see neurology

• the diagnosis of a psychogenic disorder is always a diagnosis of exclusion

• pt is not aware of the lack of organic basis
• symptoms may be brought on or altered by suggestion
• history is often vague
• symptoms may be bizarre & unexplainable by specific anatomic lesions
• pt's attitude & affect may be inappropriate for the given symptoms

• a conscious & deliberate feigning of an illness or symptom
• symptoms often fail to fit an organic pattern
• if involves pain, it may be very difficult to distinguish from the true sufferer:
  • pain may correlate with proximity of staff
  • Mannkopf's sign:
    • examiner induced pressure over a painful area increases HR by 10-30bpm
    • not completely reliable but usually occurs if organic or psychogenic pain but not in malingerers.
• if involves weakness:
  • Hoover's sign helps verify unilateral muscle weakness:
    • pt lying supine is asked to raise affected leg while the examiner places a hand under the pt's contralateral heel.
    • the pt with organic weakness will exert downward pressure on contralat. heel in attempt to raise the leg.
  • palpate antagonist muscles as contraction strongly suggests malingering
• try manoeuvres which attempt to confuse the patient, see elsewhere.