was realistic.)
 
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I thought I had ADHD once. Turned out I was just burned out and an urban northeasterner living in the Midwest where interrupting people is considered rude.
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:rofl:
 
The problem of patients with mental illness, especially SPMI, not getting adequate diagnostic assessment and treatment for physical complaints is a well-documented issue and one of the causes of the increased morality associated with SPMI. Essentially, their physical symptoms and complaints often get dismissed due to their psychiatric history.
 
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Just had an outpatient c/o dizziness and weakness for a year. Asian immigrant with anxiety, some PTSD issues. Finally went to ENT for vertigo and they pulled the results of an MRI from last year that was never followed up--"multiple small periventricular T2 hyperintensities...at least one within the right cerebellum..suggestive of demyelinating disorder..."

"So, Doctor, am I going to have this all my life?"
 
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If you wanna go pedantic, let's get pedantic up in here.

1) "Pseudo" does not and has never meant simple negation, i.e. "not" or "non". Pseudo means "false". Always has.

2) Pseudo in the context of seizures is not a term of art conveying some subtlety of meaning. It is saying "these seizures aren't real". Note the alternative is saying "these seizures aren't epilepsy." You are a big fan of objective tests; as I understand it it is part of why you are leaving psychiatry.

Which conclusion do you think is better supported by EEG? If the first, please explain to me what electrophysiological findings demonstrate faking.

First of all, to each his own. We can all use whatever terms we want, as long as they effectively communicate the right information to other doctors. It's not that big a deal.

Of course pseudo does not mean simple negation. It means that something appears real but has a phony quality. It says that the patient's convulsions are not actually seizures, even though they look like siezures. None of this says that the patient is consciously faking anything. But they're still not "seizures."

The alternative, using a phrase that says "these seizures aren't epilepsy," classifies the convulsions AS seizures, just not ones associated with epilepsy. Why do you need to do that?

Do you feel that the term "pseudoseizures" demeans the people who have the condition? Then why stop there? Why not rename obesity while we're at it? And what about leprosy - which has been stigmatized a lot longer than pseudoseizures?

Honestly if I saw "non-epileptic" seizures in a chart I'd initially think the patient had a one time simple partial seizure or something like that. The few pseudoseizures I have ever witnessed didn't look like grand mal seizures at all. They looked "fake" for lack of a better word. Even without an EEG, there are classic hallmarks of actual seizures, and it's gotta be the rare pseudoseizure that convincingly mimics them.

Now what we tell PATIENTS - that depends on the patient individually. This is where bedside manner comes in. There is no substitute for that.

Sometimes I think we don't want to admit the truth, which is that mentally ill patients are mentally ill. Every week there seems to be a new euphemism in psychiatry. If you ask me, the problem isn't the terminology, but the people who use it. I.e. us. We all know there are many doctors who don't like dealing with psychosomatic patients. That's not going to change just because we rename our conditions.
 
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Honestly if I saw "non-epileptic" seizures in a chart I'd initially think the patient had a one time simple partial seizure or something like that. The few pseudoseizures I have ever witnessed didn't look like grand mal seizures at all. They looked "fake" for lack of a better word. Even without an EEG, there are classic hallmarks of actual seizures, and it's gotta be the rare pseudoseizure that convincingly mimics them.

Not always. Spent a good deal of time on a Long-Term monitoring unit for epilepsy, with a good portion being pseudo/non epileptics. Some pseudoseizures can fool seasoned clinicians. A colleague of mine does a nifty demonstration showing video of events and has the room (mostly clinicians of various specializations, including neurology) try to guess if the event was a associated with epileptiform activity on EEG or not. Spoiler, people are terrible at guessing just by seeing the event. Additionally, there is a significant portion of epileptics who concurrently experience pseudoseizures.
 
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I KNEW that was a documentary! My wife insisted it wasn't. (She didn't think the portrayal of nursing mothers was realistic.)

:roflcopter:

But seriously, I hated that movie. Watched it once, never want to see it again. There is only one Mad Max as far as I'm concerned, and he don't live on Fury Road. :laugh:
 
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Just had an outpatient c/o dizziness and weakness for a year. Asian immigrant with anxiety, some PTSD issues. Finally went to ENT for vertigo and they pulled the results of an MRI from last year that was never followed up--"multiple small periventricular T2 hyperintensities...at least one within the right cerebellum..suggestive of demyelinating disorder..."

