Medically Unexplained Symptoms and Neuropsychological Assessment

Abstract

Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin. There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress.

Overlap in prevalence between various types of environmental intolerance

“…The similarities between reported symptoms and their unspecific pattern, together with the overlap between the EIs presented in this study, indicate that we are possibly dealing with conditions that are similar to some extent. The medically unexplained symptoms characterizing EIs have been suggested as somatic stress disorders (Binder and Campbell, 2004). These disorders are characterized by physical symptoms resulting from physical and/or psychological stressors.…”

Fibromyalgia, infection and vaccination: Two more parts in the etiological puzzle

“…Characterized by chronic fatigue, general malaise, irritability and cognitive impairment as well as musculoskeletal symptoms [68,69] and overlapping with post-traumatic stress disorder [70], the syndrome clearly carries attributes of a functional disorder (alternatively e a syndrome of ''Medically unexplained symptoms'' [71]) and holds obvious similarities with fibromyalgia and chronic fatigue syndrome. Due to its specific historical and geographical characteristics, however, Gulf War syndrome offers an opportunity to study the association between such symptoms and specific exposures, thus potentially illuminating etiological factors which may be relevant for additional functional disorders, such as fibromyalgia.…”

Opinions of Slovenian family physicians on medically unexplained symptoms: A qualitative study

“…15 Such issues are compounded by psychological problems and stressful social situations, social and financial problems, problems at work, changes in everyday routine, 5 as well as factors of an unhealthy lifestyle (such as insufficient exercise, weight increase and/or social isolation, depression and loss of self-confidence). 16 The healthcare system in Slovenia has undergone substantial change since 1992. The objectives of these changes were primarily economic rather than medical, since the level of services rendered has long been fairly high and there were limited needs for improvement.…”