Psychogenic Unconsciousness Flashcards

A complete set of vocabulary flashcards covering the definitions, clinical signs, and pathophysiology of psychogenic unconsciousness based on the lecture notes.

Psychogenic Unconsciousness

A coma-like or unresponsive state occurring in the absence of structural or metabolic CNS abnormality, identified as involuntary rather than feigned.

Functional Neurological Symptom Disorder

The diagnostic term for psychogenic unconsciousness according to the DSM-5-TR.

Dissociative Neurological Symptom Disorder

The diagnostic term for psychogenic unconsciousness as defined by the ICD-11.

Rule-in Diagnosis

A diagnostic approach based on the presence of positive clinical signs rather than the exclusion of other conditions.

Functional Stupor

A state along a continuum of unresponsiveness where eyes may be open but the patient performs no action or response, typically lasting more than $30$ minutes with brain function preserved.

Functional Coma

A state of unresponsiveness where eyes are closed and there is no response to any stimulus, characterized by a normal awake EEG and intact brainstem reflexes.

Functional / Dissociative Seizures (FDS)

Paroxysmal events that resemble epilepsy but lack epileptiform discharges on EEG; formerly known as Psychogenic Non-Epileptic Seizures (PNES).

Ictal Weeping

A clinical feature that may occur during Functional / Dissociative Seizures (FDS) but is rare in epileptic seizures.

Catatonia

A psychomotor syndrome occurring in approximately $10\%$ of acutely ill psychiatric inpatients, requiring at least $3$ of $12$ specific features (e.g., stupor, waxy flexibility, mutism) for diagnosis per DSM-5-TR.

Bush–Francis (BFCRS)

A screening tool used to assess for the presence of catatonia.

Malingering

The volitional production of symptoms for external gain (such as court, work, or compensation); it is not classified as a mental disorder.

Factitious Disorder

The volitional production of symptoms to assume the sick role without external incentives; it is classified as a mental disorder.

Ganser-type Answers

Approximate answers given to very simple questions (e.g., answering "five" to "What is two plus two?"), sometimes seen in cases of malingering.

Geotropic Gaze

A positive bedside sign of functional coma where the patient's eyes always look toward the floor regardless of which side the body is turned.

Harvey's Sign

A bedside sign where the patient grimaces in response to a vibrating tuning fork ($440-1024\,Hz$) applied to the mucosa overlying the nasal septum.

Hand-drop Test

A clinical maneuver where the patient's hand is dropped toward their face; in functional coma, the hand deviates to 'avoid' hitting the face.

Oculocephalic Reflex (Doll's Eyes Maneuver)

A test of brainstem function where the head is turned quickly; if intact, the eyes rotate opposite to the direction of head rotation.

Cold Caloric Oculovestibular Reflex

A test where iced water is introduced into the ear canal; in an awake or functional coma patient, it produces nystagmus with the quick component away from the irrigated ear.

Alpha Rhythm

The posterior dominant rhythm seen on a normal awake EEG, which is the hallmark of brain activity in functional coma.

Conversion V Profile

An MMPI/MMPI-2 pattern frequently seen in nonepileptic seizures involving elevations in scales $1$ (Hypochondriasis) and $3$ (Hysteria) with a depression in scale $2$ (Depression).

Right TPJ (Temporoparietal Junction)

A brain region associated with the sense of agency that shows abnormal activity in research fMRI of functional neurological disorders.

Amygdala-Motor Cortex Connectivity

A pathway found to have increased connectivity in research PET/fMRI studies of patients with Functional / Dissociative Seizures.