"So, Doctor, am I going to have this all my life?"

That sucks :( Sounds like a lot of mental health care patients get a raw deal everywhere.
 
Just had an outpatient c/o dizziness and weakness for a year. Asian immigrant with anxiety, some PTSD issues. Finally went to ENT for vertigo and they pulled the results of an MRI from last year that was never followed up--"multiple small periventricular T2 hyperintensities...at least one within the right cerebellum..suggestive of demyelinating disorder..."

"So, Doctor, am I going to have this all my life?"

Aw man. :-(. I think I'd rather be "crazy".


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First of all, to each his own. We can all use whatever terms we want, as long as they effectively communicate the right information to other doctors. It's not that big a deal.

Of course pseudo does not mean simple negation. It means that something appears real but has a phony quality. It says that the patient's convulsions are not actually seizures, even though they look like siezures. None of this says that the patient is consciously faking anything. But they're still not "seizures."

The alternative, using a phrase that says "these seizures aren't epilepsy," classifies the convulsions AS seizures, just not ones associated with epilepsy. Why do you need to do that?

Do you feel that the term "pseudoseizures" demeans the people who have the condition? Then why stop there? Why not rename obesity while we're at it? And what about leprosy - which has been stigmatized a lot longer than pseudoseizures?

Honestly if I saw "non-epileptic" seizures in a chart I'd initially think the patient had a one time simple partial seizure or something like that. The few pseudoseizures I have ever witnessed didn't look like grand mal seizures at all. They looked "fake" for lack of a better word. Even without an EEG, there are classic hallmarks of actual seizures, and it's gotta be the rare pseudoseizure that convincingly mimics them.

Now what we tell PATIENTS - that depends on the patient individually. This is where bedside manner comes in. There is no substitute for that.

Sometimes I think we don't want to admit the truth, which is that mentally ill patients are mentally ill. Every week there seems to be a new euphemism in psychiatry. If you ask me, the problem isn't the terminology, but the people who use it. I.e. us. We all know there are many doctors who don't like dealing with psychosomatic patients. That's not going to change just because we rename our conditions.

I guess you are unaware that generally we try not to call it leprosy anymore. Hansen's disease is very much more au courant.

Look, if you don't fundamentally get how calling something "fake" attributes a particular motivation and agenda to patients that is really problematic treating them with human dignity, I am not sure we can have a productive conversation.

Unless you think that everyone with these spells are malingerers. If that is the case, I think your burnout may be more profound than you realize.
 
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Look, if you don't fundamentally get how calling something "fake" attributes a particular motivation and agenda to patients that is really problematic treating them with human dignity, I am not sure we can have a productive conversation.

Unless you think that everyone with these spells are malingerers. If that is the case, I think your burnout may be more profound than you realize.

I said "looked fake, for lack of a better word." I never said "fake." There's a world of difference between what you said I said and what I actually said, but I get the sense you won't ever understand.

And please don't accuse me of burnout. You don't know me, and please don't pretend that you do.
 
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I guess you are unaware that generally we try not to call it leprosy anymore. Hansen's disease is very much more au courant.

By the way, congrats on the French I inclusion. As if anyone actually uses the term "Hansen's disease." At the last tropical medicine lecture I was at, it was still leprosy, and guess what, it's still a neglected disease no matter what you call it. Doesn't help the patients if all you do is change the words.

And, as if, you have ever run into a case and really need to use the word "we" here. You do know, that's reserved for royalty, right?
 
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Fair enough. And yes, I am idealistic (though not unrealistic). And no, I hope I don't grow wizened over time.

My point was this: out of all three countries I've worked in, either as a healthcare consultant or a medical student/Sub-I, I've never experienced the same level of outright hostility or disregard for psychiatry than in the US--vocal, eyerolling, dismissive, "it's a waste." That might have to with more meaningful exposure than anything else.



Maybe not deal, but the stigma appears less. And actually, there is an openly bipolar surgery registrar at our hospital. He speaks at the mental health forums organised for junior doctors. We also have no-risk-disclosure on our residency applications, so that reasonable accommodations can be made for sleep hygiene, etc. It doesn't have to be any different anywhere else...

I believe everything you say. Australia is a much more chill, laid back, and progressive country than the US. I would love to live there. Once my loans are paid off, maybe I will!
 
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I believe everything you say. Australia is a much more chill, laid back, and progressive country than the US. I would love to live there. Once my loans are paid off, maybe I will!

@nancysinatra you've been pretty harsh to me (and others above), but I used to enjoy your posts as a MS-nothing. If you ever need tips on moving, just shoot me a PM.
 
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@nancysinatra you've been pretty harsh to me (and others above), but I used to enjoy your posts as a MS-nothing. If you ever need help moving, just shoot me a PM.

I'm sorry if I've been harsh. I didn't mean to sound that way! I'm just jaded about the medical profession, and I'm sure it comes through in my posts. I have always had extremely limited patience for people who have more rosy or lofty views about medicine than I do. I've been that way since I was about 4 years old. (Maybe because my dad is a doctor. He thinks he knows EVERYTHING.) I never wanted to be a doctor myself, and absolutely never did I see myself becoming a psychiatrist of all things, waiving my hands around at patients and using a bunch of inscrutable jargon on a daily basis just to get paid. Even medicine itself, I only went into because I watched too many episodes of ER in the late 90s and I thought I'd have an exciting life that way. Yeah, not quite. Anyway, hence, my sarcastic attitude, which maybe comes across as harsh. Sorry, I can't help it. It's not personal though, and I'm sorry if I've said anything that sounded mean.

But I am not "burned out" and I resent that presumptuous insinuation from certain people above who see fit to make psychological speculations about others whom they have never met on an online forum. I personally would never do this.

I don't know when or if I will ever actually move to Australia. I do have friends there. If a certain person wins the US election in November, it would definitely make me more likely to consider it...

Getting back to the topic of this thread, now, I think there is a major component of fibromyalgia which is psychosomatic, but we don't know everything about this condition, and shouldn't be too sure of ourselves. The part that is psychosomatic, is frustrating to deal with, that's for sure. There's no need to deny that. If you ask me, the solution doesn't lie in getting doctors on other services to be "nicer" to these patients (though they should be) but in getting ourselves to do really good therapy with the patients so the symptoms subside. But, it's hard.
 
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Unless you think that everyone with these spells are malingerers. If that is the case, I think your burnout may be more profound than you realize.
well a minority opinion in the field, which is not to be discounted, is these people are just faking. I have a special interest in functional neurological symptoms and have treated more of these patients than most, and do not have a good way of understanding non-epileptic attacks compared with say functional motor or sensory phenomena, or even functional movement disorders. It is hard not be extremely skeptical of patients with non-epileptic attacks and I have not been able to convince myself that these patients are unconsciously producing these symptoms. They may lack awareness of their motivations (which is not the same as being unconscious of course) but I don't have a sense of how the actual symptom production is not something they are actively putting on, in comparison to say patients with functional paralysis or sensory loss.

Also in practice, the divisions between malingering, somatization, conversion, factitious disorder and compensation neurosis are not clear cut. Often (in fact almost all of the patients referred to me with functional neurological disorder) are involved in some sort of disability/compensation claim, and those with a pain component may be seeking opioids etc.

as clinicians we have to believe the patients, and I never tell patients that I think they are making it all up, but yes I often think they might be.
 
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well a minority opinion in the field, which is not to be discounted, is these people are just faking. I have a special interest in functional neurological symptoms and have treated more of these patients than most, and do not have a good way of understanding non-epileptic attacks compared with say functional motor or sensory phenomena, or even functional movement disorders. It is hard not be extremely skeptical of patients with non-epileptic attacks and I have not been able to convince myself that these patients are unconsciously producing these symptoms. They may lack awareness of their motivations (which is not the same as being unconscious of course) but I don't have a sense of how the actual symptom production is not something they are actively putting on, in comparison to say patients with functional paralysis or sensory loss.

Also in practice, the divisions between malingering, somatization, conversion, factitious disorder and compensation neurosis are not clear cut. Often (in fact almost all of the patients referred to me with functional neurological disorder) are involved in some sort of disability/compensation claim, and those with a pain component may be seeking opioids etc.

as clinicians we have to believe the patients, and I never tell patients that I think they are making it all up, but yes I often think they might be.

True Briquet's (meaning, using the original Perley Guze checklist, which hardly anyone uses anymore) presents pretty consistently and has a predictable course, family history, etc, but I didn't appreciate how murky the line between PNES, malingering, factitious disorder, etc was until I became a resident. Here is a nice review of the subject: http://www.ncbi.nlm.nih.gov/pubmed/21036784
 
By the way, congrats on the French I inclusion. As if anyone actually uses the term "Hansen's disease." At the last tropical medicine lecture I was at, it was still leprosy, and guess what, it's still a neglected disease no matter what you call it. Doesn't help the patients if all you do is change the words.

And, as if, you have ever run into a case and really need to use the word "we" here. You do know, that's reserved for royalty, right?

I was really reacting to your assertion that everyone still called it leprosy, which is just not true anymore.

I actually have encountered two patients who ended up testing positive for it. Refugee clinics with a largely recently-arrived and deeply impoverished South Asian and Southeast Asian population = tropical diseases.

You seem to find corporate "we" offensive in some way, so I'll drop it.
 
well a minority opinion in the field, which is not to be discounted, is these people are just faking. I have a special interest in functional neurological symptoms and have treated more of these patients than most, and do not have a good way of understanding non-epileptic attacks compared with say functional motor or sensory phenomena, or even functional movement disorders. It is hard not be extremely skeptical of patients with non-epileptic attacks and I have not been able to convince myself that these patients are unconsciously producing these symptoms. They may lack awareness of their motivations (which is not the same as being unconscious of course) but I don't have a sense of how the actual symptom production is not something they are actively putting on, in comparison to say patients with functional paralysis or sensory loss.

Also in practice, the divisions between malingering, somatization, conversion, factitious disorder and compensation neurosis are not clear cut. Often (in fact almost all of the patients referred to me with functional neurological disorder) are involved in some sort of disability/compensation claim, and those with a pain component may be seeking opioids etc.

as clinicians we have to believe the patients, and I never tell patients that I think they are making it all up, but yes I often think they might be.

I can understand that, and even accept that for possibly a majority of people there is a strong volitional component to these spells, but what does it buy you as a clinicians to go in assuming that they are putting them on?

What is the utility of that approach versus requiring yourself to be driven to the conclusion of fakery by evidence?
 
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versus requiring yourself to be driven to the conclusion of fakery by evidence?

Is that the standard in any other area of medicine? If I fake a heart attack, will my cardiologist be required to prove that I am faking it? No, of course not. They simply rule out a real MI, and let me go, with far less empathy than even the most burnt out psychiatrist (i.e moi, apparently) is going to show to the most hardened repeat pseudoseizure patient.

I believe I see your point though - which is, we shouldn't assume people are faking things. But I think most doctors don't assume patients are faking things. Most of us give the patient the benefit of the doubt. It's actually extremely rare to see "malingering" in the chart. On the rare occasion I've seen it - it was written by a psychiatrist. Because ironically, of all the notes in medicine, those written by psychiatrists tend to be the most unflattering to the patients. It isn't the internists who are putting "borderline traits" in patients' charts, after all. I've never seen a neurologist accuse a patient of "malingering" in the chart. But psychiatry? Many times!
 
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I was really reacting to your assertion that everyone still called it leprosy, which is just not true anymore.

I actually have encountered two patients who ended up testing positive for it. Refugee clinics with a largely recently-arrived and deeply impoverished South Asian and Southeast Asian population = tropical diseases.

Ok, fine, leprosy has a new name, to replace its former name, which apparently, despite its literally Biblical heritage, was too hard a name for people to remember. But we both know it was not renamed so as to decrease stigma. It was renamed in order to bring glory to Dr. Hansen, whoever he was. Anyway, kudos to him.

Look, I would be perfectly happy with renaming pseudoseizures as "clausewitz2 disease." It fits with tradition, and it's a lot better than "non-epileptic seizures." But good luck convincing the DSM 6 committee.
 
Is that the standard in any other area of medicine? If I fake a heart attack, will my cardiologist be required to prove that I am faking it? No, of course not. They simply rule out a real MI, and let me go, with far less empathy than even the most burnt out psychiatrist (i.e moi, apparently) is going to show to the most hardened repeat pseudoseizure patient.

I believe I see your point though - which is, we shouldn't assume people are faking things. But I think most doctors don't assume patients are faking things. Most of us give the patient the benefit of the doubt. It's actually extremely rare to see "malingering" in the chart. On the rare occasion I've seen it - it was written by a psychiatrist. Because ironically, of all the notes in medicine, those written by psychiatrists tend to be the most unflattering to the patients. It isn't the internists who are putting "borderline traits" in patients' charts, after all. I've never seen a neurologist accuse a patient of "malingering" in the chart. But psychiatry? Many times!

Extremely rare to see it in the chart, sure. Other specialties frequently don't want to even get into it. Are you saying, though, that you have not heard other physicians complain about how someone is a faker wasting everyone's time?

I know for legal purposes if it's not documented it didn't happen, but that's not literally true.
 
I know for legal purposes if it's not documented it didn't happen, but that's not literally true.
this is not actually correct for legal purposes either - it is just that if you don't document it then whether the courts accept it happens is based entirely on your credibility which can easily be destroyed. the converse is also not true - physicians frequently document things that didn't happen or in ways that they didn't happen. for example if there is a bad outcome like suicide and the discharge summary wanst written before you can bet it will be written with more detail and embellishment or a more thorough risk assessment documented than might have actually been done...
 
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this is not actually correct for legal purposes either - it is just that if you don't document it then whether the courts accept it happens is based entirely on your credibility which can easily be destroyed. the converse is also not true - physicians frequently document things that didn't happen or in ways that they didn't happen. for example if there is a bad outcome like suicide and the discharge summary wanst written before you can bet it will be written with more detail and embellishment or a more thorough risk assessment documented than might have actually been done...

In our state at least apparently courts have in the past refused to accept discharge summaries clearly written after a patient's suicide for exactly this reason.
 
That's a shame. Because "pseudo" has a specific meaning in medicine.

I mention this on occasion. The term "non-epileptic seizures" is in my opinion a bad term.

First off they're not seizures. So how can they be a non-epileptic seizure? Other seizures do fit into the literal description such as a drug induced seizure. That's non-epileptic too.

Second it turns out that there is a link between non-epileptic seizures and epilepsy. Some studies show about 5-20% to a majority with non-epileptic seizures have a seizure disorder so to say they are "non-epileptic" isn't accurate. There is some connection between these phenomenon.

It's not a seizure but we call it a seizure? It's not epileptic despite having a link to epilepsy? WTF?

I think a better term would've been psychogenic seizure-like episode.

Well hey maybe I'm just too old fashioned but I thought a diagnosis name should accurately reflect what the diagnosis is. Let's call cubic zirconium non-carbon diamonds. (They're not diamonds so why call it a diamond?)
 
I mention this on occasion. The term "non-epileptic seizures" is in my opinion a bad term.

First off they're not seizures. So how can they be a non-epileptic seizure? Other seizures do fit into the literal description such as a drug induced seizure. That's non-epileptic too.

Second it turns out that there is a link between non-epileptic seizures and epilepsy. Some studies show about 5-20% to a majority with non-epileptic seizures have a seizure disorder so to say they are "non-epileptic" isn't accurate. There is some connection between these phenomenon.

It's not a seizure but we call it a seizure? It's not epileptic despite having a link to epilepsy? WTF?

I think a better term would've been psychogenic seizure-like episode.

Well hey maybe I'm just too old fashioned but I thought a diagnosis name should accurately reflect what the diagnosis is. Let's call cubic zirconium non-carbon diamonds. (They're not diamonds so why call it a diamond?)

Yeah, point taken, I think calling them "spells" or some such is probably the best approach at the end of the day, but a) my old institution's neurologists had conniptions about calling them that and b) some patients seem to take it the wrong way. PNES is obviously more technically accurate, but acronyms = less useful in communicating with laypeople.
 
I get why some people don't like the term pseudoseizures though I don't find problems with the term. I do believe that some people with this phenomenon are not willfully controlling them. But to use a term like "non-epileptic seizure" in my opinion is replacing what some people accuse to be a bad term with another bad term. Problem is it's already caught on.
 
Pretty sure fibromyalgia is another name for, "cluster b personality disorder". You know I'm right. If you doubt me, repeat a little experiment I did during training -- get to know a patient a bit before asking about past medical history. If you are leaning towards a cluster b personality disorder, look for a fibromyalgia diagnosis -- I will bet you money at least 7/10 times you will find it in the record, if they didn't already find some way to bring it up during the interview.

I got pretty good at identifying the, "fibromyalgia personality".

I'm half joking
 
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clausewitz 2 - Can you say more about what your actual complaint is about the term "pseudoseizures?" Can you tell us more specifically why you dislike this term? Please don't just say "because it's stigmatizing." Every term used in psychiatry is stigmatizing at some level. If you think this one is especially stigmatizing, then please tell us why.
 
I think a lot of the stigma that we assign to these terms is just that - stigma that we assign to these terms. It's not like the average person ever says, " oh she is just so borderline". They don't even know what that means. Occasionally they might say that they think that a persons health complaints are "all in their head",. Hopefully we can explain somatic complaints and conversion symptoms and the psychological component better than that. Changing a name to make it sound more palatable is a collusion with the defense if you ask me. The old psychoanalytic formula of first confront (not to be confused with being confrontational) then clarify, and lastly interpret for these defenses is actually an effective rubric for working with these issues. Too bad we throw the babies out with the bathwater in this field. I also throw in some psycho-education to the mix 'cause that helps too.
 
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clausewitz 2 - Can you say more about what your actual complaint is about the term "pseudoseizures?" Can you tell us more specifically why you dislike this term? Please don't just say "because it's stigmatizing." Every term used in psychiatry is stigmatizing at some level. If you think this one is especially stigmatizing, then please tell us why.

It's really the pseudo bit in the context where a significant number of clinicians already think the behavior is being faked. The pseudo morpheme does not usefully describe the behavior, it simply names what it is not. It does, however, call the patient a liar.

Note that this is not a problem with pseudohypoparathyroidism, for instance, because no one seriously believes you can manipulate your blood electrolytes at will. I still think the term is outdated and much less clear than it ought to be, but struggling against Anglophone medicine 's tendency to use Greco-Latin jargon wherever possible is properly Sisphyean.

When we are talking about a behavioral output, if you are saying it is a false exemplar of something, you are saying that the person producing it is being deceitful (or at least winking quite a lot as you dance around it).

Also just generally clearer to say what things are than what they are not, but that is a separate issue.
 
Seems to me that "non-seizure convulsions" is a lot more descriptive than "a seizure (definition: a specific class of neurologic phenomenon often caused by a particular neurologic disorder) that's not caused by a disorder that causes seizures," especially given the fact that what's going on is not a seizure. Or you could call it "seizuriform convulsive activity" if you wanted to make it sound like you were calling it a seizure, but not.
 
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Seems to me that "non-seizure convulsions" is a lot more descriptive than "a seizure (definition: a specific class of neurologic phenomenon often caused by a particular neurologic disorder) that's not caused by a disorder that causes seizures," especially given the fact that what's going on is not a seizure. Or you could call it "seizuriform convulsive activity" if you wanted to make it sound like you were calling it a seizure, but not.

Yeah, these are good suggestions . I would even be happy with "quasi-seizure", which suggests that what you are talking about is like but is not actually an exemplar of the category seizure, but without the implications of lying or deception. Latin root, obviously, rather than Greek, but it's not like most people know or care about that difference.

Extreme tangent warning:
Actually more fitting in a sense that it be a Latin root, since we get "seizure" most directly from late Latin "sacire" - "to grab hold of". Probably a borrowing from Old Frankish, weirdly, and certainly not a word Caesar or Cicero EOD have recognized, but "sacire"is attested and putative Germanic reconstructions like *sakjan are not.

Miles away from Greek and this business of "pseudo", in any event.
 
It's really the pseudo bit in the context where a significant number of clinicians already think the behavior is being faked. The pseudo morpheme does not usefully describe the behavior, it simply names what it is not. It does, however, call the patient a liar.

Note that this is not a problem with pseudohypoparathyroidism, for instance, because no one seriously believes you can manipulate your blood electrolytes at will.

Thanks for the explanation. Now I know where we disagree. I don't think that "pseudo" means, or was ever intended to mean, that the patient is lying. If people have coopted it and are using it to mean that, well, they need to be corrected.

I suspect if we rename the condition, all that will happen is that in two or three years, we will be renaming it again, because those same clinicians will be making their same mistakes.

But you are entitled to your opinion. We all are. There are a lot of terms in psychiatry I dislike just because I dislike them.
 
Splik you have any favorite readings on non-epileptic events / pseudoseizures / whatever ? I did an epilepsy rotation so saw a ton of them in person and it's hard for me to conceptualize. 95% percent of them it's like "WTF are you doing your clearly not seizing",
But then others its like "Wow, that looks like a seizure but you have a stone cold normal EEG"

Are those really both the same condition?
 
Thanks for the explanation. Now I know where we disagree. I don't think that "pseudo" means, or was ever intended to mean, that the patient is lying. If people have coopted it and are using it to mean that, well, they need to be corrected.

Spend time on some of the EMT/Nurse/ER forums or blogs out there and you get distinction impression (not from everyone mind you, just to clarify) that 'pseudoseizure' is a polite stand in word for 'bull**** faker'.
 
I mention this on occasion. The term "non-epileptic seizures" is in my opinion a bad term.

First off they're not seizures. So how can they be a non-epileptic seizure? Other seizures do fit into the literal description such as a drug induced seizure. That's non-epileptic too.

Second it turns out that there is a link between non-epileptic seizures and epilepsy. Some studies show about 5-20% to a majority with non-epileptic seizures have a seizure disorder so to say they are "non-epileptic" isn't accurate. There is some connection between these phenomenon.

It's not a seizure but we call it a seizure? It's not epileptic despite having a link to epilepsy? WTF?

I think a better term would've been psychogenic seizure-like episode.

Well hey maybe I'm just too old fashioned but I thought a diagnosis name should accurately reflect what the diagnosis is. Let's call cubic zirconium non-carbon diamonds. (They're not diamonds so why call it a diamond?)
Noncarbon diamonds. Yes. :rofl:
 
In many ways, yes.

Undiagnosed sleep disorders (OSA being most common), obesity, depression/anxiety/borderline/bipolar disorder, physical deconditioning, and crappy lives are the most common causes.

They got to sleep well and exercise well.
 
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In many ways, yes.

Undiagnosed sleep disorders (OSA being most common), obesity, depression/anxiety/borderline/bipolar disorder, physical deconditioning, and crappy lives are the most common causes.

They got to sleep well and exercise well.

The old saying - don't use it, you'll lose it.
 
one theory is to do with aberrant activity in the temporoparietal junction and loss of awareness of intentionality - the patients produce the symptoms but lose awareness that they are doing so. Valerie Voon in cambridge has done some interesting work on this. In the US David Perez who is now at MGH has an interest in PNES as he calls it and I would suggest looking up his work

Interesting. By loss of intentionality do you mean loss of pre-meditation as well, as in the patient retains some awareness of what they're doing but it's not something they consciously thought through and decided on doing? If so that would actually match with the few instances of PNES type activity/behaviour I've experienced in the past.
 
Interesting. By loss of intentionality do you mean loss of pre-meditation as well, as in the patient retains some awareness of what they're doing but it's not something they consciously thought through and decided on doing? If so that would actually match with the few instances of PNES type activity/behaviour I've experienced in the past.

I think it's a more unconscious presentation and response. Perhaps a defense mechanism or sorts... that's how I read it.
 
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I think it's a more unconscious presentation and response. Perhaps a defense mechanism or sorts... that's how I read it.

Okay, that actually makes sense. I can probably count on the fingers of one hand the number of times I've experienced anything close to a PNES type episode, but the few I did were always triggered by severe emotional dysregulation, and they always followed a very similar pattern -- I'd start to become emotionally dysregulated, I was trying not to rely on old negative habits of self soothing but hadn't quite mastered the healthier methods at that stage, the emotional dysregulation would build beyond a certain point and then it was like some sort of weird mind storm would hit me and I'd just completely lose it. Initial stage typically involved a lot of primal kicking and screaming, along with me attacking myself physically; once my husband had restrained me to stop me from continuing to hurt myself then it kind of moved into a second stage, which is where I'd become very rigid, and develop uncontrollable tremors, and struggle to get air, but the weird thing was I was aware of what was happening the whole time, and in the back of my mind I'd have this running commentary going on, like 'okay, just stop, just stop', but by the that point it was almost a disassociative experience because I couldn't just make snap my fingers and make the episode stop, I had to wait for it to run it's course. Very strange experience, and something I learnt to deal with/prevent from getting that far in the first place, by creating a 'safe room'. I filled a spare room with a heap of pillows, and blankets, and old duvets (basically anything soft), and then stacked it with a heap of old news papers and magazines (basically anything I could tear up in a fit of rage without actually damaging physical property or myself), and that became my safe space to let off steam when I recognised I was starting to become emotionally dysregulated to the point where I was about to tip over the edge. God knows what the neighbours thought, but hey, it worked.
 
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